Navigating APP credentialing and privileging laws

Credentialing and privileging regulations for advanced practice professionals (APP) are currently a loose patchwork of federal and state statutes. Given this variability, today’s discussion centers on strategies that MSPs and medical staff leaders can use to identify and apply relevant laws to their APP vetting processes.

The starting point is at the state level, where the applicable practice act specifies what an APP can or cannot do and sets forth any restrictions on where the APP can practice. In some states, statutory provisions will specifically permit hospitals and other health facilities to credential and privilege certain categories of APPs.

In general, state laws addressing credentialing and privileging of APPs tend to defer to an institution's governing body and medical staff to regulate APPs at the institution. Therefore, it becomes critical to have medical staff bylaws that adequately address the role of APPs and contemplate the various issues that may arise with respect to APPs' practice.

At the federal level, the Medicare Conditions of Participation acknowledge that a Medicare-participating hospital's "non-physician practitioners" may be members of the hospital's medical staff, as long as their membership is consistent with state law. So even for purpose of federal Medicare regulations, state law is important in establishing what an APP can and cannot do from a medical staff perspective.