House Bill 4515
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Florida House of Representatives - 1998 HB 4515
By the Committee on Health Care Standards & Regulatory
Reform and Representatives Jones and Brooks
1 A bill to be entitled
2 An act relating to health care practitioners;
3 creating s. 455.557, F.S.; providing for
4 standardized credentialing of health care
5 practitioners; providing intent and
6 definitions; providing for a standardized
7 credentials verification program; providing for
8 delegation of credentialing authority by
9 contract; providing for availability of data
10 collected; prohibiting collection of duplicate
11 data; specifying conditions for reliability of
12 data; providing for standards and registration,
13 including a registration fee; preserving health
14 care entities from liability and certain
15 actions for reliance on data provided by a
16 credentials verification entity; providing for
17 practitioner review of data prior to release;
18 providing for validation of credentials;
19 providing liability insurance requirements;
20 providing for rules; providing for
21 reappointment of a task force and providing its
22 purpose; providing an effective date.
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24 Be It Enacted by the Legislature of the State of Florida:
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26 Section 1. Section 455.557, Florida Statutes, is
27 created 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 verification program be established which provides that, once
11 a health care practitioner's core credentials data are
12 collected, validated, maintained, and stored, they need never
13 be collected again. Mandatory credentialing under this section
14 shall initially include those individuals licensed under
15 chapter 458, chapter 459, chapter 460, or chapter 461.
16 However, the department shall, with the approval of the
17 applicable board, include other professions under the
18 jurisdiction of the Division of Medical Quality Assurance in
19 this credentialing program, provided they meet the
20 requirements of s. 455.565.
21 (2) DEFINITIONS.--As used in this section, the term:
22 (a) "Advisory council" or "council" means the
23 Credentials Verification Advisory Council.
24 (b) "Certified" means approved by a quality assessment
25 program, from the National Committee for Quality Assurance,
26 the Joint Commission on Accreditation of Healthcare
27 Organizations, or any such other national accreditation
28 organization authorized by the department, used to assess and
29 certify any credentials verification program, entity, or
30 organization that verifies the credentials of any health care
31 practitioner.
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1 (c) "Core credentials data" means any professional
2 education, professional training, peer references, licensure,
3 Drug Enforcement Administration certification, social security
4 number, board certification, Educational Commission for
5 Foreign Medical Graduates information, hospital affiliations,
6 managed care organization affiliations, other institutional
7 affiliations, professional society memberships, professional
8 liability insurance, claims, suits, judgments, or settlements,
9 Medicare or Medicaid sanctions, civil or criminal law
10 violations, practitioner profiling data, special conditions of
11 impairment, or regulatory exemptions not previously reported
12 to the department in accordance with both s. 455.565 and the
13 initial licensure reporting requirements specified in the
14 applicable practice act.
15 (d) "Credentialing" means the process of assessing and
16 validating the qualifications of a licensed health care
17 practitioner.
18 (e) "Credentials verification entity" means any
19 program, entity, or organization that is organized and
20 certified for the express purpose of collecting, verifying,
21 maintaining, storing, and providing to health care entities a
22 health care practitioner's total core credentials data,
23 including all corrections, updates, and modifications thereto,
24 as authorized by the health care practitioner and in
25 accordance with the provisions of this section. The division,
26 once certified, shall be considered a credentials verification
27 entity for all health care practitioners.
28 (f) "Department" means the Department of Health.
29 (g) "Designated credentials verification entity" means
30 the program, entity, or organization organized and certified
31 for the express purpose of collecting, verifying, maintaining,
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1 storing, and providing to health care entities a health care
2 practitioner's total core credentials data, including all
3 corrections, updates, and modifications thereto, which is
4 selected by the health care practitioner as the credentials
5 verification entity for all inquiries into his or her
6 credentials, if the health care practitioner chooses to make
7 such a designation. Notwithstanding any such designation by a
8 health care practitioner, the division shall also be
9 considered a designated credentials verification entity for
10 that health care practitioner.
11 (h) "Division" means the Division of Medical Quality
12 Assurance within the Department of Health.
13 (i) "Health care entity" means:
14 1. Any health care facility or other health care
15 organization licensed or certified to provide approved medical
16 and allied health services in Florida; or
17 2. Any entity licensed by the Department of Insurance
18 as a prepaid health care plan or health maintenance
19 organization or as an insurer to provide coverage for health
20 care services through a network of providers.
21 (j) "Health care practitioner" means any person
22 licensed under chapter 458, chapter 459, chapter 460, or
23 chapter 461 or any person licensed under a chapter
24 subsequently made subject to this section by the department
25 with the approval of the applicable board.
26 (k) "National accrediting organization" means an
27 organization that awards accreditation or certification to
28 hospitals, managed care organizations, or other health care
29 organizations, including, but not limited to, the Joint
30 Commission on Accreditation of Healthcare Organizations and
31 the National Committee for Quality Assurance.
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1 (l) "Primary source verification" means verification
2 of professional qualifications based on evidence obtained
3 directly from the issuing source of the applicable
4 qualification.
5 (m) "Recredentialing" means the process by which a
6 credentials verification entity verifies the credentials of a
7 health care practitioner whose core credentials data,
8 including all corrections, updates, and modifications thereto,
9 are currently on file with the entity.
10 (n) "Secondary source verification" means confirmation
11 of a professional qualification by means other than primary
12 source verification, as outlined and approved by national
13 accrediting organizations.
14 (3) STANDARDIZED CREDENTIALS VERIFICATION PROGRAM.--
15 (a) In accordance with the provisions of this section,
16 the department shall develop guidelines for the creation of a
17 standardized system, including standardized forms, for
18 collecting, verifying, maintaining, storing, and providing
19 core credentials data on health care practitioners through
20 credentials verification entities, except as otherwise
21 provided in this section, for the purpose of eliminating
22 duplication. Once the core credentials data are submitted, the
23 health care practitioner is not required to resubmit this
24 initial data when applying for practice privileges with health
25 care entities. However, as provided in paragraph (d), each
26 health care practitioner is responsible for providing any
27 corrections, updates, and modifications to his or her core
28 credentials data, to ensure that all credentialing data on the
29 practitioner remains current. Nothing in this paragraph
30 prevents the designated credentials verification entity from
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1 obtaining all necessary attestation and release form
2 signatures and dates.
3 (b) There is established a Credentials Verification
4 Advisory Council, consisting of 13 members, to assist with the
5 development of guidelines for establishment of the
6 standardized credentials verification program. The secretary,
7 or his or her designee, shall serve as one member and chair of
8 the council and shall appoint the remaining 12 members. Except
9 for any initial lesser term required to achieve staggering,
10 such appointments shall be for 4-year staggered terms, with
11 one 4-year reappointment, as applicable. Three members shall
12 represent hospitals, and two members shall represent health
13 maintenance organizations. One member shall represent health
14 insurance entities. One member shall represent the credentials
15 verification industry. Two members shall represent physicians
16 licensed under chapter 458, one member shall represent
17 osteopathic physicians licensed under chapter 459, one member
18 shall represent chiropractic physicians licensed under chapter
19 460, and one member shall represent podiatric physicians
20 licensed under chapter 461.
21 (c) The department, in consultation with the advisory
22 council, shall develop standard forms for the initial
23 reporting of core credentials data for credentialing purposes
24 and for the subsequent reporting of corrections, updates, and
25 modifications thereto for recredentialing purposes.
26 (d) Each health care practitioner licensed under
27 chapter 458, chapter 459, chapter 460, or chapter 461, or any
28 person licensed under a chapter subsequently made subject to
29 this section, must report any action or information as defined
30 in paragraph (2)(c), including any correction, update, or
31 modification thereto, to the department and his or her
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1 designated credentials verification entity, if any, as soon as
2 possible but not later than 30 days after such action occurs
3 or such information is known. In addition, a licensee must
4 update, at least quarterly, his or her data on a form
5 prescribed by the department.
6 (e) An individual applying for licensure under chapter
7 458, chapter 459, chapter 460, or chapter 461, or any person
8 applying for licensure under a chapter subsequently made
9 subject to this section, must submit the individual's initial
10 core credentials data to a credentials verification entity, if
11 such information has not already been submitted to the
12 department or the appropriate licensing board or to any other
13 credentials verification entity. Applicants may decide which
14 credentials verification entity they want to process and store
15 their core credentials data; however, such data shall at all
16 times be maintained by the department. An applicant may choose
17 not to designate a credentials verification entity, provided
18 the applicant has a written agreement with the health care
19 entity or entities that are responsible for his or her
20 credentialing. In addition, any licensee may choose to move
21 his or her core credentials data from one credentials
22 verification entity to another.
23 (f) 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 (g) 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 (h) 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 (4) DELEGATION BY CONTRACT.--A health care entity may
13 contract with any credentials verification entity to perform
14 the functions required under this section. The submission of
15 an application for health care privileges with a health care
16 entity shall constitute authorization for the health care
17 entity to access the applicant's core credentials data with
18 the department or the applicant's designated credentials
19 verification entity, if the applicant has made such a
20 designation.
21 (5) AVAILABILITY OF DATA COLLECTED.--
22 (a) The department shall make available to a health
23 care entity or credentials verification entity all core
24 credentials data it collects on any licensee, including any
25 corrections, updates, and modifications thereto, provided the
26 licensee authorizes the release of the information.
27 (b) Each credentials verification entity shall make
28 available to a health care entity, and to the department at
29 the credentials verification entity's actual cost of providing
30 the data, all core credentials data it collects on any
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1 licensee, including all corrections, updates, and
2 modifications thereto.
3 (c) The department shall charge health care entities
4 and other credentials verification entities a reasonable fee
5 to access all credentialing data it maintains on applicants
6 and licensees. The fee shall be set in consultation with the
7 advisory council and may not exceed the actual cost of
8 providing the data.
9 (6) DUPLICATION OF DATA PROHIBITED.--
10 (a) A health care entity may not collect or attempt to
11 collect duplicate core credentials data from any individual
12 health care practitioner or from any primary source if the
13 information is already on file with the department or with any
14 credentials verification entity.
15 (b) Neither the department nor any credentials
16 verification entity may attempt to collect duplicate core
17 credentials data from any individual health care practitioner
18 or from any primary source other than the department if the
19 information is already on file with another credentials
20 verification entity or with the appropriate licensing board of
21 another state, provided the other state's credentialing
22 program meets national standards and is certified, as outlined
23 by national accrediting organizations, and agrees to provide
24 all data collected under such program on that health care
25 practitioner.
26 (7) RELIABILITY OF DATA.--Any credentials verification
27 entity may rely upon core credentials data, including all
28 corrections, updates, and modifications thereto, from the
29 department if the department certifies that the information
30 was obtained in accordance with certified primary source
31 verification procedures; and the department may rely upon core
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1 credentials data, including all corrections, updates, and
2 modifications thereto, from any credentials verification
3 entity if the designated credentials verification entity
4 certifies that the information was obtained in accordance with
5 certified primary source verification procedures.
6 (8) STANDARDS AND REGISTRATION.--
7 (a) The department's credentials verification
8 procedures must meet national standards, as outlined by
9 national accrediting organizations.
10 (b) Any credentials verification entity that does
11 business in Florida must meet national standards, as outlined
12 by national accrediting organizations, and must register with
13 the department. The department may charge a reasonable
14 registration fee, not to exceed an amount sufficient to cover
15 its actual expenses in providing for such registration. Any
16 credentials verification entity that fails to meet the
17 standards required to be certified, fails to register with the
18 department, or fails to provide data collected on a health
19 care practitioner may not be selected as the designated
20 credentials verification entity for any health care
21 practitioner.
22 (9) LIABILITY.--No civil, criminal, or administrative
23 action may be instituted, and there shall be no liability,
24 against any health care entity on account of its reliance on
25 any data obtained from a credentials verification entity.
26 (10) REVIEW.--Before releasing a health care
27 practitioner's core credentials data from its data bank, a
28 designated credentials verification entity must provide the
29 practitioner up to 30 days to review such data and make any
30 corrections of fact.
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1 (11) VALIDATION OF CREDENTIALS.--The department and
2 all credentials verification entities must perform primary
3 source verification of all credentialing information submitted
4 to them pursuant to this section; however, secondary source
5 verification may be utilized if there is a documented attempt
6 to contact primary sources. The validation procedures used by
7 the department and credentials verification entities must meet
8 the standards established by rule pursuant to this section.
9 (12) LIABILITY INSURANCE REQUIREMENTS.--The
10 department, in consultation with the Credentials Verification
11 Advisory Council, shall establish the minimum liability
12 insurance requirements for each credentials verification
13 entity doing business in this state.
14 (13) RULES.--The department, in consultation with the
15 applicable board, shall adopt rules necessary to develop and
16 implement the standardized credentials verification program
17 established by this section.
18 Section 2. The Secretary of Health shall reappoint the
19 task force appointed under section 103 of chapter 97-261, Laws
20 of Florida. The reappointed task force shall develop
21 procedures to expand the standardized credentialing program
22 under section 455.557, Florida Statutes, as created by this
23 act, to include site visits.
24 Section 3. This act shall take effect July 1, 1999.
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2 HOUSE SUMMARY
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Provides for standardized credentialing of health care
4 practitioners. Provides intent and definitions. Provides
for establishment by the Department of Health, in
5 conjunction with an advisory council, of a standardized
credentials verification program. Provides for delegation
6 of credentialing authority by contract. Provides for
availability of data collected. Prohibits collection of
7 duplicate data. Specifies conditions for reliability of
data. Provides for standards and registration with the
8 department, including a registration fee. Preserves
health care entities from liability and certain actions
9 for reliance on data provided by a credentials
verification entity. Provides for practitioner review of
10 data prior to release. Provides for verification of
credentials. Provides liability insurance requirements.
11 Provides for rules. Provides for reappointment of a task
force to develop procedures to expand the standardized
12 credentialing program to include site visits. See bill
for details.
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