Michigan: Proposed criminal background checks for personal care providers

Following a state audit of the Medicaid-funded Home Help Services Program in Michigan, the Michigan Department of Community Health has proposed new policies for screening personal care providers. This will standardize criminal background checks of all providers of personal care services provided by the Michigan Medicaid State Plan, including the Home Help Program. 

The state audit, released in June 2014, found that of the approximately 70,000 individual providers of Home Help services, 3,786 had felony convictions prior to Jan. 2, 2013. "This included…572 convictions for violent crimes ranging from assault to homicide; 285 convictions for sex-related crimes; 1,148 convictions for financial crimes such as fraud, identity theft and embezzlement; and 2, 020 convictions for drug related offenses."

The proposed criminal background check policy will apply to all providers of Home Help Services, including parents and other family members who provide these services. According to Brian Barrie at the state Medical Services Administration, screenings will be done as part of the provider enrollment process.  All providers will be placed in the CHAMPS system [CHAMPS is the state computerized Medicaid Processing System]  and the screenings will be done then.  Any additional cost will be absorbed by MDCH.

Comments on the proposed policy are due by July 25, 2014.

Mail comments to:

Brian Barrie
Bureau of Medicaid Policy and Health System Innovation
Medical Services Administration
P.O. Box 30479
Lansing, Michigan 48909-7979

Telephone Number: (517) 335 - 5131
Fax Number: (517) 241-7816
E-mail Address: Barrieb@Michigan.gov

The effective date of the policy is September 1, 2014.

The proposed criminal background checks are required by the Affordable Care Act. Section 1128(a) of 42 U.S.C.1320a-7 (the Social Security Act) prohibits individuals or entities from participating in programs funded under the Act if they have been convicted of any of the Mandatory Exclusion offenses outlined in the policy.

Here are excerpts from the proposed policy:

Mandatory Exclusions: Providers (any individual or entity) MUST be screened for and, as required by the State of Michigan, MUST disclose the following excludable convictions. Any applicant or provider found to meet one of these four categories is prohibited from participating as a service provider for Medicaid or the Home Help program. The mandatory exclusion categories are:

1. Any criminal convictions related to the delivery of an item or service under Medicare (Title XVIII), Medicaid (Title XIX) or other state health care programs (e.g., Children's Special Health Care Services, Healthy Kids), (Title V, Title XX, and Title XXI)
2. Any criminal convictions under federal or state law, relating to neglect or abuse of patients in connection with the delivery of a health care item or service.
3. Felony convictions occurring after August 21, 1996, relating to an offense, under federal or state law, in connection with the delivery of health care items or services or with respect to any act or omission in a health care program (other than those included in number 1 above) operated by or financed in whole or in part by any federal, state, or local government agency, of a criminal offense consisting of a felony relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct
4. Felony convictions occurring after August 21, 1996, under federal or state law, related to unlawful manufacture, distribution, prescription, or dispensing of a controlled substance.

Criminal Background Screening: All providers and applicants covered under this policy must agree to a criminal background screening…Individual provider applicants must agree to a criminal history screening by completing and submitting MSA-4678 Medical Assistance Home Provider Agreement to MDCH. Approved and existing individual providers will be periodically reviewed and rescreened by MDCH.

Provider agencies will be held to the same requirements for their employees.

Sanctions: For any provider found to be in violation of any of the four mandatory exclusions listed above, MDCH may terminate or deny enrollment in the Michigan Medicaid program.

Providers will be notified within 90 days of initiation of a payment suspension. The notification will include the general allegations as the to nature of the suspension action, the period of suspension, and the circumstances under which the suspension will be terminated. Providers may submit written evidence for consideration through the administrative appeal process. All payment suspensions will include referral to the Office of Health Services Inspector General.

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For complete information on criminal convictions, sanctions, appeals processes, etc., refer to the proposed policy.