Medicare Compliance & Reimbursement

New Medicare legislation beefs up employee background check requirements. 

Skilled nursing facilities should brace themselves for a new take on criminal background checks for prospective employees.

That's because the Medicare Act requires the Centers for Medicare & Medicaid Services to set up a pilot program designed to test the success and viability of a federal system of criminal background checks for new hires who care directly for patients covered by Medicare or Medicaid, reports Barbara Gay, director of information for the American Association of Homes and Services for the Aging.

The three-year project affects nursing facilities, home health agencies, hospices, personal care providers and others -and will affect providers in as many as 10 states. The plan requires at least one state to implement a program that would prevent facilities from bring new employees on until complete background checks were run; at least one other state will be required to test a program that allows for so-called provisional hiring, meaning that a worker can be hired pending a background check, according to Gay.

In all likelihood, all facilities in the states participating in the demonstration projects would be required to participate, notes Gay.

Findings that would rule out a new hire include a history of resident abuse or felony convictions related to health care fraud or drugs.

The demonstration is evidence that the feds are serious about requiring background checks in the near future, says Susan Kayser, an attorney with New York City's Duane Morris. "It's an indication of the direction we're going," she says.