Alerts and Updates
HRSA Proposed Rule Will Expand National Practitioner Data Bank's Reporting Requirements
April 17, 2006
On March 21, 2006, the Health Resources and Services Administration ("HRSA") of the U.S. Department of Health and Human Services published a proposed rule that incorporates the statutory requirements under Section 1921 of the Social Security Act ("SSA") into the regulations governing the reporting of information to the National Practitioner Data Bank for Information on Physicians and Other Health Care Practitioners ("NPDB"). See 71 Fed. Reg. 14135. This proposed rule would revise existing regulations, 45 C.F.R. Part 60, to require each state to adopt a system of reporting adverse licensure actions taken against healthcare practitioners and healthcare entities to the Secretary of Health and Human Services ("Secretary"). If you wish to comment about the HRSA's rule proposal, HRSA is accepting comments through May 22, 2006.
The proposed regulation is designed to coordinate several existing reporting systems. The NPDB was established by the Health Care Quality Improvement Act of 1986 ("HCQIA"). The reporting of information under HCQIA is limited to medical malpractice payers, state medical and dental boards, professional societies with formal peer review, and hospitals and other healthcare entities. The HCQIA requires reporting to the NPDB only certain incidents based on professional conduct and competence.
Section 1921 of the SSA (last amended in 1990) requires each state to adopt a system of reporting adverse licensure actions taken against healthcare providers and to report any negative action or finding by a state licensing authority, peer review organization or private accreditation entity. This section allows reporting for all licensure actions, not only those based on professional conduct or competence.
Another reporting system is found in Section 1128E of the SSA, which was added by the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). This section establishes the Healthcare Integrity and Protection Data Bank ("HIPDB"), which began collecting reports in November 1999. Only federal and state agencies and health plans report to the HIPDB.
Under Section 60.9(b) of the new regulation, the actions which would be required to be reported include:
- Any adverse action taken by the licensing authority of the state as a result of a formal proceeding, including revocation or suspension of a license (and the length of any such suspension), reprimand, censure, or probation;
- Any dismissal or closure of the formal proceeding by reason of the practitioner or entity surrendering the license, or the practitioner leaving the state or jurisdiction;
- Any other loss of the license of the practitioner or entity, whether by operation of law, voluntary surrender (excluding those due to nonpayment of licensure renewal fees, retirement, or change to inactive status), or otherwise; and
- Any negative action or finding that the state licensing authority, peer review organization, or private accreditation entity has concluded against the healthcare practitioner or healthcare entity.
The adverse licensure actions taken must be the result of formal proceedings, as defined in Section 60.3 of the regulation.
"Negative action or finding by a state licensing or credentialing authority, peer review organization, or private accreditation entity" is defined under the proposed rule to mean:
- Receipt of less than full accreditation from a private accreditation entity that indicates a substantial risk to the safety of patient care or quality of healthcare services and includes, but is not limited to, denial of accreditation or non-accreditation;
- Any recommendation by a peer review organization to sanction a practitioner; or
- Any negative action or finding that under the state's law is publicly available information and is rendered by a licensing or certification authority, including, but not limited to, limitations on the scope of practice, liquidations, injunctions and forfeitures.
Administrative fines, or citations and corrective action plans are not included as a negative finding or action unless they involve the delivery of healthcare services and occur in conjunction with other licensure or certification actions. 45 C.F.R. § 60.3 [proposed].
All organizations eligible to query the NPDB under the HCQIA will have access to this information. These include hospitals, healthcare entities that conduct peer review and provide healthcare services, state medical or dental boards and other healthcare practitioners, other state licensing authorities, agencies administering federal healthcare programs, including private entities administering such programs under contract, state agencies administering or supervising the administration of state healthcare programs, state Medicaid fraud control units, certain law enforcement agencies and utilization and quality control/quality improvement organizations, the U.S. Attorney General and such other law enforcement officials as the Secretary of the Department of Health and Human Services deems just, and, upon request, the Comptroller General, the head of the Government Accountability Office.
The proposed rule does not eliminate or change any of the current reporting responsibilities of hospitals, other healthcare entities, professional societies or medical malpractice payers regarding physicians or dentists, but it expands the NPDB obligations of state licensing boards, peer review organizations and private accreditation entities to match the reporting requirements of HIPDB. The change will make the reporting of adverse actions by all state licensure and certification authorities identical for both the NPDB and HIPDB.
HRSA is accepting comments on the proposed rule only through May 22, 2006. Additional information about the NPDB can be found at www.npdb-hipdb.com.
For Further Information
For more information or if you have a question about this Alert, please contact one of the attorneys of our Health Law Practice Group or the attorney in the firm with whom you are regularly in contact.
Disclaimer: This Alert has been prepared and published for informational purposes only and is not offered, nor should be construed, as legal advice. For more information, please see the firm's full disclaimer.
