[Code of Federal Regulations]

[Title 45, Volume 1]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 45CFR61.7]



[Page 151-153]

 

                        TITLE 45--PUBLIC WELFARE

 

                    SUBTITLE A--DEPARTMENT OF HEALTH

                           AND HUMAN SERVICES

 

PART 61_HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL ADVERSE 

INFORMATION ON HEALTH CARE PROVIDERS, SUPPLIERS AND PRACTITIONERS--Table 

of Contents

 

                   Subpart B_Reporting of Information

 

Sec.  61.7  Reporting licensure actions taken by Federal or State 

licensing and certification agencies.



    (a) What actions must be reported. Federal and State licensing and 

certification agencies must report to the HIPDB the following final 

adverse actions that are taken against a health care provider, supplier, 

or practitioner (regardless of whether the final adverse action is the 

subject of a pending appeal)--

    (1) Formal or official actions, such as revocation or suspension of 

a license or certification agreement or contract for participation in 

Federal or State health care programs (and the length of any such 

suspension), reprimand, censure or probation;

    (2) Any other loss of the license or loss of the certification 

agreement or contract for participation in Federal or State health care 

programs, or the right to apply for, or renew, a license or 

certification agreement or contract of the provider, supplier, or 

practitioner, whether by operation of law, voluntary surrender, non-

renewal (excluding nonrenewals due to nonpayment of fees, retirement, or 

change to inactive status), or otherwise; and

    (3) Any other negative action or finding by such Federal or State 

agency that is publicly available information.

    (b) Entities described in paragraph (a) of this section must report 

the following information:

    (1) If the subject is an individual, personal identifiers, 

including:

    (i) Name;

    (ii) Social Security Number (or Individual Taxpayer Identification 

Number (ITIN));

    (iii) Home address or address of record;



[[Page 152]]



    (iv) Sex; and

    (v) Date of birth.

    (2) If the subject is an individual, that individual's employment or 

professional identifiers, including:

    (i) Organization name and type;

    (ii) Occupation and specialty, if applicable;

    (iii) National Provider Identifier (NPI), when issued by theCenters 

for Medicare & Medicaid Services (CMS);

    (iv) Name of each professional school attended and year of 

graduation; and

    (v) With respect to the State professional license (including 

professional certification and registration) on which the reported 

action was taken, the license number, the field of licensure, and the 

name of the State or territory in which the license is held.

    (3) If the subject is an organization, identifiers, including:

    (i) Name;

    (ii) Business address;

    (iii) Federal Employer Identification Number (FEIN), or Social 

Security Number (or ITIN) when used by the subject as a Taxpayer 

Identification Number (TIN);

    (iv) The NPI, when issued by CMS;

    (v) Type of organization; and

    (vi) With respect to the State license (including certification and 

registration) on which the reported action was taken, the license and 

the name of the State or territory in which the license is held.

    (4) For all subjects:

    (i) A narrative description of the acts or omissions and injuries 

upon which the reported action was based;

    (ii) Classification of the acts or omissions in accordance with a 

reporting code adopted by the Secretary;

    (iii) Classification of the action taken in accordance with a 

reporting code adopted by the Secretary, and the amount of any monetary 

penalty resulting from the reported action;

    (iv) The date the action was taken, its effective date and duration;

    (v) If the action is on appeal;

    (vi) Name of the agency taking the action;

    (vii) Name and address of the reporting entity; and

    (viii) The name, title and telephone number of the responsible 

official submitting the report on behalf of the reporting entity.

    (c) Entities described in paragraph (a) of this section should 

report, if known, the following information:

    (1) If the subject is an individual, personal identifiers, 

including:

    (i) Other name (s) used;

    (ii) Other address;

    (iii) FEIN, when used by the individual as a TIN; and

    (iv) If deceased, date of death.

    (2) If the subject is an individual, that individual's employment or 

professional identifiers, including:

    (i) Other State professional license number(s), field(s) of 

licensure, and the name(s) of the State or territory in which the 

license is held;

    (ii) Other numbers assigned by Federal or State agencies, to 

include, but not limited to Drug Enforcement Administration (DEA) 

registration number(s), Unique Physician Identification Number(s) 

(UPIN), and Medicaid and Medicare provider number(s);

    (iii) Name(s) and address(es) of any health care entity with which 

the subject is affiliated or associated; and

    (iv) Nature of the subject's relationship to each associated or 

affiliated health care entity.

    (3) If the subject is an organization, identifiers, including:

    (i) Other name(s) used;

    (ii) Other address(es) used;

    (iii) Other FEIN(s) or Social Security Numbers (or ITIN) used;

    (iv) Other NPI(s) used;

    (v) Other State license number(s) and the name(s) of the State or 

territory in which the license is held;

    (vi) Other numbers assigned by Federal or State agencies, to 

include, but not limited to Drug Enforcement Administration (DEA) 

registration number(s), Clinical Laboratory Improvement Act (CLIA) 

number(s), Food and Drug Administration (FDA) number(s), and Medicaid 

and Medicare provider number(s);

    (vii) Names and titles of principal officers and owners;

    (viii) Name(s) and address(es) of any health care entity with which 

the subject is affiliated or associated; and

    (ix) Nature of the subject's relationship to each associated or 

affiliated health care entity.



[[Page 153]]



    (4) For all subjects:

    (i) If the subject will be automatically reinstated; and

    (ii) The date of appeal, if any.

    (d) Sanctions for failure to report. The Secretary will provide for 

a publication of a public report that identifies those Government 

agencies that have failed to report information on adverse actions as 

required to be reported under this section.



[64 FR 57758, Oct. 26, 1999, as amended at 69 FR 33868, June 17, 2004]