New Data Bank Regulations Implement

Social Security Act §1921 – MMPPA §5(h)

The Medicare and Medicaid Program Protection Act (MMPPA) added Soc. Sec. §1921. This law expanded state licensure reporting obligations to match those already in place for the Healthcare Integrity and Protection Data Bank (HIPDB), which became active in 1999. These regulations will make reporting of adverse actions by state licensure and certification authorities nearly identical for NPDB and HIPDB, but does not change current NPDB reporting obligations for hospitals, healthcare entities, medical practice payers or other reporting entities.

One critical issue was the definition of what must be reported, and providing sufficient protection to physicians in order  to guard against reports by entities that provided no due process protections. Although HRSA and HHS rejected the proposal of emulating the immunity due process requirements of HCQIA, the definition of "formal proceeding" was revised to state as follows:

"Formal proceeding means a proceeding held before a state licensing or certification authority, peer review organization, or private accreditation entity that maintains defined rules, policies or procedures for such a proceeding."