AR 40–68

Clinical Quality Management

This rapid action revision, dated 22 May 2009–

o Establishes specific responsibilities for credentialing functions by Army Reserve Clinical Credentialing Affairs, Human Resources Command-St.Louis, and Active Army units (para 1-4h).

o Replaces all content in chapter 2 with new guidance regarding the Executive Committee of the Medical Staff; medical staff bylaws; military treatment facility committees and functions; and departmental/service organization, structure, and leadership (chap 2).

o Eliminates the requirement to submit the annual military treatment facility Quality Management Program Summary Report to the U.S. Army Medical Command (previously covered in chap 2).

o Identifies the American Nurses Association Standards of Nursing Practice or other national professional organizations’ standards as the source of practice expectations (para 3-3b(7)).

o Relocates information regarding confidentiality of quality assurance documents from paragraph 2-5 to chapter 3 (para 3-7).

o Requires veterinarians to maintain a current, active, valid, and unrestricted license to practice independently within their defined scope of practice (para 4-4a(1)).

o Specifies the educational preparation by an accredited institution for military and civilian registered nurses and licensed practical nurses and requires the National Council Licensure Examination- Registered Nurses/ Practical Nurses for the military Army Nurse Corps and 68WM6/M3 (para 4-6c).

o Restates the requirement for an unrestricted license (all Corps) and explains the process for limited waiver/exception (paras 4-6g and 4-7).

o Clarifies the licensure requirement for personal services versus nonpersonal services contract healthcare personnel (para 4-8a).

o Specifies the use of DA Forms 7653 and 7654 for competency verification of Army Nurses Corps personnel with skill identifier 8A (Critical Care) and M5 (Emergency Nursing) (para 5-1a(1)(b)).

o Requires currency of emergency life support training at all times (para 5-1e).

o Deletes the requirement for the advanced practice registered nurse, other than the non-personal services advanced practice registered nurse, to possess and maintain advanced practice licensure (para 7-4b(2)).

o Restates the collaborative interaction required between the certified registered nurse anesthetist and anesthesiologist or operating surgeon (para 7-4e(4)(a)-(c)).

o Authorizes selected prescription writing by occupational therapists (para 7-13c(2)(a)(6)).

o Updates professional credentials requirements for physician assistants (para 7-16b).

o Clarifies Category I and II privileges for physical therapists (para 7-17c).

o Provides 10 USC 1102 protection to all documents in the provider credential file and the provider activity file (paras 8-3b(2)(c) and 8-9a).

o Stipulates that the chairperson of the credentials committee will be a physician and that he/she will vote only in event of a tie (paras 8-5b and 8-5c(5).

o Indicates that the responsibility for credentials verification for contracted personnel will be specified in the contract (para 8-6d).

o Allows use of the American Board of Medical Specialties Web site to verify board certification (para 8-7d).

o Exempts providers outside the continental United States from the requirement of a current Drug Enforcement Agency certificate (para 8-7k).

o Directs that qualified healthcare providers obtain a National Provider Identifier (para 8-7r).

o Provides detailed information related to telemedicine procedures (para 9-2c(7)(a)).

o Directs the military treatment facility credentials office to maintain the provider credential file for any assigned provider not currently involved in clinical practice (para 9-6b).

o Provides new instruction for U.S. Army Reserve/Army National Guard deployment privileging (para 9-8c(4)(d)).

o Clarifies that peer review for an adverse privileging/practice action be performed by a panel (para 10-6e(2)(c)).

o Requires that a physician chair the adverse actions hearing board (para 10-8a) and that he/she will vote only in the event of a tie (para 10-8g).

o Eliminates the requirement for verbatim transcript of the adverse actions hearing board (para 10-8e(3)).

o States that the voluntary modification of privileges/practice as a result of a medical or behavioral condition is not an adverse privileging/practice action (para 11-4c).

o Revises the risk management content entirety and omits reference to the now disbanded Consultation Case Review Branch (paras 13-1 through 13-5).

o Specifies that any death/disability of a military member as a result of medical care will be treated as a potentially compensable event (para 13-5b).

o Revises the layout and contents of the competency assessment file (app C).

o Make additional rapid action revision changes (chaps 6, 7, 8, 9, 10, 11,

13,14, and apps E, F, G, H, I, J).


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