Full Text of HB2827 103rd General Assembly
HB2827eng 103RD GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning health.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Health Care Professional Credentials Data | 5 | | Collection Act is amended by changing Sections 5, 15, 20, 25, | 6 | | 30, 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 | 11 | | answers to questions
required by a health care entity, health
| 12 | | care plan, or hospital to complete the credentialing or
| 13 | | recredentialing of a health care professional.
| 14 | | "Credentialing" means the process of assessing and | 15 | | validating 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 | 18 | | Health.
| 19 | | "Health care entity" means any of the following which | 20 | | require the submission
of credentials data: (i) a health care | 21 | | facility or other
health care organization licensed or | 22 | | certified to provide medical or
health services in Illinois, | 23 | | other than a hospital; (ii) a health care
professional |
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| 1 | | partnership, corporation, limited liability company, | 2 | | professional
services corporation or group practice; or (iii) | 3 | | an independent
practice association or physician hospital | 4 | | organization. Nothing in this
definition shall be construed to | 5 | | mean that a hospital is a health care
entity.
| 6 | | "Health care plan" means any entity licensed by the | 7 | | Department of Insurance
as a prepaid health care plan or | 8 | | health maintenance
organization or as an insurer
which | 9 | | requires the submission of
credentials data.
| 10 | | "Health care professional" means any person licensed under | 11 | | the Medical
Practice Act of 1987 or any person licensed under | 12 | | any
other Act subsequently made subject to this Act by the | 13 | | Department.
| 14 | | "Hospital" means a hospital licensed under the Hospital | 15 | | Licensing Act or any
hospital organized under the University | 16 | | of Illinois
Hospital Act.
| 17 | | "Recredentialing" means the process by which a health care | 18 | | entity, health
care plan or hospital ensures that a health | 19 | | care professional
who is currently credentialed by the health | 20 | | care entity, health care plan or
hospital continues to meet | 21 | | the credentialing criteria used by the
health care entity, | 22 | | health care plan, or hospital no more than once every 3 2
| 23 | | years.
| 24 | | "Single credentialing cycle" means a process whereby for | 25 | | purposes of
recredentialing each health care professional's | 26 | | credentials
data are collected by all health care entities and |
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| 1 | | health care plans that
credential the health care professional | 2 | | during the same time period and
only once every 3 2 years.
| 3 | | "Site survey" means a process by which a health care | 4 | | entity or health care
plan assesses the office locations and | 5 | | medical record
keeping practices of a health care | 6 | | professional.
| 7 | | "Single site survey" means a process by which, for | 8 | | purposes of
recredentialing, each health care professional | 9 | | receives a site visit only
once every two years.
| 10 | | "Uniform health care credentials form" means the form | 11 | | prescribed developed by the
Department under Section 15 to | 12 | | collect the credentials
data commonly requested by health care | 13 | | entities and health care plans for
purposes of credentialing.
| 14 | | "Uniform health care recredentials form" means the form | 15 | | prescribed developed by the
Department under Section 15 to | 16 | | collect the credentials data commonly requested
by health care | 17 | | entities and health care plans for purposes of
| 18 | | recredentialing.
| 19 | | "Uniform hospital credentials form" means the form | 20 | | prescribed developed by the
Department
under Section 15 to | 21 | | collect the credentials data
commonly requested by hospitals | 22 | | for purposes of credentialing.
| 23 | | "Uniform hospital recredentials form" means the form | 24 | | prescribed developed by the
Department under Section 15 to | 25 | | collect the credentials data commonly requested
by
hospitals | 26 | | for purposes of recredentialing.
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| 1 | | "Uniform site survey instrument" means the instrument | 2 | | developed by the
Department under Section 25 to complete a | 3 | | single site
survey as part of a credentialing or | 4 | | recredentialing process.
| 5 | | "Uniform updating form" means the a standardized form | 6 | | prescribed by the Department for reporting of
corrections,
| 7 | | updates, and modifications to credentials data to
health care | 8 | | entities, health care plans, and hospitals when those data | 9 | | change
following credentialing or recredentialing of a health | 10 | | care
professional.
| 11 | | (Source: P.A. 91-602, eff. 8-16-99.)
| 12 | | (410 ILCS 517/15)
| 13 | | Sec. 15. Development and use of uniform health care and | 14 | | hospital
credentials forms. | 15 | | (a) The Department , in consultation with the council, | 16 | | shall by rule
establish:
| 17 | | (1) a uniform health care credentials form that shall | 18 | | include the
credentials data commonly requested by health | 19 | | care entities
and health care plans for purposes of | 20 | | credentialing and shall minimize the
need for the | 21 | | collection of
additional credentials data;
| 22 | | (2) a uniform health care recredentials form that | 23 | | shall include the
credentials data commonly requested by | 24 | | health care entities and health care
plans for purposes of | 25 | | recredentialing and shall minimize the need for the
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| 1 | | collection of additional credentials data;
| 2 | | (3) a uniform hospital credentials form that shall | 3 | | include the credentials
data commonly requested by | 4 | | hospitals for purposes of credentialing and
shall
minimize | 5 | | the need for the collection of additional credentials | 6 | | data;
| 7 | | (4) a uniform hospital recredentials form that shall | 8 | | include the
credentials data commonly requested by | 9 | | hospitals for purposes of
recredentialing and shall | 10 | | minimize the need for collection of additional
credentials | 11 | | data; and
| 12 | | (5) uniform updating forms.
| 13 | | The forms described in this subsection may be prescribed | 14 | | in a print format, electronic format, or both as provided by | 15 | | the Department. | 16 | | (b) The uniform forms established by the Department under | 17 | | this Section in subsection (a) shall be coordinated to
reduce | 18 | | the need to provide redundant information.
Further, the forms | 19 | | shall be made available in both paper and electronic
formats | 20 | | upon request and in the format requested .
| 21 | | (c) The Department , in consultation with the council, | 22 | | shall
establish by rule a process for the submittal of forms in | 23 | | an a date after which an electronic format with required | 24 | | content for may be
required by a health care entity, a health | 25 | | care plan, or a hospital, and a
health care professional may | 26 | | require acceptance of forms in an electronic
format by a |
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| 1 | | health care entity, a health care plan, or a hospital.
| 2 | | (d) Beginning January 1, 2002, each health care
entity or | 3 | | health
care plan that
employs, contracts with, or allows | 4 | | health care
professionals to provide medical or health care | 5 | | services and requires health
care professionals to be | 6 | | credentialed or recredentialed shall for
purposes of | 7 | | collecting credentials data only require:
| 8 | | (1) the uniform health care credentials form;
| 9 | | (2) the uniform health care recredentials form;
| 10 | | (3) the uniform updating forms; and
| 11 | | (4) any additional credentials data requested ; and .
| 12 | | (5) an online credential with required content as | 13 | | required by forms under this Section. | 14 | | (e) Beginning January 1, 2002, each hospital that
employs,
| 15 | | contracts with, or
allows health care professionals to provide | 16 | | medical or
health care services and requires health care | 17 | | professionals to be credentialed
or recredentialed shall for | 18 | | purposes of collecting credentials
data only require:
| 19 | | (1) the uniform hospital credentials form;
| 20 | | (2) the uniform hospital recredentials form;
| 21 | | (3) the uniform updating forms; and
| 22 | | (4) any additional credentials data requested ; and .
| 23 | | (5) an online credential with required content as | 24 | | required by forms under this Section. | 25 | | (f) Each health care entity and health care plan shall | 26 | | complete the process
of verifying a health care professional's |
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| 1 | | credentials data
in a timely fashion and shall complete the | 2 | | process of credentialing or
recredentialing of the health care | 3 | | professional within 60 days after
submission of all | 4 | | credentials data and completion of verification of the
| 5 | | credentials data.
| 6 | | (g) Each health care professional shall provide any | 7 | | corrections, updates,
and modifications to his or her | 8 | | credentials data to ensure
that all credentials data on the | 9 | | health care professional remains current.
Such corrections, | 10 | | updates, and modifications shall be provided within
5 business | 11 | | days for State health care professional license revocation, | 12 | | federal
Drug
Enforcement Agency license revocation,
Medicare | 13 | | or Medicaid sanctions, revocation of hospital privileges, any | 14 | | lapse
in professional liability coverage required by a health | 15 | | care entity, health
care plan, or hospital,
or conviction of a | 16 | | felony, and within 45 days for any
other
change in the | 17 | | information from the date the health care professional knew of
| 18 | | the change. All updates shall be made on the uniform updating
| 19 | | forms prescribed developed by the Department.
| 20 | | (h) Any credentials data collected or obtained by the | 21 | | health care entity,
health care plan, or hospital shall be | 22 | | confidential, as provided by law,
and otherwise may not be | 23 | | redisclosed without written consent of the
health care | 24 | | professional, except that in any proceeding to challenge
| 25 | | credentialing or recredentialing, or in any judicial review, | 26 | | the claim
of confidentiality shall not be invoked to deny a |
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| 1 | | health care professional,
health care entity,
health care | 2 | | plan, or hospital access to or use of credentials data. | 3 | | Nothing in
this Section prevents a health
care entity, health | 4 | | care plan, or hospital from disclosing any credentials data
to | 5 | | its officers, directors, employees, agents, subcontractors,
| 6 | | medical staff members, any committee of the health care | 7 | | entity, health care
plan, or hospital involved in the | 8 | | credentialing process, or
accreditation bodies or licensing | 9 | | agencies. However, any redisclosure of
credentials data | 10 | | contrary to this Section is prohibited.
| 11 | | (i) Nothing in this Act shall be construed to restrict the | 12 | | right of any
health care entity, health care plan or hospital | 13 | | to request additional
information necessary for credentialing | 14 | | or recredentialing.
| 15 | | (j) Nothing in this Act shall be construed to restrict in | 16 | | any way the
authority of any health care entity, health care | 17 | | plan or hospital to
approve, suspend or deny an application | 18 | | for hospital staff membership, clinical
privileges, or managed | 19 | | care network participation.
| 20 | | (k) Nothing in this Act shall be construed to prohibit | 21 | | delegation of
credentialing and recredentialing activities as | 22 | | long as the delegated
entity follows the requirements set | 23 | | forth in this Act.
| 24 | | (l) Nothing in this Act shall be construed to require any | 25 | | health care
entity or health care plan to credential or survey | 26 | | any health care
professional. |
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| 1 | | (m) Nothing in this Act prohibits a hospital from granting | 2 | | disaster privileges pursuant to the provisions of Section 10.4 | 3 | | of the Hospital Licensing Act. When a hospital grants disaster | 4 | | privileges pursuant to Section 10.4 of the Hospital Licensing | 5 | | Act, that hospital is not required to collect credentials data | 6 | | pursuant to this Act.
| 7 | | (Source: P.A. 92-193, eff. 1-1-02; 93-829, eff. 7-28-04.)
| 8 | | (410 ILCS 517/20)
| 9 | | Sec. 20. Single credentialing cycle.
| 10 | | (a) The Department , in consultation with the council, | 11 | | shall by rule
establish a single credentialing cycle. The | 12 | | single credentialing cycle shall
be based on a specific | 13 | | variable or variables. To the extent possible the
single | 14 | | credentialing cycle shall be established to ensure that the | 15 | | credentials
data of all health care professionals in a group | 16 | | or at a single site
are collected during the same time period. | 17 | | However, nothing in this Act
shall be construed to require the | 18 | | single credentialing cycle to be established
to ensure that | 19 | | the credentials data of all health care professionals in a | 20 | | group
or at a single site are collected during the same time | 21 | | period.
| 22 | | (b) Beginning July 1, 2002, all health care entities
and | 23 | | health care
plans shall obtain credentials data on all health | 24 | | care
professionals according to the established single | 25 | | credentialing cycle.
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| 1 | | (c) The Department , in consultation with the council, | 2 | | shall by rule
establish a process to exempt a small or unique | 3 | | health care entity
or small or unique health care plan from the | 4 | | single credentialing cycle if
the health
care entity or health | 5 | | care plan demonstrates to the Department that
adherence to the | 6 | | single credentialing cycle would be an undue hardship for the
| 7 | | health care entity or health care plan.
| 8 | | (d) The requirements of this Section shall not apply when | 9 | | a health care
professional submits initial credentials data to | 10 | | a health care
entity or health care plan outside of the | 11 | | established single credentialing
cycle, when a health care | 12 | | professional's credentials data change
substantively, or when | 13 | | a health care entity or health care plan requires
| 14 | | recredentialing as a result of patient or quality assurance | 15 | | issues.
| 16 | | (Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)
| 17 | | (410 ILCS 517/25)
| 18 | | Sec. 25. Single site survey.
| 19 | | (a) The Department , in consultation with the council, | 20 | | shall by rule
establish a uniform site survey instrument | 21 | | taking into
account national accreditation standards and State | 22 | | requirements. The
uniform site survey instrument
shall include | 23 | | all the site survey data requested by health care
entities and | 24 | | health care plans.
| 25 | | (b) No later than July 1, 2002, the Department , in
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| 1 | | consultation with
the council, shall publish, in rule, the | 2 | | variable or variables for completing
the
single site survey. | 3 | | To the extent possible, the single site survey shall be
| 4 | | established to ensure that all health care professionals in a | 5 | | group or at a
site are reviewed during the same time period.
| 6 | | (c) Beginning January 1, 2003, health care entities and
| 7 | | health care plans
shall implement the single site survey, if a | 8 | | site
survey is required by any of the health care | 9 | | professional's health
care entities or health care plans. The | 10 | | site survey shall be completed using
the uniform site survey | 11 | | instrument.
| 12 | | (d) The uniform site survey instrument shall be used when | 13 | | a health care
professional seeks initial credentialing by a | 14 | | health care entity
or health care plan, when a health care | 15 | | professional's credentials data
change substantively, or when | 16 | | a health care plan or health care entity requires
a site survey | 17 | | as a result of patient or quality assurance issues, if a site
| 18 | | survey is required by the health care entity or
health care | 19 | | plan.
| 20 | | (e) Nothing in this Section prohibits health care entities | 21 | | and health care
plans from choosing the independent party to | 22 | | conduct the
single site survey.
| 23 | | (Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)
| 24 | | (410 ILCS 517/30)
| 25 | | Sec. 30. Study of coordinated credentials verification.
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| 1 | | (a) The Department , in consultation with the council, | 2 | | shall study the
need for coordinated credentials data | 3 | | verification.
| 4 | | (b) The study shall address the need for, the advantages | 5 | | and disadvantages
of, and the costs and cost savings, if any, | 6 | | of coordinated
credentials verification.
| 7 | | (c) The study also may address other changes to improve | 8 | | the credentialing
and recredentialing processes, to improve | 9 | | the timeliness
of the credentials data, and reduce the costs, | 10 | | time, and administrative burden
associated with the processes.
| 11 | | (d) The Department shall make a recommendation to the | 12 | | General Assembly and
the Governor regarding the need for | 13 | | further
legislation no later than January 1, 2003.
| 14 | | (Source: P.A. 91-602, eff. 8-16-99.)
| 15 | | (410 ILCS 517/35)
| 16 | | Sec. 35. Rules. The Department , in consultation with the | 17 | | council,
shall adopt rules necessary to develop and implement | 18 | | and enforce the
requirements established by this Act.
| 19 | | (Source: P.A. 91-602, eff. 8-16-99.)
| 20 | | (410 ILCS 517/10 rep.)
| 21 | | Section 10. The Health Care Professional Credentials Data | 22 | | Collection Act is amended by repealing Section 10.
| 23 | | Section 99. Effective date. This Act takes effect upon | 24 | | becoming law. |
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