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Public Act 91-0602
HB1780 Enrolled LRB9105596ACtmA
AN ACT creating the Health Care Professional Credentials
Data Collection Act.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. Short title. This Act may be cited as the
Health Care Professional Credentials Data Collection Act.
Section 5. Definitions. As used in this Act:
"Council" means the Health Care Credentials Council.
"Credentials data" means those data, information, or
answers to questions required by a health care entity, health
care plan, or hospital to complete the credentialing or
recredentialing of a health care professional.
"Credentialing" means the process of assessing and
validating the qualifications of a health care professional.
"Department" means the Department of Public Health.
"Director" means the Director of the Department of Public
Health.
"Health care entity" means any of the following which
require the submission of credentials data: (i) a health care
facility or other health care organization licensed or
certified to provide medical or health services in Illinois,
other than a hospital; (ii) a health care professional
partnership, corporation, limited liability company,
professional services corporation or group practice; or (iii)
an independent practice association or physician hospital
organization. Nothing in this definition shall be construed
to mean that a hospital is a health care entity.
"Health care plan" means any entity licensed by the
Department of Insurance as a prepaid health care plan or
health maintenance organization or as an insurer which
requires the submission of credentials data.
"Health care professional" means any person licensed
under the Medical Practice Act of 1987 or any person licensed
under any other Act subsequently made subject to this Act by
the Department.
"Hospital" means a hospital licensed under the Hospital
Licensing Act or any hospital organized under the University
of Illinois Hospital Act.
"Recredentialing" means the process by which a health
care entity, health care plan or hospital ensures that a
health care professional who is currently credentialed by the
health care entity, health care plan or hospital continues to
meet the credentialing criteria used by the health care
entity, health care plan, or hospital no more than once every
2 years.
"Single credentialing cycle" means a process whereby for
purposes of recredentialing each health care professional's
credentials data are collected by all health care entities
and health care plans that credential the health care
professional during the same time period and only once every
2 years.
"Site survey" means a process by which a health care
entity or health care plan assesses the office locations and
medical record keeping practices of a health care
professional.
"Single site survey" means a process by which, for
purposes of recredentialing, each health care professional
receives a site visit only once every two years.
"Uniform health care credentials form" means the form
developed by the Department under Section 15 to collect the
credentials data commonly requested by health care entities
and health care plans for purposes of credentialing.
"Uniform health care recredentials form" means the form
developed by the Department under Section 15 to collect the
credentials data commonly requested by health care entities
and health care plans for purposes of recredentialing.
"Uniform hospital credentials form" means the form
developed by the Department under Section 15 to collect the
credentials data commonly requested by hospitals for purposes
of credentialing.
"Uniform hospital recredentials form" means the form
developed by the Department under Section 15 to collect the
credentials data commonly requested by hospitals for purposes
of recredentialing.
"Uniform site survey instrument" means the instrument
developed by the Department under Section 25 to complete a
single site survey as part of a credentialing or
recredentialing process.
"Uniform updating form" means a standardized form for
reporting of corrections, updates, and modifications to
credentials data to health care entities, health care plans,
and hospitals when those data change following credentialing
or recredentialing of a health care professional.
Section 10. Health Care Credentials Council.
(a) There is established a Health Care Credentials
Council, consisting of 13 members, to assist the Department
in accordance with Sections 15, 20, 25, and 30 of this Act.
The Director, or his or her designee, shall serve as one
member and chair of the council and the Governor shall
appoint the remaining 12 members. Three members shall
represent hospitals, 3 members shall represent health
maintenance organizations, one member shall represent health
insurance entities, 3 members shall represent physicians
licensed to practice medicine in all its branches, one member
shall represent chiropractic physicians, and one member shall
represent ambulatory surgical treatment centers. In making
these appointments, the Governor shall take into
consideration the recommendations of various organizations
representing hospitals, health maintenance organizations,
insurers, ambulatory surgical treatment centers, and
physicians. The initial appointments of 6 of the members
shall be for 2 years. All other appointments shall be for 4
years, with no more than one 4-year reappointment. The
hospital representatives shall not vote on the development of
guidelines to implement Sections 20 and 25 of this Act.
(b) On July 1, 2003, the council is abolished.
Section 15. Development and use of uniform health care
and hospital credentials forms.
(a) The Department, in consultation with the council,
shall by rule establish:
(1) a uniform health care credentials form that
shall include the credentials data commonly requested by
health care entities and health care plans for purposes
of credentialing and shall minimize the need for the
collection of additional credentials data;
(2) a uniform health care recredentials form that
shall include the credentials data commonly requested by
health care entities and health care plans for purposes
of recredentialing and shall minimize the need for the
collection of additional credentials data;
(3) a uniform hospital credentials form that shall
include the credentials data commonly requested by
hospitals for purposes of credentialing and shall
minimize the need for the collection of additional
credentials data;
(4) a uniform hospital recredentials form that
shall include the credentials data commonly requested by
hospitals for purposes of recredentialing and shall
minimize the need for collection of additional
credentials data; and
(5) uniform updating forms.
(b) The uniform forms established in subsection (a)
shall be coordinated to reduce the need to provide redundant
information. Further, the forms shall be made available in
both paper and electronic formats.
(c) The Department, in consultation with the council,
shall establish by rule a date after which an electronic
format may be required by a health care entity, a health care
plan, or a hospital, and a health care professional may
require acceptance of an electronic format by a health care
entity, a health care plan, or a hospital.
(d) Beginning July 1, 2000, each health care entity or
health care plan that employs, contracts with, or allows
health care professionals to provide medical or health care
services and requires health care professionals to be
credentialed or recredentialed shall for purposes of
collecting credentials data only require:
(1) the uniform health care credentials form;
(2) the uniform health care recredentials form;
(3) the uniform updating forms; and
(4) any additional credentials data requested.
(e) Beginning July 1, 2000, each hospital that employs,
contracts with, or allows health care professionals to
provide medical or health care services and requires health
care professionals to be credentialed or recredentialed shall
for purposes of collecting credentials data only require:
(1) the uniform hospital credentials form;
(2) the uniform hospital recredentials form;
(3) the uniform updating forms; and
(4) any additional credentials data requested.
(f) Each health care entity and health care plan shall
complete the process of verifying a health care
professional's credentials data in a timely fashion and shall
complete the process of credentialing or recredentialing of
the health care professional within 60 days after submission
of all credentials data and completion of verification of the
credentials data.
(g) Each health care professional shall provide any
corrections, updates, and modifications to his or her
credentials data to ensure that all credentials data on the
health care professional remains current. Such corrections,
updates, and modifications shall be provided within 5
business days for State health care professional license
revocation, federal Drug Enforcement Agency license
revocation, Medicare or Medicaid sanctions, revocation of
hospital privileges, any lapse in professional liability
coverage required by a health care entity, health care plan,
or hospital, or conviction of a felony, and within 45 days
for any other change in the information from the date the
health care professional knew of the change. All updates
shall be made on the uniform updating forms developed by the
Department.
(h) Any credentials data collected or obtained by the
health care entity, health care plan, or hospital shall be
confidential, as provided by law, and otherwise may not be
redisclosed without written consent of the health care
professional, except that in any proceeding to challenge
credentialing or recredentialing, or in any judicial review,
the claim of confidentiality shall not be invoked to deny a
health care professional, health care entity, health care
plan, or hospital access to or use of credentials data.
Nothing in this Section prevents a health care entity, health
care plan, or hospital from disclosing any credentials data
to its officers, directors, employees, agents,
subcontractors, medical staff members, any committee of the
health care entity, health care plan, or hospital involved in
the credentialing process, or accreditation bodies or
licensing agencies. However, any redisclosure of credentials
data contrary to this Section is prohibited.
(i) Nothing in this Act shall be construed to restrict
the right of any health care entity, health care plan or
hospital to request additional information necessary for
credentialing or recredentialing.
(j) Nothing in this Act shall be construed to restrict
in any way the authority of any health care entity, health
care plan or hospital to approve, suspend or deny an
application for hospital staff membership, clinical
privileges, or managed care network participation.
(k) Nothing in this Act shall be construed to prohibit
delegation of credentialing and recredentialing activities as
long as the delegated entity follows the requirements set
forth in this Act.
(l) Nothing in this Act shall be construed to require
any health care entity or health care plan to credential or
survey any health care professional.
Section 20. Single credentialing cycle.
(a) The Department, in consultation with the council,
shall by rule establish a single credentialing cycle. The
single credentialing cycle shall be based on a specific
variable or variables. To the extent possible the single
credentialing cycle shall be established to ensure that the
credentials data of all health care professionals in a group
or at a single site are collected during the same time
period. However, nothing in this Act shall be construed to
require the single credentialing cycle to be established to
ensure that the credentials data of all health care
professionals in a group or at a single site are collected
during the same time period.
(b) Beginning January 1, 2001, all health care entities
and health care plans shall obtain credentials data on all
health care professionals according to the established single
credentialing cycle.
(c) The Department, in consultation with the council,
shall by rule establish a process to exempt a small or unique
health care entity or small or unique health care plan from
the single credentialing cycle if the health care entity or
health care plan demonstrates to the Department that
adherence to the single credentialing cycle would be an undue
hardship for the health care entity or health care plan.
(d) The requirements of this Section shall not apply
when a health care professional submits initial credentials
data to a health care entity or health care plan outside of
the established single credentialing cycle, when a health
care professional's credentials data change substantively, or
when a health care entity or health care plan requires
recredentialing as a result of patient or quality assurance
issues.
Section 25. Single site survey.
(a) The Department, in consultation with the council,
shall by rule establish a uniform site survey instrument
taking into account national accreditation standards and
State requirements. The uniform site survey instrument shall
include all the site survey data requested by health care
entities and health care plans.
(b) No later than January 1, 2001, the Department, in
consultation with the council, shall publish, in rule, the
variable or variables for completing the single site survey.
To the extent possible, the single site survey shall be
established to ensure that all health care professionals in a
group or at a site are reviewed during the same time period.
(c) Beginning July 1, 2001, health care entities and
health care plans shall implement the single site survey, if
a site survey is required by any of the health care
professional's health care entities or health care plans.
The site survey shall be completed using the uniform site
survey instrument.
(d) The uniform site survey instrument shall be used
when a health care professional seeks initial credentialing
by a health care entity or health care plan, when a health
care professional's credentials data change substantively, or
when a health care plan or health care entity requires a site
survey as a result of patient or quality assurance issues, if
a site survey is required by the health care entity or health
care plan.
(e) Nothing in this Section prohibits health care
entities and health care plans from choosing the independent
party to conduct the single site survey.
Section 30. Study of coordinated credentials
verification.
(a) The Department, in consultation with the council,
shall study the need for coordinated credentials data
verification.
(b) The study shall address the need for, the advantages
and disadvantages of, and the costs and cost savings, if any,
of coordinated credentials verification.
(c) The study also may address other changes to improve
the credentialing and recredentialing processes, to improve
the timeliness of the credentials data, and reduce the costs,
time, and administrative burden associated with the
processes.
(d) The Department shall make a recommendation to the
General Assembly and the Governor regarding the need for
further legislation no later than January 1, 2003.
Section 35. Rules. The Department, in consultation with
the council, shall adopt rules necessary to develop and
implement and enforce the requirements established by this
Act.
Section 40. Enforcement. The Department has authority to
enforce the provisions of the Act. In addition to any other
penalty provided by law, any health care entity, health care
plan, hospital, or health care professional that violates any
Section of this Act shall forfeit and pay to the Department a
fine in an amount determined by the Department of not more
than $1,000 for the first offense and not more than $5,000
for each subsequent offense.
Section 45. Administrative Procedure Act. The Illinois
Administrative Procedure Act is hereby expressly adopted and
incorporated herein as if all the provisions of the Act were
included in the Act. For the purpose of this Act, the notice
required under Section 10-25 of the Administrative Procedure
Act is deemed sufficient when mailed to the last known
address of a party.
Section 50. Administrative Review Law. All final
administrative decisions of the Department are subject to
judicial review pursuant to the provisions of the
Administrative Review Law and all rules adopted pursuant
thereto. The term "administrative decision" is defined as in
Section 3-101 of the Code of Civil Procedure.
Section 99. Effective Date. This Act takes effect upon
becoming law.
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