Sen. Laura Fine

Filed: 3/3/2023

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 2221

2    AMENDMENT NO. ______. Amend Senate Bill 2221 by replacing
3everything after the enacting clause with the following:
 
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.

 

 

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1    "Director" means the Director of the Department of Public
2Health.
3    "Health care entity" means any of the following which
4require the submission of credentials data: (i) a health care
5facility or other health care organization licensed or
6certified to provide medical or health services in Illinois,
7other than a hospital; (ii) a health care professional
8partnership, corporation, limited liability company,
9professional services corporation or group practice; or (iii)
10an independent practice association or physician hospital
11organization. Nothing in this definition shall be construed to
12mean that a hospital is a health care entity.
13    "Health care plan" means any entity licensed by the
14Department of Insurance as a prepaid health care plan or
15health maintenance organization or as an insurer which
16requires the submission of credentials data.
17    "Health care professional" means any person licensed under
18the Medical Practice Act of 1987 or any person licensed under
19any other Act subsequently made subject to this Act by the
20Department.
21    "Hospital" means a hospital licensed under the Hospital
22Licensing Act or any hospital organized under the University
23of Illinois Hospital Act.
24    "Recredentialing" means the process by which a health care
25entity, health care plan or hospital ensures that a health
26care professional who is currently credentialed by the health

 

 

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1care entity, health care plan or hospital continues to meet
2the credentialing criteria used by the health care entity,
3health care plan, or hospital no more than once every 3 2
4years.
5    "Single credentialing cycle" means a process whereby for
6purposes of recredentialing each health care professional's
7credentials data are collected by all health care entities and
8health care plans that credential the health care professional
9during the same time period and only once every 3 2 years.
10    "Site survey" means a process by which a health care
11entity or health care plan assesses the office locations and
12medical record keeping practices of a health care
13professional.
14    "Single site survey" means a process by which, for
15purposes of recredentialing, each health care professional
16receives a site visit only once every two years.
17    "Uniform health care credentials form" means the form
18prescribed developed by the Department under Section 15 to
19collect the credentials data commonly requested by health care
20entities and health care plans for purposes of credentialing.
21    "Uniform health care recredentials form" means the form
22prescribed developed by the Department under Section 15 to
23collect the credentials data commonly requested by health care
24entities and health care plans for purposes of
25recredentialing.
26    "Uniform hospital credentials form" means the form

 

 

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

 

 

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1    care entities and health care plans for purposes of
2    credentialing and shall minimize the need for the
3    collection of additional credentials data;
4        (2) a uniform health care recredentials form that
5    shall include the credentials data commonly requested by
6    health care entities and health care plans for purposes of
7    recredentialing and shall minimize the need for the
8    collection of additional credentials data;
9        (3) a uniform hospital credentials form that shall
10    include the credentials data commonly requested by
11    hospitals for purposes of credentialing and shall minimize
12    the need for the collection of additional credentials
13    data;
14        (4) a uniform hospital recredentials form that shall
15    include the credentials data commonly requested by
16    hospitals for purposes of recredentialing and shall
17    minimize the need for collection of additional credentials
18    data; and
19        (5) uniform updating forms.
20    The forms described in this subsection may be provided in
21a print format, electronic format, or both as prescribed by
22the Department.
23    (b) The uniform forms established by the Department under
24this Section in subsection (a) shall be coordinated to reduce
25the need to provide redundant information. Further, the forms
26shall be made available in both paper and electronic formats

 

 

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1upon request and in the format requested.
2    (c) The Department, in consultation with the council,
3shall establish by rule a process for the submittal of forms in
4an a date after which an electronic format with required
5content for may be required by a health care entity, a health
6care plan, or a hospital, and a health care professional may
7require acceptance of forms in an electronic format by a
8health care entity, a health care plan, or a hospital.
9    (d) Beginning January 1, 2002, each health care entity or
10health care plan that employs, contracts with, or allows
11health care professionals to provide medical or health care
12services and requires health care professionals to be
13credentialed or recredentialed shall for purposes of
14collecting credentials data only require:
15        (1) the uniform health care credentials form;
16        (2) the uniform health care recredentials form;
17        (3) the uniform updating forms; and
18        (4) any additional credentials data requested; and .
19        (5) an online credential with required content as
20    required by forms under this Section.
21    (e) Beginning January 1, 2002, each hospital that employs,
22contracts with, or allows health care professionals to provide
23medical or health care services and requires health care
24professionals to be credentialed or recredentialed shall for
25purposes of collecting credentials data only require:
26        (1) the uniform hospital credentials form;

 

 

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1        (2) the uniform hospital recredentials form;
2        (3) the uniform updating forms; and
3        (4) any additional credentials data requested; and .
4        (5) an online credential with required content as
5    required by forms under this Section.
6    (f) Each health care entity and health care plan shall
7complete the process of verifying a health care professional's
8credentials data in a timely fashion and shall complete the
9process of credentialing or recredentialing of the health care
10professional within 60 days after submission of all
11credentials data and completion of verification of the
12credentials data.
13    (g) Each health care professional shall provide any
14corrections, updates, and modifications to his or her
15credentials data to ensure that all credentials data on the
16health care professional remains current. Such corrections,
17updates, and modifications shall be provided within 5 business
18days for State health care professional license revocation,
19federal Drug Enforcement Agency license revocation, Medicare
20or Medicaid sanctions, revocation of hospital privileges, any
21lapse in professional liability coverage required by a health
22care entity, health care plan, or hospital, or conviction of a
23felony, and within 45 days for any other change in the
24information from the date the health care professional knew of
25the change. All updates shall be made on the uniform updating
26forms prescribed developed by the Department.

 

 

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1    (h) Any credentials data collected or obtained by the
2health care entity, health care plan, or hospital shall be
3confidential, as provided by law, and otherwise may not be
4redisclosed without written consent of the health care
5professional, except that in any proceeding to challenge
6credentialing or recredentialing, or in any judicial review,
7the claim of confidentiality shall not be invoked to deny a
8health care professional, health care entity, health care
9plan, or hospital access to or use of credentials data.
10Nothing in this Section prevents a health care entity, health
11care plan, or hospital from disclosing any credentials data to
12its officers, directors, employees, agents, subcontractors,
13medical staff members, any committee of the health care
14entity, health care plan, or hospital involved in the
15credentialing process, or accreditation bodies or licensing
16agencies. However, any redisclosure of credentials data
17contrary to this Section is prohibited.
18    (i) Nothing in this Act shall be construed to restrict the
19right of any health care entity, health care plan or hospital
20to request additional information necessary for credentialing
21or recredentialing.
22    (j) Nothing in this Act shall be construed to restrict in
23any way the authority of any health care entity, health care
24plan or hospital to approve, suspend or deny an application
25for hospital staff membership, clinical privileges, or managed
26care network participation.

 

 

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1    (k) Nothing in this Act shall be construed to prohibit
2delegation of credentialing and recredentialing activities as
3long as the delegated entity follows the requirements set
4forth in this Act.
5    (l) Nothing in this Act shall be construed to require any
6health care entity or health care plan to credential or survey
7any health care professional.
8    (m) Nothing in this Act prohibits a hospital from granting
9disaster privileges pursuant to the provisions of Section 10.4
10of the Hospital Licensing Act. When a hospital grants disaster
11privileges pursuant to Section 10.4 of the Hospital Licensing
12Act, that hospital is not required to collect credentials data
13pursuant to this Act.
14(Source: P.A. 92-193, eff. 1-1-02; 93-829, eff. 7-28-04.)
 
15    (410 ILCS 517/20)
16    Sec. 20. Single credentialing cycle.
17    (a) The Department, in consultation with the council,
18shall by rule establish a single credentialing cycle. The
19single credentialing cycle shall be based on a specific
20variable or variables. To the extent possible the single
21credentialing cycle shall be established to ensure that the
22credentials data of all health care professionals in a group
23or at a single site are collected during the same time period.
24However, nothing in this Act shall be construed to require the
25single credentialing cycle to be established to ensure that

 

 

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1the credentials data of all health care professionals in a
2group or at a single site are collected during the same time
3period.
4    (b) Beginning July 1, 2002, all health care entities and
5health care plans shall obtain credentials data on all health
6care professionals according to the established single
7credentialing cycle.
8    (c) The Department, in consultation with the council,
9shall by rule establish a process to exempt a small or unique
10health care entity or small or unique health care plan from the
11single credentialing cycle if the health care entity or health
12care plan demonstrates to the Department that adherence to the
13single credentialing cycle would be an undue hardship for the
14health care entity or health care plan.
15    (d) The requirements of this Section shall not apply when
16a health care professional submits initial credentials data to
17a health care entity or health care plan outside of the
18established single credentialing cycle, when a health care
19professional's credentials data change substantively, or when
20a health care entity or health care plan requires
21recredentialing as a result of patient or quality assurance
22issues.
23(Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)
 
24    (410 ILCS 517/25)
25    Sec. 25. Single site survey.

 

 

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1    (a) The Department, in consultation with the council,
2shall by rule establish a uniform site survey instrument
3taking into account national accreditation standards and State
4requirements. The uniform site survey instrument shall include
5all the site survey data requested by health care entities and
6health care plans.
7    (b) No later than July 1, 2002, the Department, in
8consultation with the council, shall publish, in rule, the
9variable or variables for completing the single site survey.
10To the extent possible, the single site survey shall be
11established to ensure that all health care professionals in a
12group or at a site are reviewed during the same time period.
13    (c) Beginning January 1, 2003, health care entities and
14health care plans shall implement the single site survey, if a
15site survey is required by any of the health care
16professional's health care entities or health care plans. The
17site survey shall be completed using the uniform site survey
18instrument.
19    (d) The uniform site survey instrument shall be used when
20a health care professional seeks initial credentialing by a
21health care entity or health care plan, when a health care
22professional's credentials data change substantively, or when
23a health care plan or health care entity requires a site survey
24as a result of patient or quality assurance issues, if a site
25survey is required by the health care entity or health care
26plan.

 

 

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1    (e) Nothing in this Section prohibits health care entities
2and health care plans from choosing the independent party to
3conduct the single site survey.
4(Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)
 
5    (410 ILCS 517/30)
6    Sec. 30. Study of coordinated credentials verification.
7    (a) The Department, in consultation with the council,
8shall study the need for coordinated credentials data
9verification.
10    (b) The study shall address the need for, the advantages
11and disadvantages of, and the costs and cost savings, if any,
12of coordinated credentials verification.
13    (c) The study also may address other changes to improve
14the credentialing and recredentialing processes, to improve
15the timeliness of the credentials data, and reduce the costs,
16time, and administrative burden associated with the processes.
17    (d) The Department shall make a recommendation to the
18General Assembly and the Governor regarding the need for
19further legislation no later than January 1, 2003.
20(Source: P.A. 91-602, eff. 8-16-99.)
 
21    (410 ILCS 517/35)
22    Sec. 35. Rules. The Department, in consultation with the
23council, shall adopt rules necessary to develop and implement
24and enforce the requirements established by this Act.

 

 

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1(Source: P.A. 91-602, eff. 8-16-99.)
 
2    (410 ILCS 517/10 rep.)
3    Section 10. The Health Care Professional Credentials Data
4Collection Act is amended by repealing Section 10.".