NPDB New Guidebook Draft Review. Kathy Russell, JD, MN, RN Nursing Regulation

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1 NPDB New Guidebook Draft Review Kathy Russell, JD, MN, RN Nursing Regulation

2 ! NPDB!! Applicable Law Title IV Public Law Section 1921 of SSA Section 1128E of SSA Section 6403 of ACA Establishes health care fraud and abuse data collection program Designed to improve healthcare quality, protect the public, and reduce health care fraud and abuse in the U.S. Laws define terms and reporting rules for NPDB NPDB Guidebook Draft November 2013

3 Questions answered in NEW Guidebook Draft REPORTABLE? Cease & desist orders/letters Withdrawal or nrenewal of applications Administrative fines Letters of concern Voluntary surrender Denial of initial license or renewal license Consent agreement Non-final actions

4 NPDB Guidebook (draft 2013) Completely updated Incorporates HIPDB info More examples More & clearer tables Live links

5 ****IMPORTANT REMINDER**** v Boards of Nursing create procedures, processes and protocols for coding specific disciplinary actions and entering data into Nursys and NPDB v The following information should inform the jurisdiction s Board regarding the latest guidelines for federal reporting from NPDB v Do t make changes to the jurisdiction s procedures, processes and protocols for coding specific disciplinary actions and entering data into Nursys and NPDB without approval from the Executive Officer or other authorized person at the Board of Nursing

6 NPDB requirements for Reportable State Licensure Actions actions taken against health care practitioners as a result of formal proceedings publicly available NPDB Guidebook Draft 11/2013 E-50

7 actions taken against health care practitioners Revocation or suspension of a license, reprimand, censure or probation or any dismissal or closure of a formal proceeding because the nurse surrendered the license or because the nurse left the jurisdiction Any other loss of license or the right to apply for or renew a license whether by operation of law, voluntary surrender, nrenewal or otherwise (excluding nrenewal due to npayment of fees, retirement or change to inactive status) NPDB Guidebook Draft 11/2013 E-50

services or any individual who, without authority, holds himself or

8 actions taken against health care practitioners An individual who is licensed or otherwise authorized by the State to provide health care services or any individual who, without authority, holds himself or herself out to be so licensed or authorized. NPDB Guidebook Draft 11/2013 E-60

9 as a result of formal proceedings The definition of formal proceedings is written broadly to include formal hearings as well as other processes that follow defined rules, policies, or procedures. NPDB Guidebook Draft 11/2013 E-51

publicly available Any negative action or finding by the board that, under state law, is publicly available information, including but t limited to

10 publicly available Any negative action or finding by the board that, under state law, is publicly available information, including but t limited to limitations on scope of practice, revocations or suspensions of license that occur in conjunction with settlement. NPDB Guidebook Draft 11/2013 E-50

11 NPDB requirements for reporting are t limited to final actions Interim or nfinal adverse actions taken by a State licensing authority also must be reported to the NPDB Examples summary or emergency suspension of a license voluntary agreement to refrain from practice pending completion of a State licensing board investigation Once a final action is taken that supersedes or modifies the initial action, the State licensing or certification authority must submit a Revision-to-Action Report NPDB Guidebook Draft 11/2013 E-54

12 Reportable State Licensure Actions actions taken against health care practitioners as a result of formal proceedings publicly available REPORTABLE? NPDB Guidebook Draft 11/2013 E-50

13 Does a Consent Agreement need to be reported?! Any State licensure action that meets NPDB reporting requirements must be reported. actions taken against health care practitioners as a result of formal proceedings publicly available The requirement to report depends upon whether the consent agreement is publicly available. NPDB Guidebook Draft 11/2013 E-54

14 Consent Agreements! It is the action itself, rather than the method by which the action was taken, that determines whether the action must be reported Regardless of whether the action was imposed through board order, consent agreement, or other method For example, if a State licensing board issues a reprimand through a consent agreement, the reprimand is reportable NPDB Guidebook Draft 11/2013 E-54

15 Do Formal Monetary Penalties need to be reported?! actions taken against health care practitioners as a result of formal proceedings publicly available The requirement to report depends upon whether the monetary penalty or fine is publicly available. NPDB Guidebook Draft 11/2013 E-52

16 Do Administrative Fines need to be reported?! Administrative fines reported as negative actions or findings must be either 1 or 2 1. Connected to the delivery of health care services 2. Taken in conjunction with other adverse licensure or certification actions, such as revocation, suspension, censure, reprimand, probation, or surrender. publicly available The answer depends upon whether the action meets the NPDB definition of negative licensure action. NPDB Guidebook Draft 11/2013 E-52

17 Do Voluntary Surrenders after complaint to BON need to be reported?! OR Voluntarily surrenders a license in exchange for a decision by the licensing authority to cease an investigation or similar proceeding Voluntarily surrenders a license in return for t conducting an investigation or proceeding, or in lieu of a disciplinary action. The answer depends upon whether the surrender meets the NPDB requirement that the surrender be either in exchange for ceasing an investigation or in lieu of discipline. NPDB Guidebook Draft 11/2013 E-54

18 Does a Cease & Desist of Unlicensed Practitioner need to be reported?! actions taken against health care practitioners as a result of formal proceedings publicly available The answer depends upon whether the cease and desist order/letter is publicly available. NPDB Guidebook Draft 11/2013 E-60

19 How to make an entry into Nursys for the Cease & Desist of Unlicensed Practice of Nursing! Action Code Basis Code License # Licensure Field Other Practicing without a license No license Impersonated as whatever the person was holding self out to be RN or PN NPDB Guidebook Draft 11/2013 E-60

20 Does a Withdrawal of an Application for Licensure or a Nonrenewal of License need to be reported?! Ongoing investigation at the time of the withdrawal or abandonment of application OR Nonrenewal of a license during an investigation The answer depends upon whether there was ongoing investigation at the time NPDB Guidebook Draft 11/2013 E-60 & 69

21 Do Denials of Initial Licensure or Renewal of Licensure need to be reported?! actions taken against health care practitioners as a result of formal proceedings publicly available Generally an administrative denial is t an action and is t public. Whereas, a for cause denial is an action and is public and therefore reportable. NPDB Guidebook Draft 11/2013 E-50

22 " When to report denial of initial " or renewal licensure"! Reason for denial Administrative or For Cause Reportable Failure to meet educational requirement Failure to pass NCLEX Omitting or falsifying requested application information i.e. criminal or disciplinary actions Positive criminal background check Failure to answer all application questions Failure to pay registration fee Failure to meet continuing education requirement Administrative Administrative For Cause For Cause Administrative Administrative Administrative NPDB Guidebook Draft 11/2013 E-57

23 Do LeQers of Concern need to be reported?! actions taken against health care practitioners as a result of formal proceedings publicly available The key is whether the letter of concern is publicly available. NPDB Guidebook Draft 11/2013 E-62

24 QUESTIONS???

25 ****REMEMBER**** Do t make changes to the jurisdiction s procedures, processes and protocols for reporting specific disciplinary actions and entering data into Nursys and NPDB without approval from the Executive Officer or other authorized person at the Board of Nursing

Retrospective Review of Criminal Convictions in Nursing

Retrospective Review of Criminal Convictions in Nursing 2012-2013 Elizabeth H. Zhong, PhD 2016 NCSBN Scientific Symposium, October 6, 2016, Chicago, IL Outline 1. Introduction 2. Methods 3. Main Findings