Effective March 1, 2010, the information collected and available through the National Practitioner Data Bank (NPDB) will expand dramatically to include data obtained pursuant to Section 1921 of the Social Security Act. See 75 Fed. Reg. 4656 (January 28, 2010) (final rule promulgated by the U.S. Department of Health and Human Services (HHS)). Section 1921 requires states to report adverse licensure actions against health care practitioners and health care entities by any state authority responsible for their licensure. It also requires states to report any negative action or finding that a State licensing authority, peer review organization, or private accreditation organization has finalized against a health care practitioner or entity.
Background
Established by the Health Care Quality Improvement Act of 1986 (HCQIA), the NPDB facilitates comprehensive review of a health care practitioner's professional credentials. Historically, "HCQIA Information" maintained by the NPDB has included adverse licensure actions against physicians and dentists, as well as clinical privilege and professional society membership actions against physicians, dentists, and other health care practitioners. It has also included information about adverse actions by the Drug Enforcement Administration (DEA) and medical malpractice payments made for the benefit of any health care practitioner.
Impact Of The New Regulations
Under Section 1921 and the new rule, all licensure actions taken against all types of licensed health care practitioners or entities must be reported to the NPDB. Previously, the reporting obligation extended only to licensure actions based on professional competence or conduct and only such actions taken against physicians or dentists. This means that the data bank will now include new, "Section 1921 Information" in the form of licensure data regarding – among other types of practitioners – chiropractors, podiatrists, pharmacists, optometrists, physical therapists, respiratory therapists, physician assistants, social workers, and professional and paraprofessional nurses.
Section 1921 also expands reporting obligations so that state licensing authorities, peer review organizations, and private accreditation organizations must now report certain negative actions or findings against health care practitioners or entities to the NPDB. In the past, only hospitals, medical malpractice payers, state medical and dental boards, the DEA, the HHS Office of Inspector General, and professional societies and other health care entities with formal peer review were obligated to report.
The types of entities eligible to query the NPDB, finally, has also expanded, although the new queriers' access will be limited. Entities that may now query the NPDB under Section 1921 will be allowed to receive only "Section 1921 Information." These new queriers include agencies administering federal health care programs (such as Medicare Administrative Contractors), state agencies administering or supervising the administration of state health care programs (such as the Pennsylvania Department of Public Welfare), state agencies responsible for licensing health care entities, Medicaid Fraud Control Units, law enforcement agencies, Quality Improvement Organizations, and the U.S. Comptroller General. By contrast, all entities that were previously eligible to query the NPDB will have access to both "HCQIA Information" and "Section 1921 Information."
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
We operate a free-to-view policy, asking only that you register in order to read all of our content. Please login or register to view the rest of this article.