House Bill 1881e1
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HB 1881, First Engrossed/ntc
1 A bill to be entitled
2 An act relating to standardized credentialing
3 for health care practitioners; amending s.
4 455.557, F.S.; revising the credentials
5 collection program for health care
6 practitioners; revising and providing
7 definitions; providing requirements for health
8 care practitioners and the Department of Health
9 under the program; renaming the advisory
10 council and abolishing it at a future date;
11 prohibiting duplication of data available from
12 the department; authorizing collection of
13 certain other information; revising
14 requirements for registration of credentials
15 verification organizations; providing for
16 biennial renewal of registration; providing
17 grounds for suspension or revocation of
18 registration; revising liability insurance
19 requirements; revising rulemaking authority;
20 specifying authority of the department after
21 the council is abolished; providing an
22 effective date.
23
24 Be It Enacted by the Legislature of the State of Florida:
25
26 Section 1. Section 455.557, Florida Statutes, 1998
27 Supplement, is amended to read:
28 455.557 Standardized credentialing for health care
29 practitioners.--
30 (1) INTENT.--The Legislature recognizes that an
31 efficient and effective health care practitioner credentialing
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1 program helps to ensure access to quality health care and also
2 recognizes that health care practitioner credentialing
3 activities have increased significantly as a result of health
4 care reform and recent changes in health care delivery and
5 reimbursement systems. Moreover, the resulting duplication of
6 health care practitioner credentialing activities is
7 unnecessarily costly and cumbersome for both the practitioner
8 and the entity granting practice privileges. Therefore, it is
9 the intent of this section that a mandatory credentials
10 collection verification program be established which provides
11 that, once a health care practitioner's core credentials data
12 are collected, validated, maintained, and stored, they need
13 not be collected again, except for corrections, updates, and
14 modifications thereto. Participation Mandatory credentialing
15 under this section shall initially include those individuals
16 licensed under chapter 458, chapter 459, chapter 460, or
17 chapter 461. However, the department shall, with the approval
18 of the applicable board, include other professions under the
19 jurisdiction of the Division of Medical Quality Assurance in
20 this credentialing program, provided they meet the
21 requirements of s. 455.565.
22 (2) DEFINITIONS.--As used in this section, the term:
23 (a) "Advisory council" or "council" means the
24 Credentials Verification Advisory Council.
25 (b) "Applicant" means an individual applying for
26 licensure or a current licensee applying for credentialing.
27 (b)(c) "Certified" or "accredited," as applicable,
28 means approved by a quality assessment program, from the
29 National Committee for Quality Assurance, the Joint Commission
30 on Accreditation of Healthcare Organizations, the American
31 Accreditation HealthCare Commission/URAC Utilization Review
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1 Accreditation Commission, or any such other nationally
2 recognized and accepted organization authorized by the
3 department, used to assess and certify any credentials
4 verification program, entity, or organization that verifies
5 the credentials of any health care practitioner.
6 (c)(d) "Core credentials data" means the following
7 data: current name, any former name, and any alias, any
8 professional education, professional training, peer
9 references, licensure, current Drug Enforcement Administration
10 certification, social security number, specialty board
11 certification, Educational Commission for Foreign Medical
12 Graduates certification information, hospital or affiliations,
13 managed care organization affiliations, other institutional
14 affiliations, professional society memberships, evidence of
15 professional liability coverage or evidence of financial
16 responsibility as required by s. 458.320 or s. 459.0085
17 insurance, history of claims, suits, judgments, or
18 settlements, final disciplinary action reported pursuant to s.
19 455.565(1)(a)8., and Medicare or Medicaid sanctions, civil or
20 criminal law violations, practitioner profiling data, special
21 conditions of impairment, or regulatory exemptions not
22 previously reported to the department in accordance with both
23 s. 455.565 and the initial licensure reporting requirements
24 specified in the applicable practice act.
25 (d)(e) "Credential" or "credentialing" means the
26 process of assessing and verifying validating the
27 qualifications of a licensed health care practitioner or
28 applicant for licensure as a health care practitioner.
29 (e)(f) "Credentials verification organization entity"
30 means any program, entity, or organization that is organized
31 and certified or accredited as a credentials verification
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1 organization for the express purpose of collecting, verifying,
2 maintaining, storing, and providing to health care entities a
3 health care practitioner's total core credentials data,
4 including all corrections, updates, and modifications thereto,
5 as authorized by the health care practitioner and in
6 accordance with the provisions of this including all
7 corrections, updates, and modifications thereto, as authorized
8 by the health care practitioner and in accordance with the
9 provisions of this section. The division, once certified,
10 shall be considered a credentials verification entity for all
11 health care practitioners.
12 (f)(g) "Department" means the Department of Health,
13 Division of Medical Quality Assurance.
14 (g)(h) "Designated credentials verification
15 organization entity" means the credentials verification
16 program, entity, or organization organized and certified or
17 accredited for the express purpose of collecting, verifying,
18 maintaining, storing, and providing to health care entities a
19 health care practitioner's total core credentials data,
20 including all corrections, updates, and modifications thereto,
21 which is selected by the health care practitioner as the
22 credentials verification entity for all inquiries into his or
23 her credentials, if the health care practitioner chooses to
24 make such a designation. Notwithstanding any such designation
25 by a health care practitioner, the division, once certified,
26 shall also be considered a designated credentials verification
27 entity for that health care practitioner.
28 (h) "Drug Enforcement Administration certification"
29 means certification issued by the Drug Enforcement
30 Administration for purposes of administration or prescription
31 of controlled substances. Submission of such certification
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1 under this section must include evidence that the
2 certification is current and must also include all current
3 addresses to which the certificate is issued.
4 (i) "Division" means the Division of Medical Quality
5 Assurance within the Department of Health.
6 (i)(j) "Health care entity" means:
7 1. Any health care facility or other health care
8 organization licensed or certified to provide approved medical
9 and allied health services in this state Florida; or
10 2. Any entity licensed by the Department of Insurance
11 as a prepaid health care plan or health maintenance
12 organization or as an insurer to provide coverage for health
13 care services through a network of providers; or
14 3. Any accredited medical school in this state.
15 (j)(k) "Health care practitioner" means any person
16 licensed, or, for credentialing purposes only, any person
17 applying for licensure, under chapter 458, chapter 459,
18 chapter 460, or chapter 461 or any person licensed or applying
19 for licensure under a chapter subsequently made subject to
20 this section by the department with the approval of the
21 applicable board.
22 (k) "Hospital or other institutional affiliations"
23 means each hospital or other institution for which the health
24 care practitioner or applicant has provided medical services.
25 Submission of such information under this section must
26 include, for each hospital or other institution, the name and
27 address of the hospital or institution, the staff status of
28 the health care practitioner or applicant at that hospital or
29 institution, and the dates of affiliation with that hospital
30 or institution.
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1 (l) "National accrediting organization" means an
2 organization that awards accreditation or certification to
3 hospitals, managed care organizations, credentials
4 verification organizations, or other health care
5 organizations, including, but not limited to, the Joint
6 Commission on Accreditation of Healthcare Organizations, the
7 American Accreditation HealthCare Commission/URAC, and the
8 National Committee for Quality Assurance.
9 (m) "Professional training" means any internship,
10 residency, or fellowship relating to the profession for which
11 the health care practitioner is licensed or seeking licensure.
12 (n) "Specialty board certification" means
13 certification in a specialty issued by a specialty board
14 recognized by the board in this state that regulates the
15 profession for which the health care practitioner is licensed
16 or seeking licensure.
17 (m) "Primary source verification" means verification
18 of professional qualifications based on evidence obtained
19 directly from the issuing source of the applicable
20 qualification.
21 (n) "Recredentialing" means the process by which a
22 credentials verification entity verifies the credentials of a
23 health care practitioner whose core credentials data,
24 including all corrections, updates, and modifications thereto,
25 are currently on file with the entity.
26 (o) "Secondary source verification" means confirmation
27 of a professional qualification by means other than primary
28 source verification, as outlined and approved by national
29 accrediting organizations.
30 (3) STANDARDIZED CREDENTIALS VERIFICATION PROGRAM.--
31 (a) Every health care practitioner shall:
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1 1. Report all core credentials data to the department
2 which is not already on file with the department, either by
3 designating a credentials verification organization to submit
4 the data or by submitting the data directly.
5 2. Notify the department within 45 days of any
6 corrections, updates, or modifications to the core credentials
7 data either through his or her designated credentials
8 verification organization or by submitting the data directly.
9 Corrections, updates, and modifications to the core
10 credentials data provided the department under this section
11 shall comply with the updating requirements of s. 455.565(3)
12 related to profiling.
13 (b)(a) In accordance with the provisions of this
14 section, The department shall:
15 1. Maintain a complete, current file of core
16 credentials data on each health care practitioner, which shall
17 include all updates provided in accordance with subparagraph
18 (3)(a)2.
19 2. Release the core credentials data that is otherwise
20 confidential or exempt from the provisions of chapter 119 and
21 s. 24(s), Art. I of the State Constitution and any
22 corrections, updates, and modifications thereto, if authorized
23 by the health care practitioner.
24 3. Charge a fee to access the core credentials data,
25 which may not exceed the actual cost, including prorated setup
26 and operating costs, pursuant to the requirements of chapter
27 119. The actual cost shall be set in consultation with the
28 advisory council.
29 4. Develop, in consultation with the advisory council,
30 standardized forms to be used by the health care practitioner
31 or designated credentials verification organization for the
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1 initial reporting of core credentials data, for the health
2 care practitioner to authorize the release of core credentials
3 data, and for the subsequent reporting of corrections,
4 updates, and modifications thereto develop standardized forms
5 necessary for the creation of a standardized system as well as
6 guidelines for collecting, verifying, maintaining, storing,
7 and providing core credentials data on health care
8 practitioners through credentials verification entities,
9 except as otherwise provided in this section, for the purpose
10 of eliminating duplication. Once the core credentials data are
11 submitted, the health care practitioner is not required to
12 resubmit this initial data when applying for practice
13 privileges with health care entities. However, as provided in
14 paragraph (d), each health care practitioner is responsible
15 for providing any corrections, updates, and modifications to
16 his or her core credentials data, to ensure that all
17 credentialing data on the practitioner remains current.
18 Nothing in this paragraph prevents the designated credentials
19 verification entity from obtaining all necessary attestation
20 and release form signatures and dates.
21 5.(b) Establish There is established a Credentials
22 Verification Advisory Council, consisting of 13 members, to
23 assist the department as provided in this section with the
24 development of guidelines for establishment of the
25 standardized credentials verification program. The secretary,
26 or his or her designee, shall serve as one member and chair of
27 the council and shall appoint the remaining 12 members. Except
28 for any initial lesser term required to achieve staggering,
29 such appointments shall be for 4-year staggered terms, with
30 one 4-year reappointment, as applicable. Three members shall
31 represent hospitals, and two members shall represent health
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1 maintenance organizations. One member shall represent health
2 insurance entities. One member shall represent the credentials
3 verification industry. Two members shall represent physicians
4 licensed under chapter 458. One member shall represent
5 osteopathic physicians licensed under chapter 459. One member
6 shall represent chiropractic physicians licensed under chapter
7 460. One member shall represent podiatric physicians licensed
8 under chapter 461.
9 (c) A registered credentials verification organization
10 may be designated by a health care practitioner to assist the
11 health care practitioner to comply with the requirements of
12 subsection (3)(a)2. A designated credentials verification
13 organization shall:
14 1. Timely comply with the requirements of subsection
15 (3)(a)2. pursuant to rules adopted by the department.
16 2. Not provide the health care practitioner's core
17 data, including all corrections, updates, and modifications,
18 without the authorization of the practitioner.
19 (c) The department, in consultation with the advisory
20 council, shall develop standard forms for the initial
21 reporting of core credentials data for credentialing purposes
22 and for the subsequent reporting of corrections, updates, and
23 modifications thereto for recredentialing purposes.
24 (d) Each health care practitioner licensed under
25 chapter 458, chapter 459, chapter 460, or chapter 461, or any
26 person licensed under a chapter subsequently made subject to
27 this section, must report any action or information as defined
28 in paragraph (2)(d), including any correction, update, or
29 modification thereto, as soon as possible but not later than
30 30 days after such action occurs or such information is known,
31 to the department or his or her designated credentials
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1 verification entity, if any, who must report it to the
2 department. In addition, a licensee must update, at least
3 quarterly, his or her data on a form prescribed by the
4 department.
5 (e) An individual applying for licensure under chapter
6 458, chapter 459, chapter 460, or chapter 461, or any person
7 applying for licensure under a chapter subsequently made
8 subject to this section, must submit the individual's initial
9 core credentials data to a credentials verification entity, if
10 such information has not already been submitted to the
11 department or the appropriate licensing board or to any other
12 credentials verification entity.
13 (f) Applicants may decide which credentials
14 verification entity they want to process and store their core
15 credentials data; however, such data shall at all times be
16 maintained by the department. An applicant may choose not to
17 designate a credentials verification entity, provided the
18 applicant has a written agreement with the health care entity
19 or entities that are responsible for his or her credentialing.
20 In addition, any licensee may choose to move his or her core
21 credentials data from one credentials verification entity to
22 another.
23 (g) Any health care entity that employs, contracts
24 with, or allows health care practitioners to treat its
25 patients must use the designated credentials verification
26 entity to obtain core credentials data on a health care
27 practitioner applying for privileges with that entity, if the
28 health care practitioner has made such a designation, or may
29 use the division in lieu thereof as the designated credentials
30 verification entity required for obtaining core credentials
31 data on such health care practitioner. Any additional
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1 information required by the health care entity's credentialing
2 process may be collected from the primary source of that
3 information either by the health care entity or its contractee
4 or by the designated credentials verification entity.
5 (h) Nothing in this section may be construed to
6 restrict the right of any health care entity to request
7 additional information necessary for credentialing.
8 (i) Nothing in this section may be construed to
9 restrict access to the National Practitioner Data Bank by the
10 department, any health care entity, or any credentials
11 verification entity.
12 (d)(j) Nothing in This section shall not may be
13 construed to restrict in any way the authority of the health
14 care entity to credential and to approve or deny an
15 application for hospital staff membership, clinical
16 privileges, or managed care network participation.
17 (4) DELEGATION BY CONTRACT.--A health care entity may
18 contract with any credentials verification entity to perform
19 the functions required under this section. The submission of
20 an application for health care privileges with a health care
21 entity shall constitute authorization for the health care
22 entity to access the applicant's core credentials data with
23 the department or the applicant's designated credentials
24 verification entity, if the applicant has made such a
25 designation.
26 (5) AVAILABILITY OF DATA COLLECTED.--
27 (a) The department shall make available to a health
28 care entity or credentials verification entity registered with
29 the department all core credentials data it collects on any
30 licensee that is otherwise confidential and exempt from the
31 provisions of chapter 119 and s. 24(a), Art. I of the State
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1 Constitution, including corrections, updates, and
2 modifications thereto, if a health care entity submits proof
3 of the licensee's current pending application for purposes of
4 credentialing the applicant based on the core credentials data
5 maintained by the department.
6 (b) Each credentials verification entity shall make
7 available to a health care entity the licensee has authorized
8 to receive the data, and to the department at the credentials
9 verification entity's actual cost of providing the data, all
10 core credentials data it collects on any licensee, including
11 all corrections, updates, and modifications thereto.
12 (c) The department shall charge health care entities
13 and other credentials verification entities a reasonable fee,
14 pursuant to the requirements of chapter 119, to access all
15 credentialing data it maintains on applicants and licensees.
16 The fee shall be set in consultation with the advisory council
17 and may not exceed the actual cost of providing the data.
18 (4)(6) DUPLICATION OF DATA PROHIBITED.--
19 (a) A health care entity or credentials verification
20 organization is prohibited from collecting or attempting may
21 not collect or attempt to collect duplicate core credentials
22 data from any individual health care practitioner or from any
23 primary source if the information is available from already on
24 file with the department or with any credentials verification
25 entity. This section shall not be construed to restrict the
26 right of any health care entity or credentials verification
27 organization to collect additional information from the health
28 care practitioner which is not included in the core
29 credentials data file. This section shall not be construed to
30 prohibit a health care entity or credentials verification
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1 organization from obtaining all necessary attestation and
2 release form signatures and dates.
3 (b) Effective July 1, 2002, a state agency in this
4 state which credentials health care practitioners may not
5 collect or attempt to collect duplicate core credentials data
6 from any individual health care practitioner if the
7 information is already available from the department. This
8 section shall not be construed to restrict the right of any
9 such state agency to request additional information not
10 included in the core credential data file, but which is deemed
11 necessary for the agency's specific credentialing purposes.
12 (b) A credentials verification entity other than the
13 department may not attempt to collect duplicate core
14 credentials data from any individual health care practitioner
15 if the information is already on file with another credentials
16 verification entity or with the appropriate licensing board of
17 another state, provided the other state's credentialing
18 program meets national standards and is certified or
19 accredited, as outlined by national accrediting organizations,
20 and agrees to provide all data collected under such program on
21 that health care practitioner.
22 (7) RELIABILITY OF DATA.--Any credentials verification
23 entity may rely upon core credentials data, including all
24 corrections, updates, and modifications thereto, from the
25 department if the department certifies that the information
26 was obtained in accordance with primary source verification
27 procedures; and the department may rely upon core credentials
28 data, including all corrections, updates, and modifications
29 thereto, from any credentials verification entity if the
30 designated credentials verification entity certifies that the
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1 information was obtained in accordance with primary source
2 verification procedures.
3 (5)(8) STANDARDS AND REGISTRATION.--
4 (a) The department's credentials verification
5 procedures must meet national standards, as outlined by
6 national accrediting organizations.
7 (b) Any credentials verification organization entity
8 that does business in this state Florida must be fully
9 accredited or certified as a credentials verification
10 organization meet national standards, as outlined by a
11 national accrediting organization as specified in paragraph
12 (2)(b) organizations, and must register with the department.
13 The department may charge a reasonable registration fee, set
14 in consultation with the advisory council, not to exceed an
15 amount sufficient to cover its actual expenses in providing
16 and enforcing for such registration. The department shall
17 establish by rule for biennial renewal of such registration.
18 Failure by a registered Any credentials verification
19 organization to maintain full accreditation or certification,
20 to provide data as authorized by the health care practitioner,
21 to report to the department changes, updates, and
22 modifications to a health care practitioner's records within
23 the time period specified in subparagraph (3)(a)2., or to
24 comply with the prohibition against collection of duplicate
25 core credentials data from a practitioner may result in denial
26 of an application for renewal of registration or in revocation
27 or suspension of a registration entity that fails to meet the
28 standards required to be certified or accredited, fails to
29 register with the department, or fails to provide data
30 collected on a health care practitioner may not be selected as
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1 the designated credentials verification entity for any health
2 care practitioner.
3 (6)(9) LIABILITY.--No civil, criminal, or
4 administrative action may be instituted, and there shall be no
5 liability, against any registered credentials verification
6 organization or health care entity on account of its reliance
7 on any data obtained directly from the department a
8 credentials verification entity.
9 (10) REVIEW.--Before releasing a health care
10 practitioner's core credentials data from its data bank, a
11 designated credentials verification entity other than the
12 department must provide the practitioner up to 30 days to
13 review such data and make any corrections of fact.
14 (11) VALIDATION OF CREDENTIALS.--Except as otherwise
15 acceptable to the health care entity and applicable certifying
16 or accrediting organization listed in paragraph (2)(c), the
17 department and all credentials verification entities must
18 perform primary source verification of all credentialing
19 information submitted to them pursuant to this section;
20 however, secondary source verification may be utilized if
21 there is a documented attempt to contact primary sources. The
22 validation procedures used by the department and credentials
23 verification entities must meet the standards established by
24 rule pursuant to this section.
25 (7)(12) LIABILITY INSURANCE REQUIREMENTS.--The
26 department, in consultation with the Credentials Verification
27 Advisory Council, shall establish the minimum liability
28 insurance requirements for Each credentials verification
29 organization entity doing business in this state shall
30 maintain liability insurance appropriate to meet the
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1 certification or accreditation requirements established in
2 this section.
3 (8)(13) RULES.--The department, in consultation with
4 the advisory council applicable board, shall adopt rules
5 necessary to develop and implement the standardized core
6 credentials data collection verification program established
7 by this section.
8 (9) COUNCIL ABOLISHED; DEPARTMENT AUTHORITY.--The
9 council shall be abolished October 1, 1999. After the council
10 is abolished, all duties of the department required under this
11 section to be in consultation with the council may be carried
12 out by the department on its own.
13 Section 2. This act shall take effect upon becoming a
14 law.
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