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91_HB1780enr
HB1780 Enrolled LRB9105596ACtmA
1 AN ACT creating the Health Care Professional Credentials
2 Data Collection Act.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 1. Short title. This Act may be cited as the
6 Health Care Professional Credentials Data Collection Act.
7 Section 5. Definitions. As used in this Act:
8 "Council" means the Health Care Credentials Council.
9 "Credentials data" means those data, information, or
10 answers to questions required by a health care entity, health
11 care plan, or hospital to complete the credentialing or
12 recredentialing of a health care professional.
13 "Credentialing" means the process of assessing and
14 validating the qualifications of a health care professional.
15 "Department" means the Department of Public Health.
16 "Director" means the Director of the Department of Public
17 Health.
18 "Health care entity" means any of the following which
19 require the submission of credentials data: (i) a health care
20 facility or other health care organization licensed or
21 certified to provide medical or health services in Illinois,
22 other than a hospital; (ii) a health care professional
23 partnership, corporation, limited liability company,
24 professional services corporation or group practice; or (iii)
25 an independent practice association or physician hospital
26 organization. Nothing in this definition shall be construed
27 to mean that a hospital is a health care entity.
28 "Health care plan" means any entity licensed by the
29 Department of Insurance as a prepaid health care plan or
30 health maintenance organization or as an insurer which
31 requires the submission of credentials data.
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1 "Health care professional" means any person licensed
2 under the Medical Practice Act of 1987 or any person licensed
3 under any other Act subsequently made subject to this Act by
4 the Department.
5 "Hospital" means a hospital licensed under the Hospital
6 Licensing Act or any hospital organized under the University
7 of Illinois Hospital Act.
8 "Recredentialing" means the process by which a health
9 care entity, health care plan or hospital ensures that a
10 health care professional who is currently credentialed by the
11 health care entity, health care plan or hospital continues to
12 meet the credentialing criteria used by the health care
13 entity, health care plan, or hospital no more than once every
14 2 years.
15 "Single credentialing cycle" means a process whereby for
16 purposes of recredentialing each health care professional's
17 credentials data are collected by all health care entities
18 and health care plans that credential the health care
19 professional during the same time period and only once every
20 2 years.
21 "Site survey" means a process by which a health care
22 entity or health care plan assesses the office locations and
23 medical record keeping practices of a health care
24 professional.
25 "Single site survey" means a process by which, for
26 purposes of recredentialing, each health care professional
27 receives a site visit only once every two years.
28 "Uniform health care credentials form" means the form
29 developed by the Department under Section 15 to collect the
30 credentials data commonly requested by health care entities
31 and health care plans for purposes of credentialing.
32 "Uniform health care recredentials form" means the form
33 developed by the Department under Section 15 to collect the
34 credentials data commonly requested by health care entities
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1 and health care plans for purposes of recredentialing.
2 "Uniform hospital credentials form" means the form
3 developed by the Department under Section 15 to collect the
4 credentials data commonly requested by hospitals for purposes
5 of credentialing.
6 "Uniform hospital recredentials form" means the form
7 developed by the Department under Section 15 to collect the
8 credentials data commonly requested by hospitals for purposes
9 of recredentialing.
10 "Uniform site survey instrument" means the instrument
11 developed by the Department under Section 25 to complete a
12 single site survey as part of a credentialing or
13 recredentialing process.
14 "Uniform updating form" means a standardized form for
15 reporting of corrections, updates, and modifications to
16 credentials data to health care entities, health care plans,
17 and hospitals when those data change following credentialing
18 or recredentialing of a health care professional.
19 Section 10. Health Care Credentials Council.
20 (a) There is established a Health Care Credentials
21 Council, consisting of 13 members, to assist the Department
22 in accordance with Sections 15, 20, 25, and 30 of this Act.
23 The Director, or his or her designee, shall serve as one
24 member and chair of the council and the Governor shall
25 appoint the remaining 12 members. Three members shall
26 represent hospitals, 3 members shall represent health
27 maintenance organizations, one member shall represent health
28 insurance entities, 3 members shall represent physicians
29 licensed to practice medicine in all its branches, one member
30 shall represent chiropractic physicians, and one member shall
31 represent ambulatory surgical treatment centers. In making
32 these appointments, the Governor shall take into
33 consideration the recommendations of various organizations
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1 representing hospitals, health maintenance organizations,
2 insurers, ambulatory surgical treatment centers, and
3 physicians. The initial appointments of 6 of the members
4 shall be for 2 years. All other appointments shall be for 4
5 years, with no more than one 4-year reappointment. The
6 hospital representatives shall not vote on the development of
7 guidelines to implement Sections 20 and 25 of this Act.
8 (b) On July 1, 2003, the council is abolished.
9 Section 15. Development and use of uniform health care
10 and hospital credentials forms.
11 (a) The Department, in consultation with the council,
12 shall by rule establish:
13 (1) a uniform health care credentials form that
14 shall include the credentials data commonly requested by
15 health care entities and health care plans for purposes
16 of credentialing and shall minimize the need for the
17 collection of additional credentials data;
18 (2) a uniform health care recredentials form that
19 shall include the credentials data commonly requested by
20 health care entities and health care plans for purposes
21 of recredentialing and shall minimize the need for the
22 collection of additional credentials data;
23 (3) a uniform hospital credentials form that shall
24 include the credentials data commonly requested by
25 hospitals for purposes of credentialing and shall
26 minimize the need for the collection of additional
27 credentials data;
28 (4) a uniform hospital recredentials form that
29 shall include the credentials data commonly requested by
30 hospitals for purposes of recredentialing and shall
31 minimize the need for collection of additional
32 credentials data; and
33 (5) uniform updating forms.
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1 (b) The uniform forms established in subsection (a)
2 shall be coordinated to reduce the need to provide redundant
3 information. Further, the forms shall be made available in
4 both paper and electronic formats.
5 (c) The Department, in consultation with the council,
6 shall establish by rule a date after which an electronic
7 format may be required by a health care entity, a health care
8 plan, or a hospital, and a health care professional may
9 require acceptance of an electronic format by a health care
10 entity, a health care plan, or a hospital.
11 (d) Beginning July 1, 2000, each health care entity or
12 health care plan that employs, contracts with, or allows
13 health care professionals to provide medical or health care
14 services and requires health care professionals to be
15 credentialed or recredentialed shall for purposes of
16 collecting credentials data only require:
17 (1) the uniform health care credentials form;
18 (2) the uniform health care recredentials form;
19 (3) the uniform updating forms; and
20 (4) any additional credentials data requested.
21 (e) Beginning July 1, 2000, each hospital that employs,
22 contracts with, or allows health care professionals to
23 provide medical or health care services and requires health
24 care professionals to be credentialed or recredentialed shall
25 for purposes of collecting credentials data only require:
26 (1) the uniform hospital credentials form;
27 (2) the uniform hospital recredentials form;
28 (3) the uniform updating forms; and
29 (4) any additional credentials data requested.
30 (f) Each health care entity and health care plan shall
31 complete the process of verifying a health care
32 professional's credentials data in a timely fashion and shall
33 complete the process of credentialing or recredentialing of
34 the health care professional within 60 days after submission
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1 of all credentials data and completion of verification of the
2 credentials data.
3 (g) Each health care professional shall provide any
4 corrections, updates, and modifications to his or her
5 credentials data to ensure that all credentials data on the
6 health care professional remains current. Such corrections,
7 updates, and modifications shall be provided within 5
8 business days for State health care professional license
9 revocation, federal Drug Enforcement Agency license
10 revocation, Medicare or Medicaid sanctions, revocation of
11 hospital privileges, any lapse in professional liability
12 coverage required by a health care entity, health care plan,
13 or hospital, or conviction of a felony, and within 45 days
14 for any other change in the information from the date the
15 health care professional knew of the change. All updates
16 shall be made on the uniform updating forms developed by the
17 Department.
18 (h) Any credentials data collected or obtained by the
19 health care entity, health care plan, or hospital shall be
20 confidential, as provided by law, and otherwise may not be
21 redisclosed without written consent of the health care
22 professional, except that in any proceeding to challenge
23 credentialing or recredentialing, or in any judicial review,
24 the claim of confidentiality shall not be invoked to deny a
25 health care professional, health care entity, health care
26 plan, or hospital access to or use of credentials data.
27 Nothing in this Section prevents a health care entity, health
28 care plan, or hospital from disclosing any credentials data
29 to its officers, directors, employees, agents,
30 subcontractors, medical staff members, any committee of the
31 health care entity, health care plan, or hospital involved in
32 the credentialing process, or accreditation bodies or
33 licensing agencies. However, any redisclosure of credentials
34 data contrary to this Section is prohibited.
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1 (i) Nothing in this Act shall be construed to restrict
2 the right of any health care entity, health care plan or
3 hospital to request additional information necessary for
4 credentialing or recredentialing.
5 (j) Nothing in this Act shall be construed to restrict
6 in any way the authority of any health care entity, health
7 care plan or hospital to approve, suspend or deny an
8 application for hospital staff membership, clinical
9 privileges, or managed care network participation.
10 (k) Nothing in this Act shall be construed to prohibit
11 delegation of credentialing and recredentialing activities as
12 long as the delegated entity follows the requirements set
13 forth in this Act.
14 (l) Nothing in this Act shall be construed to require
15 any health care entity or health care plan to credential or
16 survey any health care professional.
17 Section 20. Single credentialing cycle.
18 (a) The Department, in consultation with the council,
19 shall by rule establish a single credentialing cycle. The
20 single credentialing cycle shall be based on a specific
21 variable or variables. To the extent possible the single
22 credentialing cycle shall be established to ensure that the
23 credentials data of all health care professionals in a group
24 or at a single site are collected during the same time
25 period. However, nothing in this Act shall be construed to
26 require the single credentialing cycle to be established to
27 ensure that the credentials data of all health care
28 professionals in a group or at a single site are collected
29 during the same time period.
30 (b) Beginning January 1, 2001, all health care entities
31 and health care plans shall obtain credentials data on all
32 health care professionals according to the established single
33 credentialing cycle.
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1 (c) The Department, in consultation with the council,
2 shall by rule establish a process to exempt a small or unique
3 health care entity or small or unique health care plan from
4 the single credentialing cycle if the health care entity or
5 health care plan demonstrates to the Department that
6 adherence to the single credentialing cycle would be an undue
7 hardship for the health care entity or health care plan.
8 (d) The requirements of this Section shall not apply
9 when a health care professional submits initial credentials
10 data to a health care entity or health care plan outside of
11 the established single credentialing cycle, when a health
12 care professional's credentials data change substantively, or
13 when a health care entity or health care plan requires
14 recredentialing as a result of patient or quality assurance
15 issues.
16 Section 25. Single site survey.
17 (a) The Department, in consultation with the council,
18 shall by rule establish a uniform site survey instrument
19 taking into account national accreditation standards and
20 State requirements. The uniform site survey instrument shall
21 include all the site survey data requested by health care
22 entities and health care plans.
23 (b) No later than January 1, 2001, the Department, in
24 consultation with the council, shall publish, in rule, the
25 variable or variables for completing the single site survey.
26 To the extent possible, the single site survey shall be
27 established to ensure that all health care professionals in a
28 group or at a site are reviewed during the same time period.
29 (c) Beginning July 1, 2001, health care entities and
30 health care plans shall implement the single site survey, if
31 a site survey is required by any of the health care
32 professional's health care entities or health care plans.
33 The site survey shall be completed using the uniform site
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1 survey instrument.
2 (d) The uniform site survey instrument shall be used
3 when a health care professional seeks initial credentialing
4 by a health care entity or health care plan, when a health
5 care professional's credentials data change substantively, or
6 when a health care plan or health care entity requires a site
7 survey as a result of patient or quality assurance issues, if
8 a site survey is required by the health care entity or health
9 care plan.
10 (e) Nothing in this Section prohibits health care
11 entities and health care plans from choosing the independent
12 party to conduct the single site survey.
13 Section 30. Study of coordinated credentials
14 verification.
15 (a) The Department, in consultation with the council,
16 shall study the need for coordinated credentials data
17 verification.
18 (b) The study shall address the need for, the advantages
19 and disadvantages of, and the costs and cost savings, if any,
20 of coordinated credentials verification.
21 (c) The study also may address other changes to improve
22 the credentialing and recredentialing processes, to improve
23 the timeliness of the credentials data, and reduce the costs,
24 time, and administrative burden associated with the
25 processes.
26 (d) The Department shall make a recommendation to the
27 General Assembly and the Governor regarding the need for
28 further legislation no later than January 1, 2003.
29 Section 35. Rules. The Department, in consultation with
30 the council, shall adopt rules necessary to develop and
31 implement and enforce the requirements established by this
32 Act.
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1 Section 40. Enforcement. The Department has authority to
2 enforce the provisions of the Act. In addition to any other
3 penalty provided by law, any health care entity, health care
4 plan, hospital, or health care professional that violates any
5 Section of this Act shall forfeit and pay to the Department a
6 fine in an amount determined by the Department of not more
7 than $1,000 for the first offense and not more than $5,000
8 for each subsequent offense.
9 Section 45. Administrative Procedure Act. The Illinois
10 Administrative Procedure Act is hereby expressly adopted and
11 incorporated herein as if all the provisions of the Act were
12 included in the Act. For the purpose of this Act, the notice
13 required under Section 10-25 of the Administrative Procedure
14 Act is deemed sufficient when mailed to the last known
15 address of a party.
16 Section 50. Administrative Review Law. All final
17 administrative decisions of the Department are subject to
18 judicial review pursuant to the provisions of the
19 Administrative Review Law and all rules adopted pursuant
20 thereto. The term "administrative decision" is defined as in
21 Section 3-101 of the Code of Civil Procedure.
22 Section 99. Effective Date. This Act takes effect upon
23 becoming law.
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