HF 952

as introduced - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health; creating the ability for health 
  1.3             care providers to designate a credentials verification 
  1.4             entity; proposing coding for new law as Minnesota 
  1.5             Statutes, chapter 145D. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7               CREDENTIALING FOR HEALTH CARE PROVIDERS
  1.8      Section 1.  [145D.01] [DEFINITIONS.] 
  1.9      For purposes of this chapter, the following terms have the 
  1.10  meanings given to them. 
  1.11     Subdivision 1.  [CERTIFIED.] "Certified" means officially 
  1.12  approved by a national accrediting organization.  
  1.13     Subd. 2.  [CORE CREDENTIALS DATA.] "Core credentials data" 
  1.14  means any professional education; professional training; peer 
  1.15  references; licensure; registration; certification; Drug 
  1.16  Enforcement Administration certification; social security 
  1.17  number; board certification; Education Commission for Foreign 
  1.18  Medical Graduates information; hospital affiliations; managed 
  1.19  care organization affiliations; other institutional 
  1.20  affiliations; professional society memberships; professional 
  1.21  liability insurance; claims, suits, judgments, or settlements; 
  1.22  Medicare or Medicaid sanctions; civil or criminal law 
  1.23  violations; or special conditions of impairment.  
  1.24     Subd. 3.  [CREDENTIALING.] "Credentialing" means the 
  1.25  process of collecting and verifying the information used to 
  2.1   determine the qualifications of a health care provider.  
  2.2      Subd. 4.  [CREDENTIALS VERIFICATION ENTITY.] "Credentials 
  2.3   verification entity" means any program, entity, or organization 
  2.4   that is certified for the express purpose of collecting, 
  2.5   verifying, maintaining, storing, and providing to health care 
  2.6   entities a health care provider's core credentials data, 
  2.7   including all corrections, updates, and modifications, as 
  2.8   authorized by the health care provider and in accordance with 
  2.9   the provisions of this chapter.  
  2.10     Subd. 5.  [COMMISSIONER.] "Commissioner" means the 
  2.11  commissioner of health. 
  2.12     Subd. 6.  [DESIGNATED CREDENTIALS VERIFICATION 
  2.13  ENTITY.] "Designated credentials verification entity" means the 
  2.14  credentials verification entity that is designated by the health 
  2.15  care provider to collect the provider's core credentials data. 
  2.16     Subd. 7.  [HEALTH CARE ENTITY.] "Health care entity" means: 
  2.17     (1) a health care facility licensed under chapter 144 or 
  2.18  144A; or 
  2.19     (2) a health plan company as defined in section 62Q.01, 
  2.20  subdivision 4. 
  2.21     Subd. 8. [HEALTH CARE PROVIDER.] "Health care provider" 
  2.22  means any person licensed, certified, or registered under 
  2.23  chapter 144A; 147; 147A; 147B; 147C; 148; 148B; 148C; 150A; 151; 
  2.24  153; or 153A or any person licensed, certified, or registered 
  2.25  under a chapter subsequently made subject to this chapter by the 
  2.26  commissioner with the approval of the applicable board. 
  2.27     Subd. 9.  [HEALTH-RELATED LICENSING BOARD.] "Health-related 
  2.28  licensing board" has the meaning given in section 214.01, 
  2.29  subdivision 2. 
  2.30     Subd. 10.  [NATIONAL ACCREDITING ORGANIZATION.] "National 
  2.31  accrediting organization" means an organization that awards 
  2.32  accreditation or certification to hospitals, managed care 
  2.33  organizations, or other health care entities, including, but not 
  2.34  limited to, the Joint Commission on Accreditation of Healthcare 
  2.35  Organizations and the National Committee for Quality Assurance. 
  2.36     Subd. 11.  [PRIMARY SOURCE VERIFICATION.] "Primary source 
  3.1   verification" means verification of professional qualifications 
  3.2   based on evidence obtained directly from the issuing source of 
  3.3   the applicable qualification. 
  3.4      Subd. 12.  [RECREDENTIALING.] "Recredentialing" means the 
  3.5   process by which a credentials verification entity verifies the 
  3.6   credentials of a health care provider whose core credentials 
  3.7   data, including all corrections, updates, and modifications, are 
  3.8   currently on file with the entity. 
  3.9      Subd. 13.  [SECONDARY SOURCE VERIFICATION.] "Secondary 
  3.10  source verification" means confirmation of a professional 
  3.11  qualification by means other than primary source verification, 
  3.12  as outlined and approved by a national accrediting organization. 
  3.13     Sec. 2.  [145D.02] [DESIGNATED CREDENTIALS VERIFICATION 
  3.14  ENTITY.] 
  3.15     Subdivision 1.  [DESIGNATION.] A health care provider may 
  3.16  designate a credentials verification entity to collect, verify, 
  3.17  maintain, store, and provide to a health care entity, a 
  3.18  health-related licensing board, or the commissioner the health 
  3.19  care provider's core credentials data.  Once the core 
  3.20  credentials data are submitted to the credentials verification 
  3.21  entity, the provider is not required to resubmit this initial 
  3.22  data to a health care entity when applying for practice 
  3.23  privileges or participating provider status.  As provided in 
  3.24  subdivision 2, each health care provider is responsible for 
  3.25  providing any corrections, updates, and modifications to the 
  3.26  provider's core credentials data, to ensure that all 
  3.27  credentialing data on the provider remain current.  Nothing in 
  3.28  this section shall be construed to prevent the designated 
  3.29  credentials verification entity from obtaining all necessary 
  3.30  attestation and release form signatures and dates.  
  3.31     Subd. 2.  [REPORTING CORE CREDENTIALS DATA.] Each health 
  3.32  care provider is responsible for reporting core credentials 
  3.33  data, including any correction, update, or modification, to the 
  3.34  the provider's designated credentials verification entity as 
  3.35  soon as possible but not later than 30 days after such action 
  3.36  occurs or such information is known.  In addition, a health care 
  4.1   provider is responsible to update, at least quarterly, the 
  4.2   provider's data on a form prescribed by the credentials 
  4.3   verification entity.  
  4.4      Subd. 3.  [USE OF THE DESIGNATED CREDENTIALS VERIFICATION 
  4.5   ENTITY.] Any health care entity that employs, contracts with, or 
  4.6   allows health care providers to treat its patients must use the 
  4.7   designated credentials verification entity to obtain core 
  4.8   credentials data on a health care provider applying for 
  4.9   privileges or participating provider status with that entity, if 
  4.10  the health care provider has made such a designation.  Any 
  4.11  additional information required by the health care entity's 
  4.12  credentialing process may be collected from the primary source 
  4.13  of that information either by the health care entity or its 
  4.14  contractee or by the designated credentials verification entity. 
  4.15     Subd. 4.  [ADDITIONAL CREDENTIALING INFORMATION.] Nothing 
  4.16  in this chapter shall be construed to restrict the right of any 
  4.17  health care entity to request additional information necessary 
  4.18  for credentialing.  
  4.19     Subd. 5.  [ACCESS TO NATIONAL PRACTITIONER DATA 
  4.20  BANK.] Nothing in this chapter shall be construed to restrict 
  4.21  access to the National Practitioner Data Bank by the 
  4.22  commissioner, a health-related licensing board, a health care 
  4.23  entity, or a credentials verification entity. 
  4.24     Sec. 3.  [145D.03] [DUPLICATION OF DATA PROHIBITED.] 
  4.25     Subdivision 1.  [PROHIBITION ON A HEALTH CARE ENTITY.] A 
  4.26  health care entity shall not collect or attempt to collect 
  4.27  duplicate core credentials data from a health care provider or 
  4.28  from any primary source if the health care provider has a 
  4.29  certified designated credentials verification entity and the 
  4.30  designation has been communicated to the health care entity.  
  4.31     Subd. 2.  [PROHIBITION ON A CREDENTIALS VERIFICATION 
  4.32  ENTITY.] A credentials verification entity shall not attempt to 
  4.33  collect duplicate core credentials data from a health care 
  4.34  provider or from any primary source if the information is 
  4.35  already on file with another credentials verification entity 
  4.36  that has been designated by the provider as the provider's 
  5.1   designated credentials verification entity, unless authorized by 
  5.2   the health care provider.  
  5.3      Sec. 4.  [145D.04] [AVAILABILITY OF DATA COLLECTED.] 
  5.4      Subdivision 1.  [DATA COLLECTED BY A CREDENTIALS 
  5.5   VERIFICATION ENTITY.] A credentials verification entity shall 
  5.6   make available, upon request, to a health care entity, the 
  5.7   commissioner, or a health-related licensing board all core 
  5.8   credentials data it collects on any health care provider, 
  5.9   including all corrections, updates, and modifications. 
  5.10     Subd. 2.  [FEES.] A credentials verification entity may 
  5.11  charge a reasonable fee to access all credentialing data 
  5.12  maintained by the entity.  The fee must not exceed the health 
  5.13  care entity's actual cost of collecting and verifying the data.  
  5.14     Sec. 5.  [145D.05] [STANDARDS.] 
  5.15     Any credentials verification entity that does business in 
  5.16  this state must meet national standards, as outlined and 
  5.17  approved by a national accrediting organization. 
  5.18     Sec. 6.  [145D.06] [RECREDENTIALING.] 
  5.19     A health care entity shall not require a health care 
  5.20  provider who already has privileges with that entity to undergo 
  5.21  recredentialing solely because the health care provider has 
  5.22  changed practice location or affiliation. 
  5.23     Sec. 7.  [145D.07] [REIMBURSEMENT.] 
  5.24     A health care entity shall not deny reimbursement for 
  5.25  health care services provided by a health care provider whose 
  5.26  core credentials have been verified by a certified credentials 
  5.27  verification entity for the sole reason that the provider is in 
  5.28  the process of being recredentialed. 
  5.29     Sec. 8.  [145D.08] [LIABILITY.] 
  5.30     No civil, criminal, or administrative action may be 
  5.31  instituted, and there shall be no liability against any health 
  5.32  care entity on account of its reliance on any data obtained from 
  5.33  a credentials verification entity that meets the requirements of 
  5.34  this chapter.