Orlene ChristieToni Dennis

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

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Michigan Demographics
2000
2030
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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

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Michigans 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

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Legislation- PA 27, 28 and 29

• Effective April 1, 2006
• Expand the scope of Michigans laws to include
  all licensed Medicare/Medicaid long term care
  facilities and agencies

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
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Legislation- PA 27, 28 and 29
Strengthen Michigans Background Checks

• Includes substantiated findings of abuse and
  neglect
• Includes on-line registry checks

• Fingerprinting Required
• Specifies prohibited offenses
• Specifies exclusionary time frames

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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

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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

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Exempt Employees

• 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

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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 1320a-7)

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Independent Contractors

• 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

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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.

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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

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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

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Legislative Update

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

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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

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Process
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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

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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

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Facility-Types
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Statistics Applicants (as of 3/13/2007)
Applications started Applications started 186,507 Total Applications 186,507 Total Applications
Withdrawn prior to fingerprinting Withdrawn prior to fingerprinting 43,729 23
By Applicant 13,124 7
By Provider 30,605 16

Withdrawn after fingerprinting Withdrawn after fingerprinting 4,932 2
By Applicant 2,048 1.1
By Provider 2,884 1.5
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Statistics Registry Checks
Registry Total Hits6914 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

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Registry Checks - Exclusions
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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
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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
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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

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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

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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

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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

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Looking Forward

• National Background Check Program
• Proposed by Sen. Kohl (WI)
• Based on Michigans program
• Legislation pending

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• Questions?