42 USC 1396r-2 - Information concerning sanctions taken by State licensing authorities against health care practitioners and providers

U.S Code last checked for updates: Nov 22, 2024

§ 1396r–2.

Information concerning sanctions taken by State licensing authorities against health care practitioners and providers

(a)

Information reporting requirement

The requirement referred to in section 1396a(a)(49) of this title is that the State must provide for the following:

(1)

Information reporting system

(A)

Licensing or certification actions

The State must have in effect a system of reporting the following information with respect to formal proceedings (as defined by the Secretary in regulations) concluded against a health care practitioner or entity by a State licensing or certification agency:

(i)

Any adverse action taken by such licensing authority as a result of the proceeding, including any revocation or suspension of a license (and the length of any such suspension), reprimand, censure, or probation.

(ii)

Any dismissal or closure of the proceedings by reason of the practitioner or entity surrendering the license or leaving the State or jurisdiction.

(iii)

Any other loss of license or the right to apply for, or renew, a license by the practitioner or entity, whether by operation of law, voluntary surrender, nonrenewability, or otherwise.

(iv)

Any negative action or finding by such authority, organization, or entity regarding the practitioner or entity.

(B)

Other final adverse actions

(2)

Access to documents

(b)

Form of information

The information described in subsection (a)(1) shall be provided to the Secretary (or to an appropriate private or public agency, under suitable arrangements made by the Secretary with respect to receipt, storage, protection of confidentiality, and dissemination of information) in such a form and manner as the Secretary determines to be appropriate in order to provide for activities of the Secretary under this chapter and in order to provide, directly or through suitable arrangements made by the Secretary, information—

(1)

to agencies administering Federal health care programs, including private entities administering such programs under contract,

(2)

to State licensing or certification agencies and Federal agencies responsible for the licensing and certification of health care providers, suppliers, and licensed health care practitioners; 1

 So in original. The semicolon probably should be a comma.

(3)

to State agencies administering or supervising the administration of State health care programs (as defined in section 1320a–7(h) of this title),

(4)

to utilization and quality control peer review organizations 2

 So in original. Probably should be “to quality improvement organizations”.

described in part B of subchapter XI and to appropriate entities with contracts under section 1320c–3(a)(4)(C) 3

 See References in Text note below.

of this title with respect to eligible organizations reviewed under the contracts, but only with respect to information provided pursuant to subsection (a)(1)(A),

(5)

to State law or fraud enforcement agencies,

(6)

to hospitals and other health care entities (as defined in section 431 of the Health Care Quality Improvement Act of 1986 [42 U.S.C. 11151]), with respect to physicians or other licensed health care practitioners that have entered (or may be entering) into an employment or affiliation relationship with, or have applied for clinical privileges or appointments to the medical staff of, such hospitals or other health care entities (and such information shall be deemed to be disclosed pursuant to section 427 [42 U.S.C. 11137] of, and be subject to the provisions of, that Act [42 U.S.C. 11101 et seq.]), but only with respect to information provided pursuant to subsection (a)(1)(A),

(7)

to health plans (as defined in section 1320a–7c(c) of this title); ¹

(8)

to the Attorney General and such other law enforcement officials as the Secretary deems appropriate, and

(9)

upon request, to the Comptroller General,

in order for such authorities to determine the fitness of individuals to provide health care services, to protect the health and safety of individuals receiving health care through such programs, and to protect the fiscal integrity of such programs.

(c)

Confidentiality of information provided

(d)

Disclosure and correction of information

(1)

Disclosure

With respect to information reported pursuant to subsection (a)(1), the Secretary shall—

(A)

provide for disclosure of the information, upon request, to the health care practitioner who, or the entity that, is the subject of the information reported; and

(B)

establish procedures for the case where the health care practitioner or entity disputes the accuracy of the information reported.

(2)

Corrections

(e)

Fees for disclosure

(f)

Protection from liability for reporting

(g)

References

For purposes of this section:

(1)

State licensing or certification agency

(2)

State law or fraud enforcement agency

The term “State law or fraud enforcement agency” includes—

(A)

a State law enforcement agency; and

(B)

a State medicaid fraud control unit (as defined in section 1396b(q) of this title).

(3)

Final adverse action

(A)

In general

Subject to subparagraph (B), the term “final adverse action” includes—

(i)

civil judgments against a health care provider, supplier, or practitioner in State court related to the delivery of a health care item or service;

(ii)

State criminal convictions related to the delivery of a health care item or service;

(iii)

exclusion from participation in State health care programs (as defined in section 1320a–7(h) of this title);

(iv)

any licensing or certification action described in subsection (a)(1)(A) taken against a supplier by a State licensing or certification agency; and

(v)

any other adjudicated actions or decisions that the Secretary shall establish by regulation.

(B)

Exception

(h)

Appropriate coordination

(Aug. 14, 1935, ch. 531, title XIX, § 1921, as added Pub. L. 100–93, § 5(b), Aug. 18, 1987, 101 Stat. 690; amended Pub. L. 101–508, title IV, § 4752(f)(1), Nov. 5, 1990, 104 Stat. 1388–208; Pub. L. 111–148, title VI, § 6403(b), Mar. 23, 2010, 124 Stat. 764.)

cite as: 42 USC 1396r-2