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| Public Act 103-0436
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| HB2827 Enrolled | LRB103 30778 CPF 57265 b |
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AN ACT concerning health.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Health Care Professional Credentials Data |
Collection Act is amended by changing Sections 5, 15, 20, 25, |
30, and 35 as follows:
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(410 ILCS 517/5)
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Sec. 5. Definitions. As used in this Act:
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"Council" means the Health Care Credentials Council.
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"Credentials data" means those data, information, or |
answers to questions
required by a health care entity, health
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care plan, or hospital to complete the credentialing or
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recredentialing of a health care professional.
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"Credentialing" means the process of assessing and |
validating the
qualifications of a health care professional.
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"Department" means the Department of Public Health.
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"Director" means the Director of the Department of Public |
Health.
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"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 |
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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.
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"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.
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"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.
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"Hospital" means a hospital licensed under the Hospital |
Licensing Act or any
hospital organized under the University |
of Illinois
Hospital Act.
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"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
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years.
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"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 |
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health care plans that
credential the health care professional |
during the same time period and
only once every 3 2 years.
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"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.
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"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.
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"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.
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"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
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recredentialing.
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"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.
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"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.
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"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.
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"Uniform updating form" means the a standardized form |
prescribed by the Department for reporting of
corrections,
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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.
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(Source: P.A. 91-602, eff. 8-16-99.)
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(410 ILCS 517/15)
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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:
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(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;
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(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
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collection of additional credentials data;
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(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;
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(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
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(5) uniform updating forms.
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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.
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(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 |
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health care entity, a health care plan, or a hospital.
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(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:
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(1) the uniform health care credentials form;
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(2) the uniform health care recredentials form;
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(3) the uniform updating forms; and
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(4) any additional credentials data requested; and .
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(5) an online credential with required content as |
required by forms under this Section. |
(e) Beginning January 1, 2002, each hospital that
employs,
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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:
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(1) the uniform hospital credentials form;
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(2) the uniform hospital recredentials form;
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(3) the uniform updating forms; and
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(4) any additional credentials data requested; and .
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(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 |
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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
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credentials data.
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(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
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the change. All updates shall be made on the uniform updating
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forms prescribed developed by the Department.
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(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
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credentialing or recredentialing, or in any judicial review, |
the claim
of confidentiality shall not be invoked to deny a |
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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,
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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.
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(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.
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(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.
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(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.
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(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. |
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(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.
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(Source: P.A. 92-193, eff. 1-1-02; 93-829, eff. 7-28-04.)
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(410 ILCS 517/20)
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Sec. 20. Single credentialing cycle.
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(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.
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(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.
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(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
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health care entity or health care plan.
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(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
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recredentialing as a result of patient or quality assurance |
issues.
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(Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)
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(410 ILCS 517/25)
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Sec. 25. Single site survey.
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(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.
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(b) No later than July 1, 2002, the Department, in
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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
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established to ensure that all health care professionals in a |
group or at a
site are reviewed during the same time period.
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(c) Beginning January 1, 2003, health care entities and
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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.
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(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
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survey is required by the health care entity or
health care |
plan.
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(e) Nothing in this Section prohibits health care entities |
and health care
plans from choosing the independent party to |
conduct the
single site survey.
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(Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)
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(410 ILCS 517/30)
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Sec. 30. Study of coordinated credentials verification.
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(a) The Department, in consultation with the council, |
shall study the
need for coordinated credentials data |
verification.
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(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.
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(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.
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(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.
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(Source: P.A. 91-602, eff. 8-16-99.)
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(410 ILCS 517/35)
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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.
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(Source: P.A. 91-602, eff. 8-16-99.)
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(410 ILCS 517/10 rep.)
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Section 10. The Health Care Professional Credentials Data |
Collection Act is amended by repealing Section 10.
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