093_SB0459sam002
LRB093 03318 AMC 14189 a
1 AMENDMENT TO SENATE BILL 459
2 AMENDMENT NO. . Amend Senate Bill 459, AS AMENDED,
3 by replacing everything after the enacting clause with the
4 following:
5 "Section 5. The Managed Care Reform and Patient Rights
6 Act is amended by changing Section 20 as follows:
7 (215 ILCS 134/20)
8 Sec. 20. Notice of nonrenewal or termination. A health
9 care plan must give at least 60 days notice of nonrenewal or
10 termination of a health care provider to the health care
11 provider and to the enrollees served by the health care
12 provider. The notice shall include a name and address to
13 which an enrollee or health care provider may direct comments
14 and concerns regarding the nonrenewal or termination.
15 Immediate written notice may be provided without 60 days
16 notice when a health care provider's license has been
17 disciplined by a State licensing board or a health care
18 provider's hospital medical staff privileges required in a
19 contract with a health care plan have been suspended or
20 revoked.
21 (Source: P.A. 91-617, eff. 1-1-00.)
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1 Section 10. The Health Care Professional Credentials
2 Data Collection Act is amended by changing Section 15 as
3 follows:
4 (410 ILCS 517/15)
5 Sec. 15. Development and use of uniform health care and
6 hospital credentials forms.
7 (a) The Department, in consultation with the council,
8 shall by rule establish:
9 (1) a uniform health care credentials form that
10 shall include the credentials data commonly requested by
11 health care entities and health care plans for purposes
12 of credentialing and shall minimize the need for the
13 collection of additional credentials data;
14 (2) a uniform health care recredentials form that
15 shall include the credentials data commonly requested by
16 health care entities and health care plans for purposes
17 of recredentialing and shall minimize the need for the
18 collection of additional credentials data;
19 (3) a uniform hospital credentials form that shall
20 include the credentials data commonly requested by
21 hospitals for purposes of credentialing and shall
22 minimize the need for the collection of additional
23 credentials data;
24 (4) a uniform hospital recredentials form that
25 shall include the credentials data commonly requested by
26 hospitals for purposes of recredentialing and shall
27 minimize the need for collection of additional
28 credentials data; and
29 (5) uniform updating forms.
30 (b) The uniform forms established in subsection (a)
31 shall be coordinated to reduce the need to provide redundant
32 information. Further, the forms shall be made available in
33 both paper and electronic formats.
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1 (c) The Department, in consultation with the council,
2 shall establish by rule a date after which an electronic
3 format may be required by a health care entity, a health care
4 plan, or a hospital, and a health care professional may
5 require acceptance of an electronic format by a health care
6 entity, a health care plan, or a hospital.
7 (d) Beginning January 1, 2002, each health care entity
8 or health care plan that employs, contracts with, or allows
9 health care professionals to provide medical or health care
10 services and requires health care professionals to be
11 credentialed or recredentialed shall for purposes of
12 collecting credentials data only require:
13 (1) the uniform health care credentials form;
14 (2) the uniform health care recredentials form;
15 (3) the uniform updating forms; and
16 (4) any additional credentials data requested.
17 (e) Beginning January 1, 2002, each hospital that
18 employs, contracts with, or allows health care professionals
19 to provide medical or health care services and requires
20 health care professionals to be credentialed or
21 recredentialed shall for purposes of collecting credentials
22 data only require:
23 (1) the uniform hospital credentials form;
24 (2) the uniform hospital recredentials form;
25 (3) the uniform updating forms; and
26 (4) any additional credentials data requested.
27 (f) Each health care entity and health care plan shall
28 complete the process of verifying a health care
29 professional's credentials data in a timely fashion and shall
30 complete the process of credentialing or recredentialing of
31 the health care professional within 60 days after submission
32 of all credentials data and completion of verification of the
33 credentials data.
34 (f-5) Each health care plan that credentials health care
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1 professionals may request of the Director of Professional
2 Regulation information concerning the licensure status of,
3 any disciplinary action taken against, and specified
4 mandatory reports concerning an individual health care
5 professional. The Director of Professional Regulation shall
6 transmit, in writing not later than 15 days after the close
7 of the month in which action is taken or reported to the
8 Department of Professional Regulation, the following
9 information: (1) the current licensure status and any
10 disciplinary action with regard to a license, including but
11 not limited to any limitations, restrictions, suspensions,
12 probations, or revocations or failure to renew a license and
13 (2) any report of an adverse action of a peer review
14 committee of a hospital or other health care entity with
15 respect to an allegation against a health care professional
16 or a matter that relates to the professional conduct or
17 qualifications of the health care professional. Any
18 transmittal of information by the Director of Professional
19 Regulation under this Section shall be to the health care
20 plan's peer review designee. The information provided under
21 this subsection shall be afforded the same status as is
22 information concerning medical studies by Part 21 of Article
23 VIII of the Code of Civil Procedure. The Department of
24 Professional Regulation may carry out its duties under this
25 subsection through the creation of an automated transmittal
26 system to registered health plans.
27 (g) Each health care professional shall provide any
28 corrections, updates, and modifications to his or her
29 credentials data to ensure that all credentials data on the
30 health care professional remains current. Such corrections,
31 updates, and modifications shall be provided within 5
32 business days for State health care professional license
33 revocation, federal Drug Enforcement Agency license
34 revocation, Medicare or Medicaid sanctions, revocation of
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1 hospital privileges, any lapse in professional liability
2 coverage required by a health care entity, health care plan,
3 or hospital, or conviction of a felony, and within 45 days
4 for any other change in the information from the date the
5 health care professional knew of the change. All updates
6 shall be made on the uniform updating forms developed by the
7 Department.
8 (h) Any credentials data collected or obtained by the
9 health care entity, health care plan, or hospital shall be
10 confidential, as provided by law, and otherwise may not be
11 redisclosed without written consent of the health care
12 professional, except that in any proceeding to challenge
13 credentialing or recredentialing, or in any judicial review,
14 the claim of confidentiality shall not be invoked to deny a
15 health care professional, health care entity, health care
16 plan, or hospital access to or use of credentials data.
17 Nothing in this Section prevents a health care entity, health
18 care plan, or hospital from disclosing any credentials data
19 to its officers, directors, employees, agents,
20 subcontractors, medical staff members, any committee of the
21 health care entity, health care plan, or hospital involved in
22 the credentialing process, or accreditation bodies or
23 licensing agencies. However, any redisclosure of credentials
24 data contrary to this Section is prohibited.
25 (i) Nothing in this Act shall be construed to restrict
26 the right of any health care entity, health care plan or
27 hospital to request additional information necessary for
28 credentialing or recredentialing.
29 (j) Nothing in this Act shall be construed to restrict
30 in any way the authority of any health care entity, health
31 care plan or hospital to approve, suspend or deny an
32 application for hospital staff membership, clinical
33 privileges, or managed care network participation.
34 (k) Nothing in this Act shall be construed to prohibit
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1 delegation of credentialing and recredentialing activities as
2 long as the delegated entity follows the requirements set
3 forth in this Act.
4 (l) Nothing in this Act shall be construed to require
5 any health care entity or health care plan to credential or
6 survey any health care professional.
7 (m) Nothing in this Act shall be construed to prevent any
8 health care entity or health care plan from submitting a
9 query to the Department of Professional Regulation for the
10 current licensure status of any health care professional or
11 the National Practitioner Data Bank at any time.
12 (Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)".