Tracking Long Term Care Employees

The Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), which established the Centers for Medicare & Medicaid Services’ National Background Check Program (NBCP), does not specifically mandate that States track employment information on long term care (LTC) employees. However, doing so offers a number of advantages to NBCP grantee States. For example, the Affordable Care Act requires that States notify the appropriate employers if information becomes available showing that LTC employees are convicted of disqualifying crimes any time after their criminal history background checks have been completed. (See the State Rap Back Implementation resource document.) For this and other reasons (discussed below) States may want to implement systems for tracking where LTC employees work. This resource document discusses the benefits of an LTC employee tracking system and provides details from two States already operating such systems—Illinois and Alaska.

What benefits does an LTC employee tracking system offer?
How do LTC employee tracking systems work?
Are there examples of legislation related to employee tracking?
Additional Resources

What benefits does an LTC employee tracking system offer?

The Affordable Care Act requires NBCP grantee States to describe and test capabilities they could use to “immediately inform the facility or provider” that employs the direct access employee of new disqualifying information. States can use LTC employee tracking systems to quickly locate employees’ current employers in order to notify them of such information.

An LTC employee tracking system can also automatically generate compliance-related reports and other types of reports for employers and the State, saving employer and State staff time. Furthermore, such a system can serve as a comprehensive, single source of information on a State’s direct access workforce. For example, the system can indicate the rate of facility/provider staff turnover and which providers have the highest termination rates. This allows the State to investigate root causes of staff turnover.

How do LTC employee tracking systems work?

A State can integrate an LTC employee tracking system with its general background check system or set up a separate database for tracking LTC employees. In either case, the State must establish a way for providers to access the LTC employee tracking system and enter or alter information in applicants’ records. Systems can include features such as employee registration, employment status monitoring, and employment verification.

Registration

Registration is an important first step of the employee tracking process. When a provider chooses to hire an applicant, the provider checks the State’s LTC employee tracking system to see whether the applicant is already registered. If the applicant is already registered, the provider can update the applicant’s record with the new date of hire. For any applicant who is not already in the system, the employer can enter an online portal to register the applicant into the State’s LTC employee tracking system.

Employment Status Monitoring

Once the provider registers the applicant, the grantee State agency and the provider can monitor the applicant’s employment status (e.g., provisionally employed, hired, barred) through the LTC employee tracking system.

If the grantee State agency clears an applicant who is provisionally employed for hire, the provider must update the applicant’s record with a hire date and provider location. The provider must also update the applicant’s record in the case of termination. States can establish deadlines (e.g., within a certain number of business days or calendar days of employee hire or termination) for providers to update applicant records.

Employment Verification

The LTC employee tracking system can play a role in employment verification. For example, the grantee State agency can send randomly selected facilities and providers lists of employees and require the employers to update the status of each employee in the LTC employee tracking system. Through this process, the State can reduce the potential for provider non-compliance without having to manually check each employer’s records.

If an employee is terminated, at the time of termination, the provider enters a termination date on the employee’s record in the LTC employee tracking system. The grantee State agency may also allow the provider to include a reason for termination.

Are there examples of legislation related to employee tracking?

Illinois and Alaska have legislation related to employee tracking systems. Please see details below.

Illinois

The Illinois language is incorporated in the Illinois Administrative Code in section 955.145 (see Additional Resource 1), which states:

  1. Each direct care employer or its designee must provide employment verification and update the demographic information for each employee no less than annually. (Section 33(i) of the Act)
    1. The health care employer or its designee must log into the Health Care Worker Registry through a secure login in a method prescribed by the Department. (Section 33(i) of the Act)
    2. The health care employer or its designee must indicate employment and termination dates (separation dates) within 30 days after hiring or terminating an employee. (Section 33(i) of the Act)
    3. The health care employer shall provide the employment category and type. (Section 33(i) of the Act)
  2. Failure to comply with this Section constitutes a licensing violation. For health care employers that are not licensed or certified, a fine of up to $500 may be imposed for failure to maintain these records. (Section 33(i) of the Act)
  3. The information required in this Section shall be used by the Department of Public Health to notify any current employer of any disqualifying offenses that are reported by the Department of State Police. (Section 33(i) of the Act)

Alaska

Alaska’s statutes are not as explicit as Illinois’ regulations on employee tracking. The relevant language is in Alaska Administrative Code section 7 AAC 10.925 (see Additional Resource 2), which states:

  1. An provider shall monitor to ensure that all applicants associated with the provider in any manner described in 7 AAC 10.900(b) continue to meet the applicable requirements of AS 47.05.300 - 47.05.390 and 7 AA C 10.900 - 7 AAC 10.990. The provider shall require each applicant for whom a background check is required to report to the provider within 24 hours or the next business day if the applicant is charged with, convicted of, found not guilty by reason of insanity for, or adjuticated as a delinquent for, a barrier crime listed in 7 AAC 10.905.
  2. The provider shall notify the department by telephone, by electronic mail, by facsimile, by letter, or in person within
    1. 24 hours or the next business day after the provider has knowledge that an applicant associated with the provider has been arrested for, charged with, convicted of, found not guilty by reason of insanity for, or adjudicated as a delinquent for, a barrier crime listed in 7 AAC 10.905;
    2. 14 days after any change in association with the provider for an applicant who has a valid background check or is the subject of a provisional valid background check, including a change that involves an applicant whose association described in 7 AAC 10.900(b) has been terminated; notification under this paragraph may be provided through a change in the department's electronic database.
  3. Failure to notify the department as required under this section may result in an enforcement action, including suspension or revocation of the license, certification, approval, or finding of eligibility to receive payments.

Additional Resources

  1. Section 955.145 of Illinois Administrative Code: Employment Verification can be accessed at: http://www.ilga.gov/commission/jcar/admincode/077/077009550001450R.html.
  2. Section 7 AAC 10.925 of Alaska’s Statues: Monitoring and Notification Requirements can be accessed at: http://www.akleg.gov/basis/aac.asp#7.10.925.