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U.S. Code as of:
01/19/04
Section 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
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 any authority of the State
(or of a political subdivision thereof) responsible for the
licensing of health care practitioners (or any peer review
organization or private accreditation entity reviewing the
services provided by health care practitioners) or entities:
(A) 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.
(B) Any dismissal or closure of the proceedings by reason of
the practitioner or entity surrendering the license or leaving
the State or jurisdiction.
(C) Any other loss of the license of the practitioner or
entity, whether by operation of law, voluntary surrender, or
otherwise.
(D) Any negative action or finding by such authority,
organization, or entity regarding the practitioner or entity.
(2) Access to documents
The State must provide the Secretary (or an entity designated
by the Secretary) with access to such documents of the authority
described in paragraph (1) as may be necessary for the Secretary
to determine the facts and circumstances concerning the actions
and determinations described in such paragraph for the purpose of
carrying out this chapter.
(b) Form of information
The information described in subsection (a)(1) of this section
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 licensing authorities described in subsection (a)(1) of
this section,
(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 described in part B of subchapter XI of this
chapter and to appropriate entities with contracts under section
1320c-3(a)(4)(C) of this title with respect to eligible
organizations reviewed under the contracts,
(5) to State medicaid fraud control units (as defined in
section 1396b(q) of this title),
(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.]),
(7) to the Attorney General and such other law enforcement
officials as the Secretary deems appropriate, and
(8) 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
The Secretary shall provide for suitable safeguards for the
confidentiality of the information furnished under subsection (a)
of this section. Nothing in this subsection shall prevent the
disclosure of such information by a party which is otherwise
authorized, under applicable State law, to make such disclosure.
(d) Appropriate coordination
The Secretary shall provide for the maximum appropriate
coordination in the implementation of subsection (a) of this
section and section 422 of the Health Care Quality Improvement Act
of 1986 [42 U.S.C. 11132].
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