Allied Health Professionals / Non-Physician Practitioners (NAMSS Comparison) Flashcards
Does not use the term “allied health professionals”, rather it refers to other “licensed practitioners”.
a. NCQA
b. TJC (CAMH)
c. URAC
TJC (CAMH)
CR1, Factor 1 Non-physician practitioners who have an independent relationship with the organization and provide care under the organization’s medical benefits must be credentialed
a. NCQA
b. Medicare CoP
c. URAC
NCQA
This standard does not refer to “allied health professionals”, rather they use the term “non-physician practitioners”.
a. Medicare CoP
b. ACHC (HFAP)
c. DNV (NIAHO)
ACHC (HFAP)
MS.2 SR.4 There shall be established policies and procedures approved by the medical staff and governing body for non-physician clinical activities including:
* specific type of clinical activities that each class of practitioner will be eligible to perform, consistent with the scope of practice under applicable state law
* oversight process by the medical staff over each class of practitioner
* physician supervision or collaboration as defined by the hospital and in accordance with state law
* process and criteria for reviewing qualifications of each individual practitioner before he/she is permitted to provide patient care
* and the process, criteria and frequency for evaluating the performance in providing clinical services by practitioners other than physicians.
a. DNV (NIAHO)
b. NCQA
c. Medicare CoP
DNV (NIAHO)
All practitioners who are participating providers and who provide covered health care services to consumers and those who appear in the organization’s directory are credentialed.
a. URAC
b. NCQA
c. AAAHC
URAC
The medical and/or dental staff includes all credentialed and privileged health care professionals, including physicians and AHPs. AHPs include, but are not limited to Advanced Practice Registered Nurses and Physician Assistants. If allowed by the organization, the board must provide a process for the initial appointment, reappointment, assignment, or curtailment of privileges and practice for AHPs. Accredited organizations may wish to include additional categories of health care professionals e.g. dental assistants and orthopedic technicians, who are employed by a credentialed dentist or physician and assist in surgical procedures.
a. DNV (NIAHO)
b. AAAHC
c. TJC (CAMH)
AAAHC
Interpretive Guidelines §482.12(a)(1) and §482.22(a) The governing body must determine, in accordance with state law, which categories of practitioners are eligible for appointment to the medical staff. Furthermore, the governing body has the authority, in accordance with state saw, to grant medical staff privileges and membership to non-physician practitioners. The corresponding regulation at 42 CFR 482.22(a) allows hospitals and their medical staff to take advantage of the expertise and skills of all types of practitioners who practice at the hospital when making decisions concerning medical staff privileges and membership. Granting medical staff privileges and membership to non-physician practitioners is an option available to the governing body; it is not a requirement.
a. ACHC (HFAP)
b. Medicare CoP
c. AAAHC
Medicare CoP
For non-physician practitioners granted privileges only, the hospital’s governing body and its medical staff must exercise oversight, such as through credentialing and competency review, of those non-physician practitioners to whom it grants privileges, just as it would for those practitioners appointed to its medical staff. Practitioners are described in Section 1842(b)(18)(C) of the Act as any of the following:
* Physician Assistant (as defined in Section 1861(aa)(5) of the Act; Nurse Practitioner (as defined in Section 1861(aa)(5) of the Act
* Clinical Nurse Specialist (as defined in Section 1861(bb)(2) of the Act
* Certified Registered Nurse Anesthetist (as defined in Section 1861(bb)(2) of the Act
* Certified Nurse Midwife (as defined in Section 1861(gg)(2) of the Act
* Clinical Social Worker (as defined in Section 1861(hh)(1) of the Act
* Clinical psychologists (as defined in 42 CFR)
* 410.71 for purposes of Section 1861(ii) of the Act
* Anesthesiologist’s Assistant (as defined at §410.69)
* Registered Dietitian or Nutrition Professional
Other types of licensed healthcare professionals have a more limited scope of practice and usually are not eligible for hospital medical staff privileges, unless their permitted scope of practice in their state makes them more comparable to the above listed types of non-physician practitioners. Some examples of types of such licensed healthcare professionals who might be eligible for medical staff privileges, depending on State law and medical staff bylaws, rules, and regulations include, but are not limited to:
*Physical Therapist (as defined at §410.60 and §484.4.
* Occupational Therapist (as defined at §410.59 and §484.4)
* Speech Language Therapist (as defined at §410.62 and §484.4)
a. DNV (NIAHO)
b. Medicare CoP
c. NCQA
Medicare CoP
Some states have established a scope of practice for certain licensed pharmacists who are permitted to provide patient care, services that make them more like the above types of non-physician practitioners, including the monitoring and assessing of patients and ordering medications and laboratory tests. In such states, a hospital may grant medical staff privileges to such pharmacists and/or appoint them as members of the medical staff. There is no standard term for such pharmacists, although they are sometimes referred to as “clinical pharmacists”
a. Medicare CoP
b. AAAHC
c. TJC (CAMH)
Medicare CoP
For staff other than PAs and APRNs: Human Resources Standards require that, before providing care, treatment, or services, the qualifications and competence of a non-employee individual, brought into the hospital by a licensed practitioner are assessed by the hospital and are determined to be commensurate with the qualifications and competence required if the individual were to be employed by the hospital to perform the same or similar services. The organization reviews the qualifications, performance, and competence of each non-employee individual brought into the organization by a licensed practitioner to provide care, treatment, or services at the same frequency as individuals employed by the organization.
a. ACHC (HFAP)
b. DNV
c. TJC (CAMH)
TJC
Standards regarding non-physician practitioners are a direct quote of CMS 42 CFR §482.22(a) and §482.12. The following additional comments are included:
* the governing body must ensure that any privileges granted to non-physician practitioners are in accordance with state law, regulations, and scope of practice
* Medical Staff rules delineate the “qualification” process for non-physician first assistants
* The Credentials Committee (function) is responsible for credentialing the medical staff as well as non-physician practitioners who provide a medical level of care, as applicable.
a. ACHC (HFAP)
b. AAAHC
c. NCQA
ACHC (HFAP)
SRE.5a The medical staff process for examination of credentials and governing body review and approval shall also be extended to non-physician practitioners and licensed healthcare professionals who are applying for clinical privileges but are not eligible for membership. Non-physician practitioners may include physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists (CRNA), certified nurse-midwives, clinical social workers, clinical psychologists, anesthesiologist assistants, or registered dietitians/nutrition professionals.
a. AAAHC
b. DNV (NIAHO)
c. ACHC (HFAP)
DNV (NIAHO)
The organization verifies the qualifications of all AHPs that may provide clinical services to consumers through a written agreement with the organization
a. URAC
b. DNV (NIAHO)
c. TJC
URAC
All PAs and APRNs who are providing a medical level of care (making medical diagnosis and treatment decisions) are credentialed, privileged, and reprivileged through the medical staff process. PAs and APRNs who are not providing a medical level of care can be credentialed, privileged, and reprivileged through the medical staff process or an equivalent process that has been approved by the governing body. An equivalent process at a minimum:
* evaluates the applicant’s credentials
* evaluates the applicant’s current competence
* includes peer review recommendations
* and involves communication with and input from individuals and committees, including the MEC, in order to make an informed decision regarding the applicant’s request for privileges.
a. TJC (CAMH)
b. NCQA
c. AAAHC
TJC (CAMH)
All patient care is provided by or in accordance with the orders of a practitioner who meets the medical staff criteria and procedures for the privileges granted, who has been granted privileges in accordance with those criteria by the governing body, and who is working within the scope of those granted privileges. For non-physician practitioners granted privileges only, the hospital’s governing body and its medical staff shall exercise oversight, such as through credentialing and competency review, of those practitioners to whom it grants privileges, just as it would for those practitioners appointed to its medical staff
a. ACHC (HFAP)
b. AAAHC
c. DNV (NIAHO)
DNV (NIAHO)
For Nurse Practitioners and Physician Assistants, a collaborative agreement or supervisory agreement is required, per State regulations, with a physician who holds the same privileges being requested
a. Medicare CoP
b. TJC (CAMH)
c. ACHC (HFAP)
ACHC (HFAP)
