Orlene ChristieToni Dennis DirectorProgram Manager Legislative & Statutory Compliance Office Workforce Background Check

Michigan Demographics

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 Health Nursing 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 Services Adult 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?

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

Process Consent 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 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/MR1 Skilled Nursing Facilities/Nursing Facilities429 Psychiatric Hospitals6 Psychiatric Units in general hospitals57 Long-term care Hospitals, swing beds27 Assisted Living Facilities (AFC & Homes for the Aged)4744 Health/Adult Foster Care Facilities and Agencies

Statistics – Applicants (as of 3/13/2007) Applications started186,507 % Total Applications Withdrawn prior to fingerprinting 43,72923 By Applicant 13,124 7 By Provider 30, Withdrawn after fingerprinting4,9322 By Applicant2, By Provider2,8841.5

Statistics – Registry Checks RegistryTotal Hits=6914% Total Hits Medicare OIG Exclusion List427 6 Offender Tracking Information System (OTIS) Public Sex Offender Registry (PSOR) Michigan Nurse Aide Registry (NAR) Internet Criminal History Access Tool (ICHAT)

Registry Checks - Exclusions

Number % Total FP Taken % Total Hits State AFIS FBI IAFIS Both State and FBI 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 FBI IAFIS Both State and FBI

Success Stories/Promising Practices State Rap Back 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?