| 47 | | - | SECTION 1. The legislature finds that the credentialing of health care providers is a well-established risk management and patient safety practice that involves the collection and verification of a health care provider's qualifications required for a health care provider to render services and receive reimbursement. Credentialing practices are largely uniform across the country because the standards are established by major payors like the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, and by private sector health care facility and health plan accreditation programs. Entities that require credentialing of health care providers include hospitals, universities, clinics, health plans, and independent practice associations. The credentialing process involves the verification and periodic reverification of a nearly identical set of core information for the same pool of health care providers such as relevant training, licensure, certifications, and registrations. The legislature finds that duplicative credentialing diverts resources from other priorities including patient care and contributes to higher health care costs. A centralized credentialing system, such as the one used by the Ohio department of medicaid can create benefits that improve efficiency and quality of health care services. It can reduce workflows, overall system costs, and provider frustration, and can increase patient access as providers are verified to participate in health plans more easily and quickly to provide care at health facilities. The legislature further finds that a centralized credentialing pilot project can reduce unnecessary paperwork, improve provider recruitment and retention, and ultimately increase patient access. Accordingly, the purpose of this Act is to require the department of health to establish a two-year pilot program that establishes a centralized credentialing entity to which providers submit their information and fees one time and from which multiple end-users such as hospitals, universities, clinics, health plans, and independent practice associations can access that information. SECTION 2. (a) The department of health shall establish a two-year centralized health care credentialing pilot program to improve patient access to health care by reducing the administrative burden related to credentialing. The pilot program shall: (1) Review existing credentialing practices in the community; (2) Establish agreements with participating credentialing entities to coordinate credentialing activities, including roles and responsibilities; and (3) Establish and measure pre- and post-intervention process measures and outcome measures. (b) The pilot program may include the following health care provider verification services, or others as determined by the department of health: (1) Training and education, including dates of post‑graduate education or training and completion of residencies or practicums in a specialty; (2) Licensing and certification, including licensure status in the State of Hawaii, national provider identifier number, active United States Drug Enforcement Agency number, certificate of controlled dangerous substances, and eligibility to participate in medicare or medicaid; (3) Work history details, including a five-year work history, explanations for gaps longer than six months, and histories of loss of license, felony convictions, and loss of privileges; and (4) Active and sufficient malpractice insurance including malpractice history. (c) The department of health shall incorporate credentialing standards published by the Joint Commission, National Committee on Quality Assurance, or other relevant entities into policies and procedures as applicable. (d) The department of health may partner with private sector entities and may accept financial and in-kind donations from private sector entities to operate the pilot program. (e) The department of health shall convene an advisory committee to make recommendations to the department on the implementation and operation of the pilot program. The members shall include: (1) A representative from the Hawaii health systems corporation; (2) A representative from the university of Hawaii John A. Burns School of Medicine; (3) A representative from the Healthcare Association of Hawaii to be invited by the director of health; (4) A representative from the Hawaii Medical Association to be invited by the director of health; (5) A representative from the Hawaii Association of Health Plans to be invited by the director of health; (6) A representative from the Hawaii Primary Care Association to be invited by the director of health; and (7) Any other entity invited by the director of health. (f) The department of health may contract for all or part of the pilot program. (g) The department of health shall submit a report to the legislature of its finding and recommendations, including any proposed legislation, no later than twenty days prior to the convening of the regular sessions of 2026 and 2027. SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $250,000 or so much thereof as may be necessary for fiscal year 2025-2026 and the same sum or so much thereof as may be necessary for fiscal year 2026-2027 to carry out the purposes of this Act, including for the establishment and administration of a two-year centralized health care credentialing pilot program. The sums appropriated shall be expended by the department of health for the purposes of this Act. SECTION 4. This Act shall take effect on December 31, 2050. |
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| 47 | + | SECTION 1. The legislature finds that the credentialing of health care providers is a well-established risk management and patient safety practice that involves the collection and verification of a health care provider's qualifications required for a health care provider to render services and receive reimbursement. Credentialing practices are largely uniform across the country because the standards are established by major payors like the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services, and by private sector health care facility and health plan accreditation programs. Entities that require credentialing of health care providers include hospitals, universities, clinics, health plans, and independent practice associations. The credentialing process involves the verification and periodic reverification of a nearly identical set of core information for the same pool of health care providers such as relevant training, licensure, certifications, and registrations. The legislature finds that duplicative credentialing diverts resources from other priorities including patient care and contributes to higher health care costs. A centralized credentialing system, such as the one used by the Ohio department of Medicaid can create benefits that improve efficiency and quality of health care services. It can reduce workflows, overall system costs, and provider frustration, and can increase patient access as providers are verified to participate in health plans more easily and quickly to provide care at health facilities. The legislature further finds that a centralized credentialing pilot project to reduce unnecessary paperwork, improve provider recruitment and retention, and ultimately increase patient access. Accordingly, the purpose of this Act is to authorize the department of health to implement a two-year pilot project that establishes a centralized credentialing entity to which providers submit their information and fees one time and from which multiple end-users such as hospitals, universities, clinics, health plans, and independent practice associations can access that information. SECTION 2. (a) The department of health shall establish a two-year centralized health care credentialing pilot program to improve patient access to health care by reducing the administrative burden related to credentialing. The pilot program shall: (1) Review existing credentialing practices in the community; (2) Establish agreements with participating credentialing entities to coordinate credentialing activities, including roles and responsibilities; and (3) Establish and measure pre- and post-intervention process measures and outcome measures. (b) The pilot program may include the following health care provider verification services, or others as determined by the department: (1) Training and education, including dates of post-graduate education or training and completion of residencies or practicums in a specialty; (2) Licensing and certification, including licensure status in the State of Hawaii, national provider identifier number, active United States Drug Enforcement Agency number, certificate of controlled dangerous substances, and eligibility to participate in medicare or medicaid; (3) Work history details, including a five-year work history, explanations for gaps longer than six months, and histories of loss of license, felony convictions, and loss of privileges; and (4) Active and sufficient malpractice insurance including malpractice history. (c) The department shall incorporate credentialing standards published by the Joint Commission, National Committee on Quality Assurance, or other relevant entities into policies and procedures as applicable. (d) The department may partner with private sector entities and may accept financial and in-kind donations from private sector entities to operate the pilot program. (e) The department shall convene an advisory committee to make recommendations to the department on the implementation and operation of the pilot program. The members shall include: (1) A representative from the Hawaii health systems corporation; (2) A representative from the university of Hawaii John A. Burns School of Medicine; (3) A representative from the Healthcare Association of Hawaii; (4) A representative from the Hawaii Medical Association; (5) A representative from the Hawaii Association of Health Plans; (6) A representative from the Hawaii Primary Care Association; and (7) Any other entity invited by the director of health. (f) The department may contract for all or part of the pilot program. (g) The department shall submit a report to the legislature of its finding and recommendations, including any proposed legislation no later than twenty days prior to the convening of the regular sessions of 2026 and 2027. SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $250,000 or so much thereof as may be necessary for fiscal year 2025-2026 and the same sum or so much thereof as may be necessary for fiscal year 2026-2027 to carry out the purposes of this Act, including for the establishment and administration of a two-year centralized health care credentialing pilot program. The sums appropriated shall be expended by the department of health for the purposes of this Act. SECTION 4. This Act, upon its approval, shall take effect on July 1, 2025. INTRODUCED BY: _____________________________ BY REQUEST |
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