Expansion of the National Practitioner Data Bank
Effective March 1, 2010, the National Practitioner Data Bank (NPDB) is expanded through the implementation of Section 1921 of the Social Security Act. Section 1921 expands the NPDB by including adverse licensure information on all licensed health care practitioners and health care entities. It will also have certain final actions or recommendations to sanction that have been taken by Private Accreditation Entities and Peer Review Organizations.
Role of the Data Banks
The role of the Data Banks has not changed. The information maintained in the Data Banks is designed to augment and/or verify other sources of information. Information in the Data Banks should not be used as the sole source of verification of the professional credentials of a practitioner, provider, entity, or supplier. The accuracy, completeness, and timeliness of the information contained in the Data Banks are dependent upon states and other reporters fulfilling their statutory duty to report.
Important Note
The Health Resources and Services Administration (HRSA) is currently reviewing the completeness and accuracy of state licensure information contained in the Data Banks. HRSA’s initial review of state licensure reports of actions against nurses and nursing-related practitioners listed on State Board web sites reveals some gaps between final adverse actions taken by certain State Boards of Nursing and the reports contained in the Healthcare Integrity and Protection Data Bank (HIPDB) and now in the NPDB under Section 1921.
HRSA’s review of Data Bank reports with state licensing boards is continuing, and updated information on the completeness of reporting will be provided at http://www.npdb-hipdb.hrsa.gov on a regular basis.
- HRSA is also providing technical assistance to the states to assist in obtaining any identified missing reports.
- On July 1, 2010, a list of Government agencies that have failed to meet the Data Bank statutory reporting requirements will be published on this site.
Available Data
On March 1, 2010, when a hospital or other current querier accesses the National Practitioner Data Bank they will continue to receive the previously available reports.
The reporting requirements for the following actions and the access to this information are not affected by the implementation of Section 1921:
- Medical Malpractice Payment Reports - required for malpractice payments for the benefit of physicians, dentists, and other licensed health care practitioners;
- Adverse Clinical Privilege and Professional Society Reports - required for physicians and dentists, although other practitioners may be reported;
- Adverse Licensure Action Reports - required for physicians and dentists; and
- Medicare and Medicaid Exclusions - for physicians, dentists and other licensed health care practitioners.
Expanded Data
Additionally, effective March 1, 2010, current NPDB queriers will have immediate access to the following additional information:
- Adverse Licensure Reports that meet Section 1921 requirements:
- With the permission of the state agency that reported the action, all adverse licensure actions taken against health care practitioners and entities reported to the HIPDB as of February 28, 2010, have been placed in the NPDB under Section 1921.
Note: As of March 29, 2010, all state agencies have granted permission to copy data from the HIPDB into the NPDB.
- Beginning March 1, 2010, all newly reported adverse licensure actions will be placed in BOTH the NPDB under Section 1921 and the HIPDB.
- The following actions become reportable to NPDB under Section 1921 and they will be available to current NPDB queriers as soon as they are reported:
- Certain final actions taken by Private Accreditation Entities against health care entities and recommendations to sanction taken by Peer Review Organizations against health care practitioners. For purposes of reporting under Section 1921, the term “peer review organization” only includes stand-alone organizations and does not include the internal peer review committees of hospitals, professional societies, or other health care entities.
Expanded Queriers Added under Section 1921
Beginning March 1, 2010, the following organizations have access to only: 1) Section 1921 adverse licensure actions; 2) the Private Accreditation Organization; and, 3) Peer Review Organization reports:
- Agencies administering Federal health care programs or their contractors;
- State agencies administering State health care programs;
- Quality Improvement Organizations;
- State Medicaid Fraud Control Units;
- U.S. Comptroller General; and
- U.S. Attorney General and other law enforcement.