[ Search ] [ Legislation ]
[ Home ] [ Back ] [ Bottom ]
| [ Engrossed ] | [ Enrolled ] | [ Senate Amendment 001 ] |
| [ Senate Amendment 002 ] | [ Senate Amendment 003 ] |
91_HB1780
LRB9105596ACtmA
1 AN ACT creating the Health Care Professional
2 Credentialing Act.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 1. Short title. This Act may be cited as the
6 Health Care Professional Credentialing Act.
7 Section 5. Purpose. The Legislature recognizes that an
8 efficient and effective health care professional
9 credentialing program helps to ensure access to quality
10 health care and also recognizes that health care professional
11 credentialing activities have increased significantly as a
12 result of recent changes in health care delivery and
13 financing systems. Moreover, the resulting duplication of
14 health care professional credentialing activities is
15 unnecessarily costly and cumbersome for both the health care
16 professional and the entity granting practice privileges.
17 Therefore, it is the intent of this Act that a voluntary
18 credentials verification program be established which
19 provides that once a health care professional's core
20 credentials data is collected, validated, maintained, and
21 stored they need not be collected and validated again.
22 Voluntary credentialing under this Act shall initially
23 include those individuals licensed under the Medical Practice
24 Act of 1987. However, the Department shall, with the
25 approval of the applicable board, include other health care
26 professionals under the jurisdiction of this credentialing
27 program.
28 Section 10. Definitions. As used in this Act:
29 "Advisory council" or "council" means the Credentials
30 Verification Advisory Council.
-2- LRB9105596ACtmA
1 "Core credentials data" means any professional education,
2 professional training, peer references, licensure status,
3 Drug Enforcement Administration certification, Social
4 Security Number, board certification, Educational Commission
5 for Foreign Medical Graduates information, hospital
6 affiliations, Medicare and Medicaid participation
7 information, managed care organization affiliations, other
8 institutional affiliations, and professional society
9 memberships.
10 "Credentialing" means the process of assessing and
11 validating the qualifications of a health care professional.
12 "Credentials verification organization" means any
13 program, entity, or organization that:
14 (1) is organized for the express purpose of
15 collecting, verifying, maintaining, storing, and
16 providing to health care entities a health care
17 professional's total core credentials data, including all
18 corrections, updates, and modifications thereto, as
19 authorized by the health care professional and in
20 accordance with the provisions of this Act; and
21 (2) is accredited or certified by a nationally
22 recognized and accepted organization, including the
23 National Committee for Quality Assurance, the Joint
24 Commission on Accreditation of Healthcare Organizations,
25 and the American Accreditation HealthCare
26 Commission/URAC, and any other nationally recognized and
27 accepted organization approved by the Department for the
28 purpose of collecting, verifying, storing, and providing
29 to health care entities a health care professional's core
30 credentials data.
31 "Department" means the Department of Public Health.
32 "Designated credentials verification organization" means
33 the credentials verification organization collecting,
34 verifying, maintaining, storing, and providing to health care
-3- LRB9105596ACtmA
1 entities a health care professional's total core credentials
2 data, including all integrated corrections, updates, and
3 modifications thereto, which is selected by the health care
4 professional as the credentials verification organization for
5 all inquiries into his or her core credentials data, if the
6 health care professional chooses to make such a designation.
7 "Director" means the Director of Public Health.
8 "Health care entity" means (i) a health care facility or
9 other health care organization licensed or certified to
10 provide approved medical and health services in Illinois;
11 (ii) a health care professional partnership, corporation,
12 limited liability company, professional services corporation,
13 or group practice; or (iii) any entity licensed by the
14 Department of Insurance as a prepaid health care plan or
15 health maintenance organization or as an insurer to provide
16 coverage for health care services through a network of
17 providers.
18 "Health care professional" means any person licensed
19 under the Medical Practice Act of 1987 or any person licensed
20 under any other Act subsequently made subject to this Act by
21 the Department with the approval of the applicable board.
22 "National accrediting organization" means an organization
23 that awards accreditation or certification to hospitals,
24 managed care organizations, or other health care
25 organizations, including, but not limited to, the Joint
26 Commission on Accreditation of Healthcare Organizations, the
27 National Committee for Quality Assurance, and the American
28 Accreditation HealthCare Commission/URAC.
29 "Primary source verification" means verification of
30 professional qualifications based on evidence obtained
31 directly from the issuing source of the applicable
32 qualification, such as the state licensing agency or hospital
33 medical staff that granted membership or privileges.
34 "Recredentialing" means the process by which a
-4- LRB9105596ACtmA
1 credentials verification organization verifies the corrected,
2 updated, or modified credentials of a health care
3 professional whose core credentials data, including all
4 previous corrections, updates, and modifications thereto, if
5 any, are currently on file with the credentials verification
6 organization.
7 "Secondary source verification" means confirmation of a
8 professional qualification by means other than primary source
9 verification, as outlined and approved by national
10 accrediting organizations.
11 Section 15. Standardized credentials verification
12 program; Credentials Verification Advisory Council.
13 (a) In accordance with the provisions of this Act, the
14 Department shall develop a standardized system as well as
15 guidelines for collecting, verifying, maintaining, storing,
16 and providing core credentials data on health care
17 professionals through credentials verification organizations
18 for the purpose of eliminating duplication. Once the core
19 credentials data is submitted to a designated credentials
20 verification organization, the health care professional is
21 not required to resubmit this data when applying for practice
22 privileges with health care entities. However, as provided
23 in paragraph (d), each health care professional is
24 responsible for providing any corrections, updates, and
25 modifications to his or her core credentials data to ensure
26 that all credentialing data on the health care professional
27 remains current. Nothing in this subsection prevents the
28 designated credentials verification organization from
29 obtaining all necessary attestation and release form
30 signatures and dates.
31 (b) There is established a Credentials Verification
32 Advisory Council consisting of 9 members to assist with the
33 development of guidelines for establishment of the
-5- LRB9105596ACtmA
1 standardized credentials verification program. The Director,
2 or his or her designee, shall serve as one member and chair
3 of the council and shall appoint the remaining 8 members.
4 One member shall represent hospitals, one member shall
5 represent health maintenance organizations, one member shall
6 represent health insurance entities, one member shall
7 represent credentials verification organizations, 2 members
8 shall represent physicians licensed to practice medicine in
9 all its branches, one member shall represent chiropractic
10 physicians, and one member shall represent the public. The
11 initial appointments of 4 of the members shall be for 2
12 years. All other appointments shall be for 4 years, with no
13 more than one 4-year reappointment.
14 (c) The Department, in consultation with the advisory
15 council, shall develop standardized forms for the initial
16 reporting of core credentials data for credentialing purposes
17 and for the subsequent reporting of corrections, updates, and
18 modifications thereto as well as any other necessary forms.
19 (d) Each health care professional licensed under the
20 Medical Practice Act of 1987 or any person licensed under an
21 Illinois law subsequently made subject to this Act may, but
22 is not required to, report core credentials data to his or
23 her designated credentials verification organization, if any.
24 Any correction, update, or modification to core credentials
25 data should be reported as soon as possible, but not later
26 than 60 days after any changes in the core credentials data.
27 (e) An individual applying for licensure under the
28 Medical Practice Act of 1987 or any person applying for
29 licensure under an Illinois law subsequently made subject to
30 this Act may, but is not required to, submit his or her
31 initial core credentials data to a credentials verification
32 organization.
33 (f) Health care professionals may decide which
34 credentials verification organization, if any, they want to
-6- LRB9105596ACtmA
1 process and store their core credentials data. Health care
2 professionals may choose not to designate a credentials
3 verification organization. In addition, any health care
4 professional may choose to move his or her core credentials
5 data from one credentials verification organization to
6 another at any time.
7 (g) Any health care entity that employs, contracts with,
8 or allows health care professionals to provide medical or
9 health care services and requires health care professionals
10 to be credentialed must use the health care professional's
11 designated credentials verification organization to obtain
12 core credentials data on the health care professional
13 applying for privileges with that entity, if the health care
14 professional has made such a designation. Upon submission of
15 a notarized written consent for the health care
16 professional's non-core information, any non-core information
17 required by the health care entity's credentialing process
18 must be collected from the health care professional's
19 designated credentials verification organization, if the
20 health care professional has made a designation. This
21 non-core information shall be verified either by the health
22 care entity or by the health care professional's designated
23 credentials verification organization. Any non-core
24 credentials data collected by the health care entity or a
25 designated credentials verification organization shall be
26 designated confidential or trade secret and may not be
27 redisclosed to any person, court, tribunal board, or any
28 other entity without written consent of the health care
29 professional.
30 (h) A designated credentials verification organization
31 may charge each health care professional a reasonable fee not
32 to exceed $60 for initial reporting of core credentials data
33 and $30 annually to cover the costs for maintenance and
34 integration of all corrections, updates, and modifications
-7- LRB9105596ACtmA
1 thereto.
2 (i) Nothing in this Act may be construed to restrict the
3 right of any health care entity to request additional
4 information necessary for credentialing.
5 (j) Nothing in this Act may be construed to restrict in
6 any way the authority of a health care entity to approve or
7 deny an application for hospital staff membership, clinical
8 privileges, or managed care network participation.
9 Section 20. Delegation by contract. A health care
10 entity may contract with any credentials verification
11 organization to perform credentialing verification for the
12 health care entity. The submission of a notarized form
13 developed by the Department by a health care professional
14 shall constitute authorization for the health care entity to
15 request the health care professional's core credentials data
16 with the health care professional's designated credentials
17 verification organization, if the health care professional
18 has made such a designation.
19 Section 25. Availability of data collected.
20 (a) Each credentials verification organization shall
21 make available all core credentials data it collects on the
22 health core professional to a health care entity the health
23 care professional has authorized to receive the data.
24 Authorization shall be submitted on notarized forms developed
25 by the Department. The credentials verification organization
26 may charge a reasonable fee for providing the credentials
27 data it collects on the health care professional.
28 (b) If a health care professional chooses to change
29 designated credentials verification organizations, the health
30 care professional's current designated credentials
31 verification organization shall make all core credentials
32 data it collected on the health care professional available
-8- LRB9105596ACtmA
1 to the new credentials verification organization that the
2 health care professional has authorized to receive the data
3 at a charge not to exceed the current credentials
4 verification organization's actual cost of collecting,
5 storing, verifying, and providing the data.
6 Section 30. Duplication of data prohibited.
7 (a) A health care entity may not collect or attempt to
8 collect duplicate core credentials data from any health care
9 professional or from any primary source if the information is
10 already on file with the health care professional's
11 designated credentials verification organization.
12 (b) A credentials verification organization may not
13 attempt to collect duplicate credentials data from any health
14 care professional if the information is already on file with
15 a designated credentials verification organization.
16 Section 35. Reliability of data. Health care entities
17 may rely upon core credentials data provided by a credentials
18 verification organization when the designated credentials
19 verification organization certifies that the information was
20 obtained in accordance with primary source or secondary
21 source verification procedures.
22 Section 40. Standards and registration. Any credentials
23 verification organization that does business in Illinois must
24 meet the standards established by rule and must register with
25 the Department. The Department may charge a reasonable
26 registration fee not to exceed $150 for initial registration
27 and $75 annually for all modifications, changes, and
28 maintenance for such registration. Any entity that fails to
29 qualify as a credentials verification organization and any
30 credentials verification organization that fails to register
31 with the Department may not be selected as the designated
-9- LRB9105596ACtmA
1 credentials verification organization for any health care
2 professional.
3 Section 45. Liability. No civil, criminal, or
4 administrative action may be instituted, and there shall be
5 no liability, against any health care entity on account of
6 its reliance on any data obtained from a credentials
7 verification organization.
8 Section 50. Review. Before releasing a health care
9 professional's core credentials data to any health care
10 entity, a designated credentials verification organization
11 must provide the health care professional up to 30 days to
12 review such data and make any corrections of fact. This
13 review shall be documented with appropriate forms signed by
14 the health care professional.
15 Section 55. Validation of credentials. All credentials
16 verification organizations must perform primary source
17 verification of all credentialing information submitted to
18 them pursuant to this Act; however, secondary source
19 verification may be utilized if there is a documented attempt
20 to contact primary sources. The validation procedures used
21 by the credentials verification organizations must meet the
22 standards established by rule pursuant to this Act.
23 Section 60. Rules. The Department, in consultation with
24 the council and applicable health care professional licensing
25 boards, shall adopt rules necessary to develop and implement
26 the standardized credentials verification program established
27 by this Act.
28 Section 65. Civil penalties. In addition to any other
29 penalty provided by law, any health care entity or
-10- LRB9105596ACtmA
1 credentials verification organization that violates any
2 Section of this Act shall forfeit and pay to the Department a
3 civil penalty in an amount determined by the Department of
4 not more than $1,000 for the first offense and not more than
5 $5,000 for each subsequent offense.
6 Section 70. Administrative Procedure Act. The Illinois
7 Administrative Procedure Act is hereby expressly adopted and
8 incorporated herein as if all of the provisions of the Act
9 were included in the Act. For the purpose of this Act, the
10 notice required under Section 10-25 of the Administrative
11 Procedure Act is deemed sufficient when mailed to the last
12 known address of a party.
13 Section 75. Administrative Review Law. All final
14 administrative decisions of the Department are subject to
15 judicial review pursuant to the provisions of the
16 Administrative Review Law and all rules adopted pursuant
17 thereto. The term "administrative decision" is defined as in
18 Section 3-101 of the Code of Civil Procedure.
19 Section 99. This Act takes effect January 1, 2000.