W. Va. Code R. § 64-89B-7 - Use and Maintenance of Confidential Data Gathered by the CVO

7.1. The CVO shall establish and maintain procedures that ensure the confidentiality and integrity of all practitioners' credentialing information in accordance with standards promulgated by NCQA, the Joint Commission and any applicable state and federal regulatory agencies.

7.2. The CVO shall develop procedures to ensure that credentialing information is only provided to the applicable practitioner and to credentialing entities after a complete and valid practitioner's authorization and release has been obtained and is on file.

7.3. Credentialing information shall not be used for any purposes other than review by credentialing entities of the professional background, competency and qualifications, and credential or the renewal of credentials of a health care practitioner or appeals there from except as provided in subsection 7.4 of this section. All credentialing information is exempt from disclosure under the provisions of the Freedom of Information Act and from disclosure pursuant to civil law subpoena and discovery processes.

7.4. Credentialing information may be disclosed in the following circumstances:

7.4.a. In appeals of credentialing decisions or to peer review and quality improvement committees, subject to protections provided in W. Va. Code § 30-3C-3;

7.4.b. In matters in which an action or order of a professional licensing board or other state or federal regulatory agency is at issue, including any proceeding brought by or on behalf of a health care practitioner or a patient or by a regulatory body that challenges the actions, omissions or conduct of a credentialing entity with respect to a credentialing decision, or;

7.4.c. When authorized by the health care practitioner to whom the credentialing information relates, but only to the extent that the disclosure is information that the practitioner provided directly to the statewide CVO.

Notes

W. Va. Code R. § 64-89B-7