sb655 intr

Senate Bill No. 655
(By Senators McCabe and Plymale)
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[Introduced March 26, 2001; referred to the Committee on Health and Human Resources

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A BILL to amend chapter sixteen of the code of West Virginia, one thousand nine hundred thirty-one, as amended, by adding thereto a new article, designated article twenty-nine-f, relating to the health care professional credentials data collection act; short title; definitions; health care credentials advisory council; development and use of uniform health care credentials forms; and single credentialing cycle.

Be it enacted by the Legislature of West Virginia:

That chapter sixteen of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended by adding thereto a new article, designated article twenty-nine-f, to read as follows:
ARTICLE 29F. HEALTH CARE PROFESSIONAL CREDENTIALS DATA COLLECTION ACT.

§16-29F-1. Short title.
This article may be cited as the "Health Care Professional Credentials Data Collection Act."
§16-29F-2. Definitions.

As used in this article:

(a) "Council" means the health care credentials advisory council.

(b) "Credentials data" means data, information, or answers to questions required by a health care entity or health care plan to complete the credentialing or recredentialing of a health care professional.

(d) "Department" means the department of health and human resources.

(e) "Secretary" means the secretary of the department of health and human resources.

(f) "Health care entity" means any of the following which require the submission of credentials data: (1) A health care facility or other health care organization licensed or certified to provide medical or health services in West Virginia; (2) a health care professional partnership, corporation, limited liability company, professional services corporation or group practice; or (3) an independent practice association or physician hospital organization.

(g) "Health care plan" means any entity licensed by the commissioner of insurance as a prepaid health care plan or health maintenance organization or as an insurer which requires the submission of credentials data.

(h) "Health care professional" means any person licensed under the authority of this state to provide health care services.

(i) "Recredentialing" means the process by which a health care entity or health care plan ensures that a health care professional who is currently credentialed by the health care entity or health care plan continues to meet the credentialing criteria used by the health care entity or health care plan, no more than once every two years.

(j) "Single credentialing cycle" means a process whereby for purposes of recredentialing each health care professional's credentials data are collected by all health care entities and health care plans that credential the health care professional during the same time period and only once every two years.

(k) "Site survey" means a process by which a health care entity or health care plan assesses the office locations and medical record keeping practices of a health care professional.

(l) "Single site survey" means a process by which, for purposes of recredentialing, each health care professional receives a site visit only once every two years.

(m) "Uniform health care credentials form" means the form developed by the department under section three of this article to collect the credentials data commonly requested by health care entities and health care plans for purposes of credentialing.

(n) "Uniform health care recredentials form" means the form developed by the department under section three of this article to collect the credentials data commonly requested by health care entities and health care plans for purposes of recredentialing.

(o) "Uniform hospital credentials form" means the form developed by the department under section three of this article to collect the credentials data commonly requested by hospitals for purposes of credentialing.

(p) "Uniform hospital recredentials form" means the form developed by the department under section three of this article to collect the credentials data commonly requested by hospitals for purposes of recredentialing.

(q) "Uniform site survey instrument" means the instrument developed by the department under section five of this article to complete a single site survey as part of a credentialing or recredentialing process.

(r) "Uniform updating form" means a standardized form for reporting of corrections, updates, and modifications to credentials data to health care entities or health care plans when those data change following credentialing or recredentialing of a health care professional.
§16-29F-3. Health care credentials advisory council.

(a) There is established a health care advisory council, consisting of thirteen members, to advise and assist the department in accordance with the provisions of this article. The secretary, or his or her designee, shall serve as one member and chair of the council. The secretary shall appoint the remaining twelve members of the council as follows: One member shall represent a hospital with less than one hundred beds, one member shall represent a hospital with one hundred beds or more, one member shall represent a teaching hospital, one member shall represent nursing homes, one member shall represent ambulatory surgical treatment centers, one member shall represent a health maintenance insurance organization, one member shall represent a preferred provider health insurance organization domiciled in this state, one member shall represent a third-party administrator health insurance organization or a regular accident and sickness health insurer, one member shall be an allopathic physician, one member shall be an allopathic physician specializing in family practice, one member shall be an osteopathic physician, and one member shall be a physician assistant. The insurance commissioner or his or her designee shall serve as an ex officio nonvoting member of the council.

(b) On the first day of July, two thousand four, the health care credentials advisory council is abolished.

§16-29F-4. Development and use of uniform health care credentials forms.

(a) The department, in consultation with the council, shall propose legislative rules in accordance with article three, chapter twenty-nine-a of this code to establish:

(1) A uniform health care credentials form that shall include the credentials data commonly requested by health care entities and health care plans for purposes of credentialing and shall minimize the need for the collection of additional credentials data;

(2) A uniform health care recredentials form that shall include the credentials data commonly requested by health care entities and health care plans for purposes of recredentialing and shall minimize the need for the collection of additional credentials data;

(3) Uniform updating forms.

(b) The uniform forms established in subsection (a) of this section shall be coordinated to reduce the need to provide redundant information. Further, the forms shall be made available in both paper and electronic formats.

(c) The department, in consultation with the council, shall establish a date after which an electronic format may be required by a health care entity or a health care plan, and a health care professional may require acceptance of an electronic format by a health care entity or a health care plan.

(d) Beginning on the first day of July, two thousand two, each health care entity or health care plan that employs, contracts with, or allows health care professionals to provide medical or health care services and requires health care processionals to be credentialed or recredentialed shall, for purposes of collecting credentials data only, require:

(1) The uniform health care credentials form;

(2) The uniform health care recredentials form;

(3) The uniform updating forms;

(4) Any additional credentials data requested.

(e) Each health care entity and health care plan shall complete the process of verifying a health care professional's credentials data in a timely fashion and shall complete the process of credentialing or recredentialing of the health care professional within sixty days after submission of all credentials data and completion of verification of the credentials data. Contracts between each health care entity or health care plan shall provide that upon the application by a health care professional of all necessary information and materials for credentialing or recredentialing, a provisional credentialing status shall be given pending full accreditation status. Provisional credentialing accreditation authorizes the applicant to treat a covered individual and to receive reimbursement for professional services rendered according to the terms of the contract.

(f) Each health care professional shall provide any corrections, updates, and modifications to his or her credentials data to ensure that all credentials data on the health care professional remains current. The corrections, updates, and modifications shall be provided within five business days for state health care professional license revocation, federal drug enforcement agency license revocation, medicare or medicaid sanctions, revocation of hospital privileges, any lapse in professional liability coverage required by a health care entity or health care plan, or conviction of a felony, and within forty-five days for any other change in the information from the date the health care professional knew of the change. All updates shall be made on the uniform updating forms developed by the department.

(g) Any credentials data collected or obtained by the health care entity or health care plan shall be confidential, as provided by law, and otherwise may not be redisclosed without written consent of the health care professional, except that in any proceeding to challenge credentialing or recredentialing, or in any judicial review, the claim of confidentiality may not be invoked to deny a health care professional, health care entity or health care plan access to or use of credentials data. Nothing in this section prevents a health care entity or health care plan from disclosing any credentials data to its officers, directors, employees, agents, subcontractors, medical staff members, any committee of the health care entity or health care plan involved in the credentialing process, or accreditation bodies or licensing agencies. However, any redisclosure of credentials data contrary to this section is prohibited.

(h) Nothing in this article may be construed to restrict the right of any health care entity or health care plan to request additional information necessary for credentialing or recredentialing.

(i) Nothing in this article may be construed to restrict in any way the authority of any health care entity or health care plan to approve, suspend or deny an application for hospital staff membership, clinical privileges, or managed care network participation.

(j) Nothing in this article may be construed to prohibit delegation of credentialing and recredentialing activities as long as the delegated entity follows the requirements set forth in this article.

(k) Nothing in this article may be construed to require any health care entity or health care plan to credential or survey any health care professional.
§16-29F-5. Single credentialing cycle.

(a) The department, in consultation with the council, shall propose legislative rules in accordance with article three, chapter twenty-nine-a of this code to establish a single credentialing cycle. The single credentialing cycle shall be based on a specific variable or variables. To the extent possible the single credentialing cycle shall be established to ensure that the credentials data of all health care professionals in a group or at a single site are collected during the same time period. However, nothing in this article may be construed to require the single credentialing cycle to be established to ensure that the credentials data of all health care professionals in a group or at a single site are collected during the same time period.

(b) Beginning on the first day January, two thousand three, all health care entities and health care plans shall obtain credentials data on all health care professionals according to the established single credentialing cycle.

(c) The department, in consultation with the council, shall propose legislative rules in accordance with article three, chapter twenty-nine-a of this code to establish a process to exempt a small or unique health care entity or small or unique health care plan from the single credentialing cycle if the health care entity or health care plan demonstrates to the department that adherence to the single credentialing cycle would be an undue hardship for the health care entity or health care plan.

(d) The requirements of this section do not apply when a health care professional submits initial credentials data to a health care entity or health care plan outside of the established single credentialing cycle, when a health care professional's credentials data change substantively, or when a health care entity or health care plan requires recredentialing as a result of patient or quality assurance issues.
§16-29F-6. Single site survey.

(a) The department, in consultation with the council, shall propose legislative rules in accordance with article three, chapter twenty-nine-a of this code to establish a uniform site survey instrument taking into account national accreditation standards and state requirements. The uniform site survey instrument shall include all the site survey data requested by health care entities and health care plans.

(b) No later than the first day of January, two thousand two, the department, in consultation with the council, shall publish the variable or variables for completing the single site survey. To the extent possible, the single site survey shall be established to ensure that all health care professionals in a group or at a site are reviewed during the same time period.

(c) Beginning the first day of July, two thousand two, health care entities and health care plans shall implement the single site survey, if a site survey is required by any of the health care professional's health care entities or health care plans. The site survey shall be completed using the uniform site survey instrument.

(d) The uniform site survey instrument shall be used when a health care professional seeks initial credentialing by a health care entity or health care plan, when a health care professional's credentials data change substantively, or when a health care plan or health care entity requires a site survey as a result of patient or quality assurance issues, if a site survey is required by the health care entity or health care plan.

(e) Nothing in this section prohibits health care entities and health care plans from choosing the independent party to conduct the single site survey.

NOTE: The purpose of this bill is to provide for the health care professional credentials data collection act. The purpose of the proposed legislation is to make sure, through the credentialing process provided for, that health care providers are properly trained and educated. The bill provides definitions, and establishes a health care credentials advisory council. The bill further provides for the use of uniform health care credentials forms to verify quality of staff and services. Finally, the bill provides for a single credentialing cycle wherein recredentialing of each health care professional's credentials data is achieved by all health care entities and plans during the same time period and no more than once every two years.

This article[TYPE INFORMATION] is new; therefore, strike-throughs and underscoring have been omitted.