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Public Act 103-0436


 

Public Act 0436 103RD GENERAL ASSEMBLY

  
  
  

 


 
Public Act 103-0436
 
HB2827 EnrolledLRB103 30778 CPF 57265 b

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

Effective Date: 8/4/2023