[Federal Register Volume 64, Number 39 (Monday, March 1, 1999)]
[Rules and Regulations]
[Pages 9921-9922]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-4871]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration

45 CFR Part 60

RIN 0906-AA42


National Practitioner Data Bank for Adverse Information on 
Physicians and Other Health Care Practitioners: Charge for Self-Queries

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Final rule.

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SUMMARY: This final rule amends the existing regulations implementing 
the Health Care Quality Improvement Act of l986 (the Act), which 
established the National Practitioner Data Bank for Adverse Information 
on Physicians and Other Health Care Practitioners (the Data Bank). The 
final rule amends the existing fee structure so that the Data Bank can 
fully recover its costs, as required by law. This rule removes the 
prohibition against charging for self-queries and, therefore, allows 
the Data Bank to assess costs in an equitable manner. This is 
consistent with both the Freedom of Information Act and the Privacy Act 
which allow the Government to charge fees for the reproduction of 
records. The Data Bank will continue its current practice of sending to 
the practitioner in whose name it was submitted--automatically, without 
a request, and free of charge-- a copy of every report received by the 
Data Bank for purposes of verification and dispute resolution.

EFFECTIVE DATE: These regulations are effective March 1, 1999. The 
Department has announced as a notice, published elsewhere in this 
issue, the actual fee and its effective date.

FOR FURTHER INFORMATION CONTACT: Mr. Thomas C. Croft, Director, 
Division of Quality Assurance, Bureau of Health Professions, Health 
Resources and Services Administration, Parklawn Building, Room 8A-55, 
5600 Fishers Lane, Rockville, Maryland 20857; telephone: (301) 443-
2300.

SUPPLEMENTARY INFORMATION: On March 24, 1998, the Secretary published a 
Notice of Proposed Rulemaking (NPRM) (63 FR 14059) in order to remove 
the prohibition against charging practitioners a fee when they request 
information about themselves (self-query). The Department received four 
public comments opposing the provisions of this rule. The Secretary 
would like to thank the respondents for the thoroughness and quality of 
their comments. Among the four comments received, seven specific issues 
were raised. These seven issues and the Department's responses to these 
issues appear below.
    One respondent mistakenly cited Sec. 60.12 of the Data Bank 
regulations (45 CFR part 60) as a section of the legislation, the 
Health Care Quality Improvement Act of 1986, as amended, that led to 
the creation of the Data Bank. The respondent subsequently erroneously 
concluded that the Act prevents the Data Bank from establishing a fee 
for self-queries.
    The Department would like to clarify that the Act does not preclude 
the Data Bank from charging a fee for self-queries. Section 427(b)(4) 
of the Act states:

    The Secretary may establish or approve reasonable fees for 
disclosure of information * * *

It is the current regulatory language, which this Final Rule amends, 
that is preventing the Data Bank from charging a fee for self-queries.
    Two respondents indicated that health care practitioners should not 
have to pay a fee in order to exercise their Privacy Act rights to view 
Data Bank information about themselves.
    Section 522(f)(5) of the Privacy Act does allow for the imposition 
of fees for providing individuals copies of their own Federal records, 
such as those contained in the Data Bank. Nevertheless, the Department 
will continue to appropriately respond to its obligations under the 
Privacy Act and its own policy of fair information practice by 
proactively providing a copy to the practitioner in whose name it was 
submitted--free of charge--a copy of every report received by the Data 
Bank for purposes of verification and dispute resolution. However, the 
Department reiterates that the purpose of the great majority of the 
self-queries that the Data Bank receives is not about practitioners' 
exercising their Privacy Act rights to access to information about 
themselves. In conversations with practitioners who call for self-query 
assistance, nearly all indicate that they are acting under duress and 
in response to demands from licensing bodies and other entities to 
submit copies of their Data Bank records as a condition of doing 
business. In exchange for these records, these practitioners expect to 
benefit by obtaining licenses to practice, membership in various 
organizations or, perhaps, malpractice insurance.
    Two respondents questioned why the cost of self-queries should be 
shifted to the practitioners, when it is the licensing bodies and other 
entities that, by forcing practitioners to submit their self-query 
results in order to obtain licensure or membership, are creating the 
great increase in the volume of self-queries.
    The Department encourages authorized queriers, such as licensing 
boards, to query the Data Bank directly to ensure they are getting 
accurate and complete information. However, since these organizations 
are not required by the Act to query, the Department has no way of 
mandating that they query the Data Bank directly, instead of requiring 
practitioners to provide self-query responses.
    One respondent indicated that the Department should charge the 
entities, such as licensing bodies and malpractice insurers, that are 
forcing practitioners to provide their self-query responses in order to 
obtain licensure or malpractice insurance. The Department does not know 
which entities are requiring self-query responses, and has neither the 
legal authority to charge the entity nor any practical way to collect 
the fee from the entity.
    One respondent indicated that the Department should focus its 
efforts on thwarting unauthorized entities, such as managed care 
organizations without formal peer review processes, who are ``abusing 
the law'' by requiring practitioners to submit their self-query results 
in order to obtain membership.
    The Department shares these concerns about unauthorized entities 
obtaining Data Bank information. However, under current law, the 
Department cannot prosecute any act related to the use of Data Bank 
information other than unlawful disclosure. It is the Secretary's 
position that a practitioner's disclosure of his or her own Data Bank 
records is not unlawful disclosure. In other words, practitioners may 
give copies of self-query responses to anyone they choose.
    One respondent asked that the Department take into account the 
financial burden the self-query fee would place on physicians, 
particularly young physicians as they apply for licensure and 
membership.
    The Department will make every effort to ensure that the self-query 
fee is nominal and no more than is necessary to recover the costs of 
processing.

[[Page 9922]]

    One respondent suggested that the Department should consider an on-
line, Internet self-query system to minimize the cost of self-queries.
    The Department is actively examining the feasibility of an 
Internet-based self-query process, but is concerned that the current 
technology may not provide a means of ensuring that a self-query 
submitted via the Internet is actually from the practitioner in whose 
name the query is made. If an Internet-based approach is ultimately 
implemented, cost savings would be passed along to queriers.
    The Department also notes that individual practitioners have 
expressed almost no opposition to the imposition of a self-query 
charge. Indeed, the current self-query form, introduced in April of 
1998, includes a field for the practitioner's credit card number. This 
field was included when other changes were made to the form so that the 
Data Bank could begin collecting the self-query fee, if ultimately 
imposed, without having to print another set of forms. Thus, 
practitioners who self-query have had constructive notice of the 
possibility of the imposition of a fee since April of this year. 
Despite the fact that the form does not list a specific charge, and the 
instructions clearly indicate that no charge is being imposed at this 
time, practitioners have willingly provided their credit card numbers 
on the new form. Furthermore, in conversations with practitioners who 
call the Data Bank for assistance in completing the self-query form, 
there have been no complaints about the possibility of paying a fee for 
self-query processing. The Data Bank, of course, has not actually 
charged for any self-queries. We believe that the fact that 
practitioners have willingly provided their credit card numbers on the 
new form without complaint is a very significant indication that there 
is little or no opposition by individual practitioners to imposition of 
a fee for the service of providing a self-query response.
    Therefore, the change to remove the prohibition against charging 
practitioners a fee when they request information about themselves has 
been retained as proposed. The Department has amended Sec. 60.12 by 
deleting the phrase ``other than those of individuals for information 
concerning themselves'' in the first sentence of paragraph (a).
    A notice published elsewhere in this issue of the Federal Register 
announces the fee for self-queries and the effective date of the 
change. As with other changes, this fee will be subject to change as 
further costs may warrant.

Economic Impact

    Executive Order 12866 requires that all regulations reflect 
consideration of alternatives, of costs, of benefits, of incentives, of 
equity, and of available information. Regulations must meet certain 
standards, such as avoiding an unnecessary burden. Regulations which 
are ``significant'' because of cost, adverse effects on the economy, 
inconsistency with other agency actions, effects on the budget, or 
novel legal or policy issues, require special analysis.
    The Department believes that the resources required to implement 
the requirement in these regulations are minimal. Therefore, in 
accordance with the Regulatory Flexibility Act of 1980, the Secretary 
certifies that these regulations will not have a significant impact on 
a substantial number of small entities. For the same reasons, the 
Secretary has also determined that this is not a ``significant'' rule 
under Executive Order 12866.

Paperwork Reduction Act of 1995

    The National Practitioner Data Bank for Adverse Information on 
Physicians and Other Health Care Practitioners regulation contains 
information collections which have been approved by the Office of 
Management and Budget (OMB) under the Paperwork Reduction Act of 1995 
and assigned control number 0915-0126. This amendment does not affect 
the recordkeeping or reporting requirements in the existing 
regulations.

List of Subjects in 45 CFR Part 60

    Claims, Fraud, Health maintenance organizations (HMOs), Health 
professions, Hospitals, Insurance companies, Malpractice.

    Dated: October 29, 1998.
Claude Earl Fox,
Administrator, Health Resources and Services Administration.

    Approved: November 18, 1998.
Donna E. Shalala,
Secretary.

    Accordingly, 45 CFR part 60 is amended as set forth below:

PART 60--NATIONAL PRACTITIONER DATA BANK FOR ADVERSE INFORMATION ON 
PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS

    1. The authority citation for 45 CFR part 60 continues to read as 
follows:

    Authority: Secs. 401-432 of the Health Care Quality Improvement 
Act of 1986, Pub. L. 99-660, 100 Stat. 3784-3794, as amended by sec. 
402 of Pub. L. 100-177, 101 Stat. 1007-1008 (42 U.S.C. 11101-11152).

    2. Section 60.12, is amended by revising the first sentence in 
paragraph (a) to read as follows:


Sec. 60.12  Fees applicable to requests for information.

    (a) Policy on Fees. The fees described in this section apply to all 
requests for information from the Data Bank. * * *
* * * * *
[FR Doc. 99-4871 Filed 2-26-99; 8:45 am]
BILLING CODE 4160-15-P