[Federal Register Volume 87, Number 1 (Monday, January 3, 2022)] [Notices] [Pages 95-103] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 2021-28377] ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency Information Collection Activities: Submission to OMB for Review and Approval; Public Comment Request; National Practitioner Data Bank: Modification of the National Practitioner Data Bank Code Lists AGENCY: Health Resources and Services Administration (HRSA), Department of Health and Human Services. ACTION: Request for public comment on the National Practitioner Data Bank's (NPDB) Basis for action code lists for licensure and certification actions. ----------------------------------------------------------------------- SUMMARY: HRSA, a sub-agency of the Department of Health and Human Services, is announcing a change in the NPDB Basis for Action Code Lists for Federal Licensure, and State Licensure or Certification Actions to individuals and entities authorized to report and request information from the NPDB. These changes will contain updated codes and code use guidance applicable to organizations submitting Federal Licensure, or State Licensure or Certification Actions. The code modifications and guidance are intended to provide improved report accuracy and promote a better understanding of the use and application of the basis of action codes available for report submission. The modifications are based in part upon recommendations made through a collaborative effort with NPDB industry partners: the Federation of State Boards of Physical Therapy, the National Council of State Boards of Nursing, the Federation of State Medical Boards, the Association of State and Provincial Psychology Boards, the National Board for Certification in Occupational Therapy, the Association of Social Work Boards, and the National Association of Boards of Pharmacy. Basis for Action codes help to accurately describe the basis for licensure actions reported. Basis for Action codes have no impact on the licensure action reported or the applicability of NPDB reporting criteria. New, modified, and retired codes have no impact on historical reporting. The coding of previously submitted reports will remain unchanged. DATES: Submit comments no later than February 2, 2022. ADDRESSES: Written and/or electronic comments should be submitted to [email protected] by February 2, 2022. [[Page 96]] FOR FURTHER INFORMATION CONTACT: David Loewenstein, Director, Division of Practitioner Data Bank, Bureau of Health Workforce, HRSA, (301) 443- 2300, [email protected]. SUPPLEMENTARY INFORMATION: The current published NPDB Code Lists are available on the NPDB website: https://www.npdb.hrsa.gov/hcorg/codes.jsp. The NPDB is authorized by the Health Care Quality Improvement Act of 1986 (the Act), Title IV of Public Law 99-660, as amended (42 U.S.C. 11101 et seq.). Further, two additional statutes expanded the scope of the NPDB--Section 1921 of the Social Security Act, as amended (42 U.S.C. 1396r-2) and Section 1128E of the Social Security Act, as amended (42 U.S.C. 1320a-7e). Information collected under the Section 1128E authority was consolidated within the NPDB pursuant to Section 6403 of the Affordable Care Act, Public Law 111-148; this consolidation became effective on May 6, 2013. Proposed NPDB Code Lists Modifications ---------------------------------------------------------------------------------------------------------------- Guideline or Table Code Status Current code New/modified code explanation of Code use examples description description status change and explanations ---------------------------------------------------------------------------------------------------------------- Non-Compliance With Requirements ---------------------------------------------------------------------------------------------------------------- 48........ 44.......... U......... Default on Health ................. Fails to meet Explanation: Use Education Loan health education only if your or Scholarship loan or state has this Obligations. scholarship requirement. obligations. 48........ 35.......... U......... Drug Screening ................. Fails a drug Examples: Violation. screening test.Failure of a required drug screen or failure to comply with the requested drug screen; Sample is adulterated, invalid or substituted; Failure of a drug screen for employment. 48........ A2.......... U......... Failure to Comply ................. Fails to meet the Examples: With Continuing continuing Failure Education or education or to complete Competency competency state Requirements. requirements for requirements; renewal or If the reinstatement. licensee falsified meeting the requirements, then also use Code E3. 48........ 31.......... M......... Failure to Comply Failure to comply Fails to comply Examples: With Health and with health and with federal, Failure Safety safety state, local, or to meet required Requirements. requirements or institutional health tests or state health safety inoculations. code. requirements or DO NOT use for: state health codes. Violation of infection control, sterile technique, and isolation requirements; instead use Code 17. 48........ 23.......... U......... Failure to ................. Interferes with Examples: Cooperate With an investigation Failure Board or disciplinary to respond or to Investigation. proceeding by respond withholding adequately to information, board deliberate investigation misrepresentatio requests; n of facts or Failure attempts to to cooperate suppress with the board evidence. as a witness to an investigation. 48........ 50.......... M......... Failure to Failure to Fails to meet Example: Maintain Maintain or documentation Failure Adequate or Provide Adequate requirements for to provide Accurate Records. or Accurate maintaining adequate Medical Records, patient care, documentation of Financial financial or treatment/care Records or Other other records. in the medical Required record. Information. 48........ 45.......... R......... Failure to ................. Redundant code, Maintain Records use code 50. or Provide Medical, Financial or Other Required Information. 48........ A3.......... R......... Failure to Meet ................. Use code A1...... Licensing Board Reporting Requirements. [[Page 97]] 48........ A1.......... M......... Failure to Meet Failure to Meet Fails to meet Examples: the Initial Licensure board specified Failure Requirements of Requirements/ licensing to meet board a License. Licensing Board requirements or requirements Reporting provide other than Requirements. requested/ threshold required licensure information. requirements; NOTE: Do not Failure report or to provide include information threshold required by the criteria: the board (e.g., accepted minimum criminal licensure conviction, loss requirements of job due to that are unprofessional universally conduct, applied without disciplinary decision or action in exception. another Examples include jurisdiction, academic change of degrees, address etc.); criminality, Failure certifications, to report any or training renewal and hours or reinstatement requirements. requirements; Failure to report another health care professional as required by mandatory reporting obligations. DO NOT use for: Failure to meet threshold criteria: the accepted minimum licensure requirements that are universally applied without decision or exception. Examples include academic degrees, criminality, certifications, or training hours or requirements; Continuing Competency requirements; instead use Code A2; Obtaining a license but failing to disclose required information on the application; instead use Code E4. 48........ 37.......... M......... Failure to Pay Failure to Pay or Fails to meet Explanation: Use Child Support/ Delinquent with child support only if your Delinquent Child Child Support. responsibilities. state has this Support. requirement. 48........ 39.......... M......... License Disciplinary Grounds for Examples: Revocation, Action Taken by action are based A Suspension or another Federal, on action(s) licensee is Other State or Local taken by another licensed in Disciplinary Licensing state licensing, another Action Taken by Authority. federal, or jurisdiction and a Federal, State other authority. has final or Local disciplinary Licensing action by that Authority. authority. DO NOT use for: Your own jurisdiction's disciplinary action. 48........ 29.......... U......... Practicing Beyond ................. Provides care not Examples: the Scope of permitted under Practice. the terms of a Performing license or practice within the interventions, licensee's level whether advanced of education, or not, without training, required knowledge, license, skills, certification or experience, or training; demonstrated Failure competency. to work with adequate/ required supervision. DO NOT use for: Substandard or Inadequate Care for incompetence issues; instead use Code F6; Negligence for not exercising reasonable judgement; instead use Code 13. 48........ 24.......... U......... Practicing With ................. Fails to renew Example: an Expired license and Failure License. continues to to renew license practice. intentionally or unintentionally and continues to practice. DO NOT use for: A new graduate who fails the exam and continues to practice under a temporary license which expired on getting exam results; instead use Code A4; Someone who has had their license revoked and continues to practice; instead use Code A4. 48........ 25.......... R......... Practicing ................. Redundant code, Without a use code A4. License. 48........ A4.......... U......... Practicing ................. Practices without Examples: Without a Valid obtaining the Failure License. proper to cease authorization. practice after a temporary license or permit has expired; Applicant or licensee practices after passing the exam but before licensing authority has issued license. DO NOT use for: Someone whose license has expired; instead use Code 24. [[Page 98]] 48........ A6.......... U......... Violation of ................. Violation of Examples: Federal or State federal or state Failure Statutes, statutes, to meet alimony Regulations or regulations or responsibilities Rules. rules not ; associated with Failure the practice act. to report abuse or other federal or state requirement. DO NOT use for: Violations of the state practice act; Failure to meet child support; instead use Code 37. 48........ 36.......... U......... Violation of ................. Fails to meet Example: Federal or State federal or state Failure Tax Code. tax code to meet federal responsibilities. or state tax code responsibilities . Explanation: Use with appropriate criminal conviction or adjudication code if applicable. 48........ 84.......... R......... Violation of ................. Redundant code, State Health use code 31. Code. 48........ A5.......... U......... Violation of or ................. Fails to comply Example: Failure to with a specific Failure Comply With board order. to meet terms of Licensing Board a board order. Order. ---------------------------------------------------------------------------------------------------------------- Criminal Conviction or Adjudication ---------------------------------------------------------------------------------------------------------------- 49........ 19.......... U......... Criminal ................. Convicted of a Example: Conviction. felony or misdemeanor Convicted of a crime. felony or misdemeanor crime. Explanation: Use this code along with the appropriate code to describe the underlying violation of law; If there is no appropriate code, describe the criminal conviction in the narrative. 49........ 18.......... U......... Deferred ................. Plea that avoids Explanation: Adjudication. criminal Deferred conviction by adjudication meeting certain involves probationary probation, requirements. treatment programs, and/or some type of community supervision; Use this code along with the appropriate code to describe the underlying violation of law; If there is no appropriate code, describe the violation in the narrative. 49........ B1.......... U......... Nolo Contendere ................. Plea of no Plea. contest, same consequence as a guilty plea. 49........ I1.......... U......... Diverted ................. Pre-trial Explanation: Conviction. sentencing that Pretrial avoids criminal sentencing conviction by includes completing a participating in court ordered a treatment or intervention rehabilitation program. program; Use this code along with the appropriate code to describe the underlying violation of law; If there is no appropriate code, describe the violation in the narrative. ---------------------------------------------------------------------------------------------------------------- Confidentiality, Consent or Disclosure Violations ---------------------------------------------------------------------------------------------------------------- 50........ C3.......... U......... Breach of ................. Releases or Example: Confidentiality. obtains patient information Releasing or without obtaining appropriate patient authorization. information without appropriate authorization. 50........ C2.......... U......... Failure to Comply ................. Fails to meet Examples: With Patient requirements for Failure Consultation consultation to consult with Requirements. with other or refer to an health care appropriate providers or licensee when refer when care is beyond appropriate. the licensee's level of training, skill, expertise or license; Failure to keep a referring source informed of the patient's progress. 50........ C1.......... U......... Failure to Obtain ................. Fails to meet Examples: Informed Consent. informed consent Failure requirements. to explain procedures and possible complications; Failure to obtain permission of the patient to evaluate and treat; as well as failure to obtain parental permission for a minor. ---------------------------------------------------------------------------------------------------------------- [[Page 99]] Misconduct or Abuse ---------------------------------------------------------------------------------------------------------------- 51........ D4.......... U......... Abusive Conduct ................. Engages in the Example: Toward Staff. maltreatment of Engaging a colleague or in the employee which maltreatment of can include a colleague or mental, physical employee (i.e. and/or verbal mental, physical abuse. and/or verbal abuse). DO NOT use for: Sexual abuse; instead use Code D1. 51........ D7.......... M......... Conduct Conduct Engages in Examples: Evidencing Evidencing conduct that is Failure Ethical Ethical or Moral unethical or to respect the Unfitness. Unfitness. violates the beliefs and ethical code of values of conduct. patient without prejudice; Failure to protect or disregards the rights, health, safety of the patient. 51........ D6.......... R......... Conduct ................. Use Code D7...... Evidencing Moral Unfitness. 51........ 71.......... U......... Conflict of ................. Fails to disclose Examples: Interest. information that Failure presents a to-disclose conflict of ownership; interest. Failure to provide freedom of choice. 51........ D5.......... U......... Disruptive ................. Engages in Example: Conduct. conduct which interferes with Interferes with or disrupts or disrupts normal normal operations in operations in the patient care the patient care setting or setting or workplace. workplace. DO NOT use for: Patient abuse; instead use Code 14. 51........ D3.......... U......... Exploiting a ................. Exploits a Examples: Patient for professional Takes Financial Gain. relationship advantage of the with a patient patient to benefit relationship by financially selling products beyond that that are not which is needed for reasonable for treatment or the provision of could be treatment. obtained for a lower price; Takes advantage of the patient relationship by inviting them into business opportunities. DO NOT use for: Excessive or fraudulent billing; instead use Code 55. 51........ 16.......... U......... Misappropriation ................. Uses a patient's Example: of Patient or coworker's Using or Property or property or the taking a Other Property. property of a patient's or facility without coworker's approval or property or the permission. property of a facility without approval or permission. Explanation: Also use Code 19 Criminal Conviction if there has been a criminal conviction. DO NOT use for: Diverting medications from a patient; instead use Code H6. 51........ D2.......... M......... Non-Sexual Dual Non-Sexual Engages in a non- Examples: Relationship or Boundary sexual Boundary Violation. relationship, Excessive Violation. behavior or personal boundary disclosure, violation that secrecy, involves reversal of exploitation or roles or actions coercion of a that meet the patient or needs of the former patient licensee and contains (borrowing harmful or money); potentially harmful elements. Non[hyphen]sexua l relationship with a patient's significant other. 51........ 14.......... U......... Patient Abuse.... ................. Engages in the Example: maltreatment of Mental, a patient which physical and/or can include verbal abuse of mental, physical a patient. and/or verbal DO NOT use for: abuse. Sexual abuse or sexual assault; instead use Code D1. 51........ D1.......... U......... Sexual Misconduct ................. Engages in Examples: behavior that Sexual exploits the exploitation of practitioner- a patient; patient relationship in Workplace sexual a sexual way, or harassment; engages in Sexual workplace sexual Assault; harassment such Sexual as unwelcome Abuse. sexual advances or conduct of a sexual nature which interferes with the performance of another person's job or creates an intimidating, hostile, or offensive work environment. 51........ D8.......... R......... Other ................. Redundant code, Unprofessional covered by other Conduct, Specify. categories, or use code 99. ---------------------------------------------------------------------------------------------------------------- [[Page 100]] Fraud, Deception, or Misrepresentation ---------------------------------------------------------------------------------------------------------------- 52........ E6.......... U......... Failure to ................. Fails to disclose Examples: Disclose. information that Failure is required by to disclose the board. criminal or disciplinary history on a license application; Failure to disclose revenues generated from selling equipment or other financial relationships, etc. 52........ E3.......... U......... Filing False ................. Fabricates Examples: Reports or patient, Failure Falsifying medical, health, to provide Records. employee, or accurate other records. patient, medical, health, employee, or other records; Documenting treatment that did not occur. Explanation: Use this code in conjunction with A2 Failure to Comply with Continuing Education or Competency Requirements for falsifying licensee continuing education or competence records. DO NOT use for: False billing for care/ treatment; instead use Code 56. 52........ 5........... R......... Fraud--Unspecifie ................. Redundant code, d. covered by other fraud codes. 52........ E4.......... U......... Fraud, Deceit or ................. Provides false, Examples: Material altered or Provides Omission in omitting false Obtaining documents and documentation in License or information when licensure Credentials. applying for application licensure. materials (transcript, letters, etc.); Failure to disclose prior disciplinary action or criminal conviction on application; Falsifies testing materials (cheating, trafficking, etc.). 52........ 55.......... M......... Improper or Improper Billing Knowingly or Examples: Abusive Billing Practices. intentionally Practices. bills improperly. Knowingly uses incorrect treatment or billing codes; Charges unreasonable fees; Intentionally overbills. DO NOT use for: Conviction of insurance fraud; instead use Code E1. 52........ E1.......... U......... Insurance Fraud ................. Convicted of Examples: (Medicare, Medicare, Medicaid or Medicaid or Convicted of Other Insurance). other insurance Medicare, fraud. Medicaid or other insurance fraud. Explanation: Use in conjunction with Code 19 Criminal Conviction. 52........ E5.......... U......... Misleading, False ................. Uses misleading, Example: or Deceptive false or False or Advertising or deceptive misleading Marketing. advertising or advertising marketing related to related to license. services, DO NOT use for: treatment, Failure procedures or to correctly care. identify credentials; instead use Code 81. 52........ 81.......... U......... Misrepresentation ................. Fails to properly Example: of Credentials. identify oneself Failure with regards to to properly education, identify training, education, knowledge, training, experience, or knowledge, skills. experience, or skills. 52........ E2.......... U......... Providing or ................. Orders or Examples: Ordering provides Unnecessary unnecessary Overutilization Tests or tests, of tests/ Services. procedures, services; treatment or services. Providing unnecessary treatment. 52........ 56.......... U......... Submitting False ................. Requests Example: Claims. reimbursement for services Intentionally that did not billing for occur or does interventions/ not reflect the care that did actual treatment not occur. provided. DO NOT use for: Conviction for insurance fraud; instead use Code E1; Documenting treatments/care that did not occur or falsifying patient records; instead use Code E3. ---------------------------------------------------------------------------------------------------------------- Unsafe Practice or Substandard Care ---------------------------------------------------------------------------------------------------------------- 53........ F8.......... U......... Failure to ................. Fails to provide Example: Consult or Delay or delaying Failure in Seeking proper to consult with Consultation consultation or report to a With Supervisor/ with supervisor supervisor/ Proctor. or proctor. ordering health care provider/ proctor. [[Page 101]] 53........ 53.......... R......... Failure to ................. Redundant code, Provide use code 13. Medically Reasonable and/ or Necessary Items or Services. 53........ F1.......... M......... Immediate Threat Immediate Threat Presents an Examples: to Health or to Public. immediate risk Safety. to health or Emergency or safety; Board summary uses emergency suspension of a measures to license. remove a Explanation: practitioner Use in from practice. combination with a code that best describes the violation. 53........ 17.......... U......... Inadequate or ................. Fails to conform Example: Improper to recognized Failure Infection standards or to follow Control orders for policies or Practices. infection procedures for control. infection control, sterile technique or isolation requirements. DO NOT use for: Failure to comply with federal, state, local or institutional safety requirements or state health codes; instead use Code 31. 53........ FA.......... U......... Inappropriate ................. Refuses to treat Example: Refusal to Treat. a patient due to Refusal religious, moral to treat a or other reasons. patient due to religious, moral or other reasons. 53........ 11.......... R......... Incompetence..... ................. Redundant code, use F1 or F6. 53........ 12.......... R......... Malpractice...... ................. Redundant code, use specific reason associated with malpractice. 53........ 13.......... U......... Negligence....... ................. Fails to exercise Example: the skill, care Failure and learning to exercise expected of a reasonable reasonably judgment. prudent health DO NOT use for: care provider. Competence issue; instead use Code F6. 53........ F9.......... U......... Patient ................. Terminates care Example: Abandonment. without adequate Deserts notice of the or neglects a professional patient with relationship whom there is an between a health established care provider provider-patient and a patient/ relationship client at a time without making when the patient reasonable needs further arrangements for care. the continuation of care and without reasonable notice. 53........ 15.......... R......... Patient Neglect.. ................. Redundant code, use 13. 53........ F6.......... M......... Substandard or Substandard Care Fails to meet Example: Inadequate Care. or Inadequate clinical Failure Skill Level. standards of to provide practice, unable competent care. to practice DO NOT use for: competently or practicing with Practicing insufficient beyond level of skill. training; instead use Code 29. 53........ F7.......... R......... Substandard or ................. Redundant code, Inadequate Skill use code F6. Level. 53........ F5.......... R......... Unable to ................. Redundant code, Practice Safely. use code F2, F3, or F4. 53........ F2.......... M......... Unable to Unable to Unable to Example: Practice Safely Practice Safely practice safely Failure/ by Reason of by Reason of by reason of inability to Alcohol or Other Substance Use. substance use. practice safely Substance Abuse. by reason of substance use. 53........ F4.......... M......... Unable to Unable to Unable to Example: Practice Safely Practice Safely practice safely Failure/ by Reason of by Reason of by reason of inability to Physical Illness Physical physical practice safely or Impairment. Impairment. impairment. by reason of physical impairment. 53........ F3.......... M......... Unable to Unable to Unable to Example: Practice Safely Practice Safely practice safely Failure/ by Reason of by Reason of by reason of inability to Psychological Psychological psychological practice safely Impairment or Impairment. impairment. by reason of Mental Disorder. psychological impairment. 53........ To be N......... N/A.............. Incorrect Site Procedure Example: determined. Procedure. performed on the wrong side or Performing an site of the invasive body, wrong procedure on surgical wrong side of procedure the body; performed. Performing a non- invasive procedure on the wrong side of the body, i.e. taking blood pressure on the side of an arteriovenous fistula. [[Page 102]] 53........ To be N......... N/A.............. Foreign Body Leaves an item(s) Example: determined. Retained inside a patient Retained Inappropriately after a foreign body in a Patient. procedure that refers to any should not be item or foreign there. object related to any operative or invasive procedure that is left inside a patient. Common items include sponges and towels; retractors, unretrieved device components or fragments, parts of trocars, guidewires, catheters, and pieces of drains; needles and other sharps. 53........ To be N......... N/A.............. Wrong Patient.... Procedure or Example: determined. treatment performed on the Performing an wrong patient. invasive procedure on the wrong patient; Performing a non- invasive procedure on the wrong patient i.e. ambulating the wrong patient. ---------------------------------------------------------------------------------------------------------------- Improper Supervision or Allowing Unlicensed Practice ---------------------------------------------------------------------------------------------------------------- 54........ G2.......... U......... Allowing or ................. Allows or assists Example: Aiding someone practice Unlicensed without a Knowingly allows Practice. license. unlicensed practice. 54........ G1.......... U......... Improper or ................. Fails to Example: Inadequate supervise Failing Supervision or adequately or to supervise Delegation. properly those adequately or assigned to you. properly those assigned to you. ---------------------------------------------------------------------------------------------------------------- Improper Prescribing, Dispensing, Administering Medication/Drug Violation ---------------------------------------------------------------------------------------------------------------- 55........ H6.......... U......... Inappropriate ................. Diverts Example: Acquisition or prescription Removing Diversion of medication from a prescribed Controlled a patient or a medication from Substance. healthcare a patient's facility with inventory, intent to sell, unused portion, distribute or waste, trash or consume for healthcare personal misuse. facility inventory for self or someone other than the patient. 55........ H5.......... U......... Error in ................. Makes an error Examples: Prescribing, when Giving Dispensing or prescribing, the wrong Administering dispensing, or medication; Medication or administering Giving Sedation. medications. medication to the wrong patient; Giving the wrong dosage of medication; Improper storage of medication. 55........ H1.......... M......... Narcotics Drug Drug Violation or Controlled Examples: Violation or Other Violation substance Other Violation of Drug Statutes. violation Controlled of Drug Statutes. regardless of substance conviction. violation regardless of conviction. Explanation: If there is a conviction, also use Code 19 Criminal Conviction. 55........ H4.......... U......... Inappropriate or ................. Administers Example: Unauthorized medications Failure Administration improperly or to administer of Medication or without the medications Sedation. appropriate properly or prescription or without the medication order. appropriate prescription/ order. 55........ H3.......... U......... Inappropriate or ................. Dispenses Example: Unauthorized medication Failure Dispensing of improperly or to obtain Medication. without the authorization or appropriate prescription to authorization. dispense medication. 55........ H2.......... U......... Inappropriate or ................. Improper Examples: Unauthorized prescribing or Forging Prescribing of attempting to signature on Medication. prescribe order/ without prescription; authority or Altering altering an order/ medication order. prescription; Failure to obtain prescriber authorization or signature. ---------------------------------------------------------------------------------------------------------------- Other ---------------------------------------------------------------------------------------------------------------- 56........ 99.......... U......... Other--Not ................. Use only if no Classified, other code is Specify. applicable. ---------------------------------------------------------------------------------------------------------------- Table Key: [ssquf] Table # and name as it appears in published NPDB Code Lists. [ssquf] Code # as it appears in published NPDB Code Lists. NOTE: Code number is subject to change with the next published version. [ssquf] Status: Unchanged (U), Modified (M), Retired (R), New (N). [ssquf] Current Code Description. [ssquf] New or Modified Code Description. [ssquf] Guideline: a new category of information to help explain the code. [ssquf] Code use examples and explanations: a new category of information to show how to apply the code. [[Page 103]] Diana Espinosa, Acting Administrator. [FR Doc. 2021-28377 Filed 12-30-21; 8:45 am] BILLING CODE 4165-15-P