Using Registries in the National Background Check Program

Registries are non-criminal State and Federal databases that may contain disqualifying information about individuals applying for direct patient access employment. They are used in the background check process as a source of information about the applicant. Several types of registries exist, including caregiver competency and/or abuse and neglect registries, professional licensure databases, and other State and Federal misconduct databases.

This resource page discusses the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act) requirements regarding registries, the different types of registries available, how background check programs may access these registries, and why registries are useful to a background check program. Additional resources include links to compilations of some of the types of registries.

What is meant by the term "registry"?
What are the Affordable Care Act requirements regarding the use of registries in background check programs?
What is the main type of registry relevant to this program?
How can nurse aide registries be accessed?
What other types of State or Federal misconduct databases are available?
Why are registries useful?
Additional Resources

What is meant by the term "registry"?

By registries, we are referring to non-criminal State and Federal databases that may contain disqualifying information about individuals applying for direct patient access employment. Several types of registries exist, including caregiver competency and/or abuse and neglect registries, professional licensure databases, and other State and Federal misconduct databases.

What are the Affordable Care Act requirements regarding the use of registries in background check programs?

The Affordable Care Act requires that State background check programs “utilize a search of State-based abuse and neglect registries and databases, including the abuse and neglect registries of another State in the case where a prospective employee previously resided in that State.” (See Additional Resource 4 below.) States commonly search registries from other States when an applicant has lived in another State during the previous one to three years. In searching other States’ registries, States have leeway in deciding how far back to search.

The Affordable Care Act also requires States to utilize a search of “the records of any proceedings in the State that may contain disqualifying information about prospective employees (such as proceedings conducted by State professional licensing and disciplinary boards and State Medicaid Fraud Control Units).” (See Additional Resource 4 below.)

The overall goal is to search all available relevant registries to determine whether they contain information showing that it would be inappropriate to hire an applicant. It's important to note that the Affordable Care Act refers to databases containing information on a range of types of health care professionals, not only nurse aide registries.

What is the main type of registry relevant to this program?

All States have nurse aide registries, which should be checked under this program. Federal regulations for long term care (LTC) facilities require that before hiring an individual as a nurse aide, a facility must receive registry verification that the individual has met competency requirements. Further, such facilities must search a misconduct registry prior to employing a nurse’s aide. In some States, these two types of information (certification/competency and findings of abuse or neglect) are in a single registry; in others they are compiled separately. These registries contain listings of substantiated findings of:

  • Abuse or neglect of a resident;
  • Abuse of or misappropriation of a resident’s or facility’s property;
  • Fraud against a resident or facility;
  • Diversion of drugs belonging to a resident or facility.

States may have competency and/or misconduct registries for other types of caregivers/employees as well, including medication aides, other unlicensed health care personnel, nursing facility administrators, and child care workers.

How can nurse aide registries be accessed?

Almost all nurse aide and other LTC employee registries are publicly available on the Internet and can be accessed at no charge. The National Council of State Boards of Nursing (NCSBN) maintains a list of nurse aide registries, including contact information and links to online search capabilities where available. In a few states, users seeking access to the State's nurse aide registry must contact the registry program administrator first.

Often, a registry search can be conducted with as little information as the applicant's last name. To narrow the search, users can enter first name, date of birth, certificate number, or Social Security number. In some States, registry searches are only allowed by Social Security number.

What other types of State or Federal misconduct databases are available?

  1. A number of States provide online licensure verification for many (if not all) types of health care professionals. These websites can be accessed by anyone. OnlineSearches.com provides links to State professional licensure verification websites. Generally, the only information necessary for looking up a provider is a name or license number. Specific profession and/or location can help narrow the search. Records returned by the search indicate whether individuals have active licenses in good standing. The database record may indicate that a disciplinary action was taken against a licensed individual, but often will not provide information on the nature of the disciplinary action. Disciplinary actions must be further investigated.
  2. Disciplinary actions against health professionals are publicly available online or by special request to the relevant State board or other State agency. Database instructions often remind users to look for all updated information (as a later board decision may overwrite an earlier one) and suggest that original documents be consulted, as there may be discrepancies between original documents and online copies. Copies of original orders can be obtained through written requests to the responsible licensing board or State agency.
  3. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) provides a database of information relating to parties (individuals and entities) excluded from participation in Medicare, Medicaid and all Federal health care programs. The Exclusion database can be accessed through the HHS OIG website at https://exclusions.oig.hhs.gov/.
  4. State Medicaid Fraud Control Units conduct criminal investigations of Medicaid providers who are suspected of cheating the program. The Units also investigate allegations of physical abuse and neglect in health care facilities that receive Medicaid funding. The National Association of Medicaid Fraud Control Units (NAMFCU) maintains a list of links to State websites with information on State Medicaid Fraud Control Units. These websites rarely contain searchable databases of offenders, but can provide contact information for Unit staff.
  5. The National Sex Offender Public Website (NSOPW) provides centralized access to registries from all 50 States, Guam, Puerto Rico, and the District of Columbia. The NSOPW can be accessed through the U.S. Department of Justice website at https://www.nsopw.gov/.

Why are registries useful?

Registries are useful because:

  1. They are usually easily accessible online and require no more than a name, license number, or (sometimes) a Social Security number to conduct a check.
  2. Results from a registry search can rule out an applicant before time and money are spent conducting a fingerprint check.
  3. Some databases, such as databases of professional disciplinary actions, can provide relevant information that may not be part of a person’s criminal history. For instance, a health care professional may have been terminated from a position due to drug or alcohol abuse, but never prosecuted for a drug- or alcohol-related offense.

Using a check of all available registries as a first level of screening may not only save money and resources, but could prevent an unsuitable job applicant from being placed in a provisional employment position with access to vulnerable individuals.

Registries are not sufficient for identifying all individuals with disqualifying offenses, as they do not cover most non-health care direct patient access employees, such as housekeeping and maintenance staff. Registries also don’t provide criminal histories, which are an important part of the NBCP.

For specific descriptions of ways in which States are implementing registry searches in their NBCP business processes, see the document titled "How to Implement NBCP Registry Searches: Two Alternative Workflows."

Additional Resources

  1. Nurse Aide Registries: A link to the nurse aide registry search website in each State (where available) and contact information such as address, phone number(s), and fax numbers for each State nurse aide registry. For a small number of States, the nurse aide registry can only be searched by contacting the State registry program to obtain access. Generally, nurse aide competency and misconduct information are in a single database.
  2. Professional License Online Search Sites: A link to a centralized online professional license verification website for each State, where available. For some States that do not have centralized license verification websites, the list provides a link to a webpage with links to individual licensing boards.
  3. State Medicaid Fraud Control Unit Websites: The websites with information about the State Medicaid Fraud Control Units. These websites rarely contain searchable databases of offenders, but can provide contact information for Unit staff.
  4. Section 6201 of the Affordable Care Act
    This legislation, which can be found at https://www.democrats.senate.gov/pdfs/reform/patient-protection-affordable-care-act-as-passed.pdf, describes the nationwide program for national and State background checks on direct patient access employees of LTC facilities and other providers.