HHS: States have to adopt adverse licensure action reporting system

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The U.S. Department of Health and Human Services (HHS) has posted a notice of final rule in the Jan. 28 Federal Register requiring each state to adopt a system to report certain adverse licensure actions taken against licensed healthcare practitioners to the Secretary of HHS, effective March 1.

Additionally, the rule requires each state to report any negative actions or findings that a state licensing authority, peer review organization or private accreditation entity has concluded against a healthcare practitioner or healthcare entity.

According to HHS, the rule revises existing regulations of the HealthCare Quality Improvement Act (HCQIA) of 1986, governing the national practitioner data bank (NPDB) for adverse information on physicians and other healthcare practitioners, to incorporate statutory requirements as amended by the Medicare and Medicaid Patient and Program Protection Act of 1987 (MMPPPA) and the Omnibus Budget Reconciliation Act (OBRA) of 1990.

The MMPPPA and OBRA were designed to protect program beneficiaries from unfit healthcare practitioners and improve anti-fraud provisions of Medicare and state healthcare programs, HHS stated.

The HealthCare Integrity and Protection Data Bank (HIPDB) was set up in 1999 as a national healthcare fraud and abuse data collection program in the U.S. for the reporting and disclosing of certain final adverse actions taken against healthcare providers, suppliers or practitioners.

Currently, the HCQIA limits NPDB reporting by medical and dental licensing authorities only to adverse actions related to professional competence or conduct but these authorities must report all actions to the HIPDB, according to HHS. The change will make the reporting of adverse actions by all state licensure and certification authorities nearly identical for both NPDB and HIPDB, the final rule stated.

According to the rule, peer review organizations or private accreditation entities must report any negative actions or findings to the state within 15 days from the date the action was taken or the finding was made. Each state, through the adopted system of reporting, must submit to the NPDB the information received from the peer review organization or private accreditation entity within 15 days from the date on which it received this information, the rule stated.