HB1105

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\r\n HOUSE OF REPRESENTATIVES \r\n	\r\n H.B. NO. \r\n	\r\n 1105 \r\n
\r\n THIRTY-THIRD LEGISLATURE, 2025 \r\n		\r\n \r\n
\r\n STATE OF HAWAII \r\n		\r\n \r\n
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A BILL FOR AN ACT

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RELATING TO CREDENTIALING OF HEALTH CARE PROVIDERS.

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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

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\xa0\xa0\xa0\xa0 SECTION 1.\xa0 The\r\nlegislature finds that the credentialing of health care providers is a\r\nwell-established risk management and patient safety practice that involves the\r\ncollection and verification of a health care provider\'s\r\nqualifications required for a health care provider to render services and\r\nreceive reimbursement.\xa0 Credentialing\r\npractices are largely uniform across the country because the standards are\r\nestablished by major payors like the United States Department of Health and\r\nHuman Services, Centers for Medicare and Medicaid Services, and by private\r\nsector health care facility and health plan accreditation programs.

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\xa0\xa0\xa0\xa0 Entities that require credentialing of\r\nhealth car'b"e providers include hospitals, universities, clinics, health plans,\r\nand independent practice associations.\xa0\r\nThe credentialing process involves the verification and periodic\r\nreverification of a nearly identical set of core information for the same pool\r\nof health care providers such as relevant training, licensure, certifications,\r\nand registrations.

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\xa0\xa0\xa0\xa0 The legislature finds that duplicative\r\ncredentialing diverts resources from other priorities including patient care\r\nand contributes to higher health care costs.\xa0\r\nA centralized credentialing system, such as the one used by the Ohio\r\ndepartment of Medicaid can create benefits that improve efficiency and quality\r\nof health care services.\xa0 It can reduce\r\nworkflows, overall system costs, and provider frustration, and can increas"b"e\r\npatient access as providers are verified to participate in health plans more\r\neasily and quickly to provide care at health facilities.

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\xa0\xa0\xa0\xa0 The legislature further finds that a\r\ncentralized credentialing pilot project to reduce unnecessary paperwork,\r\nimprove provider recruitment and retention, and ultimately increase patient\r\naccess.

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\xa0\xa0\xa0\xa0 Accordingly, the purpose of this Act is to\r\nauthorize the department of health to implement a two-year pilot project that establishes\r\na centralized credentialing entity to which providers submit their information\r\nand fees one time and from which multiple end-users such as hospitals,\r\nuniversities, clinics, health plans, and independent practice associations can\r\naccess that information.

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\xa0\xa0\xa0\xa0 SECTION 2.\xa0\r\n(a)\xa0 The department of health\r\nshall establish a two-year centralized health care credentialing pilot program\r\nto improve patient access to health care by reducing the administrative burden\r\nrelated to credentialing.\xa0 The pilot\r\nprogram shall:

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\xa0\xa0\xa0\xa0 (1)\xa0 Review\r\nexisting credentialing practices in the community;

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\xa0\xa0\xa0\xa0 (2)\xa0 Establish\r\nagreements with participating credentialing entities to coordinate\r\ncredentialing activities, including roles and responsibilities; and

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\xa0\xa0\xa0\xa0 (3)\xa0 Establish\r\nand measure pre- and post-intervention process measures and outcome measures.

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\xa0\xa0\xa0\xa0 (b)\xa0\r\nThe pilot program may include the following health care provider\r\nverification services, or others as determined by the department:

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\xa0\xa0\xa0\xa0 (1)\xa0 Training\r\nand education, including dates of post-graduate education or training and\r\ncompletion of residencies or practicums in a specialty;

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\xa0\xa0\xa0\xa0 (2)\xa0 Licensing\r\nand certification, including licensure status in th"b"e State of Hawaii, national\r\nprovider identifier number, active United States Drug Enforcement Agency\r\nnumber, certificate of controlled dangerous substances, and eligibility to\r\nparticipate in medicare or medicaid;

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\xa0\xa0\xa0\xa0 (3)\xa0 Work\r\nhistory details, including a five-year work history, explanations for gaps\r\nlonger than six months, and histories of loss of license, felony convictions,\r\nand loss of privileges; and

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\xa0\xa0\xa0\xa0 (4)\xa0 Active\r\nand sufficient malpractice insurance including malpractice history.

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\xa0\xa0\xa0\xa0 (c)\xa0\r\nThe department shall incorporate credentialing standar"b"ds published by\r\nthe Joint Commission, National Committee on Quality Assurance, or other\r\nrelevant entities into policies and procedures as applicable.

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\xa0\xa0\xa0\xa0 (d)\xa0\r\nThe department may partner with private sector entities and may accept\r\nfinancial and in-kind donations from private sector entities to operate the\r\npilot program.

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\xa0\xa0\xa0\xa0 (e)\xa0\r\nThe department shall convene an advisory committee to make\r\nrecommendations to the department on the implementation and operation of the\r\npilot program.\xa0 The members shall include:

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\xa0\xa0\xa0\xa0 (1)"b"\xa0 A\r\nrepresentative from the Hawaii health systems corporation;

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\xa0\xa0\xa0\xa0 (2)\xa0 A\r\nrepresentative from the university of Hawaii John A. Burns School of Medicine;

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\xa0\xa0\xa0\xa0 (3)\xa0 A\r\nrepresentative from the Healthcare Association of Hawaii;

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\xa0\xa0\xa0\xa0 (4)\xa0 A\r\nrepresentative from the Hawaii Medical Association;

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\xa0\xa0\xa0\xa0 (5)\xa0 A\r\nrepresentative from the Hawaii Association of Health Plans;

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\xa0\xa0\xa0\xa0 (6)\xa0 A\r\nrepresentative from the Hawaii Primary Care Association; and

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\xa0\xa0\xa0\xa0 (7)\xa0 Any\r\nother entity invited by the director of health.

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\xa0\xa0\xa0\xa0 (f)\xa0\r\nThe department may contract for all or part of the pilot program.

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\xa0\xa0\xa0\xa0 (g)\xa0\r\nThe department shall submit a report to the legislature of its finding\r\nand recommendations, including any proposed legislation no later than twenty\r\ndays prior to the convening of the regular sessions of 2026 and 2027.

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SECTION 3.\xa0\r\nThere is appropriated out of the general revenues of the State of Hawaii\r\nthe sum of $250,000 or so much thereof as may be necessary for fiscal year\r\n2025-2026 and the same sum or so much thereof as may be necessary for fiscal\r\nyear 2026-2027 to carry out the purposes of this Act, including for the\r\nestablishment and administration of a two-year centralized health care\r\ncredentialing pilot program.

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\xa0\xa0\xa0\xa0 T'b'he sums appropriated shall be expended by the department of health\r\nfor the purposes of this Act.

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\xa0\xa0\xa0\xa0 SECTION 4.\xa0\r\nThis Act, upon its approval, shall take effect on July 1, 2025.

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INTRODUCED BY:

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BY REQUEST

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Report Title:

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DOH; Centralized Health Care Credentialing Pilot Program;\r\nAppropriation

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Description:

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Authorizes the Department of Health to implement a\r\ntwo-year pilot program that reduces duplicative activities required for the\r\ncredentialing of health care providers by hospitals, universities, clinics,\r\nhealth plans, and independent practice associations; and establishes an\r\nadvisory committee. Appropriates funds.

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The summary description\r\nof legislation appearing on this page is for informational purposes only and is\r\nnot legislation or evidence of legislative intent.

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HB 1105: RELATING TO CREDENTIALING OF HEALTH CARE PROVIDERS.

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