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Overview Submitting Reports to the NPDB Reporting Medical Malpractice Payments Reporting Adverse Clinical Privileges Actions Reporting Adverse Professional Society Membership Actions Reporting State Licensure and Certification Actions Reporting Federal Licensure and Certification Actions Reporting Peer Review Organization Negative Actions or Findings Reporting Private Accreditation Organizations Negative Actions or Findings Reporting Exclusions from Participation in Federal and State Health Care Programs Reporting Federal or State Health Care-Related Criminal Convictions Reporting Health Care-Related Civil Judgments Reporting Other Adjudicated Actions or Decisions

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 authorities includes, but is not limited to, any authority of a State or of a political subdivision that is responsible for the licensing or certification of health care practitioners (or of any peer review organization or private accreditation entity reviewing the services provided by health care practitioners), health care entities, providers, or suppliers. The actions to be reported 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.

Law Who Reports? What is Reported? Who is Reported?
Title IV State medical and dental boards Certain adverse licensure actions related to professional competence or conduct

(Medical and dental boards that meet their reporting requirements for Section 1921, below, will also meet their requirements to report under Title IV)
Physicians and dentists
Section 1921 State licensing and certification authorities State licensure and certification actions Practitioners, entities, providers, and suppliers

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 of the probation are stayed, the remaining 2 months of the probation must be reported to the NPDB.

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 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.

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 action 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 decisionmaking 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 decisionmaking 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 Agreement

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 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.

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.

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.

Action
Reportable?
A formal adverse action to deny an application for licensure or certification (initial or renewal). Yes
A State licensing board did not grant a license to an applicant who failed to pass the required licensure exam. No
The withdrawal of an initial application for licensure or certification while under investigation. No
The withdrawal, while under investigation, of an application to renew a licensure or certification. Yes
An applicant for an initial State license or for a State license renewal does not meet threshold licensing criteria and withdraws the application. No
A psychologist decides to withdraw a licensure application; the psychologist was not under investigation nor did he withdraw the application to avoid an investigation. No
The non-renewal of a license while under investigation or to avoid an investigation, if the licensee has the option to renew. Yes
A physical therapist decides, for personal reasons, to no longer practice physical therapy and to change her license to inactive status. No
The voluntary relinquishment of a practitioner's license due to retirement. No
A practitioner's surrender of a license in lieu of a disciplinary action. Yes
In lieu of taking a disciplinary action, a State licensing board issues a consent order in which a practitioner agrees not to re-apply for a license in the future. Yes
A State licensing authority censures a health care supplier based on the supplier's failure to report a licensure disciplinary action taken by another licensing authority. Yes
A State licensing board imposes, through an order that is not publicly available, monitoring that does not constitute a restriction on the license of a health care practitioner, entity, provider, or supplier for a specific period of time. No
A civil money penalty imposed by a State licensing or certification authority that is an adverse action resulting from a formal proceeding (e.g., a formal disciplinary action). Yes
A State licensing board imposes an administrative fine that is not a formal adverse action but is publicly available information and is related to the delivery of health care services. Yes
An administrative fine imposed for late payment of a licensure application renewal fee; this action is not a formal adverse action, and the State licensing board does not consider the fine to be connected to the delivery of health care, nor was it taken in conjunction with any other adverse licensure or certification action. No
An administrative fine, taken as a result of a formal proceeding, that is considered to be an adverse action. Yes
A licensure or certification action that is imposed with a "stay"; the entire action was stayed. No
A summary or emergency suspension of a health care practitioner's license, of any length, and any subsequent revision to the action. Yes
A corrective action plan that is imposed in conjunction with a reprimand. Yes
A State licensing or certification action that otherwise must be reported to the NPDB and is part of a consent agreement or settlement. Yes
A reinstatement of a practitioner's license after a previously reported indefinite suspension of the license. Yes
A cease and desist order, citation, or letter issued by a State licensing board against an unlicensed individual who holds himself or herself out to be licensed or otherwise authorized by the State to provide health care services. Yes
A finding entered into a State's nurse aide registry concerning abuse, neglect, or mistreatment of residents, or misappropriation of their property, which disqualifies the nurse aide from employment in the State's skilled nursing facilities. Yes
Based on findings that a nursing facility violated Medicare and Medicaid participation requirements, a State survey and certification agency imposes a formal money penalty and requires on-site monitoring. Yes
A State Medicaid agency's termination of a health care provider's contract, for repeated noncompliance with participation requirements, for participation in the State's Medicaid program. Yes
Type of Action
NPDB Reporting Format
Actions taken with respect to licensure, certification, registration, or other authorization by the State to provide health care services State Licensure Action category on the Adverse Action Report format
Actions taken with respect to certification agreements or contracts for participation in Government health care programs Government Administrative Action category on the Adverse Action Report format

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.

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