On January 28, 2010, the Department of Health and Human Services promulgated a final rule which expands the National Practitioner Data Bank (“NPDB”) by incorporating the requirements of Section 1921 of the Social Security Act. Section 1921 requires each State to adopt a system of reporting to the Secretary certain adverse licensure actions taken against health care practitioners and entities by any authority of the State responsible for licensing of such practitioners or entities. Additionally, each State must report any negative action or finding that a State licensing authority, a peer review organization, or a private accreditation entity has finalized against a health care practitioner or entity.

These expanded requirements match the current State reporting requirements to the Healthcare Integrity and Protection Data Bank (“HIPDB”). Section 1921 requires that the new regulations be implemented in a manner which avoids the need for an entity that must report information to both the NPDB and HIPDB to file two reports. Thus, reporters responsible for reporting the final adverse actions to both the NPDB and HIPDB will now be able to submit only one report per action to the Department’s web-based system.

Two new sections were added to existing NPDB regulations at 45 CFR part 60 to incorporate Section 1921 requirements for reporting of specific data elements to the NPDB. Section 60.9 was added to address reporting of licensure actions taken by State licensing authorities resulting from any formal or official proceedings. Specifically, this section requires the reporting of a health care practitioner who, or entity that, voluntarily surrenders a license. However, voluntary surrenders and licensure non-renewals due to the non-payment of licensure fees, changes to inactive status, and retirements are excluded from reporting to the NPDB unless they are taken in combination with a revocation, suspension, reprimand, censure, or probation, in which case they are reportable.

Further, new 45 CFR § 60.10 requires each State to adopt a system of reporting to the NPDB any negative action or finding that a peer review organization or private accreditation entity has concluded against a health care practitioner or health care entity. Private accreditation entities are now required to report determinations of less than full accreditation that indicates a substantial risk to the safety of a patient or quality of health care services. Additionally, peer review organizations are required to report any recommendation to sanction a practitioner.

It is important to note that the NPBD reporting requirements for hospitals and other health care entities are not affected by the implementation of Section 1921.