Availability of Technical Assistance for Grantee States

The Centers for Medicare & Medicaid Services (CMS) has contracted with CNA to provide technical assistance (TA) support to States that receive grants under the National Background Check Program (NBCP). CNA may assist in the development, implementation, operation, and reporting of State systems to conduct background checks on applicants for direct access employment with long term care facilities and providers. The TA is State-specific support from experienced authorities in specialized fields of expertise. This support can be as simple as providing answer to questions, or as involved as providing ongoing assistance to develop new processes or IT capabilities.

CNA-provided TA is funded directly by CMS and is available to grantee States as an adjunct to their grant awards; funding for this TA does not come out of a State’s grant funds. CNA has provided TA to grantee States under the NBCP since September 2010. Grantee States are encouraged to submit specific TA requests to CNA via email at stateliaison@cna.org or directly to their CNA liaison.

Components of Technical Assistance
State-specific Technical Assistance
Examples of Technical Assistance

Components of Technical Assistance

The three major components of CNA TA to the CMS NBCP are:

  1. State-specific TA based on identification of program needs and approval by CMS. Although there are some restrictions and limitations, CMS has enabled CNA to provide substantial TA, including onsite support to grantee States. CNA supports CMS policy regarding the dissemination and sharing of tools and databases developed during grant implementation across all grantee States. TA can include customization to adapt or integrate an existing tool to meet the needs of the State’s program, development of prototypes and proof-of-concept websites, or development of an NBCP-compliant system and database tools.
  2. Grantee State engagement and support through information-sharing events, calls, and quarterly bulletins. This includes the National Forum for Background Checks monthly meetings and ad hoc teleconferences for sharing information. The NBCP Quarterly Bulletin provides updates and important news from CMS, highlights the notable accomplishments of NBCP States, and provides program updates, promising practices, and more. These events and communications provide networking opportunities between grantee States and CMS. These events and opportunities will also facilitate interaction between program participants and subject matter experts in a variety of fields.
  3. Share lessons learned and leverage best practices across all NBCP grantee States. CNA makes this information available on a dedicated NBCP website, BGCheckInfo (https://bgcheckinfo.org/). The individual States’ “My State Page” portion of the website is also used to store State-specific information and reports.

State-specific Technical Assistance

CNA’s first step in providing TA to a grantee State is to assess the State’s needs. After the State, CMS and CNA agree on the scope and description of the TA requested, CNA will assign the appropriate subject matter experts to assist the State, and will work with that State NBCP team to supervise, monitor, and report on the progress and performance of the TA activities.

Examples of Technical Assistance

CNA offers a broad array of TA services, including, but not limited to, services in the areas described below.

Legislative planning, writing, and draft review

For some States, new or amended legislation will be required to enable proposed background check programs to be fully implemented. Often the legislative windows are short. CNA’s technical assistance team includes professionals with experience developing long term care background check program structures and policies. CNA can also provide assistance in legislative writing and/or reviews of regulatory language.

Background check process flow development

Implementing a comprehensive State-Federal fingerprint-based background check program often requires the creation of new business processes. Documenting the process flows is a prerequisite to developing operating guides, system requirements, and databases. CNA has helped States define their new business processes through facilitated sessions, resulting in easy-to-read graphic flow diagrams and supporting text.

Background check program management and development

Implementation of the NBCP grant will involve program planning and execution, and may require development and tracking new legislation (or amendments). It will also require the State to interface with the CMS, develop or enhance their background check management system. States are encouraged to conduct outreach to long term care facilities or providers throughout the State to keep them informed about program elements and implementation requirements. CNA is available to provide support for all of these activities.

CNA can also provide TA on a variety of human resource and recruiting process issues related to the implementation of background checks for long term care providers and facilities. This includes providing advice regarding procedures to help safeguard private information and protect applicants’ privacy, and offering guidance on minimizing the burdens imposed on potential applicants during the background check process.

Definition of fitness determination policies and procedures

Understanding the fitness determination rules, appeals, and rehabilitation requirements often requires experience specifically related to criminal justice. States may need assistance interpreting specialized law enforcement information, understanding what information may be missing and how to obtain it, and understanding what criminal history information may or may not change. CNA’s experts are knowledgeable regarding how fingerprint processing techniques, transmission methods, and identification may be specialized to meet State-specific requirements. They can assist States to coordinate across the various agencies that collect criminal history information, conduct fitness determinations, and process appeals and waivers.

Registry and other public database search strategies and techniques

The NBCP grants require that State background programs check abuse and neglect registries and databases. CNA has extensive experience with registry search strategies, including resource papers on registries, a registry use study, and the National Sex Offender Public Website (NSOPW). CNA’s experts can help develop tailored search strategies for individual States’ programs.

Development of information systems technology requirements

As background check programs evolve and expand, State information systems must be enhanced to keep up and provide additional capability. CNA’s experts have experience in all aspects of developing information technology (IT) solutions for the background check process, including interfaces to State criminal justice data systems, fingerprint submission methods, solutions for communicating with providers and applicants, and registry integration. CNA has worked in a variety of State IT environments and is experienced in developing solutions that meet architecture standards and security requirements.

Data collection/sharing and security

The NBCP requires States to collect information from long term care providers/facilities, applicants, fingerprinting services, registry databases, and State and Federal criminal history record custodians. Once collected, this information needs to be selectively shared with providers/facilities, applicants, and the public. An innovative information sharing component can ease the States’ administrative workload and help in efforts to garner support for the background check program.

Database development planning

The applicant and employee information database is a critical component of any State or Federal background check system. The database must be efficient and flexible. It must also support the linking of incoming data from disparate sources and allow a wide variety of reporting. CNA’s experts have experience with several database models currently used to support background check systems in NBCP grantee States.

Information sharing among Federal and State agencies

CNA will provide TA regarding various interface issues between Federal and State background check processes. Within States, there may be several agencies with varying levels of responsibility, requiring careful coordination to conduct the required range of background check activities and exchange information seamlessly. State-Federal exchanges of information may also require establishing protocols for providing and maintaining appropriate record-keeping methods that meet the requirements and needs of the participating agencies.

Coordination with law enforcement agencies

CNA will provide TA on how to work with law enforcement on processes including:

  • Fingerprinting/live scan service integration;
  • Background investigation requirements for civil applicants;
  • Criminal history record data sharing requirements;
  • National (FBI) and State processes and data integration; and
  • Rap back technology and process integration.