Reporting State Licensure and Certification Actions

State licensing and certification authorities must report to the NPDB certain actions (referred to as state licensure and certification actions) taken against health care practitioners, entities, providers, or suppliers. The term state licensing and certification authority includes, but is not limited to, any authority of a state or political subdivision that is responsible for the licensing or certification of health care practitioners (or of peer review organizations or private accreditation entities reviewing the services provided by health care practitioners), health care entities, providers, or suppliers. Reported actions must be as a result of formal proceedings.

Actions that must be reported include:

• Any adverse action taken by the state licensing or certification authority as a result of a formal proceeding, including: revocation or suspension of a license, certification agreement, or contract for participation in a government health care program; reprimand; censure; or probation.
• Any dismissal or closure of a formal proceeding because the health care practitioner, entity, provider, or supplier surrendered the license, certification agreement, or contract for participation in a government health care program, or because the subject of the proceeding left the state or jurisdiction.
• Any other loss of license or loss of certification agreement or contract for participation in a government health care program, or the right to apply for, or renew, a license or certification agreement or contract of the health care practitioner, entity, provider or supplier, whether by operation of law, voluntary surrender, nonrenewal (excluding nonrenewals due to nonpayment of fees, retirement, or change to inactive status), or otherwise.
• Any negative action or finding by the state licensing or certification authority that, under the state's law, is publicly available information, including, but not limited to, limitations on the scope of practice, liquidations, injunctions, and forfeitures. This definition also includes final adverse actions rendered by a state licensing or certification authority - such as exclusions, revocations, or suspension of license or certification - that occur in conjunction with settlements in which no finding of liability has been made (although such a settlement itself is not reportable). This definition excludes administrative fines or citations and corrective action plans and other personnel actions, unless:
  • the underlying activity is connected to the delivery of health care services,
    or
  • the action is taken in conjunction with other adverse licensure or certification actions, such as revocation, suspension, censure, reprimand, probation, or surrender.

When a license, agreement, or contract is suspended, the length of the suspension must be reported also.

State licensing and certification authorities also must report any revisions to a previously reported licensing or certification action, such as a reinstatement of a suspended license, and whether an action is on appeal. For more information, go to Types of Reports in this chapter.

An action must be reported to the NPDB based on whether it satisfies NPDB reporting requirements and not based on the name affixed to the action by the reporting entity.

Table E-9 outlines reporting obligations for state licensure and certification actions.

Formal Proceeding

State licensing and certification actions reported pursuant to Section 1921 must be the result of formal proceedings. In this context, a formal proceeding is one that is conducted by a state licensing or certification authority that maintains defined rules, policies, or procedures for such a proceeding. The definition of formal proceedings is written broadly to include formal hearings as well as other processes that follow defined rules, policies, or procedures. In determining whether a process meets this definition, the NPDB is only concerned with the presence of defined rules, policies, or procedures and not whether the rules, policies, or procedures have been strictly adhered to.

Certification

In the NPDB regulations, the term "certification" has two distinct meanings. First, the term is related to licensure, because licensure includes certification and other forms of authorization to provide health care services. Based on state laws and requirements, states may "license," "certify," or "register" certain types of health care practitioners, entities, providers, or suppliers.

Second, the term also is used to refer to certification of a health care practitioner, entity, provider, or supplier to participate in a government health care program. In this context, certification includes certification agreements and contracts for participation in a government health care program.

Administrative Fines and Formal Money Penalties

State licensing and certification authorities must report to the NPDB all money penalties and administrative fines that are adverse actions resulting from a formal proceeding (e.g., formal disciplinary actions) against health care practitioners, entities, providers, and suppliers.

However, fines that are considered administrative or technical in nature must be reported to the NPDB only if they meet the NPDB definition of negative actions or findings. First, these types of administrative fines must be publicly available information. In addition, administrative fines reported as negative actions or findings must be either:

• Connected to the delivery of health care services, or
• Taken in conjunction with other adverse licensure or certification actions, such as revocation, suspension, censure, reprimand, probation, or surrender.

Generally, each reporting entity determines whether the action is connected to the delivery of health care services.

An action must be reported to the NPDB based on whether it satisfies NPDB reporting requirements and not based on the name affixed to the action.

Publicly Available Information

Publicly available information means that information is accessible to the interested public, and this can occur in a variety of ways, including, but not limited to, phone, writing, electronic media (e.g., website or portal), or other media available for general distribution to any member of the public.

Stayed Actions

A licensure or certification action imposed with a stay should not be reported to the NPDB as long as the entire action is stayed. In instances where only part of the action is stayed, the part of the action that is not stayed must be reported. For example, if a practitioner's license is placed on probation for 6 months, but 4 months are stayed, the remaining 2 months of the probation must be reported.

In addition, if a stayed action is accompanied by another reportable action, the reportable action that accompanied the stayed action must be reported. For example, a practitioner's license is suspended for 6 months, the suspension is stayed, and the practitioner is placed on probation with terms and conditions for 1 year. The suspension should not be reported to the NPDB because it was stayed, but the probation must be reported to the NPDB.

Summary or Emergency Suspensions and Other Nonfinal Actions

The requirements for reporting state licensure and certification actions are not limited to final actions. Interim or nonfinal adverse actions taken by a state licensing or certification authority also must be reported to the NPDB. Examples of such actions include a state licensing board's summary or emergency suspension of a license, or a health care practitioner's voluntary agreement to refrain from practice pending completion of a state licensing board investigation. Once a final action is taken that supersedes or modifies the initial action, the state licensing or certification authority must submit a Revision-to-Action Report.

Denials of Initial and Renewal Applications

State licensing and certification authorities must report to the NPDB denials of initial and renewal applications for licensure or certification for health care practitioners, entities, providers, or suppliers if they are adverse actions resulting from formal proceedings. For example, if, after a formal proceeding, a state licensing board denies a practitioner's initial licensure application because the applicant misrepresented credentials, that is reportable.

However, state licensing or certification authorities should not report cases in which a health care practitioner, entity, provider, or supplier simply does not meet the threshold criteria for licensure or certification. For example, if a state licensing board determines that an applicant failed to meet the education requirements or failed to pass a required exam and denies the applicant's license, the state licensing board should not report that action.

Withdrawals of Initial and Renewal Applications While Under Investigation, and Failure to Renew While Under Investigation

Investigations should not be reported to the NPDB. However, withdrawal of a renewal application for licensure or certification, or failure to renew, while the state licensure or certification authority is investigating the applicant is reportable. In addition, an applicant's withdrawal, for any reason, of an initial application for licensure or certification is not reportable, even if the applicant is under investigation.

The NPDB interprets the word "investigation" expansively, although the investigation must be focused on a specific individual or entity. For example, if a state licensing board routinely runs a criminal background check on all applicants for license renewal, that is not considered an investigation. If, as a result of the routine check, the board decides to further examine a specific applicant's record, that examination is considered an investigation. The NPDB retains the ultimate authority to determine whether an investigation exists.

The NPDB considers an investigation to run from the start of an inquiry until a final decision is reached. In other words, an investigation is not limited to a state licensure or certification authority's gathering of facts or by the manner in which the state licensing or certification authority defines the term "investigation." An investigation begins as soon as the state licensure or certification authority begins a nonroutine inquiry and does not end until the authority's decision-making body takes a final action or makes a decision not to further pursue the matter.

A licensure or certification authority that submits a report based on a withdrawal of a renewal application while the applicant is under investigation should have evidence of an ongoing investigation at the time of withdrawal. Examples of acceptable evidence may include minutes or excerpts from committee meetings, orders from licensing or certification officials directing an investigation, or notices to renewal applicants of an investigation. (The licensure or certification authority must be able to show that the practitioner was notified of the investigation, although actual knowledge of the investigation on the part of the practitioner is not required.)

Guidelines for Investigations

• For NPDB reporting purposes, the term "investigation" is not controlled by how that term may be defined by a licensing or certification authority's policies and procedures.
• A routine review of a particular practitioner is not an investigation.
• The investigation must be focused on the practitioner in question.
• To be considered an investigation for purposes of determining whether an activity is reportable, the activity generally should be the precursor to a licensure or certification action.
• An investigation is considered ongoing until the licensing or certification authority's decision-making authority takes a final action or formally closes the investigation.

Voluntary Surrenders

State licensing and certification authorities are required to report voluntary surrenders of a license or certification agreement or contract for participation in a government health care program by a health care practitioner, entity, provider, or supplier. NPDB regulations define a voluntary surrender of a license or certification as "a surrender made after a notification of investigation or a formal official request by a federal or state licensing or certification authority for a health care practitioner, health care entity, provider, or supplier to surrender the license or certification (including certification agreements or contracts for participation in federal or state health care programs). The definition also includes those instances where a health care practitioner, health care entity, provider, or supplier voluntarily surrenders a license or certification (including program participation agreements or contracts) in exchange for a decision by the licensing or certification authority to cease an investigation or similar proceeding, or in return for not conducting an investigation or proceeding, or in lieu of a disciplinary action."

The voluntary relinquishment of a practitioner's license for personal reasons such as retirement or illness is not reportable to the NPDB if no other action or investigation is in progress. Only the surrender of the license, while under investigation or in return for not conducting an investigation, is reportable.

Consent Agreements

Any state licensure or certification action that meets NPDB reporting requirements must be reported, regardless of whether the action was imposed through board order, consent agreement, or other method. Thus, even if a consent agreement contains a provision stating that the state licensing authority agrees not to report a practitioner to the NPDB, the provision is immaterial and the consent agreement remains reportable. It is the action itself, rather than the method by which the action was taken, that determines whether the action must be reported. For example, if a state licensing board issues a reprimand through a consent agreement, the reprimand is reportable.

Private Agreements

If a state licensing or certification board takes an adverse action that is the result of a formal proceeding, it is reportable even if the state took the action through a private agreement. Any state board action that meets the definition of an adverse action is reportable. An adverse action must be taken as a result of a formal proceeding, but it need not be publicly available.

States should not use language in private agreements negotiated with providers to avoid NPDB reporting requirements. Reportability is not negotiable, and the NPDB requires reporting of such adverse actions. As always, the goal of the NPDB is to have the most accurate and complete information available to those who query in order to protect patient safety and enhance the quality of health professionals.

Confidentiality Laws Related to Drug and Alcohol Treatment

If a licensure or certification action is taken and the practitioner enters a treatment or rehabilitation program as a result, the adverse action must be reported. This is true even if the treatment is a condition of probation. However, the fact that the practitioner entered a drug or alcohol treatment facility should not be reported.

If a practitioner (or other reportable individual) voluntarily enters a treatment or rehabilitation program at the direction or suggestion of a licensing or certification authority (initiated either by the board or the practitioner) and no action is taken, a report should not be submitted to the NPDB.

Impaired Practitioners

To determine whether actions taken against an impaired practitioner are reportable to the NPDB as adverse actions, the state licensing authority should consider whether the restriction itself meets reporting requirements, regardless of the type of impairment. The impairment can arise as a result of a physical or mental illness, injury, incapacitation, or alcohol or drug abuse.

The board should file an Adverse Action Report under the following circumstances:

• Rather than discipline the practitioner, the board issues an order that includes an agreement that the practitioner will not practice. An enforceable agreement not to practice, signed by the board, is reportable.
• The board takes an adverse licensing or certification action, and the practitioner enters a treatment or rehabilitation program for drug or alcohol abuse as a result. The adverse action must be reported, but the board should not report the fact that the practitioner entered a drug or alcohol treatment program.
• The board allows a practitioner to put his or her license into "inactive status" or to voluntarily agree not to practice while under investigation or in exchange for not conducting an investigation. This is, in effect, a voluntary surrender or resignation of a license that must be reported.

The board should not file an Adverse Action Report under these circumstances:

• The practitioner enters a substance abuse treatment program, and the board knows about it. However, the board does not enter into an agreement with the practitioner that the practitioner not practice while in the program, nor does it take any other action regarding the practitioner.
• The practitioner voluntarily surrenders a license or certification due to personal reasons such as illness, the practitioner is not under investigation when the license or certification is surrendered, and the practitioner does not surrender the license or certification in order to avoid an investigation or discipline.
• The practitioner enters a treatment or rehabilitation program and agrees with the treatment or rehabilitation program not to practice while in the program. There is not a separate written agreement between the practitioner and the board that restricts the practitioner's ability to practice.
• The practitioner voluntarily enters a treatment or rehabilitation program at the direction of or suggestion of the licensing board - initiated either by the board or the practitioner - and the board does not take a formal adverse action.

Nurse Licensure Compact

The NPDB's Nurse Multi-State Privilege Adverse Action Classification Codes were developed to allow the reporting of actions taken against a nurse's privilege to practice under the Nurse Licensure Compact (NLC). The state that issues the license to practice (the nurse's home state or state of residency) should use the State Licensure Actions - Adverse Action Classification Codes for Individual Subjects to report an action it takes against the nurse's license. If the remote state (the state that did not issue the license) takes an action against the nurse's Multi-State Privilege to Practice, it also should submit a separate report of that action using the Nurse Multi-State Privilege Adverse Action Classification Codes. Both the Nurse Multi-State Privilege Adverse Action Classification Codes and the State Licensure Adverse Action Classification Codes are included under the State Licensure Action category.

Sanctions for Failing to Report

If HHS determines that a state licensing or certification authority has substantially failed to report information required to be reported to the NPDB, the name of the entity will be published and made publicly available.

Table E-10 provides guidance on when state licensure and certification actions must be reported to the NPDB. Table E-11 describes which reporting format should be used for reporting state licensing and certification actions.