Orlene Christie Director Legislative Statutory Compliance Office

Orlene Christie Director Legislative & Statutory Compliance Office Toni Dennis Program Manager Workforce Background Check

Michigan Demographics 2000 2030

Introduction 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

Michigan’s Response Collaborative Partnership: – – 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

Legislation- PA 27, 28 and 29 • Effective April 1, 2006 • Expand the scope of Michigan’s laws to include all licensed Medicare/Medicaid long term care facilities and agencies Public Act 27 & 28 Public Act 29 Department of Community Health Department of Human Services Nursing Homes, County medical care facilities, hospitals that provide swing bed services, hospices, homes for the aged, home health agencies, psychiatric facilities, ICF/MRs Adult foster care facilities

Legislation- PA 27, 28 and 29 Strengthen Michigan’s Background Checks: • • • 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 Who must be fingerprinted? 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

Exempt 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 1320 a-7) –Lose exempt status when employment is terminated or if convicted of a subsequent relevant crime

Grandfathered 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 1320 a-7)

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

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.

Volunteers 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

Staffing Agencies 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

Legislative Update Exempt employees- Compliance with the laws • Pending legislation – Extends deadline until April 1, 2009

Legislation- PA 27, 28 and 29 Rehabilitation Component – Integrated into the laws through tiered exclusionary periods Appeals Process – Inaccurate record – Record expunged – Conviction set aside

Consent and Good Faith Offer of Employment Process Check Registries Yes - Process Ends/Cannot Hire Disqualifying Information Found? No - Initiate Fingerprint Check - Identix MSP and FBI checks Hits Rapsheet to State Analyst for Review Eligibility Determination to Provider Final Hiring Decision No Hits Notification to Provider Final Hiring Decision

New Background Check Process 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 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

Facility-Types Health/Adult Foster Care Facilities and Agencies County Medical Care Facility Home Health Agency Hospice (licensed) Hospice (total programs) ICF/MR Skilled Nursing Facilities/Nursing Facilities Psychiatric Hospitals 36 349 86 152 1 429 6 Psychiatric Units in general hospitals 57 Long-term care Hospitals, swing beds 27 Assisted Living Facilities (AFC & Homes for the Aged) 4744

Statistics – Applicants (as of 3/13/2007) Applications started 186, 507 Withdrawn prior to fingerprinting 43, 729 23 By Applicant 13, 124 7 By Provider 30, 605 16 4, 932 2 By Applicant 2, 048 1. 1 By Provider 2, 884 1. 5 Withdrawn after fingerprinting % Total Applications

Statistics – Registry Checks Registry Total Hits=6914 % Total Hits Medicare OIG Exclusion List 427 6 Offender Tracking Information 1102 16 362 5 403 6 4620 67 System (OTIS) Public Sex Offender Registry (PSOR) Michigan Nurse Aide Registry (NAR) Internet Criminal History Access Tool (ICHAT)

Registry Checks - Exclusions

Statistics - Hits Total Fingerprints Taken = 124, 593 Total Hits = 17, 303 (22% of fingerprints taken) 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 – 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

Looking Forward National Background Check Program • Proposed by Sen. Kohl (WI) • Based on Michigan’s program • Legislation pending

Questions?