Section 1921 of the Social Security Act

Section 1921 authorizes the National Practitioner Data Bank (NPDB) to expand the information it collects. With this legislation, disciplinary records of allied health care professionals are now accessible to private sector hospitals, nursing homes, and other organizations so that they may be used when making employment, affiliation, certification, or licensure decisions.

The intent of this expansion is to protect beneficiaries participating in the Social Security Act’s health care programs from unfit health care practitioners and to improve the anti-fraud provisions of these programs. The Final Rule for Section 1921 was published in the Federal Register on January 28, 2010 and Section 1921 was opened for querying and reporting to the Data Bank on March 1, 2010.

Section 1921 adds State licensure actions against all types of health care professionals, not just physicians and dentists, to the NPDB. In addition, Section 1921 collects any negative action or finding by State licensing agencies, peer review organizations and private accreditation organizations against all health care practitioners and organizations.

Hospitals and their human resource departments and nurse recruitment offices now have access to licensure actions on all types of health care professionals. They may query the Data Bank on all types of health care professionals including nurses, nurse aides, and other allied health care professionals when making their hiring decisions. The ability to perform pre-employment screenings of potential health care employees is an invaluable resource that can enhance the hiring process and increase an organizationÂ’s efforts towards patient safety.

Registration and Section 1921

All organizations who wish to use the Data Bank must first register and certify their eligibility to access the Data Bank. The registration form includes a provision for Section 1921 eligibility, which must be completed by your Entity Data Bank Administrator. If your organization is already registered, you may update the registration profile from the Administrator Options screen with your Section 1921 preferences. See About Registration for more information.

Who Reports Under Section 1921?

State licensing authorities are required to report any publicly available negative action or finding that has been taken against a health care practitioner or health care entity. Peer review organizations or private accreditation organizations must report all final actions taken against a health care practitioner or organization.

Section 1921 broadens the NPDB by requiring the reporting of all adverse licensure actions, not just those based on professional competence or conduct. State licensing agencies that currently report to the HIPDB will also be required to report to the NPDB under the provision of Section 1921. The Data Bank will determine if the report is to be placed under the NPDB, the HIPDB, or both. See below for organization specific information.

Who Queries Under Section 1921?

Hospitals, including human resource and nurse recruitment departments, will now have access to all licensing board actions on all health care practitioners, not just physicians and dentists. All organizations that currently have access to the NPDB will also have access to Section 1921 of the NPDB. Organizations that are only allowed to query the NPDB through Section 1921 will receive Section 1921 information only. See below for organization specific information.

How Does Section 1921 Affect My Organization?

Whether you are a hospital, nursing home, State Licensing Board or authority, accreditation organization, quality improvement organization, peer review organization, law enforcement agency, Federal or State health care program, or other health care organization, Section 1921 affects your organization. Reporting requirements and the types of licensure actions collected have been expanded through Section 1921. Eligible queriers will now have access to State licensure actions taken against all health care practitioners. Under Section 1921, this now includes limited querying by quality improvement organizations, Federal and State health care programs, State Medicaid Fraud Control Units, and other law enforcement agencies.

Hospitals, Nursing Homes and Other Health Care Organizations

Under Section 1921, hospitals, nursing homes, and other health care organizations have access to State licensure actions taken against all health care practitioners and health care entities, not just physicians. These practitioners include nurses, nurse aides, podiatrists, physician assistants, physical therapists, respiratory therapists, social workers and other allied health care professionals. The information is accessible to both public and private sector hospitals, nursing homes, and other health care organizations through the NPDB.

The information reported to the NPDB, as expanded by Section 1921, includes all actions taken against a practitioner. The action no longer must be based on competence and conduct. This information is valuable to human resource departments and nurse recruitment offices when performing pre-employment background checks and making hiring decisions. The information may also be beneficial for hospitals when placing patients in extended care, rehabilitation, or long term care facilities.

State Licensing Boards and Authorities

Under Section 1921 reporting requirements, State licensing authorities must report all publicly available adverse licensure actions, not just those based on professional competence and conduct. This includes actions taken against all health care practitioners and health care entities, not just those concerning physicians and dentists. Section 1921 information is an important resource to State licensing agencies when making licensure determinations about health care practitioners and organizations.

Accreditation Organizations

Private Accreditation organizations are now required to report to the NPDB under Section 1921, certain types of final negative actions or findings against health care organizations. Private accreditation organizations are not authorized to query Section 1921 information.

Quality Improvement Organizations

Quality Improvement Organizations (QIOs), as defined in Section 1921 final regulations, are among the organizations that are newly authorized to query the NPDB under Section 1921. Information available under Section 1921 includes adverse licensure actions taken by a State licensing authority against health care practitioners and entities, as well as negative actions or findings that a State licensing authority, peer review organization, or private accreditation organization finalizes against a health care practitioner or organization.

Access to the information in Section 1921 of the NPDB can aid QIOs in their mission to protect and improve the quality of care for Medicare beneficiaries. For example, Quality Improvement Organizations will be able to query Section 1921 information when performing quality of care reviews and other related activities. There is no reporting requirement for QIOs in the Section 1921 final regulations.

Peer Review Organizations

Under Section 1921, peer review organizations, as defined in the Section 1921 final regulations, are required to report certain types of negative actions or findings against health care practitioners to the NPDB.

Only utilization and quality control peer review organizations under contract with the Centers for Medicare and Medicaid Services (referred to as Quality Improvement Organizations) are authorized to query Section 1921 information. Other peer review organizations do not have this authority. Section 1921 information, however, will serve as an invaluable resource for hospitals and other health care organizations with which peer review organizations work by improving employment screening, reducing the risk of negligent credentialing, and enhancing patient safety.

Law Enforcement Agencies

Law enforcement agencies and State Medicaid Fraud Control Units are among the organizations that are newly authorized to query Section 1921 of the NPDB.

Information available under Section 1921 includes adverse licensure actions taken by a State licensing authority against health care practitioners and entities, as well as negative actions or findings that a State licensing authority, peer review organization or private accreditation organization finalizes against a health care practitioner or entity.

There are no Section 1921 reporting requirements for law enforcement agencies.

Federal State Health Care Programs

Federal agencies administering Federal health care programs (and their contractors) as well as State agencies administering State health care programs are among the organizations that are newly authorized to query the NPDB under Section 1921.

Information available under Section 1921 includes adverse licensure actions taken by a State licensing authority against health care practitioners and entities, as well as negative actions or findings that a State licensing authority, peer review organization or private accreditation organization finalizes against a health care practitioner or entity.

There are no Section 1921 reporting requirements for Federal or State health care programs.

Section 1921 for Practitioners

Practitioners may access information about themselves in the Data Bank at anytime. They may request information about themselves by submitting a Request for Information (Self-Query) on the Data Bank Web site. See About Searching for Your Own Reports for more information.