Public Act 103-0436
 
HB2827 EnrolledLRB103 30778 CPF 57265 b


  
    AN ACT concerning health.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  


 
 
    Section 5. The Health Care Professional Credentials Data 
Collection Act is amended  by changing Sections 5, 15, 20, 25, 
30, and 35 as follows:
 



    (410 ILCS 517/5)



    Sec. 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 3 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 3 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 
prescribed 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 
prescribed 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 
prescribed 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 
prescribed 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 the a standardized form 
prescribed by the Department 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.

(Source: P.A. 91-602, eff. 8-16-99.)

 



    (410 ILCS 517/15)



    Sec. 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.

    The forms described in this subsection may be prescribed 
in a print format, electronic format, or both as provided by 
the Department. 
    (b) The uniform forms established by the Department under 
this Section 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 
upon request and in the format requested.

    (c) The Department, in consultation with the council, 
shall
establish by rule a process for the submittal of forms in 
an a date after which an electronic format with required 
content for may be
required by a health care entity, a health 
care plan, or a hospital, and a
health care professional may 
require acceptance of forms in an electronic
format by a 
health care entity, a health care plan, or a hospital.

    (d) Beginning January 1, 2002, 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; and .

        (5) an online credential with required content as 
    required by forms under this Section. 
    (e) Beginning January 1, 2002, 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; and .

        (5) an online credential with required content as 
    required by forms under this Section. 
    (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 prescribed 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.
    (m) Nothing in this Act prohibits a hospital from granting 
disaster privileges pursuant to the provisions of Section 10.4 
of the Hospital Licensing Act.  When a hospital grants disaster 
privileges pursuant to Section 10.4 of the Hospital Licensing 
Act, that hospital is not required to collect credentials data 
pursuant to this Act.


(Source: P.A. 92-193, eff. 1-1-02; 93-829, eff. 7-28-04.)

 



    (410 ILCS 517/20)



    Sec. 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 July 1, 2002, 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.

(Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)

 



    (410 ILCS 517/25)



    Sec. 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 July 1, 2002, 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 January 1, 2003, 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.

(Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)

 



    (410 ILCS 517/30)



    Sec. 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.

(Source: P.A. 91-602, eff. 8-16-99.)

 



    (410 ILCS 517/35)



    Sec. 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.

(Source: P.A. 91-602, eff. 8-16-99.)

 

    (410 ILCS 517/10 rep.)

    Section 10. The Health Care Professional Credentials Data 
Collection Act is amended  by repealing Section 10.


 
    Section 99. Effective date. This Act takes effect upon 
becoming law.