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National Background Check Program

May 2016 Annual Training Meeting

Summary Notes

Day One: May 2, 2016

Welcoming Remarks Day 1: May 2, 2016 10:00 a.m.

Jan Tarantino (CMS)

Overview: Jan Tarantino, Deputy Director of the CMS Survey and Certification Group,

welcomed attendees to the 2016 NBCP Annual Meeting. She shared Martin Kennedy’s vision

and encouraged attendees to continue their work and to network.

Plenary – “Roll Call!” Day 1: May 2, 2016 10:05 a.m.

Kellie Jakaitis (CMS)

Ann Casey (CNA)

Overview: In reverse alphabetical order, States were asked to have one representative introduce

themselves, their organization, and the rest of their team. They were also asked to answer one of

the following questions:

1) What has been your biggest success in implementing the program?

2) What has been your biggest challenge in implementing the program?

3) What is one piece of advice you would pass on to other States?

Observations:

Grantee States

1. West Virginia – Meghan Shears with Angela Petry, April Roberts

a. Biggest success: WV found 20-25 individuals who had applied for long term care

employment and were wanted for crimes in other States. Since the program went live,

10-15 applicants have been detained by State police and returned to their original

State.

2. Utah – Tracy Freeman

a. Biggest success: Implementation of public safety and security programs (i.e., getting

the direct access clearance system (DACS system and the Public Safety system to

work together).

3. Rhode Island –Jim Dube with Ed Cabral, William Karalis, Mark McKitchen

a. Biggest Success: RI started their background check program six weeks ago,

beginning in March. They have some legislation issues from within government;

however, overall it is going well.

4. Puerto Rico – Lourdes Borres Otero with Jorge Janer Melendez


Annual Training Meeting, May 2016

Presentation Overview and Associated Questions and Answers

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a. Biggest Success: Obtained a change in the law, including the requirement to

fingerprint, in one year.

5. Oregon - Jeff Akin with Jess Cline

a. Advice: Keep your enemies closer when working on policy and legislation, whether

that’s working with a part of government or a civil liberties union.

b. Biggest Success: OR’s success has been with in-person, face-to-face outreach.

6. Oklahoma – James Joslin

a. Biggest Success: OK’s financial model works. A financially sustainable system is

possible.

7. Ohio - Jane Lengel with Kenneth Morgan, Lora Summers

a. Biggest success: Implementation of the CMS Medicare Exclusion Database (MED)

File with the assistance of CNA/Innovative Architects.

b. Advice: Teamwork. State agencies and other parties must be willing to set aside egos

and agendas. Motto: “Work as a team and always be nice.”

8. North Carolina – Jesse Goodman with Cheryl Cameron, Beth Desmond, Kelly Hopkins

a. Biggest Success: NC purchased 52 live scan fingerprint machines for all 52 counties.

Their second success is that they are on track to fully implement their background

check program by the end of the 2016 calendar year.

9. Nevada – Leticia Metherell with Erica Souza-Llamas, Alison Lopez

a. Biggest Success: Successful implementation of their background check program and

getting their program rolled out to 1,200 providers.

10. New Mexico - Gil Mendoza with David Martinez, Kelly Muniz

a. Biggest success: Over three years of this program, NM cut background check turn-

around time from six months down to a day, including some seeking appeals.

b. Biggest Challenge: NM had an issue with rap back. NM found a problem with their

legislation and were unable to disqualify someone for an arrest that they hadn’t been

convicted on. NM legal counsel has asked them to hold off enrolling these individuals

which has caused a slowdown.

11. Missouri – Melanie Madore with Jennifer Taube, Beth Thompson

a. Biggest Success: The MO Good Cause Waiver program.

12. Minnesota – Kristin Johnson with Michelle Long

a. Advice: Motto is to “engage early and often” through extensive outreach to providers,

legislators, etc. Outreach, especially in conjunction with the MN Inspector General,

was key in getting the necessary legislation passed.

13. Michigan – Stephen Gobbo with Fuad Abujarad, Julia Gurley-Johnson, Cheryl Gandhi,

Narcisa Morris, Thomas Novak, Kenneth (Adam) Krajniak, Nick Romanov, Sherry Rosin

a. Biggest Success: During multiple government reorganizations, MI was able to

maintain continued collaboration with fellow departments, peers, and colleagues in

other State departments.

14. Maine – Phyllis Powell with Carmen Dorsey, Alex Netten

a. Biggest Success: ME is in their 5th

year in the program. They are currently at user

testing and will be launching the new system in the fall.

b. Advice: ME’s advice is to stay with it, persevere and be smart.




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15. Kentucky - David McMahan with Jennifer Mayes-Laracuente, Howard (Paul) Blanton

a. Biggest Success: KY’s program has been running since May 2014 and is able to

process 80 percent of all applications within hours.

b. Biggest Challenge: They have had some legislative issues but overall are doing well.

16. Kansas – Steve Irwin with Brenda Dreher, Amber Monzon-Hernandez

a. Biggest Success: Working with their stakeholders.

b. Biggest Challenge: KS’s challenge is dealing with other State agencies and getting

them on board with the program.

17. Hawaii – Keith Ridley with Priscilla Thode, Jennifer Sablan

a. Biggest Success: HI has switched to a biometric-based process and hopes to continue

expanding their program and the rap back system.

18. Georgia – David Ostrander with Denise Mathews, Sakinah Johnson

a. Biggest Success: Implementing the computer system “G-check” within seven months

with the assistance of CNA/Innovative Architects.

19. Florida – Taylor Haddock with April Haupt

a. Biggest Success: Implementing a system that seven State agencies use and share

while saving FL over $10 Million for providers in less than three years. FL

additionally implemented a State rap back.

b. Advice: FL advises outreach and collaboration with State law enforcement.

20. District of Columbia – Alem Ghebrezghi with Ajay Gohil, Cheng-szu Li

a. Biggest Success: Prevented a high-profile case and four sex offenders from gaining

long-term care employment. DC has a total of 451 providers on-board.

21. Connecticut – Matthew Antonetti with Steve McConaughy

a. Biggest Success: Implementation of the program with CMS and CNA assistance.

22. California – Paul DeHerrera with Dorette Pierce, Madelyn Childs

a. Biggest Challenge: Collaboration with other State departments, specifically in order

to submit documents to CMS in a timely manner. However, program implementation

has also strengthened departmental communication.

23. Alaska – Karen Benson

a. Biggest success: Implementation of a new database system reduced turn-around times

from six to12 months down to a couple of days.

Non-Grantee States

24. Colorado – Kim Fear, Thom Miller. Looking forward to begin implementation of the

Colorado State background check program.




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Plenary – CMS Update on the National Background Check Program Day 1: May 2, 2016 10:45 a.m.

Je’annine O’Malley (CMS)

Overview: This session discussed an overview of updates on behalf of the Centers for Medicaid

and Medicare Services (CMS) for the National Background Check Program.

Observation: CMS provided training and technical assistance for seven States that were selected

to participate in the Collaboration Forum Work Group (CFWG) including Alaska, Connecticut,

Florida, Michigan, New Mexico, Nevada, and Oklahoma. The CFWG has met many times over

the past year.

Observation: Kansas joined the NBCP in July 2015. Since joining, they have convened a

stakeholder advisory meeting, where they discussed prohibiting offenses, sentencing

requirements, provisional employment, probation, and restrictions. Kansas has begun rapid

deployment implementation of the NBCP-compliant system.

Observation: The Office of the Inspector General (OIG) released its interim report in January

2016. The Affordable Care Act requires the OIG to conduct an evaluation of the NBCP. The

evaluation describes the implementation status from the first four years of the program. It

provides CMS information to assist in the ongoing administration of the program.




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Plenary – Guest Speaker: Charles Thornton, Director, DC Office on Returning

Citizen Affairs (MORCA) Day 1: May 6, 2016 11:00 a.m.

Charles Thornton (The Mayor’s Office on Returning Citizen Affairs)

Alem Ghebrezghi (Office of Compliance and Quality Assurance, Health Regulation and

Licensing Administration, DC Department of Health)

Overview: Mr. Thornton discussed his agency’s mission, which provides former inmates

community resources and reentry services.

Observation: Mr. Thornton expressed that it is important for individuals such as him to address

reentry issues; the public needs to see that rehabilitation is possible and is connected to long-term

care. The person that he used to be in DC as a kid is not the same person that he is today. If he

can be rehabilitated, then there is a strong possibility that many others can do so as well. The

Mayor’s Office on Returning Citizen Affairs (MORCA) is unlike any other agency in the

country; it is the only legislatively mandated agency for reintegration. There is a movement

taking place in this country around how citizens address the return back to communities and the

numbers are staggering. There are about 65 million people in the country involved in the

criminal justice system; 2.4 million people in federal institutions around the country; and another

11 million people in jails and prisons. Eventually, most of these individuals will be returning

back to their respective communities; finding a way to do this safely is a public safety issue.

Reintegrating these individuals back into communities safely enhances the ability for

communities to be safe in America. There is a renewed interest in understanding how to find a

safe and efficient way for reintegration.Observation: The National Capital Revitalization and

Self-Government Improvement Act of 1997 eliminated prisons that housed District offenders

and the prisoners were sent into the federal system. There was a necessity for implementing

practices that allowed these individuals to return safely. MORCA is a hub for personnel to

reintegrate and does not require the individual to do anything. There is no mandatory action—it

is all voluntary on behalf of the former prisoner. Mr. Thornton said that all returning offenders

should go to their probation officer first because public safety is crucial in that aspect.

Legislation passed in 2007 convinced District taxpayers that a legislative mandate was necessary

for a reintegration program; this law came into effect in March 2007.

Observation: Mr. Thornton is a returning citizen himself; he served 12 years in prison and has

been back in his community for 25 years. He was a part of the advocacy and activism that went

into place that helped create the law that led to the establishment of MORCA. He was appointed

by the Mayor to lead the agency. There were many agencies involved in coming together to

develop this agency. Mr. Thornton emphasized that individuals previously incarcerated can be

involved in this type of activism and legislation; this is important to understand what steps to

take.




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Observation: One of MORCA’s most significant core services that the agency provides is vital

records; MORCA helps individuals coordinate with different agencies to obtain the necessary

records such as a birth certificate, which can be a large hurdle for people coming out of prison.

This issue is addressed at MORCA, explaining the importance of having identification.

Observation: MORCA provides training programs and is working with Georgetown University

to develop a program that allows individuals to do clerical work. This collaboration provides

pathways to employment. MORCA is also putting a renewed focus on women; working to

address their needs specifically. Women and men have different experiences in both

incarceration and reentry. When men reenter the community, their first priority is to get a job;

however, for women, it is their children because the majority of the time they were caregivers

prior to incarceration. Mr. Thornton explained that there must be a woman in charge of this

particular reintegration program.

Observation: One of MORCA’s biggest successes is family reunification. It is not uncommon for

prisoners to go years without any communication with their family. MORCA has a renewed

focus on family reunification because it plays such a significant role on the individual’s future.

When there is a welcoming family for someone to connect back with, they are more likely to

have an easier reentry and be successful.

Observation: Mr. Thornton observed that background checks are essential to safely doing the

work and allowing opportunities while keeping the client safe. It is important to have a policy in

place to address fraudulent applications in addition to applicants who apply for the wrong

reasons. This policy should also include having a thorough and efficient appeals process as the

applicant should not be sanctioned by fear. Mr. Thornton discussed that it is important to

consider what makes a good health care provider (i.e., someone passionate and caring).

Reflecting, reviewing, and analyzing these systems are incredibly important; NBCP has quality

systems in place, but should also always be looking for ways to improve.

Observation: The Ban the Box legislation is similar to a virus. DC leads the nation in legislation

for this popular movement because the so many of the District’s people are impacted by

incarceration. There are close to $80,000 in fines alone for violations in the District. This has

resulted in a number of companies changing their policies to allow for fair chances. They

consider how the crime is rationally related to the job the applicant is applying for.

Observation: Brian Ferguson, an investigator from the DC Office of Human Rights, was

wrongfully accused, convicted of murder, and spent 11 years in prison. Prior to being convicted,

Mr. Ferguson had attended college, maintained a 4.0 grade point average, and planned on

attending law school. After being released from prison, he had several advantages compared to

the average individual because he already had a living situation, but he did not have a job. He

had a difficult time becoming employed and wanted to become involved with issues that




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formerly incarcerated individuals experience because he understood first hand. The DC Office of

Human Rights and MORCA acknowledge and champion rights and responsibilities for health

care providers. There is an exception in law for individuals dealing with vulnerable populations,

but there should still be equal opportunity for all applicants.

Questions:

Q1: (Jeff Akin, OR): How are you funded?

A1: We are funded through District tax payers and the District’s budget.

Q2: (Jeff Akin, OR): What kind of resistance have you experienced in the community and how

have you addressed this?

A2: There actually has not been too much resistance. The legislation was passed in 2007; there

was one DC Council person, who voted in absence, but I am not sure what his reason for not

voting was, but the remaining 13 Council members voted in favor of the legislation. There has

not been much resistance as municipal policies were shaping up and 55-65 percent of the City’s

budget was spent on corrections and public safety. From a fiduciary standpoint, it costs almost

$250 per day for an inmate to stay in an institution. When there is more spending on corrections

than education or healthcare, it begins to make a claim for itself. There was a significant amount

of resistance when discussing housing; nobody wants to provide a place for individuals returning

from prison.

Q3: (Audience participant): What is the difference between male and female returning citizens?

A3: Mr. Thornton said the best answer would come from a woman; however, he explained that

90 percent of women in the criminal justice system were the head of the household and typically

experienced abuse or trauma. There is a vast difference between how a woman in prison is

perceived, compared to that of a man in prison. For example, MORCA does a significant amount

of prerelease work and holds an annual event where the agency takes children in to see their

incarcerated parents. There is one facility in West Virginia that houses a lot of incarcerated

women from the District. This facility houses about 800 women, and there are probably about 12

children that go to see their mother. In comparison, there are three buses full of children that go

to see their fathers.

Q4: (Taylor Haddock, FL): We work closely with health care providers; I think it would be a

great resource to direct applicants to a program like yours. Do you work with Alem Ghebrezghi

(the lead for DC’s NBCP)?

A4: The agency allows us to collaborate creatively; once an introduction is made, then we can

see how we could work together. There is access to real data that is significant, MORCA could

provide for individuals. DC has a commission on reentry. The commission has 11 critical




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agencies, and the Department of Health is one of these agencies. In DC, the perspective is from a

public health and safety standpoint.

Q5: (James Joslin, OK): Do you track recidivism on the success on your program?

A5: Generally, when discussing recidivism, we are referring to someone who is returning to

prison after already committing a crime within three years or less. I am not interested in the

amount of people going back to prison. I am more interested in the amount of people that stay

out and how they have done so: what choices have they made, what are their relationships in the

neighborhood, moving on with their life. This is much more valuable than counting the amount

of people going back to prison. There is data that suggests that after four years, individuals are

able to move past their incarceration; this goes unnoticed. As a country, we focus so much on the

problem that the solution may be right in front of us. There is too much money that is wasted on

recidivism studies when it can be spent on policy and legislation.

Q6: (James Joslin, OK): We see a lot of incomplete criminal history information: how does

MORCA help applicants clean up their records?

A6: There is a system that leads to frustration. DC’s system, in terms of expungement and

records-sealing, is liberal, but still needs more work. When dealing with vulnerable populations,

we have to be cautious and safety conscious. We are at the forefront and I believe that what is

being done with the NBCP will lead us to a system that can give opportunities to individuals who

want to move forward.

Q7: (Sarah Fahrendorf, CMS): Short of expungement, there are instances in individuals’ histories

that cannot be cleaned up. By the time people are reaching MORCA, have they been able to

clean up their record a little bit with legal assistance in prison or does MORCA take action?

A7: We are involved. However, the idea of becoming involved with the record while the person

is still incarcerated is complicated. Crimes have changed from the past to now. I had marijuana

use on my record in the past, but now it is legal. There is ongoing discussion on how to regard

instances such as these. For expungement, only one misdemeanor can be expunged and felonies

cannot be expunged.

Q8: (Sarah Fahrendorf, CMS): Can we put people in touch with you from Rhode Island or

Connecticut?

A8: Yes, please go through the Mayor’s Office for Public Safety.

Q9: (Audience participant to Mr. Ferguson): Were you able to complete your law degree or did

your background prohibit this?




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A9: I have only been out of prison for two years. I plan on transferring to Georgetown University

for law school.

Q10: (Mary Gabay, CNA): DC law allows background checks to look back at criminal histories

for seven years, where did this come from?

A10: The seven-year mark is due to federal law and this law changes the dynamic; the

background check can look back after a conditional offer is made.

Q11: (Audience Participant): We make decisions based on a complete criminal record, and we

need court documents. Some applicants are unable to pay the court document fees because they

are unemployed. Does your office provide financial assistance for these applicants?

A11: MORCA does provide assistance; we can reach out to public safety agencies.




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- Session 1 -

Track A – “Making the Case for NBCP: Using Case Studies to Identify Gaps and

Engage Stakeholders”

Day 1: May 2, 2016 1:30 p.m.

Rebecca Ward, RN (CMS)

CaraLee Starnes (CNA)

Overview: The presenters discussed findings from numerous studies on elder abuse, and

provided overviews of six recent incidents involving criminal activity in health care, each of

which audience members discussed further in groups.

Observation: Ms. Rebecca Ward delivered opening remarks and introduced CaraLee Starnes,

who began her presentation by asking which States in the room had experienced a major incident

of abuse, and whether this experience prompted them to improve the ways in which they work to

prevent abuse. Numerous States’ representatives answered affirmatively. Ms. Starnes described

elder abuse as a “violation of human rights.” She then discussed the findings of studies on elder

abuse by the National Center on Elder Abuse and the HHS Office of Inspector General (OIG) –

detailed in slides #4-6 of her presentation. Starnes then discussed NBCP guidelines for

background screening and noted that these include an independent appeal process and call for a

reduction in duplicative fingerprinting.

Observation: Ms. Ward provided brief overviews of six incidents involving criminal activity in a

health care setting. Ms. Starnes then asked the audience members to consider how each incident

could have been prevented, how policies and processes could be changed to prevent similar

events in the future, and how the incident and other methods could be used to engage further

discussions with stakeholders or inspire legislation.

1. In the first incident, a woman who used falsified nursing credentials in numerous States

to gain employment as a nurse was terminated and charged with financial identity fraud,

forgery, and practicing nursing without a license.

a. Observation: Group 1 discussed the first incident. In the State in which this

incident occurred background checks are voluntary and the hospice facility was

not required to perform a background check on the applicant. If the facility had

performed a background check, it would have revealed red flags. In terms of

changes to policies and processes, Group 1 proposed making all direct access

employees subject to federal background checks. Regarding methods for engaging

further discussions with stakeholders or inspiring legislation, Group 1 would like

to see the rules updated to require people to undergo thorough nurse and sex

offender registry checks. When that legislation is presented, Group 1 advocated

showcasing the people who were impacted by the wrongdoing. Group 1 hopes

this legislation will materialize in 2017, and be applicable to all facilities.




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2. In the second incident, a home health aide with an extensive criminal history working

under an alias was charged with writing a series of unauthorized checks on the account of

the person she was caring for.

a. Observation: Group 2 discussed the second incident. The group believed that

there was no fingerprint requirement in the State in which this incident occurred,

which was a non-NBCP State, and that this employee would have been flagged

had a fingerprint requirement existed. The description of the incident did not

clarify what type of search was performed. One member of Group 2, from

Washington, DC, noted that DC checks offender registries before performing a

background check, and that DC only considers convictions within the previous

seven years.

3. In the third incident, a resident at a nursing home accused a certified nursing aide (CNA),

who had a previous conviction for assault and should have been barred from direct

contact with residents, of molesting her during a back massage at a nursing home, which

hired the CNA on a contract basis from a supplemental nursing agency.

a. Observation: Group 3 discussed the third incident. Group 3 noted that the nursing

home assumed a background check had been performed on the applicant, but did

not ask for a copy of it. The supplemental nursing agency was required by State

law to conduct a background check. Group 3 said that making the facility, rather

than the supplemental nursing agency, responsible for performing background

checks would be helpful. The group also noted that, had there been a more

centralized system, this person would likely have been found to be ineligible and

this incident might have not occurred.

4. In the fourth incident, a nursing home technician on probation for using a deceased

patient’s banking card was arrested on suspicion of having stolen the identity of another

nursing home resident.

a. Observation: Group 5 discussed the fourth incident. Group 5 said that a database

showing this person was on probation would have been helpful. There seemed to

have been no reference check for her previous employer, which might have

revealed that this facility was hiring a bad actor. A decent background check

could have prevented this incident from occurring. Group 5 wondered why this

nursing home resident had a bank card to begin with; perhaps some residents who

do not want to relinquish their financial independence keep things like this, which

makes them vulnerable. Group 5 also raised the issues of whether there was

anything the family could have done to prevent this, and what precautionary

instructions, if any, the nursing home should provide to residents and their

families.

5. In the fifth incident, an assisted living facility’s marketing director, who had prior

convictions for felony theft and passing bad checks but was not required to undergo a

background screening to hold this position because he did not provide “personal services”

to residents, was suspected of robbing and killing a woman who placed her elderly father

in the facility where the marketing director worked.

a. Observation: Group 6 discussed the fifth incident. The group wondered why the

requirement for background checks would be limited to direct care staff,

especially in a place like this where nearly everybody interacted with residents.




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Group 6 thinks the first policy change to address would be requiring background

checks for all employees. The group also feels that the marketing director, who

was originally hired to perform janitorial duties, should have been required to

undergo a background check, given the high potential for direct contact with

residents in the course of performing his janitorial duties.

6. In the sixth incident, a surgical technician at a hospital who failed to report past

terminations for drug-related violations was terminated after a class-action lawsuit for

drug contamination arising from his diversion of drugs and exchange of needles prepared

for surgical patients.

a. Observation: Group 4 discussed the sixth incident. Group 4 noted that self-

reporting was relied upon heavily in this incident. Two factors that contributed to

this incident are that no criminal charges were filed against this person for his

previous drug-related violations, and there was no database that would have

connected the dots regarding his previous violations. A relational database that

hospitals themselves report into would have been helpful. Group 4 felt that it

should have been the responsibility of the hospital that previously terminated him

to explain why he was fired. Group 4 stated that this incident highlights the need

for centralized recordkeeping and decreased reliance upon self-reporting. After

the members of Group 4 concluded their remarks, an audience member pointed

out that the National Practitioner Database should have been reported into,

although the fee to search this database is prohibitive.

Observation: After the groups finished presenting the results of their discussions, Ms. Ward

discussed a case in New Jersey where a home health care aide on probation for burglary was

convicted of murdering his 74-year-old former employer, inspiring a bill, approved by the State

Assembly, which would require criminal background checks for anyone seeking such a position.

In another case, in California, nurses licensed before 1990 were not required to submit

fingerprints. They were required to do so in 2009, which revealed that many of them had

committed serious criminal offenses, including murder and sexual offenses. Ms. Ward added that

she herself was not fingerprinted at all for more than three decades during which she worked as a

nurse. Ms. Ward noted that these case studies, while horrible, make you realize these things

really happen, which further highlights the severity of the threats faced by vulnerable

populations.




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Track B. “BCS System Enhancements and Platform Direction” Day 1: May 2, 2016 1:30 P.M.

Melissa Rice (CMS)

Beth Myers (Innovative Architects)

Allison Dudziak (Innovative Architects)

Overview: Melissa Rice introduced Beth Myers and Allison Dudziak from Innovative Architects

(IA). Beth is the Solutions Architect from the development team. Allison works with States

regarding implementation. They discussed new tools, fixes and next steps regarding the

Technical Assistance (TA)-provided background check system (BCS).

Observation: Ms. Myers said the BCS was created almost five years ago; as a result, there have

been many ongoing updates and fixes to keep the system up to date.

Observation: The IA team has been involved with 21 of 26 States. The system is generic,

flexible, and fixable to meet all State requirements. Thirteen States are live (the first was DC)

and each one has a new build every month. There are about 500,000 background checks to date

and this number is growing rapidly. Every month there are new aspects changed within

programs. The rate of advancement is about 200 aspects changed monthly with a continuous

backlog; there are currently more than 6,000 users.

Observation: There has been great interest in the Applicant Initiated Applications (AIA), which

began with Alaska’s program. The following are types of Applications: Kentucky– licensing;

Minnesota – student training; Hawaii – applicant initiated; Florida – AI portal. The original

application has been completely converted since the original Alaska form. For future States,

there is the ability to turn items on and off in a customizable manner.

Q1: (Audience Participant): For the applicant initiated process, how are you approaching

verification?

A1: Users have to create a user account using Social Security Number (SSN) and they

won’t be shown background checks that the user did not start themselves. You cannot see

background checks run for other people.

Q2: (Audience Participant): At fingerprint, are you relying on ID to confirm against

system information? Where is that being done to validate online account with

identification?

A2: The information is sent to the fingerprint form or live scan machine and when

fingerprinting is to be done, you would need an ID that matches account information.

Another option is to compare driver’s license photos and user-taken photos sent in. This

is currently being done for a company that runs checks for Uber drivers.

Observation: The form editor was released after the NBCP 5th

Annual Training Meeting and also

provided some SQL Server Reporting Services (SSRS) training. IA and States like form editor

because it is useful for contact information updates.

Observation: IA discussed the User Interface/User Experience (UI/UX) updates at the 5th

Annual

Training Meeting. IA is working on the website interface responsiveness, for example the rate at




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which reports can be run, the convenience for users to access necessary information, and button

versus link standardization.

Observation: Personal Summary Pages are accessible to edit through configuration settings. IA

would like to know the State perspective concerning these new website developments, and they

asked for States to share their feedback at any time.

Observation: The NBCP Nurse Aide Registry (NBCP NAR) is another successful effort

developed over that last year that three States are currently using; Georgia and Florida will be

included in the NBCP NAR next year.

Observation: One of the biggest, most interesting things is to run background checks on different

groups, which is becoming an easily expandable process. For example, Utah has a separate

grouping for their emergency medical services (EMS) department. They share the same system

but are accessed differently, using different authentication. Another example, Kentucky has a

separate grouping for Nurse licensing. Some requests that States have for IA cannot be covered

by the technical assistance part of State grants, but Ms. Myers said this can be worked out

separately.

Observation: IA also discussed the interface with the U.S. Postal Service (USPS) Certified Mail.

Oklahoma requested this interface and other States are interested. With the April release, IA is

now coordinating with post offices. The system associates the tracking number with the correct

determination.

Q1: (Audience Participant): Is it possible to use a barcode scanner?

A1: Yes. Certified mail tracking option works very well.

Q2: (Audience Participant): What should happen in the core background check system

after the user receives a letter?

A2: States and IA are trying to answer this question. Something for new States to keep in

mind as this tool is developed.

Observation: IA recommended that if States do not want results to be viewable by other staff

members, they should use restricted determinations such that only one or two individuals can

have access. This is a new configuration setting; only users with the permission can create a

restricted determination and see it.

Observation: HasFeature offers more control over what and when users can access information

and allows restrictions at certain times of the day when people can see items. The purpose is to

limit the number of users and prevent risk of security leaks from incorrect usage.

Observation: HasFeature includes a pre-login message and a startup message, both of which are

configuration settings that allow for text edit the same way other text is edited. The startup

message displays before users log-in, saying that a certain live scan location is down; this would

help prevent providers from making an appointment at that location. This would help prevent the

applicant showing up and not being able to get fingerprinted at that time.




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Observation: Employee Import allows providers to create a spreadsheet of current employees and

import it into the system. They can be automatically rechecked each month without having to be

redone. WV has completed 37,000 employee import records in just eight months. Employee

Import began with one State and has been through a number of iterations thus far. It isn’t

foolproof but users have been able to solve issues.

Q1: (Audience Participant): Back to uploading rosters into the database with regular

rechecks, are you talking about checking against your own State database or are you

comparing against other State registries?

A1: This varies from State to State, but if a State is checking a certain registry, they can

be checked every month. This is major for bordering States to consider. Also, when

talking about training and modules, that would be huge for our staff. The help button is

not that helpful.

Observation: Equivalent offense: When a determination is reached, how can records be checked

for updates between States? The idea is to make the system self-learning to record automatic

equivalent offense.

Observation: The background checks system is five years old, which is considerably old for

technology. As of March 1, 2016, IA only supports the most recent browser version; others can

be used until a certain point in time, but eventually will be phased out. The internal framework of

the system is being changed, but this should not change how the system looks and acts. The SQL

Server should have a seamless upgrade. The SQL Server 2008 will be updated to 2012 as the

minimum requirement to move forward.

Observation: Many users are interested in whether an NBCP phone app would be applicable or

efficient. A mobile app would help individuals who do not have laptops/desktops. Prototyping

for the app has begun. Benefits of the mobile app would also include the ability to contact

applicants as an additional form of notifications, i.e., when determinations have been made or

next steps. There is no current authorization to proceed.

Observation: The advantage of cloud use is that space in the cloud can grow and be managed

very differently. Microsoft’s Azure Government is the secure hosting facility and works with the

FBI to ensure the server is Criminal Justice Information Services (CJIS) compliant. IA is

approved to use them as the hosting center. Another perk is that if States are now doing 10,000

background checks a year and that number increases to 30,000 checks with legislation change,

they will not need to change the server, they can just expand the current cloud server.

Q1: (Audience Participant): Do you envision partitioning the data set that attaches

criminal offense to a name?

A1: All data, regardless of type is treated with the same high level of security.

Q2: (Audience Participant): Do encryption requirements meet CJIS requirements as well?




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A2: This isn’t done automatically with Azure, but everything is up to CJIS standards.

Some fields are double encrypted.

Q3: (Audience Participant): Will login requirements be upped to use the cloud?

A3: No, the definition of a user account would stay the same. There may be future

discussion for State users to make sure all users are following the latest guidance.

Observation: The possible solution to improve NBCP systems training is a full training portal

where users can create a user account or have one created. Users could watch instructional

videos and take a short quiz at the end resulting in a training certificate. The DC program has

training videos that are updated every once in a while. Videos however are sometimes difficult to

keep up to date. Georgia’s videos are very simple to translate for other State usage.

Observation: IA was thanked for considering CJIS policy, as this is significant for the States.

Questions:

Q1: (Audience Participant): There is an issue with providers maintaining records without

updates, etc. Can there be a filter in the system to restrict what a user can do until they address

the employment verifications?

A1: IA is working on it.

Q2: (Audience Participant): On the offenses page, to manually import info, is there a .csv upload

option?

A2: No.

Q3: (Audience Participant): On identity verification information, I know using a snapshot is

fairly new technology. Kentucky is wondering if this is applicable for Applicant Initiated

Application use.

A3: We would have to discuss this; it depends on what the live scan vendor can accept. Identity

verification is a next hot topic we are looking at.

Q4: (Audience Participant): Are you looking at a national child abuse registry?

A4: No, we have not found one child abuse registry that we can automate yet but States are

talking about how to improve data collection from these registries since they are built differently.

Q5: (Audience Participant): Child care registration – We have to do a re-check every five years.

We are trying to think about how to notify people about their need to renew. Notification of

people for checks would be a good idea.




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A5: Yes, there has been more focus on communicating to the provider than the applicant so

we’re working on that.

Q6: (Audience Participant): Regarding Utah and including other partners, can you talk about

EMS experience and what you have done so far?

A6: Utah has very specific background check rules for the health side but different rules for

EMS, which is common. Everyone in EMS is fingerprinted (including minors) who are not

fingerprinted on the health side. EMS is similar and part of the same database but hasn’t been a

challenge so far. Utah has had a seamless transition so far. The biggest challenge so far is in

difference of terminology. IA says wording can be replaced since certain States have specific

terminology requirements. It is an interesting challenge to see how many words can be changed,

but it is possible. One thing not addressed with EMS, is when the system of record is not a

background checking system but another system. Then, we need to figure out how to collect

demographic information, etc. This may be our next challenge.

Q7: (Audience Participant): For other State agencies not using grant funding, does IA have

different agreements?

A7: Separate support agreements are defined as changes that apply to everyone in the State

versus small groups. IA does not anticipate it to be a big effort.

Q8: (Audience Participant): We had a situation where we were approached by DC Medicaid and

child protection agencies. There was issue of Originating Agency Identifier Number (ORI)

differences, have you seen this before?

A8: If the second agency has a different ORI, using the department model allows us to control

the system separately. That’s probably the answer but at the technical level, a database person

has access to all of them.




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- Session 2 -

Track A. “Enabling Legislation – How to make the NBCP work for your State” Day 1: May 2, 2016 3:30 p.m.

Sarah Fahrendorf (CMS)

Ann Casey (CNA)

Panelists:

David Ostrander (GA) - Interim Inspector General, Georgia Department of Community Health

Phyllis Powell (ME) - Director, Division of Licensing and Regulatory Services

Jennifer Mayes-Laracuente (KY) - Program Analyst for KARES

Melanie Madore (MO) – Chief, Family Care Safety Registry, Missouri Department of Health

and Senior Services

States present and number of years in the NBCP:

Kansas – First year

Kentucky – Fifth year

Maine – Fifth year

Colorado – None

Michigan – 10 years

Missouri – Sixth year

DC – Sixth year

Overview: During this workshop, participating States learned and discussed ways in which they

can participate in the NBCP without legislation being a barrier. Panelists from Kentucky and

Georgia discussed attempting to pass legislation, how to manage a situation in which legislation

does not pass, and what their respective States have been able to accomplish through the program

in lieu of such.

Questions

Q1: (Audience Participant): Does an automated system help in getting providers to participate?

A1: Yes, providers like the automated system and find it helpful.

Q2: (Audience Participant): For States graduating from the program this year, can they still rely

on section 6201 of the Affordable Care Act for fingerprint authorization once they are no longer

participating in the program?

A2: This question has not been adjudicated, yet.

Q3: (Audience Participant): For States that relied on the Affordable Care Act for appeals for

provisional employment, do they need to incorporate those appeals provisions in their statute?




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A3: This has been a challenge in Kentucky, where the legislature is not inclined to retain civil

applicant prints. Kentucky wants a statute or approved regulation that outlines the authority and

processes for retaining fingerprints.

Q4: (Audience Participant): For those States that do not currently fingerprint, when did you

realize it was not possible?

A4: Maine realized fingerprinting was not possible when they received the grant. At the time,

Maine was moving forward with developing a biometric system without legislation. One of the

issues with this was that while providers wanted a biometric system, they each had their own

legislative agenda important to their survival. So, Maine decided to work with Yale New Haven

to develop a system that could function as a name-based system.

Q5: (Audience Participant): For those providers who use a background check system, what kind

of feedback do they provide regarding why they use it?

A5: Georgia noted that some of their providers use it for marketing purposes. Kentucky noted the

system automatically checks certain abuse registries for providers prior to submitting a

background check request, which allows them the opportunity to know whether or not they have

to spend money on a criminal history background check. In addition, they claim it alleviates their

doubt and stress when hiring, knowing the program is looking everywhere.

Q6: (Audience Participant): Are other States subsidizing the cost of the background check?

A6: Yes, to some extent.




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Track B. “Office of Inspector General Update and Current Evaluations” Day 1: May 2, 2016 3:30 P.M.

Tricia Fields, Program Analyst (OIG)

Don Howard (CMS)

Overview: The Office of Inspector General (OIG) provides oversight for NBCP States and

conducts program evaluations. Don Howard, PO for Alaska and Michigan, introduced Tricia

Fields from HHS OIG who discussed the evaluation requirements and process.

Observations: This session’s presentation was a verbatim sharing of information from the

PowerPoint Slides. For more information, please refer to the presentation. Questions were also

limited to the following:

Questions:

Q1: (Audience Participant): When does OIG visit States after they have completed their grant?

Does that timeframe include no cost extensions?

A1: OIG does not conduct onsite visits but conducts reviews over the phone. They conduct the

review when the States decide they are done. So far only Delaware, Illinois and Maryland have

conducted reviews.

Q2: (Audience Participant): In the States where follow-up surveys were done with nursing

facility / LTC (long term care) administrators, what did OIG find in regards to changes in care or

availability?

A2: OIG has not done a whole lot with that as it is done on a State-by-State basis.

We plan to compare all States post-survey rather than on a State-by-State basis.

Q3: (Audience Participant): In DC we have two background check programs, one for licensing

and one for employment. Legislation for employment is standardized; however, legislation for

licensing is at the discretion of the boards. Are you aware of such a disparity?

A3: Speaker defers to CMS. Answer is unknown.




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Day Two: May 3, 2016

Plenary – FBI’s Federal Rap Back Day 2: May 3, 2016 9:05 a.m.

Jimmy Mills (FBI)

Scott Manley (CMS)

Overview: FBI Rap Back fills in the gap between the initial completed criminal history

background check to the present. The FBI Rap Back service works with any fingerprint.

Observation: There are two domains within Rap Back services: criminal domain and non-

criminal domain (civil side). The NBCP would fall into the civil category. There are quite a few

requirements to participate in Rap Back, including biometrics and a fingerprint card on file with

the FBI, which must be retained to search under databases. Other requirements include

Electronic Biometric Transmission Specification (EBTS) capability, allowing data to flow from

the State to Next Generation Identification (NGI) program and back; the authority to search,

submit, retain, and cascade searches against criminal and latent databases; and suitable privacy

statements. Also in the requirements are the ability to complete testing, that tests the live

environment and returns notifications from the FBI that are unsolicited, and a completed

Appendix 2 for Non-Criminal Purposes, which is an agreement with the FBI that you will do

certain things such as validation.

Observation: There are many key terms involved with Rap Back. Rap Back itself is a major tool

for suitability and investigative purposes that propels agencies to the next level with electronic

notifications to the submitter. The submitter will be the agency that has the wide area network

(WAN) connection to feed information to NGI. The subscriber is the subordinate agency of the

Submitter—that is everyone here. The subscription is an actual enrollment on an NGI retained

record of which automatic notifications will be sent to the submitter.

Observation: The submitter must have the statutory authority or other appropriate authority to

submit the fingerprints to NGI. When fingerprints are submitted to NGI, this does not create a

new authority for you or another State, does not create access for agencies that do not have

access, and does not provide access to CJIS data to those that already have it.

Observation: Non-criminal justice Rap Back refers to functions such as search, retain, and notify.

Searching includes submission of fingerprints for civil applicants, volunteers, licensees, and

more, to a repository such as a State Investigation Bureau (SIB) or the FBI NGI Rap Back

Service. With the search, you submit the information, we send a response back to you and then

you can make a determination. The FBI retains fingerprints as new identities or matched to

existing identities in NGI. The ID is retained for the purpose of any future triggering event that

comes in, and then we will send an unsolicited notification to your agency.




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Observation: Key stakeholders include anyone in a position of trust that interact with the

population such as health care providers, banks, mortgage lenders, teachers, Criminal Justice

Agency employees, and more. The graph shown discusses purpose codes. Everyone present falls

under Category 1; this will help you understand how States may manage systems under different

categories and which Subscription Management Plan you could possibly submit.

Observation: There are two Subscription Management Plans: event-based and person-based.

Event-based is the subscription plan to send a set of civil fingerprints and subscription to NGI for

each Rap Back subscription. Person-based is the subscription plan to send only one subscription

per category and maintain subsequent subscriptions of same category at the State or agency

level. This subscription plan means you have a robust system already; you know when certain

individuals need to be print-checked again. There are checks and balances in place, which places

a considerable amount of responsibility on the submitting agency. Providers must discuss with

CJIS prior to choosing the Subscription Management Plan. There is one estimated NGI

subscription per person per category. The submitter establishes the subscription with themselves

as the submitter and the subscriber. The submitter manages all Rap Back activities through the

Rap Back service and the submitter agrees to abide by the Rap Back rules in all record and

activities so it is compliant with the audit. New subscriptions that come into NGI will be

managed by the State. NGI will send out one notification that goes to four different agencies and

will parse those out if a triggering event returns on Category 1.

Observation: There are two ways to set the subscription into NGI: search and subscribe and

search and retain followed by subsequent subscription. Search and subscribe includes submitting

the applicant record and including Rap Back data with that information. With that information,

the FBI will search our system, retain it, and send back criminal history if there is any and also

send back subscription data. The subscriber can choose to use search and subscribe if they do not

want to review the applicant’s FBI record before setting the subscription. Search and retain

followed by subsequent subscription is for those subscribers who want to review the applicant’s

FBI record before setting the subscription. The main difference between the two is whether the

subscriber wants to vet the applicant before they subscribe.

Observation: There are eleven triggers and you can choose between the second to eleventh

trigger. The first trigger, criminal, is automatic. If there is a consolidation between two triggers,

the FBI will send out a notification with which ones they are. If there is an identity deletion, it

would have to be an accident on the State’s part, but you will get a notification. States can

contact the FBI if an identity is deleted. States will not be able to select the Security Clearance

Information Act (SCIA) with your populations; if you choose certain notifications, you will

receive them.




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Observation: There are three choices of Rap Back activity notifications including pre-

notification, triggering event, and triggering event with the Identification History Summary

(IdHS). The options include:

In-State notifications;

Monthly notifications, in which subscriptions must be renewed;

User defined fields; this is useful if Rap Back is person-based; and

Attention fields, where you should input a different ORI number and do the same with

Rap Back recipients.

Observation: Privacy risk mitigation strategies are used for your validation purposes. Subscribers

must agree with the submitter on the appropriate Privacy Risk Mitigation Strategy for their

populations including pre-notification with mandatory validation/expiration within five years,

authority for duration of a license, statutory authority for a set period of time, one-year

validation/expiration, or subscription synchronization through automated or formalized

procedures. The fifth strategy is for agencies that have robust State rap back programs and do not

need the other four strategies.

Observation: The Rap Back Term Date reflects how long a subscription period has been

purchased by the subscriber through the payment of the fee. The subscriber can choose to

subscribe for two years, five years, or a lifetime. As of now, every subscriber has chosen a

lifetime subscription, paying a fee of $13.00. The expiration date is the date you set when you

want to validate your subscription. For example, if you choose a five-year term, the expiration

date would be at three years, and the next time it would at up to two years. Management of the

subscription must be validated to stay current with auditing requirements. If you fail to validate

or renew, the FBI will send out a notification ten days in advance that you must renew. You will

not receive a notification on the expiration date and you will have 60 days after the expiration

date before they officially cancel the subscription. There is no fee charged for the subscription to

be “extended” with a new expiration date that is less than or equal to the subscription term.

Observation: Criminal stakeholders include probation/parolee officers, agents, and the law

enforcement community. Criminal preparedness includes all subscriptions that will be event

based; subscriptions that can only be set on retained criminal records; has to be the NGI identity

on record; and must follow auditing regulations. Criminal preparedness also includes authority

for criminal justice agency. If you are criminal justice agency, you cannot ask on your own for

an investigative subscription on whomever, appropriate expiration dates will be set following

authority, and authority for juvenile arrests can be placed in rap back but this is rare.

Questions:




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Q1: (Audience Participant): In order for this to work, you have to have a fingerprinted event,

correct? I have someone who has been convicted of simple assault at one point in time, but they

were not fingerprinted, so then would we receive any information from the FBI because he was

not fingerprinted?

A1: If the fingerprint is not in our system, we cannot return or report data on it.

Q2: (Audience Participant): Most of the States are choosing the lifetime subscription, do you

know why? Can you elaborate on how the subscription and validation works with the lifetime

option?

A2: There are not many agencies, only two. Personally, I think it is easier to have a lifetime

subscription and it allows you to extend your expiration date to five years, which is as far as

possible to be compliant. You will only pay a one-time fingerprint fee and one-time lifetime fee;

there is no need for multiple payments. The lifetime subscription is very similar to the five year

subscription; you can only extend your expiration date to the five years, it can be sooner, but

that’s the furthest you can extend.

Q3: (Audience Participant): For people who may not be licensed that provide services in

someone’s home, what is the acceptable validation?

A3: Validation depends on the State statute; you should follow the State legislation and select the

strategy that correlates with that.

Q4: (Audience Participant): What does validation include?

A4: When a person is still employed by the agency and they still need to be in Rap Back.

Q5: (Audience Participant): If you start out with a two- or five-year subscription, can you switch

to a lifetime subscription?

A5: If you start with two-year subscription, and you decide you want to switch to a lifetime

subscription, you will have to cancel the two-year subscription and pay the lifetime fee, but you

can still keep the fingerprint card.




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Q6: (Audience Participant): If an agency decided to renew after the subscription had expired and

they are audited locally or by an FBI audit, would that be considered a finding if the auditor

came in and said you did not validate in time?

A6: I doubt that would cause too much of a problem. Audit has a manual that they are publishing

on how they will audit.

Q7: (Audience Participant): Michigan has a good rap back system, but it does not cover federal

court; would a federal Rap Back system provide information on crimes committed and charged

in federal court?

A7: Yes, if the fingerprint is submitted in the NGI system, but this does not occur every single

time.

Q8: (Beth Meyers, IA): If there is person who is employed and not licensed and if there is a

break in employment, can we just not validate that they are working until year five? Is there

some requirement that stipulates if they are not working for a period of time, they are taken out

of Rap Back?

A8: Yes, they are taken out after they stop working for you. If the person is no longer working

for you and is arrested a week later, you will receive an unsolicited notification.

Q9: (Beth Meyers, IA): What if the individual requests to remain in Rap Back because they

know they will be working again in a week or a month and does not want to incur further

expense?

A9: When the individual is enrolled in Rap Back and they decide to no longer work and hope to

become employed soon, the criminal history is only accurate at that point in time. There are rules

on sharing criminal histories and it cannot be shared because the individual hopes to be

employed soon.




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Plenary – “A Painless Background Check Financial Model” Day 2: May 3, 2016 10:00 a.m.

Melissa Rice (CMS)

James Joslin (OK State Department of Health)

Ann Casey (CNA)

Ernie Baumann (CNA)

Overview: Melissa Rice introduced panelists James Joslin, Ann Casey, and Ernie Baumann to

discuss the significance and details of Oklahoma’s sustainability model.

Observation: Mr. Baumann gave a presentation on traditional methods of sustainability and the

different models available. One of the biggest objections he hears from States about the NBCP is

“this is going to cost so much money.” That is the conventional wisdom providers always

mention. They then talk to legislators and nothing happens (i.e., NBCP-enabling legislation is

not passed), but there is a way, thanks to an approach that Mr. Joslin created, that can balance

those costs. There is a little bit of work and data gathering required and only works if all pieces

are implemented; however, it can keep costs down. Just to orient everyone, variable costs include

live scan, State criminal record check fee, FBI criminal check fee and rap back fee. Program

costs include State program administration and the IT system support. The traditional approach

that States used for background check programs before pilot programs, involved everyone

paying their own way. The applicant, provider, and State paid each cost individually. The

challenges to that were that there was no way to bring in outside funding of any sort, and the

State would not be involved at all. It would all be between the provider and the State Police.

Observation: The Applicant-Provider-State Split Model (Option 1): The applicant fee went to the

live scan company, the provider fee went to the criminal justice agency and the State budget

went to the State determination unit. It is very simple and straightforward; some States had an

additional add-on provider user fee on each application that went in. That additional funding then

pays for the additional IT/Program costs. It made the system a little more self-supported but was

a higher cost for applicants. It also required that the State track that additional funding to make

sure funding doesn’t go elsewhere and to make sure the applicant paid the application fee.

Observation: Add-On Provider Fee Model (Option 2): This is mostly the same as Option 1 with

the exception of the provider fee is going to the State determination unit. It becomes expensive

for the provider and the State budget doesn’t see very much reduction.

Observation: Sustainability Model (Option 3): There is a third solution—a Flat-Rate Model. Mr.

Joslin said when OK began, they heard that States loved the NBCP, but could not afford it. With

that in mind, they began with these fees: $15 fee for name-based check plus an additional $4,

totaling $19. They were paying $19, which was our cost constraint. OK wanted to determine if

they could collect the same fee from every provider and be sustainable. The idea was we’d set

the fee below the actual cost of finger printing, which is $41. The State law says the State must

pay $41 to conduct a background check. The live scan fee was $15 at the time. He had to look at

collecting a flat fee for the application that would be below fingerprinting cost and figure out a

way to use the excess and Civil Money Penalty (CMP) and Medicaid funding dollars for this




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model to be successful. The provider pays $19 and the applicant pays $10. With rap back, the

first provider pays $19; the applicant pays $10, except when applicants may have applied with

two or three providers, which is the challenge. OK had to include in its statutory language,

specific language that authorized the revolving funds. The short version of that is a specific fund

that is dedicated for that sole purpose of accumulation.

Observation: Flat Rate Model: There is a one-time applicant fee, flat rate for the provider for

new and existing enrollees, Medicaid, grant and CMP funds. All of that is collected, and then the

live scan, State criminal justice and State fees are all paid.

Observation: Flat Rate Model Requirements: OK has received applicants that only have a name-

based check done who cannot be fingerprinted. In OK, the State makes the determination so

criminal history is not shared; they only tell an employer if someone is eligible or not eligible.

Observation: OK currently does not have a limit on the length of rap back enrollment. Once

employed, they are employed and can move on to other employers without a limit on how soon

they have to be fingerprinted. If someone gets a rap back hit and they are not currently

employed, OK does not disqualify them (OK does not follow them), they disconnect the existing

eligible application, which is how they respond to that. One of the selling points is that the

applicant may apply at a few places. Then if they move to the next employer, that employer can

see immediately that they have been found in the system and don’t have to pay. There is data on

the number working at Medicaid facilities vs. non-Medicaid facilities. OK uses the turnover rate

projection of 50 percent for nursing homes, which is actually closer to 70 or 80 percent. It has

exceeded my expectations. Mr. Joslin said, “You need to know current State costs, estimates for

staffing costs and IT costs. Suffice it to say, the data is available and there’s a model that allows

you to model all of this. You will have data to do immediate estimates and data to back it up

down the road through the core system.”

Observation: Benefits of Flat-rate Model: 1) State and FBI fingerprint-based checks are required

for all long term care applicants; 2) Duplicate fingerprinting is minimized; 3) Provider fees stay

static but program provides have substantial measureable benefits. While a higher provider rate

may have been required, the turnover rate was high enough that rates did not have to be changed;

and 4) State budget appropriations for program administration are not required. Since OK has

used this fee structure, they have not had to use State appropriated dollars. A portion of staff

funding was, however, used to set up this program.

Observation: Ms. Casey said applicants only have to be fingerprinted once and providers pay a

much lower rate than what their fingerprint rate would be every time to see a determination.

Observation: Mr. Baumann said the challenge to modify for each State is that States must have

information about turnover rates. It might be at the third or fourth year of the grant by the time

this can be figured out. Mr. Joslin built a spreadsheet that works for him and Mr. Baumann

generalized it to work for other States. It works year by year starting when the States receive the

grant, so that when the State gets their plan in place, they can keep track each year of what

comes out and what goes in and how long funding is likely to last.




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Observation: Mr. Baumann has highlighted a few elements he is working on with KS for their

application of the model. The State must know the number of hires (estimates can be used),

fingerprinting fees, current provider fees, and the State/federal fingerprinting costs and

administrative costs (Staff/IT), percentage of Medicaid providers, and Medicaid reimbursement

rate (which is typically 50 percent). The last three numbers will show what you are likely to have

when you get out of the grant (i.e., the rollover funds). Rollover and revolving funds help you get

by while you are collecting data. It requires some dialogue and work to get the cost estimates;

you’ll have to work with State police.

Observation: Ms. Casey said that Mr. Joslin knew that legislators would not have time or

patience to work through the spreadsheet model.

Observation: By year five, almost four out of every 10 hires in Oklahoma will be in the system

and will not require re-fingerprinting. Connected applications are almost equal to the first time

payment. OK actually peaked in 2014 in terms of fingerprint volume and first time fingerprints

are now in decline since most of those needing fingerprinting have been fingerprinted.

Question:

Q1 (Ann Casey, CNA): When did providers begin believing this would work?

A1: By November 2014, when we saw the drop in first time applicants.

Questions:

Q1: (Jane Lengel, OH): Is Oklahoma a mandatory State? Are all providers mandated?

A1: Yes, mostly. In the second or third conference, our bill was before the legislature and the

State home health care was written in as voluntary regulation. They are now participating after

having seen the cost cut.

Q2: (Audience Participant): Flat rate model example slide: Is this under the assumption that State

agencies are doing fitness determinations?

A2: Absolutely. That’s a requirement. I’m looking at this from a Medicaid perspective; we don’t

have that provider requirement. Most of our agencies in the State are Medicaid providers. Under

this assumption, as a provider, I should be able to bill Medicaid or send it to that criminal check

since Medicaid is benefitting from the process. They could include that in the costs and what I

understand is that it can be taken on that side.




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Q3: What is the plan for CMP money, since it’s only for three years?

A3: CMP dollars are available for a 25 percent match. To the extent that you get that money it

allows the fee money being collected initially to go into the revolving funds. I’m using CMP,

revolving and the 25 percent CMP match dollars and don’t require others. Extra revolving funds

will continue accumulating and works as a nest egg to use after grant funding has ended.

Hopefully the Medicaid contract comes in and can also add to the nest egg. The point is to plan

to make sure that the nest egg doesn’t go away but remains at a level at the annual expenses.

Q4: (Audience Participant): Do you know what your average number of applications per

applicant is?

A4: About 60 percent have two or more applications and some have quite a bit more.

Q5: (Audience Participant): Currently costs don’t include Federal Rap Back and I imagine that

percentage has to go up a bit for Federal Rap Back to be implemented?

A5: Medicaid contract allows administrative match. 50 percent expenses are reinvested in costs.

As costs increase I can push those costs in a Medicaid contract.

Q6: (Audience Participant): What type of rap back does Oklahoma have?

A6: Now Oklahoma has an open State rap back. Once fingerprinted, if arrested in Oklahoma, I

get a rap back notice from my State bureau of investigation.

Q7: (Audience Participant): So if an applicant is fingerprinted once, what if after a year or two,

an offense is committed out of State? How would you know?

A7: Unfortunately that is the gap. It’s less of a concern for Oklahoma, but we are working on the

technology to pull in the FBI Rap Back but don’t have that yet.

Q8: (Audience Participant): Our State has voluntary enrollment and our providers do the

determination. We don’t have an administrative State agency to handle the model. Is there a

model for a State like ours? We can’t predict the number of employees that will be enrolled in

registry checks.

A8.1: Those providers are subject to the FBI audit for handling that FBI record. If you are the

keeper of the decision, you can share the decision, but if you are not, then you can’t share the

decision and share the costs.

A8.2: (Ernie Baumann): I don’t know a way to do this type of cost levelling and get the

advantage of removing the duplicate cost without State involvement and rap back involvement.

Some States have flipped the switch and say we can do this if you change the process and make

it mandatory to have agencies do the determination. Some States are approaching in this way.




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Plenary – Guest Speaker: Dr. Jessica Neptune, Reentry Policy Analyst, APSE, HHS Day 2: May 3, 2016 11:15 a.m.

Dr. Jessica Neptune (ASPE)

Rebecca Ward (CMS)

Overview: Dr. Jessica Neptune gave an in-depth look at issues that individuals with criminal

records have. The focuses of her discussion revolved around reentry into society and

employment opportunities in the healthcare industry.

Observation: The Office of the Assistant Secretary for Planning and Evaluation (ASPE) is

located in the U.S. Department of Health and Human Services (HHS), and has a staff of 150

people, including analysts and researchers focused on policy across the government and HHS.

More information can be found on ASPE’s website.

Observation: The main focus on Dr. Neptune’s career is employing individuals with criminal

records into the healthcare industry. Dr. Neptune has supported studies that focus on low-income

men, Medicaid as a reentry strategy, and marriage and family strengthening.

Observation: Dr. Neptune evaluated the consequences that result from criminal convictions and

focused on the societal consequences for those who develop criminal records, such as reduced

employment opportunities, the effects on family life, social status, and more. Currently, more

than 2.7 million children have a parent who is in prison. Criminal records not only impact the

individual, but also the quality of life for their families and future generations. Dr. Neptune noted

that, “Employment is one of the central areas to reduce recidivism.”

Observation: During Reentry Week, the White House hosted an event called Champions of

Change. Ten individuals were honored for their achievements to assist others after having served

a prison sentence. The Council of Economic Advisors released a report on the economic impacts

of incarcerations. The report focused on how more people have criminal background than at any

other point in America’s history, and how the economy is hurt by the limited opportunities that

having a criminal record provides.

Observation: A recent Presidential memorandum established the Federal Interagency Reentry

Council, with the Council’s intent to clarify occupational licensing issues. However, due to its

recent release, agencies are still working to implement the direction into practice.

Observation: In her studies, Dr. Neptune tracks data for criminal records; it is estimated that

between 65 million to 100 million adults have a criminal record. However, it is difficult to

calculate the exact number of individuals that have a criminal record because an individual may

commit multiple crimes or recidivate. High incarceration rates of these levels among adults are a

relatively new phenomenon.

Observation: When viewing historical data for adult incarceration rates, the rates dramatically

rise from 200,000 to over 2,000,000 in just 30 years. Due to this high increase, Dr. Neptune

researched the potential causes that led to an almost ten-fold rise in incarceration rates. She

http://www.aspe.hhs.gov/




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examined rising population rates, but found that incarceration rates did not correlate despite a

doubling of population rates. Dr. Neptune also found that violent crime rates have continued to

decline over the past 25 years, regardless of rising incarceration rates. The rise in incarceration

rates is due to policy changes in criminal law, in addition to the war on drugs. Dr. Neptune found

that individuals are incarcerated for longer periods of time and the increased sentence lengths are

associated with drug offenses. An aspect of Dr. Neptune’s research focused on tracking the

amount of money spent on prisoners based on their geographic location. This data is revealing

because it shows that arrests frequently occur in certain neighborhoods. In fact, this data can be

reduced down to specific blocks in a city; some city blocks have such high incarceration rates,

causing dramatic spending on prisoners, these have been called “million dollar blocks.” This

geographic data shows that that rising incarceration rates have impacted people of color much

more so than their white counterparts. African-Americans and Latinos are more likely to be

stopped by police than Caucasians.

Observation: Dr. Neptune’s main research focuses on employment of individuals with criminal

records into the healthcare industry. She reports findings on barriers to healthcare sector

employment and she findings on opportunities in healthcare sector employment. There is, a wide

disparity of legislative activity across the States. For instance, what carries a heavy penalty in

one State might have very low consequences in another.

Observation: When fighting to change legal barriers, Dr. Neptune has learned that adding a

‘face’ to the argument helps create change. She gave the example of a woman named Jennifer

who was a high school student with good grades and a bright future; however, she was involved

in a car crash and was prescribed a high dose of pain medication. She developed an addiction to

the prescription drugs and soon was on a decline to maintain her addiction. She started to write

bad checks; she was eventually caught, where she served a string of jail sentences in each county

where she wrote bad checks. She lost custody of her children and became depressed. Later, she

moved to a different State, but she was incarcerated for grand theft auto of a rental vehicle. In

prison, she became sober and turned her life around. After leaving prison, she wanted to fulfill

her aspirations of helping people; however, her criminal history prevented her from doing so

including the denial of nursing school admission. Jennifer’s story represents the three biggest

hurdles for all individuals with criminal records: education; employment; and legal barriers.

Observation: The Transitions Clinic Network is a very successful program for introducing

individuals with criminal histories into the healthcare industry. This program trains individuals to

be health workers within their own community. The intention is for individuals from

communities in which they were raised to support other individuals they already know. The

Transitions Clinic Network enhances patient engagement, reduces healthcare costs, leverages a

stigmatized experience into job opportunity, allows individuals to give back to their community,

and allows individuals to act as mentors for others returning home from incarceration. There are

13 of these programs across the nation, and they are looking to continue expanding.

Observation: Dr. Neptune provided another example through Mary’s story; she served 15 years

in a high-security prison. In prison, access to health services is particularly difficult, and

individuals often develop the habit of providing medical care for themselves and other prisoners.




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While in prison, Mary was a leader in peer health and participated in education programs. Upon

her release, she obtained a Master’s Degree in Social Work, and currently, she is the Clinical

Director of the Coming Home Clinic at Mount Sinai/St. Luke’s Hospital. She specifically

employs other people who have a history of incarceration.

Observation: Dr. Neptune showed a video of the Alameda County EMS Corps that is aimed at

helping individuals with incarceration records. These individuals have been vilified as non-

contributing members of the community and therefore do not receive employment opportunities.

The program offers traditional EMT training, and background services, including mentoring,

community service, mental health, and health and wellness. The program has had nine cohorts

with 139 graduates.

Observation: The Bard Prison Initiative enrolls almost 300 incarcerated men and women across a

spectrum of academic disciplines, and offers over 60 courses each semester. The students are

deeply familiar with health issues and have a strong interest in public health and human service

fields.




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- Session 1 –

Track A. “Federal Rap Back Implementation” Day 2: May 3, 2016 1:30 p.m.

Scott Manley (CMS)

CaraLee Starnes (CNA)

Overview: The panelists discussed the status and process of their respective States’ federal Rap

Back implementation. Florida expects to implement Federal Rap Back in summer 2016. Rhode

Island implemented State rap back for all long-term care applicants in March 2016. Rhode Island

designed their State rap back to mirror the Federal Bureau of Investigation’s (FBI) Rap Back

because they are still awaiting legislation to implement FBI Rap Back.

Questions

Q1: Do individuals have to be fingerprinted every five years?

A1: In Florida, individuals have to be fingerprinted every five years, but starting in 2018,

fingerprints can be retained in the system, so persons will not have to get physically fingerprinted

every five years. This future ability to retain fingerprints is one of Florida’s main selling points

to providers.

Q2: What happens if an individual is not found guilty?

A2: According to Florida statute, the individual has to notify the State. The eligibility

determination would change based on the new information.

Q3: Minnesota statute requires authority to retain latent prints at the national level. Has there

been a situation in which latent prints have been used to solve criminal cases?

A3: No.

Q4: What is the cost for State rap back?

A4: For a five-year subscription, it is $24.00. When Florida implements FBI Rap Back, there

will be an additional $6.00 fee.

Q5: Once you have implemented FBI Rap Back, should you continue with State rap back?

A5: Yes, because the State is not required to receive Federal Rap Back notifications.

Q6: How many staff members does Florida have?

A6: Florida has 18 staff members, five of which are criminal history analysts implementing and

analyzing rap back. Florida processed approximately 300,000 screenings last year, 120,000 of

which involved rap back. Florida receives approximately 300 requests in a weekend.




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Q7: Is there anything in Florida legislation that requires providers to maintain an employee

roster?

A7: Florida statute requires providers to update the employee roster within 10 days of hire.

Florida did not enforce this rule at first, and so is now sending out surveyors to fine those

employers who do not abide by this 10-day requirement.

Observation: Oklahoma allows providers to update the system within a given timeframe. If the

provider does not update the system within that timeframe, his/her access becomes restricted.

Q8: Has Florida run into any problems with the courts not sending information needed for rap

back?

A8: In Florida, arrest data comes from live scan from the Sheriff’s Office and Police

Departments to FDLE, so they have not experienced any problems with acquiring information

needed for rap back.

Q9: Does Florida have any way to look for missing dispositions?

A9: Florida statute requires the applicant to provide any missing disposition information within

30 days in order to remain eligible for employment.

Observation: Oregon moved to an eCourt system so they can now more easily access court

information. When an arrest is made, the background check program watches the file. This

process is manual and dispositions are only complete beginning in 2010. The program team

works closely with the eCourt system team in identifying missing dispositions in an effort to

update records.

Q10: For those States that only have State rap back, such as Kentucky, will they be able to

receive arrest notifications or notifications regarding a change in status based on Federal Rap

Back?

A10: Rhode Island advised focusing on the State’s statute. Rhode Island statute states that the

program is not allowed to disseminate Federal Rap Back information to anyone. The program

evaluates hits to determine whether an individual should be disqualified from employment.

According to Rhode Island statute, disqualification from employment can only be based upon

conviction; however, the program can give a provider notice of a rap back hit with all of the

arrest information. Once Federal Rap Back is implemented, the program will follow this same

process.

Observation: States such as Kentucky are advised to work with the Special Investigations Bureau

(SIB) on their State legislation.

Florida sends notifications to providers indicating that there has been a change in eligibility

status without disclosing whether it came from State or Federal Rap Back. Rhode Island also

does not disclose whether hits originated from State or Federal Rap Back.




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Q11: Does Florida or Rhode Island recommend a five-year or lifetime decision?

A11: FBI needs to clarify a lifetime decision.

Rhode Island’s five-year decision is based upon State statute to allow for easy communication

and a clean transaction with providers. A lifetime decision follows a five-year decision. It is

possible a lifetime decision could be the most effective, but this is unlikely because of the

transient nature of certain jobs within the healthcare sector, specifically Certified Nursing

Assistants (CNAs).




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Track B – “Personal Care Workers” Day 2: May 3, 2016 1:30 p.m.

Dr. Fuad Abujarad (Yale University)

Don Howard (CMS)

Liz Raistrick (CNA)

Overview: Don Howard, CMS Project Officer for Michigan and Alaska, introduced Dr. Fuad

Abujarad. Dr. Abujarad is a Yale University Professor who works with the Michigan NBCP. He

discussed the pilot program he worked on for personal care workers.

Observation: Dr. Abujarad said he had the opportunity to work on Michigan’s original

background check program. The State decided to participate in the pilot background check

program Statewide. He was the background check system (BCS) architect and is still the lead for

the system. The “Personal Care Workers” (PCWs) study was just completed a few months ago. It

was a feasibility study for temporary enrollment for workers in the background check system.

They enrolled a sample of workers in the BCS to see their stakeholder views on this process.

Personal Care Workers refers to workers who provide paid in home care services to vulnerable

elders in Michigan.

Observation: The number of Americans requiring long-term care services is increasing. States

and markets will struggle to meet the demand for personal care workers. They usually work in a

stressful environment with low pay and lack upward mobility, causing high turnover rates.

Observation: MI mandates fingerprint-based background checks for residents at licensed or

certified facilities. This includes physicians, nurses, dietary staff, and housekeeping staff.

Observation: The study was aimed towards the value of security for PCWs against economics

and privacy of the workers. The study was designed to explore the stakeholder views and answer

the following key questions.

How much do background checks actually cost?

Do they really work? Will they guarantee a better environment?

Who pays for these checks? For whom are background checks required?

How often should background checks be run on PCWs?

Observation: MI’s system is web-based with initial name-based registry checks as a first step.

Then it requires fingerprinting to collect criminal history from MI and the FBI. Next employers

receive a green or red light regarding employee eligibility.

Observation: The system includes a state “rap back” (subsequently arrested, arraigned, or

convicted). The system includes an appeals process (inaccurate record or for convictions

expunged or set aside but does not include a waiver for applicants deemed rehabilitated). MI has

7,555 users (providers) total. We are at almost at one million applications processed; 879,626

have been fingerprinted; 10,000 were excluded solely based on a name-check. State rap back

excluded another 7,940 applicants. The total exclusion based on fingerprints was 18,242.




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Observation: PCWs have no uniform standard for current background check practices. MI’s

Choice Waiver program is a name-based check.

Observation: Background checks for PCWs are name-based. The goal of the study is to expand

the background check requirements to include PCWs on a temporary basis. This was authorized

by the State and aided through CMS grant funding ($55 per applicant). Researchers hoped to find

results based on 700 PCWs volunteering for the study. The study purpose was to inform MI

legislators on the effects of using background checks for safety in the workplace.

Observation: Researchers conducted five focus groups with different stakeholders and a web-

based survey for government employees, lasting between 75 – 90 minutes per group. PCWs

discussed what type of consent they may have, workplace behavior and what the background

check system should try to address. Groups included:

PCWs and recipients of support services and family (12 participants);

PCWs (13);

Waiver Agents who connected workers with recipients of care;

Provider Agency Groups; and

Relevant non-governmental organizations (NGOs)

Observation: Government employees and NGOs also used a web-based survey; 60 percent (18)

responded.

Observation: The intent of stakeholder outreach was to determine what they believed the right

methods should be. It would also aid in identifying obstacles in implementing fingerprinting for

PCWs. Researchers also conducted cost-benefit analyses. The needs assessment asked about the

potential for expansion of background checks to the PCW force.

Observation: What are positive and negative effects of expansion? Benefits include a better

environment and better security for a vulnerable population but how do the costs weigh against

that.

Observation: Shortcomings of current procedures include a lack of State-wide standards on PCW

turnover from one agency to another without any notice for potential offense, allowing felons to

work in homes.

Observation: Focus groups did not believe name-based checks would be accurate and felt there

were limitations of name-based since that search does not extend beyond boundary of State (uses

State registry only). PCWs desire a national check.

Observation: Regarding low pay, high turnover causing unevenness in worker quality. PCWs

have no learning curve and a low barrier for entry; they felt that demand is exceeding current

pool of PCWs, and wanted other protection for recipient of care from family members.

Government funding for PCWs is not adequate and is not sufficient for their work hours. PCWs

felt that background checks improved safety and security of patients. Implementing background




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checks alone can deter malicious workers from trying to apply for those jobs. The cost may

cause some agencies to think twice before running checks on employees. PCWs viewed

background checks as a credential of qualification. Some workers thought this will provide a

sense of pride and professionalism in the force.

Observation: Savings can results from weeding out unfit applicants quickly and might also

reduce the cost of liability issues. Telling insurance agencies that background checks are used

might reduce insurance premiums. Concerns include the belief that NGOs can barely cover

fingerprinting costs. It was suggested that States have a mechanism to share funding. PCWs

work in homes, so there is no facility or HR to look out for them.

Observation: Organizational concerns include the number of fingerprint sites there are in the

State, turnaround time for checks and the potential loss of customers and potential employees

(from a recruiting agency perspective). Privacy, surprisingly, is not a large concern. PCWs do

not mind background checks.

Observation: Some areas in MI have a hit rate of 100 percent, meaning everyone fingerprinted in

certain zip code has a rap sheet. If the same process was to disqualify workers, some areas will

not have anyone to work in them.

Observation: One idea is to have States try a pilot program before expanding. There is some

concern about false accusation from care recipients on PCWs. There should be a policy to cover

this issue.

Observation: Study results showed that 680 individuals completed registry checks of a total 700

participants, 612 received fingerprint results. 120 were shared results (already fingerprinted for

other reasons from other LTC facilities). Of 680 PCWs, there were five excluded based on a

name-based check and 14 excluded based on registry checks.

Observation: Dr. Abujarad summarized the session saying, “We believe in the protection of

vulnerable adults. The benefits outweigh the costs.” The majority of stakeholders also saw

conflict between security and economics, but not much between security and privacy. Broad

support existed to protect vulnerable adults but who pays is tricky: The State? PCWs? Recipients

of care? CMS? PCWs felt the cost should not be placed on PCWs because they cannot pay that

cost. There are additional concerns to address expansion efforts. Also, background checks are not

completely infallible. There should be more focus on gaps in discovery and reporting

misbehaviors. There are many gaps no one is paying attention too, requiring more research.

Questions:

Q1: (Audience Participant): Can you define PCWs again?

A1: It is specifically individual workers working at home, not included in the current MI LTC

background check program.

Q2: (Audience Participant): What is the next step for this research?




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A2: Many things. The reason this was started was CMS’s desire to study PCWs and get views of

stakeholders. Next, we wanted to draft a report for the MI legislative committee to include PCWs

in the background check mandate. The report is being viewed by a special committee and we

hope for action as well as general publishing of the report.

Q3: Are these PCWs family members themselves?

A3: Yes, they could be.

Q4: Are special considerations made for family members?

A4: I was surprised to hear some cases where they were replacing a caretaking family member

because the family member was abusing or neglecting the patient.

Q5: In describing MI’s program overall, I was surprised at number of disqualifications from rap

back.

A5: We don’t disqualify. If a person has a rap back offense, an ineligible letter goes to the

provider.

Q6: (Audience Participant): These numbers do not include patient care workers outside of the

pilot?

A6: No. Not all. These numbers include nursing homes, hospitals, home care agencies, home

health agencies, and other foster care.

Q7: (Audience Participant): Are there any States that currently have background checks done on

personal care workers? Is this the first study?

A7: Many other States already have this (e.g., representatives from Oregon and West Virginia

raised their hands).

Q8: (Audience Participant): How do other States handle disqualifying family members who care

for family members?

A8: The relationship between caregiver and patient is the contractual relationship. In OR it

depends on whether the relationship has been determined or not. We actually have a different

provider enrollment method. They can be restricted to work specifically with that person. If you

come back with a failed background check, it can be appealed. Additionally, if something

happens later on and the worker is terminated, we send a notification to the employer

(individual) and offices work with the patient (individual) to identify a new worker. In West

Virginia all are treated the same. If they have a disqualifying offense, they are disqualified. We

do have a variance process that allows the plea to be reviewed and go from there.




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Q9: (Audience Participant): Who pays?

A9: In OR the State pays. In WV, the individual pays.

Q10: (Audience Participant): For those PCWs are they all Medicaid providers? Or just

individuals?

A10: OR only allows for people to have Medicaid. We cannot provide services without a

Medicaid number.

Q11: (Audience Participant): In MI, were these services under the waiver program?

A11: Sometimes services were provided by working with agencies like Area Agencies on Aging

(AAA) to help get services or with something called fiscal intermediary to do background

checks.

Q12: (Audience Participant): Does OR do fingerprint or name-based checks?

A12: OR has a policy of name-based checks if an applicant meets a certain level of criteria (i.e.,

if they have lived in the State for five years and have no self-reported history). If an individual

has lived outside of State in the last five years or something else comes up in a name-based

check, there will be fingerprinting. Also, OR uses live scan and some other regional offices for

fingerprinting.

Q13: (Audience Participant): So it’s mainly name-based? And checks are done by State agents?

A13: Yes, it is internally done by the State in OR; however some States (MI) are not doing

name-based checks. This job is delegated to providers, agencies, recruitment agencies, or the

fiscal intermediary. Name-based searches depend on the training level of who does the check.

CA has a bifurcated system. Home health aides are covered under the public health department

but a new program began in January. They look for a fingerprint check. If an individual works

with a home health organization they have to go through a background check process.

Independent workers can voluntarily be on the registry. Some family members are exempt.

Q14: (Audience Participant): If it’s a voluntary requirement, do applicants ignore it?

A14: We are working in baby steps. Cost estimates for complaints with unlicensed caregivers

were expanding. It is paid for by providers and applicants.




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- Session 2 -

Track A – “Liability and Safety of Fitness Determination Analysts” Day 2: May 3, 2016 3:30 p.m.

Melissa Rice (CMS)

Ann Casey (CNA)

Jeff Akin (Oregon)

James Joslin (Oklahoma)

David Martinez (New Mexico)

Overview: The panelists discussed their experiences with applicants deemed ineligible

threatening them and/or their colleagues, as well as the protective measures States have

implemented in response.

Observation: The session focused on how some States have resolved problems regarding people

threatening their staff members. The session will discuss the threats they face and the protections

States have implemented and discuss what role the appeal process has as an outlet for resolving

people’s frustration.

Observation: Mr. Joslin provided a disclaimer that he is not an attorney, and that States

ultimately need to speak to their own attorneys. He stated that the issue of liability essentially

comes down to “if we act within our legal authority, we generally have immunity.” People may

try to sue, but your State will typically be able to defend you without any issue.

Observation: Ms. Casey pointed out that the staff members are often dealing with very desperate

people. She asked Mr. Jeff Akin from Oregon to discuss Oregon’s experience. Mr. Akin told the

audience that they should absolutely not provide the physical location or address of where they

work. Mr. Akin stated that his office is not in the business of making people happy. Oregon has

great systems that protect their personnel. Mr. Akin and his colleagues work from undisclosed

locations, which was not the case previously. He recounted an instance where an applicant was at

the door of his office. This person, who was deemed ineligible because he had committed violent

crimes, felt that he had been wronged by Mr. Akin and his colleagues. Mr. Akin was able to

deescalate the situation, which nonetheless drove home two points: people are denied for a

reason; and Mr. Akin felt he needed to do a better job of protecting his people.

Observation: Mr. Joslin interjected, saying that it is important for people to recognize that fitness

determination analysts are not arbitrarily preventing people from working – their criminal history

is what prevents them from being ineligible to work.

Observation: Resuming his remarks, Mr. Akin noted that Oregon does not use automatic

disqualifiers. Instead, fitness determination analysts examine people’s convictions and answer

questions laid out in Oregon statute and regulations. He also highlighted the importance of

examining the nexus between their criminal history and the job they are applying for.




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Observation: Mr. Akin recounted another story from approximately 13 years ago, before his

office took more steps to protect their people. One of Mr. Akin’s colleagues who lived in a

sparsely populated rural area had an applicant that she had denied show up at her home. She

called the police, and there was fortunately no incident.

Observation: When Mr. Akin’s office moved from paper to an automated system, they all

communicated by email and/or mail “de-identified;” correspondence is now signed by the

background check unit rather than an individual. In yet another story, Mr. Akin’s office had

someone with two murder convictions call and make numerous serious threats to Mr. Akin and

his staff. After this incident, Mr. Akin and his colleagues decided to rebrand themselves as part

of human resources (HR) because “nobody wants to talk to anybody from HR.” Mr. Akin

emphasized that even though his office took action to prevent incidents like this, the threats will

still come. Mr. Akin implored the audience to have strong management systems in place and to

work with their HR and security staff. Additionally, having an employee assistance program in

place provides employees an outlet for dealing with the horrible things they see and come across,

such as reviewing sexual offender registries, in the course of their work. Mr. Akin noted that

much of this is “basic management 101” – listening to your staff. It is important to be there as a

manager and leader to support them. Having an applicant’s future in their hands is a big weight

on these employees.

Observation: Mr. David Martinez, New Mexico, noted that the fitness determination analysts in

his office get threatened a lot. If the verbal abuse gets really severe, management asks that they

escalate it up to them. Mr. Martinez’s office asks rehabilitated applicants to compose a plea

statement, explaining why they committed the offense(s), where they were in their life at the

time, and any mitigating factors Mr. Martinez’s office should consider. Mr. Martinez said his

office wants applicants to know Mr. Martinez and his colleagues are there to help them. Mr.

Martinez and his colleagues say they are located at an undisclosed area, although people still

occasionally find them. Those who do find them do not come to the office in a threatening

manner. Mr. Martinez’s office has strong security at the building. They have a manager rather

than an analyst talk to the applicant. Often these people come to deliver documents, and are told

they need to just fax or mail them to the office.

Observation: Back in 2000, Mr. Joslin’s office used their employee assistance program to help

their staff work through workplace trauma. Mr. Joslin contacted his agency’s employee

assistance program to talk to the staff about how to deescalate these types of situations; for

example, by not taking ownership of the determination. The employee assistance program

provides staff proactive guidance. Mr. Joslin’s office also did coaching on empathic listening –

which doesn’t mean that you must agree with the person. Also, Mr. Joslin’s office has a

magnetometer to check for weapons, as well as a public space for staff to have discussions with

applicants outside of any private areas.

Observation: An audience member from Connecticut said that much of the panel’s discussion

surprised him because, in Connecticut, the fitness determination analysts almost never talk to

applicants directly. Instead, the facilities/providers have these conversations.




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Observation: An audience member, Meghan Shears from West Virginia, said that West

Virginia’s providers give out her office’s phone number and address, and that her office has told

the providers several times that this is not allowed.

Observation: An audience member from Hawaii said that Hawaii hires a vendor to notify

applicants, so that they never directly interact with anybody from her office. Applicants would

need to first go through the vendor before getting to her office.

Observation: Mr. Joslin pointed out that the initial request for information letter his office sends

to applicants makes it clear that if an applicant is found to be ineligible, they are still entitled to a

hearing. Mr. Joslin’s office can do a consent order without having to formally sit before a judge;

his office has done that, and sometimes a family member of the person being served would

accompany them and say they know about the applicant’s background and that they are okay

with the person providing care for them. Half of the people who request a waiver from Mr.

Joslin’s office are granted one. Joslin’s office empowers their staff to say whether people might

be good candidates for a waiver.

Observation: Mr. Akin stated that the first step is an informal legislative review. His office

makes it clear to the applicant that they are on the applicant’s side, and that they want to help the

applicant appeal the denial. In the second step, Mr. Akin’s office would move to a hearing with

their office of administrative hearings, which is costly and something they try to avoid. At this

point, the hearing representative turns into a salesperson trying to sell the applicant on

withdrawing their appeal. An audience member, Frank Miles from Oregon, said that only 0.34

percent of applicants request a hearing, and only 0.2 percent actually progress to a hearing. After

the administrative court decision is made, applicants can go to the Oregon court of appeals.

Questions:

Q1: (Ann Casey, CNA): Have any of the panelists found that when they have to deny people, the

people understand that the appeals process is supposed to help them?

A1: (David Martinez, NM): We hear people out and explain that they still have a chance. We tell

them to provide anything and everything that might improve their chances of being deemed

eligible. We go from telling them “no” to being their advocate. We look at how long ago the

offense(s) took place, how old the applicant was at the time, and other factors.

Q2: (Audience Participant from North Carolina): We don’t do fitness determinations in North

Carolina; instead, we provide that information to providers in order for them to make an

eligibility determination. Do you find cases where the administrative law judge doesn’t feel the

punishment (i.e., being deemed ineligible for employment) fits the crime?

A2.1: (James Joslin, OK): Yes.

A2.2: (Jeff Akin, OR): Some judges are harder to work with than others. In Oregon,

administrative law judges issue a tentative order that gives both Mr. Akin’s office and the

applicant time to take issue with the ruling.




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Q3: Follow-up question (Audience Participant from North Carolina): Do you ever take the

decision in these cases up to the State Supreme Court?

A3: (James Joslin, OK): We have not done this is Oklahoma yet. This highlights another benefit

of having rap back: rap back often provides grounds for his office to go back and remove these

people from the system




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Track B – Understanding FBI’s Identification History Summary Day 2: May 3, 2016 3:30 p.m.

Susan Tuttle (FBI)

Scott Manley (CMS)

Overview: The term FBI Identity History Summary (IdHS) was developed with the Next

Generation Identification (NGI). Within NGI, FBI is able to use other biometrics. Since 1908,

FBI has been using fingerprints and has not found two of the same fingerprints. Other biometrics

can help law enforcement with identification.

Observation: The IdHS replaced the records of arrest and prosecution sheet (rap sheet). 110

million people with criminal or civil information are in the CJIS repository; FBI only has what

the agencies have sent them. 71 million subjects are in the criminal repository. FBI does not

maintain all civil fingerprint cards they receive. 158,102 fingerprints are processed daily; the FBI

should only receive an electronic copy. 1.5 million criminal fingerprint cards and 3 million civil

fingerprint cards were processed just in March 2016. Of the total fingerprint cards, the FBI used

to receive an equal balance of criminal and civil fingerprint cards; however, now they receive 65

percent civil fingerprint cards and 35 percent criminal fingerprint cards. The decrease in received

criminal fingerprint cards does not indicate that crime has gone down, but indicates the increase

in how many more civil fingerprint cards need to be processed. Civil and criminal crime used to

have separate databases, but now NGI combines the two under one database.

Observation: The IdHS aims to provide a complete and accurate criminal history and obtain

dispositions if the agency does not have it, but this can be complicated. The IdHS includes a

Universal Control Number (UCN) instead of the FBI number. The UCN can consist of alpha and

numeric characters. Event information on the IdHS is not an arrest; it can be criminal, civil, or

other information such as a court disposition, wanted information, and sex offender and

migration violator information.

Observation: If a fingerprint card is sent to the FBI, there are a few different responses you could

receive. The FBI can reject the fingerprint card if the quality of the print is poor. Pieces of data

must be included such as name, date of birth, Originating Agency Identifying (ORI) number,

why the individual was fingerprinted, and more. Another response could be “no record,” where

there is no information available for that individual. The Civil Cover Sheet is new with NGI; the

civil sheet will include all descriptive information and displays dual citizenships, the fields are

unlimited. This record contains information from a non-criminal justice related event; it is

intended as an identifier.




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Observation: States submit information to the FBI repository. Each State determines what

information is sent to the FBI. When a fingerprint request is received at the FBI, the response

depends on whether the State participates in the National Fingerprint File (NFF). NFF States

submit fingerprint identifying information one time to the FBI and maintain all the records in the

State repository. When identification is made on a record in an NFF State, the FBI sends a

request directly to the State for the criminal history information (CHRI). When identification is

made on a non-NFF State record, the FBI responds with the information that is held on file in

their repository. Hence, the CHRI may not be as complete as what is available on the State level.

Currently there are 20 NFF States. The FBI prefers that all States participate in NFF and

maintain records at the State repository. With NGI, if you see a State name, NFF State, or State

provided FBI with the State identification number (SID), FBI will reach out to this State and

return the State record into the criminal history record, combining the two. The only issue with

this is formatting as some State records can be different.

Observation: The criminal event IdHS shows the date of when the individual is arrested or

received; this does not mean the date the individual was imprisoned. The Federal Correctional

Institute (FCI) is the agency that will send this card. Any ORI number that ends with “7C” is a

FCI, if the ORI number ends with “5C,” it is a State correctional institute. The agency case

number will not always be on the report. The Biometric Set Indicator (BSI) tells the FBI that

they have a fingerprint in their system and it has been assigned a number. The charge shown is

the charge at the time of arrest; the charge at court may be different should the individual plead

to a lesser charge; however, there should be a logical relationship between the charge at arrest

and the charge at court.

Observation: States can send dispositions to the repository at [email protected]. However, the

disposition should go to the State repository first, and then to the FBI. All dispositions should

have a single source to ensure that the records have the same information; Illinois and Kentucky

do not have to submit to the State repository first. Criminal history records could also include a

wanted notice, which discusses the agency that wants the individual, who to notify, and why they

are wanted. There is no expiration date on an individual that is listed in the sex offender registry.

Immigrant violator information is always returned to Immigration and Customs Enforcement

(ICE). If the record shows a Foreign Special Interest (FSI), please contact the Terrorist Screening

Center.

Observation: The use and dissemination restrictions are maintained by CJIS. If you will be

taking fingerprints, you must tell the individual that you will be sending the FBI a civil

fingerprint card for a background check. When you receive the response, you may only use the

results for its intended use and cannot be passed between agencies, this will be displayed on the

mailto:[email protected]




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audit. You can decide the length of time you give the individual to challenge any inaccurate

information, especially if the background check submitted is for a job.

Questions:

Q1: (Audience Participant): If an applicant requests a copy of the IdHS, are they entitled to it?

A1: (DC): Audit says the applicant may request a copy, but if the agency has rules that say

otherwise, the applicant may not have access. FBI does not have an objection if the applicant can

provide positive identification; however, some States have restrictions. The applicant can request

a copy straight from the FBI if the State has restrictions. The Compact Council has produced

brochures on fbi.gov and they are in user-friendly language on non-criminal justice privacy

rights, detailing what the applicant may receive. FBI has a name check for applicants, however,

multiple applicants can have the same name so information on the correct person will not always

be returned.

Q2: (Audience Participant): Can an applicant request a copy of the FBI record, not to challenge

it, but to keep it for licensing application purposes? If the applicant is asking for a record that is

negative?

A2.1: (West Virginia): We have a secured office and a staff of only three people. For safety

purposes, we do not want to confront the applicants. There is a third party vendor that is

responsible for providing the copy for a fee; however, this is up to the State whether they would

like the applicant to go through the vendor.

A2.2: (Michigan): As the original requester of a criminal history, the vendor can provide the

history to the applicant, but if you are not an authorized recipient, you cannot receive it.

A2.3: (California): Every applicant is entitled to a record review from the State repository. There

is legislation passed that requires agencies to provide criminal history to any applicant who

received an adverse reaction to licensing, employment, and more.

A2.4: If the applicant would like to send corrections on the record, they may send it to the

Clarksburg, WV analysis team.

Q3: (Matthew Antonetti, CT): Does the FBI have any retention time frame?

A3: No the FBI does not; however, some States do have a specific time frame, but I would not

retain records for too long as audit will ask the reason for which you are keeping them for such a

long period of time.




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Q4: (Audience Participant, CA): When someone fingerprints for a particular applicant

type/purpose: we have two applicant types, Certified Nurse Assistant (CNA) and Home Health

Aide (HHA), required to submit fingerprints. They can submit one application for both types.

Would FBI be able to apply one set of prints for both applicant types?

A4: I am not sure of the statutes for California, but there is a group called Quality Control that

can review California’s statutes. You may be able to detail more than one reason on the

fingerprint card if the reason is known at the time of submission.




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Day Three: May 4, 2016

Plenary – “Collaboration Forum Work Group” Day 3: May 4, 2016 9:05 a.m.

James Joslin (Chair, Collaboration Forum Work Group)


Melissa Rice (CMS)

Bob Fletcher (CNA)

Overview: The presenters provided background information on the Collaboration Forum,

discussed initiatives the Forum is working on, and asked audience members to provide their

input on these initiatives and to suggest others that they would like the Forum to address.

Observation: Ms. Sarah Fahrendorf noted that she hopes the audience will take back the spirit of

collaboration fostered and displayed at this conference with them and apply it in their work. She

thanked audience members for the energy, thought, and creativity they brought to this

conference.

Observation: Ms. Melissa Rice began by providing some background information on the

Collaboration Forum. There was a presentation about grant closeout at last year’s annual NBCP

Training Meeting at the end of which there was significant discussion about what States can do

to sustain themselves after graduating from NBCP. This topic came up repeatedly on evaluation

forms. The Forum is a multi-State group that facilitates sharing of lessons learned and best

practices, and helps States work together after graduation. Mr. James Joslin from Oklahoma is

the chair of the Forum. Mr. Don Howard represented CMS to the Forum. Bob Fletcher on the

CNA team worked with the work group to help facilitate meetings. Mr. Ernie Baumann from

CNA provided support.

Observation: Mr. Joslin, Chair of the Forum, began by stating that after last year’s grant closeout

session, he felt a little anxiety, frustration, maybe denial about what States are facing regarding

graduating from the program. States do not want to miss out on the benefits of the NBCP

program after they graduate. He said the Forum was born of the recognition that we need

something to promote connection and continuity. Mr. Joslin and others pulled together a group of

folks, the Forum work group, to see what an autonomous collaboration of States would look like,

without CNA and CMS. Mr. Joslin then proceeded to discuss the current status of the Forum

work group.




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Observation: Mr. Joslin introduced all of the members of the work group:

Karen Benson, AK

Matt Antonetti, CT

Taylor Haddock, FL

Steve Gobbo, MI

Gil Mendoza, NM

Leticia Metherell, NV

Don Howard, CMS

Observation: Mr. Joslin then said that the Forum would like to thank Jan Tarantino and Rebecca

Ward from CMS, as well as Ernie Baumann, Delilah Barton, Bob Fletcher, and Nandita

Ravishankar from CNA.

Observation: Mr. Joslin asked the audience members to pull out their Collaboration Forum

brochures, and noted that this is a promotional tool for their use. Mr. Joslin asked all State

representatives in the audience to stand. He pointed out that Delaware, Illinois, and Maryland did

not attend because they graduated already. Alaska, Connecticut, the District of Columbia,

Florida, Rhode Island, and others will graduate by this time next year. After Joslin asked

California, Maine, Michigan, Oklahoma, North Carolina and Utah – all of whom will graduate

subsequently – few State representatives were left standing. Joslin explained that this is why we

need the Forum.

Observation: Mr. Joslin provided an example of how the Forum can benefit States. In Mr.

Joslin’s State, Oklahoma, they had a live scan contract in place, which originally cost almost $2

million. There was a court battle, and they might now have to change to a different vendor. They

missed some language in the live scan contract about how to hold the vendor accountable. Other

States already had this language, but there was no formal means – like the Forum – of sharing

that information, so Oklahoma lost out.

Observation: If one State successfully submits a Medicaid contract, how do they share that

information with other States? Mr. Joslin noted that we need a vehicle for sharing that

information. Mr. Joslin emphasized the importance of States being able to communicate directly

with one another, rather than calling CNA and asking them to act as a middleman. States need

the comfort and access to reach out directly to each other.

Observation: Mr. Joslin noted that he recently did a no-cost technical extension. To do so, he

contacted Taylor Haddock of Florida, who had already done this and shared her information with

him.

Observation: Mr. Joslin then proceeded to discuss some of the initiatives the work group has

developed. He noted that a benefit of the Forum is that it can speak with one voice to the FBI to

facilitate advocacy.

Observation: Mr. Joslin then proceeded to discuss the issue of equity, which he noted is not the

first thing that comes to mind when you thing about NBCP. In Oklahoma, they went from a




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blanket lifetime ban to a tiered system. The healthcare sector in 2024 will be the nation’s largest

employer, “what we are doing here is about expanding the workforce for that industry.”

Observation: Mr. Joslin noted that Mr. Bob Fletcher has been the work group’s facilitator and a

good friend to the group, and has helped lead them in this process. Mr. Joslin then introduced

Mr. Fletcher, who took the audience through the initiatives the work group has developed.

Observation: Mr. Fletcher began by noting that long-distance collaboration across seven State

members, all of whom have day jobs, is a tough challenge for the work group members. The 10

initiatives developed by the work group are the distillates of a number of challenges States are

facing that the group examined. These initiatives are the top 10 at this point in time; this is the

work the Forum work group believes is the central focus of this group moving forward. The

work group has been framing up white papers and issue papers on the central thematic

challenges, to drill down to the root issues the work group is trying to solve.

Observation: Additionally, Mr. Fletcher said, the work group has also developed some

alternatives to the 10 initiatives. The work group framed the initiatives simplistically to provide

the States a template for getting their input on these initiatives. Mr. Fletcher asked the audience

whether these are issues they have faced or addressed, and whether there are any other issues

they would like the Forum to take on. The work group would like the audience’s input on what

the Forum should be focusing on.

Observation: The audience was given 30 minutes to vote on which initiatives they would like the

Forum to focus on, and to suggest new initiatives. After this time, audience members offered a

number of comments.

Observation: Mr. Fletcher provided the results of the vote. Initiative #6, Advocacy to State and

federal regulators and legislatures, had the highest number of votes, 18. He noted that this is

interesting to the members of the work group. Initiative #1, Help States obtain core Background

Check System (BCS) support after grants end, received 17 votes, which he said is unsurprising.

Initiative #4, Identify process and technology to allow States to share data in addition to the

NBCP Nurse Aide Registry (NNAR), received 14 votes, as did initiative #5, Develop a

searchable library of topic-specific best practice information for use by all States.

Observation: Mr. Joslin asked the audience whether they had any thoughts about the votes or

others’ comments. None offered any.

Observation: Mr. Joslin noted that his customers are the providers, CMS, Survey and

Certification agencies across the State, and the Medicaid contracting community. Most of these

customers are affected by the survey and certification agencies across the State. He noted that the

Association of Health Facility Survey Agencies (AHFSA) is an existing organization that might

be useful for the Forum to partner with. The Forum work group has approached AHFSA

regarding partnering, and is pursuing this now.




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Observation: Mr. Joslin also noted that CMS has been generous in its support of the

Collaboration Forum and work group. He said that the work group is going to take the

information and feedback the audience provided and incorporate it into their work.

Observation: In response to Mr. Joslin’s call for a show of hands regarding whether the Forum is

on the right track and is an initiative worth pursuing, a majority of attendees raised their hands.

Finally, Mr. Joslin said that the work group wants audience members to join with them on the

Forum. To do so, they should submit their interest to the email address listed in their

Collaboration Forum brochures.

Observation: Ms. Rice thanked all in attendance for their participation. Ms. Rice stated that this

session has been very informative, and that it provided important information for the work group.




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Plenary – “Registry Use Analysis” Day 3: May 4, 2016 10:45 a.m.


Mary Gabay (CNA)

Overview: Kellie Jakaitis introduced speaker, Mary Gabay. Mary discussed statistical research

regarding the different registries States use and the outcomes of registry searches.

Observation: Ms. Gabay studied the use of registries in State National Background Check

programs in order to answer the following questions:

What registries are used by States in their background checking process?

How do the selected States conduct registry checks?

What are the outcomes of registry checks for selected States?

Observation: The NBCP requires checks of various registry databases (Section 6201), including:

State-based abuse and neglect registries, States where an applicant has previously resided and

other registries at the State’s discretion. The intention of the analysis was to document the use,

efficiency and effectiveness of registry use to help States understand the value they provide as

well as provide guidance to CMS.

Observation: Two sets of data collection occurred including: lists of registries routinely used in

all States and three States selected for in-depth analysis (States with TA-developed core

background check programs that would have a similar database structure). All three selected

States use different registries and different registry checking processes. For the States selected

for in-depth analysis, a profile was developed documenting registry procedures and a data file

containing records from the State’s determination, registry, employment, appeal and other data

tables was obtained. A data dictionary (on paper) was created to assist the analysis of data at the

individual search level.

Observation: Data on the registries used routinely in State background check programs came

from 18 States. The remainder of grantee States had not yet implemented a background check

system. States on average use five to six registries for registry research and checking these

registries is generally mandatory. This does not include out-of-State registries for applicants with

prior addresses out-of-State. The number of registries used by States ranged from three to 10.

States used the following federal registries: the Office of Inspector General’s List of Excluded

Individuals and Entities (OIG-LEIE), National Sex Offender Public Website (NSOPW), General

Services Administration’s System for Award Management (SAM), and Social Security

Administration (SSA) registries.

Observation: The in-State Registries used by States table is categorized by type of registry.

States most often use the Nurse Aide Registry (NAR) and the second most often used was the

State Sex Offender registry. An advantage to using the State site is that you may be able to

automate it as opposed to the National Sex Offender registry, which will always be a manual

search.




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Observation: Different user groups check the registries in each State: State 1 – providers, State 2

– providers and States, State 3 – States. In States 1 and 2, registry research is done as part of the

applicant process but in State 3 the registries are checked later (after fingerprinting and the

application process is complete). Two States run registry checks automatically, one conducts

manual searches. Are all checks mandatory? Yes, in States 1 and 2 checks are mandatory, and

also yes for State 3, except when an applicant connects to an already approved determination.

Observation: Out-of-State registry checks are mandatory when an out-of-State address is

provided in all three States. For States 1 and 2, registry checks are not used as part of the

determination process. All three States changed their registry checking process over time. The

process is not static and States will add registries as they become available. Some States have

even removed some registries from mandatory searches as they were found to be unnecessary.

Observation: There are many data tables that make up your background check system database

that are linked by various IDs. For States that check by provider, this results in the data residing

in the registry research table. When the State does the registry checking, results go into a

different table. Data shows that a match to an applicant a federal or in-State registry occurs

rarely.

Observation: The first two tables divide the searches between border States and non-border

States. The second two tables compare individuals with a prior address versus those without a

prior address. More matches are from searches without a prior address than those with a prior

address.

Observation: The overall results show that the first row shows total number of registry checks

summed across each checked registry: 69 were marked not clear; this relates to 55 individuals in

State 1 showing that some people have multiple “not cleared” registry checks. While registry

checks are rare events, State 1 found 27 percent of their disqualified individuals from registry

checks. Registry checks can be a significant part of your background check process.

Observation: How long does it take to complete registry research? In State 2, registry research

was completed in a median time of about one minute across all applications and 7.67 minutes for

applications that are closed due to registry checks. The median was used since this data has a

skewed tail. The data for State 1 was very similar (median values of two and nine minutes,

respectively). State 3 was very different because of their in-depth process and time spent on

registry checks was measured in days.

Observation: States have discretion in implementing registry checks and they use it when

deciding on the number and type of registries checked. Registries used most often: OIG, State

NAR, NSOPW. Registry checking process can vary greatly. A “Not Cleared” registry finding is

rare but does not mean it is not a significant part of the background check process.

Observation: Tips for Registry Check Use: If possible, it is always best to automate the process

and use exact matches everywhere possible.




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Observation: Core background check system allows States to select which out-of-State registries

automatically appear with out-of-State addresses. This is important because WV, for example,

has 22 to 23 registries listed and can be burdensome since they will appear as mandatory checks

on the research registries screen when an applicant has a prior address in WV. This can be

prevented by going through the system functionality that allows selection of which out-of-State

registries the State wants its providers to see when an applicant has a prior address. States may

want to consider automated registry recheck to periodically recheck registries for applicants and

employees. This allows a provider to upload to a system their entire employee roster and

month/quarterly/however selected, the automated registries can be checked against employee

rosters and applications listed at the time.

Questions:

Q1: (Audience Participant from Connecticut): Is this worth it? Providers are already asked to do

a lot.

A1.1: (Beth Myers, IA): If you can automate, it is most definitely worth it even if only a few

individuals are found.

A.1.2: (Kentucky): We made our registries prior to sharing with the vendor. We use it as a cost-

saving measure for our employers. Kentucky feels it is worthwhile because of their pre-check

process.

A.1.3: (Connecticut): From the licensure side, I would say it is worth it, especially for some of

the checks that this information is looking for disqualifiers. Not only is it determining eligibility

but helps employers make more informed hiring decisions.

A.1.4: New Mexico has a State employee abuse list, which has been used to prevent disqualified

applicants from being hired over 50 times. There are only 300 individuals on that list, but these

individuals keep applying for employment in LTC. With over 2,000 providers, this is a way to

keep disqualified individuals from slipping through the cracks.

Observation: Delilah Barton concluded the session by stating that Ms. Gabay was pulled into this

project because she is as a brilliant statistician and we wanted to look at the data to see which

registries are having the most impact. As the States, we invite you to ask us questions about what

you would like to know about the registries or other types of analysis.




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Plenary – Guest Speaker: Lisa Tripp, Esq., Technical Director, Enforcement &

Certification, Division of Nursing Homes, CMS

“Concerns about appealing fitness determination”

Day 3: May 4, 2016 11:25 a.m.

Lisa Tripp (CMS)

Rebecca Ward, RN (CMS)

Overview: Guest Speaker Lisa Tripp shared concerns about the context in which the NBCP

exists in terms of issues the United States currently faces, specifically looking at mass

incarceration. Currently, the United States is at an inflection point in terms of thinking about

criminal justice reform at all levels of government.

Observation: Appeals processes should be done with the goal to encourage as many appeals as

possible. All who should appeal should have been encouraged to appeal, and all who should not

appeal should have been discouraged to appeal.

Observation: The NBCP allows for an appeals process that recognizes rehabilitation. This

process acknowledges that there can be a lot of incorrect information in abuse registries, or

among other databases. Therefore, it is important to have an appeals process that gives persons

the best chance to appeal incorrect information, or to appeal based on rehabilitation.

Observation: States noted their success rate of appeals is due to having a solid process in place

that includes listening to representatives and having a tiered philosophy. The process seeks to get

persons approved through any evidence that illustrates successful rehabilitation. States also noted

not being worried about advocacy models resulting in horrific outcomes due to evidence that ex-

offenders and non-offenders have equal opportunities to violate/harm vulnerable persons.

Observation: One of the problems with our criminal justice system is the classification of crime,

particularly classifying crimes as more terrible-sounding offenses than they are in reality. For

example, skinny-dipping is considered a sexually-related crime in Nevada. So, if there is no

process in place to look more closely at generally labeled crimes, programs may exclude persons

from employment for the wrong reasons.

Observation: It is important to recognize the kinds of jobs that are impacted by the NBCP, those

in nursing homes and other facilities that are oftentimes overrepresented by minorities. Therefore

it is important to be aware of this, States’ policies, and the interaction of race.

Observation: In conducting analysis by CMS and/or the States, the NBCP should talk to persons

at the individual level from all parts of the country that have been a part of the program to better

understand how persons have been denied, appealed, and the like.




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Questions

Q1: (Audience Participant): Michigan is beginning to write statutes regarding background checks

for persons seeking employment in childcare facilities. Michigan is considering five-year, 10-

year, and mandated lifetime eligibility. If Michigan wants to allow for appeals for rehabilitation,

would Michigan have to put exclusionary crimes in the policy rather than the statute to allow for

the appeals process and consideration of rehabilitation?

A1: Michigan has two options: to make appeals for rehabilitation explicitly stated in the statute

or to make appeals for rehabilitation vaguely stated in the statute and delegate power of this to

whatever executive branch or agency that will make the decision.

Observation: Oklahoma explicitly outlines the appeals for rehabilitation in the statute. The

statute allows persons 30 days to file an appeal. Too often the decision goes against the appellant

in that because not enough time has passed to show rehabilitation occurred successfully.

Unfortunately, there is no method in place in Oklahoma that allows such persons to come back

and appeal at a later time.

Observation: Oregon does not conduct a background check on a person until they are hired.

Oregon statute states that no decision is precedent-setting, so the background check information

can be used so long as it is not used in a decision against them in making a hiring decision. In

addition, Oregon has a very clearly defined executive-level hearings process. From the

background check program standpoint, this hearings process occurs frequently. Employees are

terminated for violating rules. In fact, Child Protective Services (CPS) investigation results are

ignored on the basis of irrelevancy to employment.

Observation: Oklahoma statute states that an applicant listed on a registry is excluded from

employment and is not granted the right to appeal.

Observation: As the NBCP evolves, it will become increasingly important to figure out these

issues and it will be interesting to see if CMS does any rule-making around this.




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Plenary – Hiring of Minors: Challenges and Considerations for NBCP States Day 3: May 4, 2016 1:30 p.m.

Tracy Freeman (Utah (UT) Department of Health)

Meghan Shears (West Virginia (WVA) Department of Health and Human Resources)

Mandy Rosenblum. Esq. (Julia E. Gabis & Associates)


Liz Raistrick (CNA)

Overview: There are federal considerations for getting background checks completed for minors.

This session will help NBCP States understand fingerprinting, acceptable forms of ID, and

privacy notification for long-term care applicants.

Observation: Mandy Rosenblum is a subject matter expert and consultant to the CNA team and

practices employment law in Pennsylvania. The NBCP is derived from the Affordable Care Act

and requires participating States to conduct background checks on personnel who have direct

patient access, but does not define age. There are considerations for States that perform

background checks with minors and CMS has not provided any guidance as it pertains to the

NBCP. For non-criminal justice purposes such as employment, there are no specifications based

on age or any specific restrictions based on minors. Based on this definition, Mandy does not see

any difference in checking minors versus adults. However, the Fair Labor Standards Act includes

provisions with respect to States and States must abide by these statutes.

Observation: Collecting identification can be a challenge with minors. Employers are required to

collect an I9 form to verify the identity and authorization to work legally in the United States.

The handbook for employers provides a list of documents that minors can use as minors may not

have the same documents as an adult. Applicants under 18 that do not have a picture ID may

present an alternate form of ID. Forms that are signed by the employee must also be signed by a

parent or guardian.

Observation: Fingerprinting is another issue that minors may face. The Compact Council

recommends that live scan vendors collect photo ID as one method to prove identity. Primary

identification is typically the driver’s license; there are secondary forms of ID through a birth

certificate and passport. There is little guidance from the federal government on privacy; federal

regulations do not address age or privacy of the applicants. There is a lot of variation between

federal and State laws as there is little information from the federal government on conducting

background screening on an applicant under age 18.

Discussion by UT: In UT, there are a large number of minors that are employed in healthcare

settings. The solution we found to conducting background checks without parental consent was

using a name-based check as there is no payment required and no burden to the applicant. If an




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applicant is employed at multiple facilities, they must have a new name-based background check

completed each time. We wanted to make the system simple; if a person is still a minor 30 days

before their birthday, the system will send out a notification that they will be 18 soon. This helps

providers know who must be fingerprinted or not. Utah conducts the name-based background

check, not the State police so there is no fee. There are 43,000 applicants in UT, 2102 applicants

were under 18, and 887 applicants under 18 are currently in the system.

Discussion by WVA: In WVA, there are many students under the age of 18. As a result, name-

based searches are done through State police and the results are returned to the program office.

Minors cannot be enrolled in rap back in WV. As a result, minors will only have a name-based

check done as they will have to be fingerprinted after they turn 18. Providers are notified 30 days

prior to when the minor will turn 18. The administrative cost is covered by the grant. State police

do not charge for name-based checks for minors, they only charge after the applicant turns 18.

Questions:

Q1: (Audience Participant): When you do a name-based check, is it only through the State or is it

a check done by the FBI?

A1.1: (WV): We cannot ask the FBI to perform a name-based check unless we receive rejected

fingerprints. We only do State name-based checks.

A1.2: (UT): We also only do State only name-based checks.

A1.3: (Mandy Rosenblum): The FBI check would be of limited use as they seal juvenile records.

Q2: (Jay Weinstein, CMS): How do you handle volunteers?

A2: In UT, volunteers are considered individuals that work 20 hours or less. This does not

include clergy, singing groups, and family members. This rule is also applied for minors. In WV,

we provide nursing homes with the definition of direct access and supervision and leave the

decision to them. WV State code states that direct access personnel do not include irregular

volunteers or students.

Q3: (Audience Participant): Is the provider expected to pay a fee?

A3: The provider can charge the applicant for fingerprint-based checks, but this ultimately falls

on the agency or facility in both UT and WV. Name-based FBI checks are not used for civil

cases such as long term care, those are only used for federal criminal cases.

Q4: (Audience Participant from KS to WV): Is it State law or the State police that decides that

minors are not eligible for rap back?




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A4: State police made this decision as they do not keep juvenile records unless the individual

was convicted as an adult.

Q5: (Sarah Fahrendorf, CMS): Do you regard aliases in a particular way?

A5: WV has not dealt with aliases yet.

Q6: (Sarah Fahrendorf, CMS): If the volume is small, is it difficult to get a sense of what type of

activity would be excluded?

A6: In WV, the only time we get a hit on a name-based check for minors is if they are convicted

as an adult; this crime would have to be severe and disqualifying.

Q7: (Audience Participant): Can minors be added to certain registries?

A7: In UT, minors can be added to Adult and Child Protective Services, there is no age limit. UT

checks juvenile records as well as adult records. We can find a number of records on the juvenile

side, most records are joy-riding.




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Plenary – “Open Forum” Day 3: May 4, 2016 2:30 p.m.

Rebecca Ward (CMS)


Don Howard (CMS)

Je’annine O’Malley (CMS)

Melissa Rice (CMS)


Scott Manley (CMS)

Delilah Barton (CNA)

Overview: Delilah Barton facilitated a question and answer session, reviewing issues and

proposed solutions submitted by participants on NBCP Issue Cards during the meeting. The

questions seen below are presented as written on the original issue cards for this session;

however, during the open forum session, some questions were paraphrased. If provided on the

issue card, the participant’s recommended solution is listed as well.

Observations:

Q1: Topic: Enrolling CHIP and high-risk providers.

Question: In order to leverage our existing NBCP system to add the new entities listed above

[CHIP and high-risk providers], we want to use the same statutory list of disqualifying offenses.

However, our State Medicaid agency wants a separate list (that is less strict). How can we

convince them to make it simpler for the fitness determination staff and use the existing list?

Recommended Solution: CMS should issue guidelines or recommendations to States to

leverage existing systems and use the same disqualifying offenses that were carefully

considered and authorized by State law!

A1: (Rebecca Ward, CMS): That is a very good question. CMS has issued guidance on this

topic. The guidance documents are provided on the BGCheckInfo website News link

(http://bgcheckinfo.cna.org/?q=node/923).

The first guidance document is a June 1, 2015, CMS letter to the State Medicaid Directors

(SMD-002 ACA#33), titled, “Medicaid/CHIP Provider Fingerprint Based Criminal Background

Check.” The CMS letter references authority from the Affordable Care Act and contains a link to

regulation requirements, and also has details about what providers must submit to screening for

fingerprints and background checks. The second document is a CMS Memorandum titled

“Advice to NBCP States regarding Medicaid high risk providers,” has further details on

fingerprint and chip requirements and the steps an NBCP State can take.

(Audience Participant from WV): May a State elect to use the standard in the NBCP

program if the Medicaid agency is agreeable?

(Rebecca Ward, CMS): They cannot use a lesser requirement, only a higher. There are no

additional requirements in the high risk provider background checks but they are allowed

to add additional requirements.

https://www.medicaid.gov/federal-policy-guidance/downloads/smd060115.pdf

https://www.medicaid.gov/federal-policy-guidance/downloads/smd060115.pdf

http://bgcheckinfo.cna.org/sites/default/files/public/Advice_to_NBCP_States_regarding_Medicaid_high_risk_providers.pdf




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(Audience Participant from WV): West Virginia has this issue. We want to use what was

established under the West Virginia Cares Act. Most providers fall under this act with the

same disqualifying offense. The problem is when we have one high risk provider who is

not specifically listed in our act. They could fall under the contractor for any long term

care provider. Would CMS provide guidance and help explain to our Medicaid agency

that we can use the same disqualifying offense for all high risk providers, not just the one

that falls under the WV cares act?

(Ann Casey, CNA): It may be best to put this in writing and email to a CMS Project

Officer for review.

Q2: Topic: NBCP [Regulation]

Question: Legislation approval is challenging due to certain agencies wanting certain exclusions

or limitations in the law.

Recommended Solution: Announce a mandate for NBCP. This would facilitate legislation

as well as standards much more easily – allowing for system

development/implementations as opposed to multiple years of introducing legislation.

A2: (Don Howard, CMS): We must refer to what is in the Affordable Care Act. I think we

believe that down the road—and it is a matter of when—this is something that will eventually be

mandated. Officially, however, at this time, we cannot say.

Q3: Topic: NBCP Graduation

Question: It is clear that NBCP is positioning itself to claim “mission accomplished” and yet

there still is no national system. How does CMS plan on managing the 50 State programs?

A3: (Rebecca Ward, CMS): At the moment, there are some graduated States. I do not know if we

would call it mission accomplished, but this would be an opportunity to say “join the forum.” We

could work together and begin transitioning together. I strongly encourage people to look into

the forum since it is one of the best ways to secure yourself as far as your program and the future

of the program.

(Delilah Barton, CNA): Where do we sit from OIG’s perspective on “mission

accomplished?”

(Tricia Fields, OIG): I do not know how to define mission accomplished, but for OIG’s

concern, OIG looks at programs that are federally funded. Once federal funding ends, we

do not have a hook to look at a program. We will be doing the final evaluation upon

completion of the program, with a report due six months after the completion of the

program.

Q4: Topic: Charles Thornton

Question: The Feds just implemented legislation requiring the fingerprinting of all child care

providers, child care center staff, and household members in child care homes. They also require




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lifetime exclusion for anyone convicted of a felony homicide, physical assault, arson, kidnapping.

I can understand for homicide, but what do you think of for arson and assault? Sometimes these

individuals were young, 17/18 at the time, but are now in their 40s and 50s.

Recommended Solution: Suggestion to address this with the Feds in DC. Has to be

implemented by 9/30/17 as part of Child Care Development Block Grant.

A4: (Rebecca Ward, CMS): We have been working with the Administration for Children &

Families over the last one and a half years and recently discussions have been somewhat stalled,

but from this conference I believe the interest is certainly increasing rather than decreasing and

we are trying. NBCP and Child Care requirements are not exactly the same so it’s a little difficult

to work together. But we are going to attempt another outreach to bring in other HHS agencies to

accomplish this.

(Audience Participant from MI): In working out of silos, in MI we went through some

State department reorganizations as well as reorgs at the bureau level. There was a bureau

for child and adult licensing which moved to another department and now no longer

exists. The child and adult licensing functions have been moved to the department that I

work for, Licensing and Regulatory Affairs, which also holds the background check

program. For a number of years those background check functions were tied to the

system. Somehow, that has to fit within our background check program so I would

encourage representatives from CMS to discuss with their counterparts because we want

to get it right.

(Rebecca Ward, CMS): CMS NBCP people were inundated with requests for information

after the Child Care Development Block Grant was reauthorized but maybe the people in

child care offices did not quite understand how the new requirements were going to

impact them. What could we do to hear from you all about the process?

(Audience Participant from MI): Part of the issue is that funding is going to the wrong

department. I think the guidance needs to come from the people who are providing the

money.

(Rebecca Ward, CMS): As part of the Federal Register process, anyone could submit

public comments regarding the child care background check regulation.

(Jeff Akin, OR): Oregon has had its background check program established for 20 years

now, but we just passed legislation in the last session that changed why we do a

background check. We do background checks tied to a population. Recent legislation

says one background check across criteria for example for teachers/people who work

with children. We are starting to develop a definition for “vulnerable person.”

(Audience Participant from MI): If you can resolve issues within the Federal HHS, it

would make things move a lot smoother.




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(Audience Participant): Under the child care development block grant, lifetime

exclusions include assault, arson, etc. What does CMS think about this and how do we

discuss this with the Agency?

(Delilah Barton, CNA): Dr. Jessica Neptune said instead of looking at the regulation,

look to the statutory language since that has very specific language regarding what those

terms mean. Go back to the statutory language and take an opportunity to comment on

the federal register.

(Audience Participant): Those regulations are likely most similar to those under Adam

Walsh. It is an area of frustration that in even higher level background studies, the barrier

offenses do not match up.

(James Joslin, OK): Oklahoma has similar issues. Our childcare programs are very

advanced, but the pressure is coming from the legislature. Applicants are being checked

in multiple places and having multiple fingerprints processed. They have different

requirements, but let’s deal with fingerprints and route the results to whoever has the

most stringent requirement. Some agencies are even interested in piggy-backing on our

system. If they make a determination of eligible, how can we leverage that? We are

looking at ways to leverage that and make that work.

Q5: Topic: Cost of Background Checks is too high

Question: Our providers want free background checks. How can we make them happy, happy,

happy?

Recommended Solution: FBI reduces fees. State reduces fees.

A5: (Scott Manley, CMS): The FBI has continually evaluated its fees and over time has reduced

the fee. At one time, it was $24 and is now $14.75. It may end up being even lower than that

figure in the future.

Q6: Topic: FBI Rap Back

Question: Can or will the FBI supply States with sample language for access to Federal Rap

Back?

A6: (Scott Manley, CMS): You can contact your Rap Back point of contact at CJIS. That person

can assist the State with language examples and tips for successful implementation. If you have

any language that incorporates the conditions that the FBI wants, feel free to share that

legislative language with the other States.

Q7: (Audience Participant): Is there any advice for helping our legislature understand how

benefits of Rap Back outweigh latent prints?

A7: (Scott Manley, CMS): Collaborate with a State that has successfully implemented Rap Back

and coordinate with your State Investigative Bureau (SIB) lead.




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Q8: Topic: Fingerprint Authorization.

Question: Many States have used the Affordable Care Act as their fingerprint authorization. Will

this still serve as the fingerprint authorization after a State graduates from the NBCP?

A8: (Scott Manley, CMS): The FBI will talk with their attorneys to determine if the authority

still exists to submit the fingerprints. If a State is submitting under a State statute that was

approved by the FBI, rather that the Affordable Care Act, then that authority would still be

relevant as long as the State didn’t change the authority.

Q9: Topic: Rap Back

Question: If the employee works at a chain provider and bounces between different entities of the

chain, can the parent or corporate make the query for the background check as opposed to each

individual entity?

A9: (Scott Manley, CMS): The FBI would need more information to answer this question. It may

be best to put this in writing and email it to your CMS Project Officer for review.

Q10: Topic: Online State Court Records

Question: As West Virginia has rolled out, we have encountered many out of State missing

dispositions.

Recommended Solution: We would like a resource of States that have online court

records. West Virginia would be happy to help gather information.

A10: (James Joslin, OK): This has been addressed in Oklahoma. We received a court database

spreadsheet from Michigan and have updated it. We can share this. This is an example of how

the States can collaborate under the Forum.

(Delilah Barton, CNA): We can share this Forum resource on the BGCheckInfo website.

Q11: Topic: Electronic versus paper systems.

Question: Why are any of these systems still using paper, faxing or certified mail instead of

secure email?

A11: (Kellie Jakaitis, CMS): CMS cannot tell a State it has to be electronic. It cuts down time

but we cannot require it.

Q12: Topic: How do we know if a convict is reformed?

Question: A number of presentations are focused on rehabilitation and waiver granting for

individuals who have been flagged. Where is the liability for offenses that occur by individuals

who were incarcerated but allowed to be hired?

A12: (Sarah Fahrendorf, CMS): There are a number of programs focused on reform. If there was

a history of remediation and time was served, that is one way to consider reform. Talking

specifically about liability, many States in their legislation have a disclaimer that the State is not




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liable because the State determines eligibility and it is the provider who makes the hiring

decision.

(Mandy Rosenblum, CNA): There is also liability for providers who don’t hire someone

who would otherwise be eligible. Another question could be ‘where is the liability for

applicants hired but not run through a background check system?’ You can also have

liability issues around workers without criminal histories. It is a tough position. There is

never a guarantee but at some point someone with a conviction record has the same

likelihood of committing a crime as someone off the street.

(James Joslin, OK): In Oklahoma, if a provider follows the law, then they are immune,

not to say that if that person is hired and then acts erratically then the provider fails to

take action, which is an issue.

Q13: Topic: Year 7

Question: We know CMS isn’t likely to offer a 7th

year extension opportunity, but if you do, we

could make the case for giving it one more try. We will have a new Governor in 2017, as well as

a number of new legislators. To us it is a possibility of at least worth exploring. Plus we are not

a heavy user of technical assistance services so we wouldn’t represent a continued burden on

CNA.

A13: (Rebecca Ward, CMS): We do not want to let you guys go, but a leadership decision was

made that we cannot extend beyond the 6th

year extension. We feel that States have progressed

enough after 6 years that it is a good place to let States go where they can be sustainable. CMS

over the past year has supported the development of the collaboration forum for ongoing support.

Q14: Topic: Next year’s Training and Graduated States

Question: Will graduated State be invited and funded to attend next year’s training?

A14: (Melissa Rice, CMS): If you are invited to participate on a panel, CMS will fund that

participant to come to the training.




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Q15: Topic: Preparing for Using Negative Incidents as Catalyst for Change

Question: Although incidents present opportunities for gaining attention and/or support for

legislative initiatives or budget enhancement requests, there I normally inadequate

time/resources to prepare a package for executive action in the period following incidents.

Recommended Solution: Prepare a generic “Legislative/Budget Package” with backup

justification, case studies and specific details on background checks for initiatives to

mitigate future incidents of this type.

A15: (Rebecca Ward, CMS): We can talk about that; it’s a great idea. It is something we’d have

to update fairly frequently so case studies stay fresh. If we are trying to present a package to a

State, the case does not have to be in State or a neighboring State. We can certainly put together

case studies.

Q16: Topic: BCS System enhancement and Platform Direction

Question: What is registry auto check and the relationship with Rap Back?

A16: (Alison Dudziak, IA): Registry rechecks and rap back we see as two different tools for the

same purpose. The registry rechecks are generally a monthly task that goes through and checks

every person in your system. It auto matches with registries that have auto match. It is every

month; providers get notifications about registry changes. Rap back requires fingerprints,

requires an extra fee and does not automatically give a determination.

Q17: Topic: Why are all the State systems different?

Question: How do all these different systems eventually communicate with each other?

Perceived implementation date?

A17: (Beth Myers, IA): Each State is special with different requirements so all the systems are

different. We do not have a plan for having them all communicate or know if it is possible. We

would love to explore it, but at this time there is no perceived date.

Q18: Topic: Fingerprint and Background Fees

Questions: 1) What is the fee structure (price charged) by State for fingerprints and background

check fees? 2) How do the various States pay for fingerprints and background checks?

A18: (Elizabeth Raistrick, CNA): There is a resource available on BGCheckInfo that is updated

regularly which provides States’ current fee structures. Some States, Oregon for example, do not

charge fees. We try to keep that updated pretty regularly. Please check BGCheckInfo. If you do

not have access, reach out to me or Delilah.

Q19: Topic: Considering Personality Typology in Susceptibility for scams and fraud

Question: Several case studies revealed subjective decisions by facility/organizations

demonstrating “empathy” in decision making versus “objectivity” in applying regulatory

rules/constraints as they apply to employment decisions.

Recommended Solution: Consider conducting a study of Myers-Briggs Type Indicator

(MBTI) personality inventory for health care/ long term care workers and their




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preferences in decision making based upon “feeling” versus “thinking” dichotomy.

Determine if results suggest stronger training emphasis on strict rule application.

Restated question to participants: When working with staff, such as determination analysts, do

you think about personality types? As was discussed in a previous session, your analysts have to

make a difficult decision and tell people their decision. Do you consider that when hiring or

training determination analysts?

A19: (Audience Participant): That cuts two ways; on the one side, we don’t want someone

swayed too much by details of graphic violence that they read in various cases. When we

interview we want a certain amount of customer service and analytical skills, but on the other

side, we want someone who is able to use a variety of stress management and other techniques to

be as judicious as possible in the face of something that can be very ugly.

(Taylor Haddock, FL): I have both areas. I consider criminal history section to be black

and white. On the other side, for the appeals process, I am more lenient. My job is to

explain to people why they cannot work. I have not had anyone be angry with me

because I have learned to talk to people and treat them in a respectful way. In those jobs I

was taught respect. When we interview, we try to ask questions as to whether or not they

could be open to that.

Florida has a new challenge in that we now require a photograph at the time fingerprints

are scanned to ensure that the individual being fingerprinted was the same person being

interviewed. We have to remind our analysts not to make a determination based on the

photo which can sometimes be unflattering.

(Audience Participant): The clearance you described, that is to share

determination between agencies? Was that a CJIS requirement to share? Where

does that come from?

(Taylor Haddock, FL): That was a requirement from the FBI when discussing the

clearinghouse; sharing the criminal history, not the determination. One of the

reasons is for biometrics but also to ensure that the individual fingerprinted is the

same person hired/interviewed for a position.

Q20: Topic: Continuity of NBCP.

Question: How is the “national” program going to be standardized and supported after all the

current enrollees “Graduate” from the NBCP? Will this become 50 independent State

programs?

Recommended Solution: CMS Mandated condition for employment be biometric

supported background checks.

A20: (Rebecca Ward, CMS): I am not the one who can make this decision. Don Howard and I

have discussed with CMS leadership the importance of moving forward. The States have done

amazing work and we want to support you moving forward. I do not have an answer for how this




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will look but within Survey and Certification we do not know how leadership/administration

changes will affect the future of the program.

Q21: (Participant Question): Can you tell us how many applications from States you currently

have? How long will applications be accepted?

A21: (Rebecca Ward, CMS): It is currently open-ended; rolling admission.

Q22: (Participant Question): What States are being reached out to, to apply?

A22: (Delilah Barton, CNA): Ernie has been reaching out, travelling to potential new sites and

doing many presentations. Just about all of you by now must have spoken to Ernie at some point;

he has everyone’s contact information and is constantly reaching out to bring in more States into

the program. Outreach is ongoing.

Q23: (Participant Question): Do you have any idea of tentative dates for next year’s Annual

Training Meeting?

A23: (Rebecca Ward, CMS): It’s usually around this time of year (early May). It will be

dependent on location, etc.

national background check program may 2016 annual training … · 2019. 2. 4. · national...

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