103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB2221

 

Introduced 2/10/2023, by Sen. Laura Fine

 

SYNOPSIS AS INTRODUCED:
 
410 ILCS 517/5
410 ILCS 517/15
410 ILCS 517/20
410 ILCS 517/25
410 ILCS 517/30
410 ILCS 517/35
410 ILCS 517/10 rep.

    Amends the Health Care Professional Credentials Data Collection Act. Provides that "recredentialing" and "single credentialing cycle" must be undertaken for a period not to exceed 3 years (rather than once every 2 years). Provides that forms established by the Department of Public Health under the provisions shall be available in both paper and electronic formats upon request and in the format requested (rather than just in both paper and electronic formats). Repeals provisions establishing the Health Care Credentials Council and makes conforming changes.


LRB103 27111 CPF 53479 b

 

 

A BILL FOR

 

SB2221LRB103 27111 CPF 53479 b

1    AN ACT concerning health.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Health Care Professional Credentials Data
5Collection Act is amended by changing Sections 5, 15, 20, 25,
630, and 35 as follows:
 
7    (410 ILCS 517/5)
8    Sec. 5. Definitions. As used in this Act:
9    "Council" means the Health Care Credentials Council.
10    "Credentials data" means those data, information, or
11answers to questions required by a health care entity, health
12care plan, or hospital to complete the credentialing or
13recredentialing of a health care professional.
14    "Credentialing" means the process of assessing and
15validating the qualifications of a health care professional.
16    "Department" means the Department of Public Health.
17    "Director" means the Director of the Department of Public
18Health.
19    "Health care entity" means any of the following which
20require the submission of credentials data: (i) a health care
21facility or other health care organization licensed or
22certified to provide medical or health services in Illinois,
23other than a hospital; (ii) a health care professional

 

 

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1partnership, corporation, limited liability company,
2professional services corporation or group practice; or (iii)
3an independent practice association or physician hospital
4organization. Nothing in this definition shall be construed to
5mean that a hospital is a health care entity.
6    "Health care plan" means any entity licensed by the
7Department of Insurance as a prepaid health care plan or
8health maintenance organization or as an insurer which
9requires the submission of credentials data.
10    "Health care professional" means any person licensed under
11the Medical Practice Act of 1987 or any person licensed under
12any other Act subsequently made subject to this Act by the
13Department.
14    "Hospital" means a hospital licensed under the Hospital
15Licensing Act or any hospital organized under the University
16of Illinois Hospital Act.
17    "Recredentialing" means a the process undertaken for a
18period not to exceed 3 years by which a health care entity,
19health care plan or hospital ensures that a health care
20professional who is currently credentialed by the health care
21entity, health care plan or hospital continues to meet the
22credentialing criteria used by the health care entity, health
23care plan, or hospital no more than once every 2 years.
24    "Single credentialing cycle" means a process undertaken
25for a period not to exceed 3 years whereby for purposes of
26recredentialing each health care professional's credentials

 

 

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1data are collected by all health care entities and health care
2plans that credential the health care professional during the
3same time period and only once every 2 years.
4    "Site survey" means a process by which a health care
5entity or health care plan assesses the office locations and
6medical record keeping practices of a health care
7professional.
8    "Single site survey" means a process by which, for
9purposes of recredentialing, each health care professional
10receives a site visit only once every two years.
11    "Uniform health care credentials form" means the form
12developed by the Department under Section 15 to collect the
13credentials data commonly requested by health care entities
14and health care plans for purposes of credentialing.
15    "Uniform health care recredentials form" means the form
16developed by the Department under Section 15 to collect the
17credentials data commonly requested by health care entities
18and health care plans for purposes of recredentialing.
19    "Uniform hospital credentials form" means the form
20developed by the Department under Section 15 to collect the
21credentials data commonly requested by hospitals for purposes
22of credentialing.
23    "Uniform hospital recredentials form" means the form
24developed by the Department under Section 15 to collect the
25credentials data commonly requested by hospitals for purposes
26of recredentialing.

 

 

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1    "Uniform site survey instrument" means the instrument
2developed by the Department under Section 25 to complete a
3single site survey as part of a credentialing or
4recredentialing process.
5    "Uniform updating form" means a standardized form for
6reporting of corrections, updates, and modifications to
7credentials data to health care entities, health care plans,
8and hospitals when those data change following credentialing
9or recredentialing of a health care professional.
10(Source: P.A. 91-602, eff. 8-16-99.)
 
11    (410 ILCS 517/15)
12    Sec. 15. Development and use of uniform health care and
13hospital credentials forms.
14    (a) The Department, in consultation with the council,
15shall by rule establish:
16        (1) a uniform health care credentials form that shall
17    include the credentials data commonly requested by health
18    care entities and health care plans for purposes of
19    credentialing and shall minimize the need for the
20    collection of additional credentials data;
21        (2) a uniform health care recredentials form that
22    shall include the credentials data commonly requested by
23    health care entities and health care plans for purposes of
24    recredentialing and shall minimize the need for the
25    collection of additional credentials data;

 

 

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1        (3) a uniform hospital credentials form that shall
2    include the credentials data commonly requested by
3    hospitals for purposes of credentialing and shall minimize
4    the need for the collection of additional credentials
5    data;
6        (4) a uniform hospital recredentials form that shall
7    include the credentials data commonly requested by
8    hospitals for purposes of recredentialing and shall
9    minimize the need for collection of additional credentials
10    data; and
11        (5) uniform updating forms.
12    (b) The uniform forms established by the Department under
13this Section in subsection (a) shall be coordinated to reduce
14the need to provide redundant information. Further, the forms
15shall be made available in both paper and electronic formats
16upon request and in the format requested.
17    (c) The Department, in consultation with the council,
18shall establish by rule a date after which an electronic
19format may be required by a health care entity, a health care
20plan, or a hospital, and a health care professional may
21require acceptance of an electronic format by a health care
22entity, a health care plan, or a hospital.
23    (d) Beginning January 1, 2002, each health care entity or
24health care plan that employs, contracts with, or allows
25health care professionals to provide medical or health care
26services and requires health care professionals to be

 

 

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1credentialed or recredentialed shall for purposes of
2collecting credentials data only require:
3        (1) the uniform health care credentials form;
4        (2) the uniform health care recredentials form;
5        (3) the uniform updating forms; and
6        (4) any additional credentials data requested.
7    (e) Beginning January 1, 2002, each hospital that employs,
8contracts with, or allows health care professionals to provide
9medical or health care services and requires health care
10professionals to be credentialed or recredentialed shall for
11purposes of collecting credentials data only require:
12        (1) the uniform hospital credentials form;
13        (2) the uniform hospital recredentials form;
14        (3) the uniform updating forms; and
15        (4) any additional credentials data requested.
16    (f) Each health care entity and health care plan shall
17complete the process of verifying a health care professional's
18credentials data in a timely fashion and shall complete the
19process of credentialing or recredentialing of the health care
20professional within 60 days after submission of all
21credentials data and completion of verification of the
22credentials data.
23    (g) Each health care professional shall provide any
24corrections, updates, and modifications to his or her
25credentials data to ensure that all credentials data on the
26health care professional remains current. Such corrections,

 

 

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1updates, and modifications shall be provided within 5 business
2days for State health care professional license revocation,
3federal Drug Enforcement Agency license revocation, Medicare
4or Medicaid sanctions, revocation of hospital privileges, any
5lapse in professional liability coverage required by a health
6care entity, health care plan, or hospital, or conviction of a
7felony, and within 45 days for any other change in the
8information from the date the health care professional knew of
9the change. All updates shall be made on the uniform updating
10forms developed by the Department.
11    (h) Any credentials data collected or obtained by the
12health care entity, health care plan, or hospital shall be
13confidential, as provided by law, and otherwise may not be
14redisclosed without written consent of the health care
15professional, except that in any proceeding to challenge
16credentialing or recredentialing, or in any judicial review,
17the claim of confidentiality shall not be invoked to deny a
18health care professional, health care entity, health care
19plan, or hospital access to or use of credentials data.
20Nothing in this Section prevents a health care entity, health
21care plan, or hospital from disclosing any credentials data to
22its officers, directors, employees, agents, subcontractors,
23medical staff members, any committee of the health care
24entity, health care plan, or hospital involved in the
25credentialing process, or accreditation bodies or licensing
26agencies. However, any redisclosure of credentials data

 

 

SB2221- 8 -LRB103 27111 CPF 53479 b

1contrary to this Section is prohibited.
2    (i) Nothing in this Act shall be construed to restrict the
3right of any health care entity, health care plan or hospital
4to request additional information necessary for credentialing
5or recredentialing.
6    (j) Nothing in this Act shall be construed to restrict in
7any way the authority of any health care entity, health care
8plan or hospital to approve, suspend or deny an application
9for hospital staff membership, clinical privileges, or managed
10care network participation.
11    (k) Nothing in this Act shall be construed to prohibit
12delegation of credentialing and recredentialing activities as
13long as the delegated entity follows the requirements set
14forth in this Act.
15    (l) Nothing in this Act shall be construed to require any
16health care entity or health care plan to credential or survey
17any health care professional.
18    (m) Nothing in this Act prohibits a hospital from granting
19disaster privileges pursuant to the provisions of Section 10.4
20of the Hospital Licensing Act. When a hospital grants disaster
21privileges pursuant to Section 10.4 of the Hospital Licensing
22Act, that hospital is not required to collect credentials data
23pursuant to this Act.
24(Source: P.A. 92-193, eff. 1-1-02; 93-829, eff. 7-28-04.)
 
25    (410 ILCS 517/20)

 

 

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1    Sec. 20. Single credentialing cycle.
2    (a) The Department, in consultation with the council,
3shall by rule establish a single credentialing cycle. The
4single credentialing cycle shall be based on a specific
5variable or variables. To the extent possible the single
6credentialing cycle shall be established to ensure that the
7credentials data of all health care professionals in a group
8or at a single site are collected during the same time period.
9However, nothing in this Act shall be construed to require the
10single credentialing cycle to be established to ensure that
11the credentials data of all health care professionals in a
12group or at a single site are collected during the same time
13period.
14    (b) Beginning July 1, 2002, all health care entities and
15health care plans shall obtain credentials data on all health
16care professionals according to the established single
17credentialing cycle.
18    (c) The Department, in consultation with the council,
19shall by rule establish a process to exempt a small or unique
20health care entity or small or unique health care plan from the
21single credentialing cycle if the health care entity or health
22care plan demonstrates to the Department that adherence to the
23single credentialing cycle would be an undue hardship for the
24health care entity or health care plan.
25    (d) The requirements of this Section shall not apply when
26a health care professional submits initial credentials data to

 

 

SB2221- 10 -LRB103 27111 CPF 53479 b

1a health care entity or health care plan outside of the
2established single credentialing cycle, when a health care
3professional's credentials data change substantively, or when
4a health care entity or health care plan requires
5recredentialing as a result of patient or quality assurance
6issues.
7(Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)
 
8    (410 ILCS 517/25)
9    Sec. 25. Single site survey.
10    (a) The Department, in consultation with the council,
11shall by rule establish a uniform site survey instrument
12taking into account national accreditation standards and State
13requirements. The uniform site survey instrument shall include
14all the site survey data requested by health care entities and
15health care plans.
16    (b) No later than July 1, 2002, the Department, in
17consultation with the council, shall publish, in rule, the
18variable or variables for completing the single site survey.
19To the extent possible, the single site survey shall be
20established to ensure that all health care professionals in a
21group or at a site are reviewed during the same time period.
22    (c) Beginning January 1, 2003, health care entities and
23health care plans shall implement the single site survey, if a
24site survey is required by any of the health care
25professional's health care entities or health care plans. The

 

 

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1site survey shall be completed using the uniform site survey
2instrument.
3    (d) The uniform site survey instrument shall be used when
4a health care professional seeks initial credentialing by a
5health care entity or health care plan, when a health care
6professional's credentials data change substantively, or when
7a health care plan or health care entity requires a site survey
8as a result of patient or quality assurance issues, if a site
9survey is required by the health care entity or health care
10plan.
11    (e) Nothing in this Section prohibits health care entities
12and health care plans from choosing the independent party to
13conduct the single site survey.
14(Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)
 
15    (410 ILCS 517/30)
16    Sec. 30. Study of coordinated credentials verification.
17    (a) The Department, in consultation with the council,
18shall study the need for coordinated credentials data
19verification.
20    (b) The study shall address the need for, the advantages
21and disadvantages of, and the costs and cost savings, if any,
22of coordinated credentials verification.
23    (c) The study also may address other changes to improve
24the credentialing and recredentialing processes, to improve
25the timeliness of the credentials data, and reduce the costs,

 

 

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1time, and administrative burden associated with the processes.
2    (d) The Department shall make a recommendation to the
3General Assembly and the Governor regarding the need for
4further legislation no later than January 1, 2003.
5(Source: P.A. 91-602, eff. 8-16-99.)
 
6    (410 ILCS 517/35)
7    Sec. 35. Rules. The Department, in consultation with the
8council, shall adopt rules necessary to develop and implement
9and enforce the requirements established by this Act.
10(Source: P.A. 91-602, eff. 8-16-99.)
 
11    (410 ILCS 517/10 rep.)
12    Section 10. The Health Care Professional Credentials Data
13Collection Act is amended by repealing Section 10.