Orlene Christie Toni Dennis

Director Program Manager

Legislative & Statutory Compliance Office Workforce Background Check

Michigan Demographics

5 4 3 2 1 0 1 2 3 4 5

0 - 4 5 - 910 - 1415 - 1920 - 2425 - 2930 - 3435 - 3940 - 4445 - 4950 - 5455 - 5960 - 6465 - 6970 - 7475 - 7980 - 84 85+

5 4 3 2 1 0 1 2 3 4 5

2000 2030

Review of the pilot program Medicaid Modernization Act of 2004 authorized the pilot

program

Purpose – Identify effective and efficient methods of

conducting background checks on long-term care

workers

Program requirements brought the state laws in line with

federal laws

Introduction

– Michigan Department of

Community Health

– Michigan Department of

Human Services

– Michigan State Police

– Michigan State University

– Office of Services to the Aging

– Michigan Department of

Information Technology

– Multiple Advocacy and Provider

Groups

Michigan’s Response

Collaborative Partnership:

• Effective April 1, 2006

• Expand the scope of Michigan’s laws to include all licensed Medicare/Medicaid long term care facilities and agencies

Legislation- PA 27, 28 and 29

Public Act 27 & 28

Department of Community HealthNursing Homes, County medical care facilities,

hospitals that provide swing bed services, hospices, homes for the aged, home health agencies,

psychiatric facilities, ICF/MRs

Public Act 29

Department of Human ServicesAdult foster care facilities

• Fingerprinting Required

• Specifies prohibited offenses

• Specifies exclusionary time

frames

• Includes substantiated

findings of abuse and neglect

• Includes on-line registry

checks

Legislation- PA 27, 28 and 29

Strengthen Michigan’s Background Checks:

Employees, independent contractors, or individuals who

are granted clinical privileges

whose job gives them

Direct access to a patient or resident, their property,

financial information, medical records, treatment

information or any other identifying information

Legislation- PA 27, 28 and 29

Who must be fingerprinted?

Who must be fingerprinted?

New Employees

• Applicants are subject to a full background check

– State and federal criminal history search

– All available registries

• New check not needed if transferring to a different facility under the same ownership

Legislation- PA 27, 28 and 29

Employees who were working in a health care facility

or agency before 4/1/06 and are still employed by that

facility are exempt from the full background check.

–Not subject to the FBI criminal history check

–Convictions prior to 4/1/06 not considered (unless

42-USC 1320a-7)

–Lose exempt status when employment is terminated

or if convicted of a subsequent relevant crime

Exempt Employees

An applicant who was employed in long-term care

before 4/1/06, and transfers to a new facility is a

“grandfathered employee.”

–Subject to State and FBI background check, but

–Convictions prior to 4/1/06 not considered (unless 42-

USC 1320a-7)

Grandfathered Employees

Independent Contractors who provide direct services

or have direct access on an ongoing basis must

undergo a background check.

– Exceptions include but are not limited to: utility,

maintenance, construction, communications service

providers

Independent Contractors

Individuals granted clinical privileges

An individual who is granted clinical privileges is subject to a background check.

•May be exempt or “grandfathered”

•MDCH student policy exempts students if the clinical training involves less that 120 hours.

Public Acts 27, 28 and 29 do not authorize background

checks on volunteers unless

–They are being granted clinical privileges

–They are a Hospice volunteer who meets the definition of

employee as outlined in the Federal Health Code

National Child Protection Act

Volunteers

Staffing agencies are not authorized to conduct

background check through the Web application.

Employees may be background checked by a covered facility or

agency IF…….

–They provide care on an ongoing basis

–Needed to maintain minimum staffing requirements

–Needed to maintain standard of care

Staffing Agencies

Exempt employees- Compliance with the laws

• Pending legislation

– Extends deadline until April 1, 2009

Legislative Update

Rehabilitation Component

– Integrated into the laws through tiered exclusionary

periods

Appeals Process

– Inaccurate record

– Record expunged

– Conviction set aside

Legislation- PA 27, 28 and 29

ProcessConsent and Good Faith

Offer of Employment

Check Registries

Disqualifying Information

Found?

Yes - Process Ends/Cannot

Hire

No - Initiate Fingerprint

Check

- Identix -MSP and

FBI checks

No Hits - Notification to

Provider

Hits - Rapsheet to State Analyst

for Review

Eligibility Determination

to Provider

Final Hiring

Decision

Final Hiring

Decision

Enhances Speed and Accuracy

• IBT™ (formerly Identix®)

– Fixed and Mobile Locations

– Digital fingerprinting

Michigan State Police

– Fully automated submission and response

• Michigan State University

– Web based application at www.miltcpartnership.org

New Background Check Process

Processing Times

Receive results (average):

• State – 4.3 days

• FBI – 4.3 days

Receive fitness determination (average):

• No Hits – 4.2 days

• Hits – 23 days

New Background Check Process

Facility-Types

County Medical Care Facility 36

Home Health Agency 349

Hospice (licensed) 86

Hospice (total programs) 152

ICF/MR 1

Skilled Nursing Facilities/Nursing Facilities 429

Psychiatric Hospitals 6

Psychiatric Units in general hospitals 57

Long-term care Hospitals, swing beds 27

Assisted Living Facilities (AFC & Homes for the Aged) 4744

Health/Adult Foster Care Facilities and Agencies

Statistics – Applicants (as of 3/13/2007)

Applications started 186,507 % Total Applications

Withdrawn prior to

fingerprinting

43,729 23

By Applicant 13,124 7

By Provider 30,605 16

Withdrawn after fingerprinting 4,932 2

By Applicant 2,048 1.1

By Provider 2,884 1.5

Statistics – Registry Checks

Registry Total Hits=6914 % Total Hits

Medicare OIG Exclusion List 427 6

Offender Tracking Information

System (OTIS)

1102 16

Public Sex Offender Registry

(PSOR)

362 5

Michigan Nurse Aide Registry

(NAR)

403 6

Internet Criminal History Access

Tool (ICHAT)

4620 67

Registry Checks - Exclusions

OTIS16%

PSOR5%

NAR6%

ICHAT67%

OIG6%

Number% Total

FP Taken% Total Hits

State AFIS 2373 1.9 14

FBI IAFIS 5380 4.3 31

Both State and

FBI 9550 7.7 55

Statistics - Hits

Total Fingerprints Taken = 124,593

Total Hits = 17,303 (22% of fingerprints taken)

Statistics – Source of Disqualification (FP)

Number

Disqualified =

1243

% Hits % Total

Fingerprints taken

= 124,593

State AFIS 632 27 0.5

FBI IAFIS 258 5 0.2

Both State and FBI 353 4 0.3

Success Stories/Promising Practices

State Rap Back

• Email notification

–Departments receive notification of arrest, arraignment and

conviction immediately

• Provider notification

–Department immediately notifies the provider of felony arrest

or arraignment and misdemeanor or felony conviction

Success Stories/Promising Practices

Creating support in the long-term care community Legislative Subcommittee

Public information Committee

Collaboration among state and other agencies Department of Community Health

Department of Human Services

Office of Services to the Aging

Michigan State Police

Department of Information Technology

Michigan State University

Success Stories/Promising Practices

Enhances the State IAFIS system Helps to improve the accuracy of criminal history records

Generates revenue for upgrades to IAFIS system

Promotes use of new technologies

AANP Training Grant program for direct access staff and managers

Creation of an expanded adult abuse and neglect prevention

curricula incorporating methods of staff empowerment,

culture change, and person-centered care

Success Stories/Promising Practices

Objective and rigorous evaluation

Michigan State University

– Cost benefit analysis and economic impact

Abt Associates, Inc.

– Contracted by CMS

– Independent, objective evaluation of the background

check program

National Background Check Program

• Proposed by Sen. Kohl (WI)

• Based on Michigan’s program

• Legislation pending

Looking Forward

Questions?