060.00.99 Ark. Code R. 009

Current through Register Vol. 49, No. 10, October, 2024

Rule 060.00.99-009 - Regulation 18 - Fees for CCVS System

subject to this act, including not less than two (2) hospital representatives and not less than two (2) insurer or health maintenance organization representatives.

(4)Credentialing information shall not be disclosed to any parties other than the applicable health care provider and the credentialing organization and its designated credentialing and appeals, peer review and quality improvement committee(s) or body(ies). Except as permitted herein, credentialing information shall not be used for any purpose other than review by the board and credentialing organizations of the professional background, competency, qualifications and credentials or renewal of credentials of a health care provide?-, or appeals therefi-om, and all such credentialing information shall be exempt from disclosure under the provisions of Arkansas Code §§ 25-19-101 through 25-19-107. Credentialing information may be disclosed in the following circumstances:

(A)By the board, in disciplinary hearings before the board or in any trial or appeal of the board action or order.

(B)By the board or credentialing organization, to any licensing, regulatory or disciplinaiy authorities or agencies of the United States or of other states or jurisdictions.

(C)In any legal or regulatory proceeding which:

(i)is brought by a health care provider; a representative of the health care provider or a class thereof; any local, state or federal agency or authority; or a patient or group or class of patients or their authorized representatives or agents; and

(ii)challenges the actions, omissions or conduct of the credentialing organization with respect to credentialing of any health care provider or the grant or denial of any affiliation or participation of such health care provider with or in the credentialing organization or any network thereof; or

(D)By any party when authorized to do so by the health care provider to whom the credentialing information relates.

(5)The evaluation and discussion of credentialing information by a credentialing organization shall not be subject to discovery or admissible pursuant to the Arkansas Rules of Civil Procedure or the Freedom of Information Act, beginning at § 25-19-101.

(6)The board may enter into contractual agreements with users of the credentialing information system to define the type and form of information to be provided and to give users assurances of the integrity of the information collected.

(7)The board may charge credentialing organizations a reasonable fee for the use of the credentialing service as established by rule and regulation. The fee shall be set in consultation with the advisory committee and shall be set at such a rate as will reimburse the board, when added to the credentialing assessments collected from physicians, for the cost of maintaining the credentialing information system. The board's costs may not exceed the fees charged by private vendors with a comparable statewide credentialing service. Each physician licensee of the Arkansas State Medical board will pay a credentialing fee of one hundred dollars ($100.00) per year at the time of the renewal of the license for the year 2000 and 2001. For the year 2002 and each year thereafter, the board may assess each physician licensee an amount not to exceed twenty-five dollars ($25.00) per year to offset the cost for providing the credentialing service. Physicians shall not be charged a credentialing fee by a credentialing organization.

(e)

(1)In lieu of testing credentialing information by its own primary source verification procedure, a credentialing organization may rely upon credentialing information fiom the board, if the board certifies that the information provided by the board has been tested by the board's primary source verification procedure. The credentialing organization shall be immune fi-om civil suit based on any allegation of wrongdoing or negligence involved in the collection and verification of or reliance upon, credentialing information on a health care provider if the credentialing organization has utilized the information provided by the board in credentialing a health care provider for affiliation or participation with the credentialing organization. This does not convey immunity from civil suit to a credentialing organization for any credentialing decision it makes.

(2)Subject only to the exceptions recognized in subsections (f)(1) and (f)(2) hereof a credentialing organization shall be precluded hereby from seeking credentialing information from the physician or from sources other than the board if:

(A)the same credentialing information is available from the board; and

(B)at the time such credentialing information is requested, the board:

(i)holds certification by the National Committee for Quality Assurance as a certified credentials verification organization; and

(ii)demonstrates compliance with the principles for credentials verification organizations set forth by the Joint Commission on the Accreditation of Healthcare Organizations;

(iii)documents compliance with the Arkansas Department of Health Rules and Regulations applicable to credentialing; and

(iv)maintains evidence of compliance with the standards referenced in (i), (ii), and (iii) above; and

(C)the board charges fees which comply with (d)(7) above. Until such time as the board satisfies each of the foregoing prerequisites, credentialing organizations may, in their discretion, utilize credentialing information obtained from the board or they may seek other sources for the same credentialing information. If at any time the board fails to satisfy any of the certification or compliance standards referenced in this subsection, no credentialing organization shall be required to utilize the board to obtain credentialing information during any period in which the board lacks such accreditation or compliance.

(f)

(1)Credentialing organizations which utilize the credentialing information system offered by the Arkansas State Medical board shall not attempt to collect duplicate information from individual physicians or originating sources, but nothing herein shall prevent any credentialing organization from collecting or inquiring about any data not available from or through the board, nor from reporting to or inquiring of the National Practitioner Data Bank.

(2)The board may seek an injunction against any credentialing organization violating or attempting to violate this act and, upon prevailing, shall be entitled to recover attorney's fees and court costs involved in obtaining the injunction.

(g)The board will have the authority to hire such employees, enter into contracts with attorneys, individuals or corporations for services, as may be necessary to bring about the purpose of this act.

SECTION 3. AH provisions of this act of a general and permanent nature are amendatory to the Arkansas Code of 1987 Annotated and the Arkansas Code Revision Commission shall incorporate the same in the Code.

SECTION 4. If any provision of this act or the application thereof to any person or circumstance is held invalid, such invalidity shall not affect other provisions or applications of the act which can be given effect without the invalid provision or application, and to this end the provisions of this act are declared to be severable.

SECTION 5. All laws and parts of laws in conflict with this act are hereby repealed.

SECTION 6. EMERGENCY CIA USE. It is hereby found and determined by the Eighty-second General Assembly of the State of Arkansas that hospitals, credentialing organizations and insurance companies are in need of physician credentialing information collected by the Arkansas State Medical Board; that said information should be privileged and the sharing of said information should be protected so as to enhance the credentialing process of medical providers; that the laws protecting the credentialing process which now exist will expire on July 1, 1999 and that passage of this act will provide for the continued protection of the credentialing process. Therefore, an emergency is declared to exist and this act being immediately necessary for the preservation of the public peace, health and safety shall become effective on July 1, 1999.

/s/ Gullett

060.00.99 Ark. Code R. 009

11/29/1999