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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                                      HB 1881, First Engrossed/ntc



  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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                                      HB 1881, First Engrossed/ntc



  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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                                      HB 1881, First Engrossed/ntc



  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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                                      HB 1881, First Engrossed/ntc



  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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                                      HB 1881, First Engrossed/ntc



  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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                                      HB 1881, First Engrossed/ntc



  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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                                      HB 1881, First Engrossed/ntc



  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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                                      HB 1881, First Engrossed/ntc



  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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                                      HB 1881, First Engrossed/ntc



  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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                                      HB 1881, First Engrossed/ntc



  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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