NAMSS Standards Criminal Background Check, DEA, Education, Licensure/Sanctions, Residency/Fellowship

Criminal Background Check NCQA, URAC and AAAHC do not address criminal background checks. TJC – standard only applies to hospital employees – required DNV – does not address as a standard, only says that it is required if state law requires it. CoP’s – required if State law requires

HFAP is the only accreditor who has something specific to say on the matter. The medical staff application must request information regarding any criminal history for 7 to 10 years. The facility conducts criminal background investigations based on information provided in the application or as required by federal and state regulations.

DEA Medicare CoP’s do not specifically address DEA’s. Otherwise, before recommending privileges, the medical staff evaluates challenges to any licensure or registration. It must be evaluated on initial appointment, reappointment, expiration and monitored continually.

Education NCQA – The organization need only verify the highest level of credentials attained. For everyone else, education is verified with primary source on initial appointment.

Licensure/Sanctions TJC – licensure is verified with the primary source at the time of appointment and initial granting of clinical privileges, at reappointment, renewal or revision of privileges and on expiration. Challenges must be evaluated. NCQA – Confirm that the practitioner holds a valid, current license, in effect at the time of the Credentials Committee decision. Verify license only in the states where practitioner provides care for organization members. Verification directly with state licensing agency.

HFAP – Verification of current license, licensure sanctions, state of current practice or intended practice and all previous licenses held. DNV – Verification of licensure on initial appointment and reappointment. Sanctions not addressed. URAC – Current licenses and history of licensure in all jurisdictions included on application. AAAHC – verified and documented on initial appointment, reappointment, expiration and continually monitored thereafter.

Residency/Fellowship At the time of appointment to membership and initial granting of privileges, verification of relevant training or experience must be obtained from the primary source(s) or a designated equivalent source. According to NCQA, only the highest level of training must be verified.