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HB1105
HOUSE OF REPRESENTATIVES
H.B. NO.
1105
THIRTY-THIRD LEGISLATURE, 2025
STATE OF HAWAII
A BILL FOR AN ACT
RELATING TO CREDENTIALING OF HEALTH CARE PROVIDERS.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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SECTION 1.
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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.
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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.
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Entities that require credentialing of
health care providers include hospitals, universities, clinics, health plans,
and independent practice associations.
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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.
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The legislature finds that duplicative
credentialing diverts resources from other priorities including patient care
and contributes to higher health care costs.
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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.
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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.
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The legislature further finds that a
centralized credentialing pilot project to reduce unnecessary paperwork,
improve provider recruitment and retention, and ultimately increase patient
access.
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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.
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SECTION 2.
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(a)
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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.
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The pilot
program shall:
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(1)
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Review
existing credentialing practices in the community;
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(2)
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Establish
agreements with participating credentialing entities to coordinate
credentialing activities, including roles and responsibilities; and
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(3)
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Establish
and measure pre- and post-intervention process measures and outcome measures.
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(b)
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The pilot program may include the following health care provider
verification services, or others as determined by the department:
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(1)
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Training
and education, including dates of post-graduate education or training and
completion of residencies or practicums in a specialty;
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(2)
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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;
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(3)
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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
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(4)
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Active
and sufficient malpractice insurance including malpractice history.
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(c)
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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.
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(d)
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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.
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(e)
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The department shall convene an advisory committee to make
recommendations to the department on the implementation and operation of the
pilot program.
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The members shall include:
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(1)
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A
representative from the Hawaii health systems corporation;
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(2)
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A
representative from the university of Hawaii John A. Burns School of Medicine;
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(3)
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A
representative from the Healthcare Association of Hawaii;
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(4)
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A
representative from the Hawaii Medical Association;
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(5)
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A
representative from the Hawaii Association of Health Plans;
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(6)
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A
representative from the Hawaii Primary Care Association; and
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(7)
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Any
other entity invited by the director of health.
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(f)
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The department may contract for all or part of the pilot program.
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(g)
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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.
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SECTION 3.
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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.
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The
sums appropriated shall be expended by the department of health
for the purposes of this Act.
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SECTION 4.
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This Act, upon its approval, shall take effect on July 1, 2025.
INTRODUCED BY:
_____________________________
BY REQUEST
Report Title:
DOH; Centralized Health Care Credentialing Pilot Program;
Appropriation
Description:
Authorizes the Department of Health to implement a
two-year pilot program that reduces duplicative activities required for the
credentialing of health care providers by hospitals, universities, clinics,
health plans, and independent practice associations; and establishes an
advisory committee. Appropriates funds.
The summary description
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not legislation or evidence of legislative intent.