About Section 1921
The Department of Health and Human Services issued the final rule for Section 1921 of the Social Security Act, as published in the Federal Register, January 28, 2010. Section 1921 expands the information collected and disseminated through the National Practitioner Data Banks. The intent of Section 1921 is to protect beneficiaries participating in the Social Security Act’s healthcare programs from unfit healthcare practitioners and improve the anti-fraud provisions of these programs.
The Data Banks will open Section 1921 for reporting and querying on March 1, 2010.
Under Section 1921, the reporting requirements expand to include all licensure actions taken against all healthcare practitioners, not just physicians and dentists, as well as healthcare entities. Previously, only actions based on competence or conduct taken against physicians and dentists were included in the NPDB. Also, peer review organizations and private accreditation organizations must report any negative actions or findings taken against healthcare practitioners and organizations.
Queriers will now have access to State licensure actions taken against all healthcare practitioners including chiropractors, podiatrists, pharmacists, physician assistants, optometrists, professional and paraprofessional nurses, physical therapists, respiratory therapists, social workers, and other healthcare practitioners. Section 1921 also provides limited querying by Quality Improvement Organizations, Federal and State Health Care Programs, State Medicaid Fraud Control Units and other law enforcement agencies.
Entity Specific Information About Section 1921
- Hospitals, Nursing Homes and Other Healthcare Organizations
The implementation of Section 1921 will permit hospitals and other healthcare organizations that query the National Practitioner Data Bank (NPDB) to now have access to State licensure actions taken against all healthcare practitioners, including allied healthcare professionals, and entities. The information is accessible to both public and private sector hospitals, nursing homes and other healthcare organizations through the NPDB.
Section 1921 also broadens the existing NPDB State licensing board reporting requirements to include reporting of all adverse licensure actions, not just those based on professional competence and conduct.
Information reported under Section 1921 serves as an invaluable resource for pre-employment and background checks, not only on physicians and dentists, but on all licensed healthcare practitioners including: professional nurses, paraprofessional nurses, optometrists, physician assistants, podiatrists, chiropractors, physical therapists, respiratory therapists, social workers, etc. With this new information available, HR departments and nurse recruitment offices will want to query the NPDB when conducting pre-employment background to reduce the risk of negligent credentialing and enhance patient safety.
- State Licensing Board and Authorities
The implementation of Section 1921 expands the current National Practitioner Data Bank (NPDB) adverse licensure action reporting requirements for State licensing boards in two ways. First, State licensing authorities must report adverse actions taken against all healthcare practitioners, not just physicians and dentists, as well as those actions taken against healthcare entities. Second, State licensing authorities must report all adverse licensure actions (not just those based on professional competence and conduct).
State licensing agencies are the only group of current Data Banks customers that must report under Section 1921. These agencies can meet historical Section 1921 reporting obligations by permitting the Data Banks to place previously reported actions under Section 1921 authority, as necessary.
Section 1921 information is especially valuable to private-sector hospitals and healthcare organizations, which previously did not have access to licensure actions taken against all healthcare practitioners through the NPDB. In addition, Section 1921 information serves as an important resource to State licensing agencies when making licensure determinations about healthcare practitioners and entities.
- Accreditation Organizations
Section 1921 of the Social Security Act expands the National Practitioner Data Bank (NPDB) by requiring the reporting of additional actions, and making this information available to current NPDB queriers as well as new types of organizations.
Under Section 1921, private accreditation organizations are required to report to the NPDB certain types of negative actions or findings against healthcare entities. Before your organization can submit reports under Section 1921, you must first register with the Data Banks.
Private accreditation organizations are not authorized to query Section 1921 information. However, this information will serve as an invaluable resource for hospitals and other types of healthcare providers that your organization accredits, by improving employment screening, reducing the risk of negligent credentialing, and enhancing patient safety. In addition, information reported under Section 1921 will aid Federal and State healthcare programs when making determinations about contracts and provider agreements.
The NPDB is a national information clearinghouse that serves as a resource to assist State licensing boards, hospitals, and other healthcare entities in conducting extensive, independent investigations of the qualifications of the healthcare practitioners they seek to license or hire, or to whom they wish to grant clinical privileges.
- Quality Improvements Organizations
Section 1921 of the Social Security Act expands the National Practitioner Data Bank (NPDB) by requiring the reporting of additional actions, and making this information available to current NPDB queriers as well as new types of organizations. Quality Improvement Organizations (QIOs), as defined in Section 1921 final regulations, are among the new organizations authorized to query the NPDB under Section 1921.
Information available under Section 1921 includes adverse licensure actions taken by a State licensing authority against healthcare practitioners and entities, as well as negative actions or findings that a State licensing authority, peer review organization or private accreditation organization finalizes against a healthcare practitioner or entity.
QIOs now have access to invaluable NPDB resources that will aid their mission to protect and improve the quality of care for Medicare beneficiaries. For example, Quality Improvement Organizations will be able to query NPDB Section 1921 information when performing quality of care reviews and other related activities. There is no reporting requirement for QIOs in the Section 1921 final regulations. To query NPDB Section 1921 information, your organization must certify its eligibility and register with the Data Banks.
The NPDB is a national information clearinghouse that serves as a resource to assist State licensing boards, hospitals, and other healthcare organizations in conducting extensive, independent investigations of the qualifications of the healthcare practitioners they seek to license or hire, or to whom they wish to grant clinical privileges.
- Peer Review Organizations
Section 1921 of the Social Security Act, expands the National Practitioner Data Bank (NPDB) by requiring the reporting of additional actions, and making this information available to current NPDB queriers as well as new types of organizations.
Under Section 1921, peer review organizations, as defined in Section 1921 final regulations, are required to report to the NPDB certain types of negative actions or findings against healthcare practitioners. Before your organization can submit reports, you must first register with the Data Banks.
Only utilization and quality control peer review organizations under contract with the Centers for Medicare and Medicaid Services (referred to as Quality Improvement Organizations) are authorized to query Section 1921 information. Other peer review organizations do not have this authority. However, Section 1921 information will serve as an invaluable resource for hospitals and other healthcare organizations with which peer review organizations work by improving employment screening, reducing the risk of negligent credentialing, and enhancing patient safety.
The NPDB is a national information clearinghouse that serves as a resource to assist State licensing boards, hospitals, and other healthcare organizations in conducting extensive, independent investigations of the qualifications of the healthcare practitioners they seek to license or hire, or to whom they wish to grant clinical privileges.
- Law Enforcement Agencies
Section 1921 of the Social Security Act expands the National Practitioner Data Bank (NPDB) by requiring the reporting of additional actions, and making this information available to current NPDB queriers as well as new types of organizations. Law enforcement agencies and State Medicaid Fraud Control Units are among the new organizations authorized to query the NPDB under Section 1921.
Information available under Section 1921 includes adverse licensure actions taken by a State licensing authority against healthcare practitioners and entities, as well as negative actions or findings that a State licensing authority, peer review organization or private accreditation organization finalizes against a healthcare practitioner or entity.
There is no Section 1921 reporting requirement for law enforcement agencies. To query NPDB Section 1921 information, your organization must certify its eligibility and register with the Data Banks.
The NPDB is a national information clearinghouse that serves as a resource to assist State licensing boards, hospitals, and other healthcare organizations in conducting extensive, independent investigations of the qualifications of the healthcare practitioners they seek to license or hire, or to whom they wish to grant clinical privileges.
- Federal State Health Care Programs
Section 1921 of the Social Security Act expands the National Practitioner Data Bank (NPDB) by requiring the reporting of additional actions, and making this information available to current NPDB queriers as well as new types of organizations. Federal agencies administering Federal health care programs (and their contractors) as well as State agencies administering State health care programs are among the new organizations authorized to query the NPDB under Section 1921.
Information available under Section 1921 includes adverse licensure actions taken by a State licensing authority against healthcare practitioners and entities, as well as negative actions or findings that a State licensing authority, peer review organization or private accreditation organization finalizes against a healthcare practitioner or entity.
There is no Section 1921 reporting requirement for Federal or State health care programs. To query NPDB Section 1921 information, your organization must certify its eligibility and register with the Data Banks.
The NPDB is a national information clearinghouse that serves as a resource to assist State licensing boards, hospitals, and other healthcare organizations in conducting extensive, independent investigations of the qualifications of the healthcare practitioners they seek to license or hire, or to whom they wish to grant clinical privileges.
