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91_HB1780enr HB1780 Enrolled LRB9105596ACtmA 1 AN ACT creating the Health Care Professional Credentials 2 Data Collection 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 Credentials Data Collection Act. 7 Section 5. Definitions. As used in this Act: 8 "Council" means the Health Care Credentials Council. 9 "Credentials data" means those data, information, or 10 answers to questions required by a health care entity, health 11 care plan, or hospital to complete the credentialing or 12 recredentialing of a health care professional. 13 "Credentialing" means the process of assessing and 14 validating the qualifications of a health care professional. 15 "Department" means the Department of Public Health. 16 "Director" means the Director of the Department of Public 17 Health. 18 "Health care entity" means any of the following which 19 require the submission of credentials data: (i) a health care 20 facility or other health care organization licensed or 21 certified to provide medical or health services in Illinois, 22 other than a hospital; (ii) a health care professional 23 partnership, corporation, limited liability company, 24 professional services corporation or group practice; or (iii) 25 an independent practice association or physician hospital 26 organization. Nothing in this definition shall be construed 27 to mean that a hospital is a health care entity. 28 "Health care plan" means any entity licensed by the 29 Department of Insurance as a prepaid health care plan or 30 health maintenance organization or as an insurer which 31 requires the submission of credentials data. HB1780 Enrolled -2- LRB9105596ACtmA 1 "Health care professional" means any person licensed 2 under the Medical Practice Act of 1987 or any person licensed 3 under any other Act subsequently made subject to this Act by 4 the Department. 5 "Hospital" means a hospital licensed under the Hospital 6 Licensing Act or any hospital organized under the University 7 of Illinois Hospital Act. 8 "Recredentialing" means the process by which a health 9 care entity, health care plan or hospital ensures that a 10 health care professional who is currently credentialed by the 11 health care entity, health care plan or hospital continues to 12 meet the credentialing criteria used by the health care 13 entity, health care plan, or hospital no more than once every 14 2 years. 15 "Single credentialing cycle" means a process whereby for 16 purposes of recredentialing each health care professional's 17 credentials data are collected by all health care entities 18 and health care plans that credential the health care 19 professional during the same time period and only once every 20 2 years. 21 "Site survey" means a process by which a health care 22 entity or health care plan assesses the office locations and 23 medical record keeping practices of a health care 24 professional. 25 "Single site survey" means a process by which, for 26 purposes of recredentialing, each health care professional 27 receives a site visit only once every two years. 28 "Uniform health care credentials form" means the form 29 developed by the Department under Section 15 to collect the 30 credentials data commonly requested by health care entities 31 and health care plans for purposes of credentialing. 32 "Uniform health care recredentials form" means the form 33 developed by the Department under Section 15 to collect the 34 credentials data commonly requested by health care entities HB1780 Enrolled -3- LRB9105596ACtmA 1 and health care plans for purposes of recredentialing. 2 "Uniform hospital credentials form" means the form 3 developed by the Department under Section 15 to collect the 4 credentials data commonly requested by hospitals for purposes 5 of credentialing. 6 "Uniform hospital recredentials form" means the form 7 developed by the Department under Section 15 to collect the 8 credentials data commonly requested by hospitals for purposes 9 of recredentialing. 10 "Uniform site survey instrument" means the instrument 11 developed by the Department under Section 25 to complete a 12 single site survey as part of a credentialing or 13 recredentialing process. 14 "Uniform updating form" means a standardized form for 15 reporting of corrections, updates, and modifications to 16 credentials data to health care entities, health care plans, 17 and hospitals when those data change following credentialing 18 or recredentialing of a health care professional. 19 Section 10. Health Care Credentials Council. 20 (a) There is established a Health Care Credentials 21 Council, consisting of 13 members, to assist the Department 22 in accordance with Sections 15, 20, 25, and 30 of this Act. 23 The Director, or his or her designee, shall serve as one 24 member and chair of the council and the Governor shall 25 appoint the remaining 12 members. Three members shall 26 represent hospitals, 3 members shall represent health 27 maintenance organizations, one member shall represent health 28 insurance entities, 3 members shall represent physicians 29 licensed to practice medicine in all its branches, one member 30 shall represent chiropractic physicians, and one member shall 31 represent ambulatory surgical treatment centers. In making 32 these appointments, the Governor shall take into 33 consideration the recommendations of various organizations HB1780 Enrolled -4- LRB9105596ACtmA 1 representing hospitals, health maintenance organizations, 2 insurers, ambulatory surgical treatment centers, and 3 physicians. The initial appointments of 6 of the members 4 shall be for 2 years. All other appointments shall be for 4 5 years, with no more than one 4-year reappointment. The 6 hospital representatives shall not vote on the development of 7 guidelines to implement Sections 20 and 25 of this Act. 8 (b) On July 1, 2003, the council is abolished. 9 Section 15. Development and use of uniform health care 10 and hospital credentials forms. 11 (a) The Department, in consultation with the council, 12 shall by rule establish: 13 (1) a uniform health care credentials form that 14 shall include the credentials data commonly requested by 15 health care entities and health care plans for purposes 16 of credentialing and shall minimize the need for the 17 collection of additional credentials data; 18 (2) a uniform health care recredentials form that 19 shall include the credentials data commonly requested by 20 health care entities and health care plans for purposes 21 of recredentialing and shall minimize the need for the 22 collection of additional credentials data; 23 (3) a uniform hospital credentials form that shall 24 include the credentials data commonly requested by 25 hospitals for purposes of credentialing and shall 26 minimize the need for the collection of additional 27 credentials data; 28 (4) a uniform hospital recredentials form that 29 shall include the credentials data commonly requested by 30 hospitals for purposes of recredentialing and shall 31 minimize the need for collection of additional 32 credentials data; and 33 (5) uniform updating forms. HB1780 Enrolled -5- LRB9105596ACtmA 1 (b) The uniform forms established in subsection (a) 2 shall be coordinated to reduce the need to provide redundant 3 information. Further, the forms shall be made available in 4 both paper and electronic formats. 5 (c) The Department, in consultation with the council, 6 shall establish by rule a date after which an electronic 7 format may be required by a health care entity, a health care 8 plan, or a hospital, and a health care professional may 9 require acceptance of an electronic format by a health care 10 entity, a health care plan, or a hospital. 11 (d) Beginning July 1, 2000, each health care entity or 12 health care plan that employs, contracts with, or allows 13 health care professionals to provide medical or health care 14 services and requires health care professionals to be 15 credentialed or recredentialed shall for purposes of 16 collecting credentials data only require: 17 (1) the uniform health care credentials form; 18 (2) the uniform health care recredentials form; 19 (3) the uniform updating forms; and 20 (4) any additional credentials data requested. 21 (e) Beginning July 1, 2000, each hospital that employs, 22 contracts with, or allows health care professionals to 23 provide medical or health care services and requires health 24 care professionals to be credentialed or recredentialed shall 25 for purposes of collecting credentials data only require: 26 (1) the uniform hospital credentials form; 27 (2) the uniform hospital recredentials form; 28 (3) the uniform updating forms; and 29 (4) any additional credentials data requested. 30 (f) Each health care entity and health care plan shall 31 complete the process of verifying a health care 32 professional's credentials data in a timely fashion and shall 33 complete the process of credentialing or recredentialing of 34 the health care professional within 60 days after submission HB1780 Enrolled -6- LRB9105596ACtmA 1 of all credentials data and completion of verification of the 2 credentials data. 3 (g) Each health care professional shall provide any 4 corrections, updates, and modifications to his or her 5 credentials data to ensure that all credentials data on the 6 health care professional remains current. Such corrections, 7 updates, and modifications shall be provided within 5 8 business days for State health care professional license 9 revocation, federal Drug Enforcement Agency license 10 revocation, Medicare or Medicaid sanctions, revocation of 11 hospital privileges, any lapse in professional liability 12 coverage required by a health care entity, health care plan, 13 or hospital, or conviction of a felony, and within 45 days 14 for any other change in the information from the date the 15 health care professional knew of the change. All updates 16 shall be made on the uniform updating forms developed by the 17 Department. 18 (h) Any credentials data collected or obtained by the 19 health care entity, health care plan, or hospital shall be 20 confidential, as provided by law, and otherwise may not be 21 redisclosed without written consent of the health care 22 professional, except that in any proceeding to challenge 23 credentialing or recredentialing, or in any judicial review, 24 the claim of confidentiality shall not be invoked to deny a 25 health care professional, health care entity, health care 26 plan, or hospital access to or use of credentials data. 27 Nothing in this Section prevents a health care entity, health 28 care plan, or hospital from disclosing any credentials data 29 to its officers, directors, employees, agents, 30 subcontractors, medical staff members, any committee of the 31 health care entity, health care plan, or hospital involved in 32 the credentialing process, or accreditation bodies or 33 licensing agencies. However, any redisclosure of credentials 34 data contrary to this Section is prohibited. HB1780 Enrolled -7- LRB9105596ACtmA 1 (i) Nothing in this Act shall be construed to restrict 2 the right of any health care entity, health care plan or 3 hospital to request additional information necessary for 4 credentialing or recredentialing. 5 (j) Nothing in this Act shall be construed to restrict 6 in any way the authority of any health care entity, health 7 care plan or hospital to approve, suspend or deny an 8 application for hospital staff membership, clinical 9 privileges, or managed care network participation. 10 (k) Nothing in this Act shall be construed to prohibit 11 delegation of credentialing and recredentialing activities as 12 long as the delegated entity follows the requirements set 13 forth in this Act. 14 (l) Nothing in this Act shall be construed to require 15 any health care entity or health care plan to credential or 16 survey any health care professional. 17 Section 20. Single credentialing cycle. 18 (a) The Department, in consultation with the council, 19 shall by rule establish a single credentialing cycle. The 20 single credentialing cycle shall be based on a specific 21 variable or variables. To the extent possible the single 22 credentialing cycle shall be established to ensure that the 23 credentials data of all health care professionals in a group 24 or at a single site are collected during the same time 25 period. However, nothing in this Act shall be construed to 26 require the single credentialing cycle to be established to 27 ensure that the credentials data of all health care 28 professionals in a group or at a single site are collected 29 during the same time period. 30 (b) Beginning January 1, 2001, all health care entities 31 and health care plans shall obtain credentials data on all 32 health care professionals according to the established single 33 credentialing cycle. HB1780 Enrolled -8- LRB9105596ACtmA 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 4 the single credentialing cycle if the health care entity or 5 health care plan demonstrates to the Department that 6 adherence to the single credentialing cycle would be an undue 7 hardship for the health care entity or health care plan. 8 (d) The requirements of this Section shall not apply 9 when a health care professional submits initial credentials 10 data to a health care entity or health care plan outside of 11 the established single credentialing cycle, when a health 12 care professional's credentials data change substantively, or 13 when a health care entity or health care plan requires 14 recredentialing as a result of patient or quality assurance 15 issues. 16 Section 25. Single site survey. 17 (a) The Department, in consultation with the council, 18 shall by rule establish a uniform site survey instrument 19 taking into account national accreditation standards and 20 State requirements. The uniform site survey instrument shall 21 include all the site survey data requested by health care 22 entities and health care plans. 23 (b) No later than January 1, 2001, the Department, in 24 consultation with the council, shall publish, in rule, the 25 variable or variables for completing the single site survey. 26 To the extent possible, the single site survey shall be 27 established to ensure that all health care professionals in a 28 group or at a site are reviewed during the same time period. 29 (c) Beginning July 1, 2001, health care entities and 30 health care plans shall implement the single site survey, if 31 a site survey is required by any of the health care 32 professional's health care entities or health care plans. 33 The site survey shall be completed using the uniform site HB1780 Enrolled -9- LRB9105596ACtmA 1 survey instrument. 2 (d) The uniform site survey instrument shall be used 3 when a health care professional seeks initial credentialing 4 by a health care entity or health care plan, when a health 5 care professional's credentials data change substantively, or 6 when a health care plan or health care entity requires a site 7 survey as a result of patient or quality assurance issues, if 8 a site survey is required by the health care entity or health 9 care plan. 10 (e) Nothing in this Section prohibits health care 11 entities and health care plans from choosing the independent 12 party to conduct the single site survey. 13 Section 30. Study of coordinated credentials 14 verification. 15 (a) The Department, in consultation with the council, 16 shall study the need for coordinated credentials data 17 verification. 18 (b) The study shall address the need for, the advantages 19 and disadvantages of, and the costs and cost savings, if any, 20 of coordinated credentials verification. 21 (c) The study also may address other changes to improve 22 the credentialing and recredentialing processes, to improve 23 the timeliness of the credentials data, and reduce the costs, 24 time, and administrative burden associated with the 25 processes. 26 (d) The Department shall make a recommendation to the 27 General Assembly and the Governor regarding the need for 28 further legislation no later than January 1, 2003. 29 Section 35. Rules. The Department, in consultation with 30 the council, shall adopt rules necessary to develop and 31 implement and enforce the requirements established by this 32 Act. HB1780 Enrolled -10- LRB9105596ACtmA 1 Section 40. Enforcement. The Department has authority to 2 enforce the provisions of the Act. In addition to any other 3 penalty provided by law, any health care entity, health care 4 plan, hospital, or health care professional that violates any 5 Section of this Act shall forfeit and pay to the Department a 6 fine in an amount determined by the Department of not more 7 than $1,000 for the first offense and not more than $5,000 8 for each subsequent offense. 9 Section 45. Administrative Procedure Act. The Illinois 10 Administrative Procedure Act is hereby expressly adopted and 11 incorporated herein as if all the provisions of the Act were 12 included in the Act. For the purpose of this Act, the notice 13 required under Section 10-25 of the Administrative Procedure 14 Act is deemed sufficient when mailed to the last known 15 address of a party. 16 Section 50. Administrative Review Law. All final 17 administrative decisions of the Department are subject to 18 judicial review pursuant to the provisions of the 19 Administrative Review Law and all rules adopted pursuant 20 thereto. The term "administrative decision" is defined as in 21 Section 3-101 of the Code of Civil Procedure. 22 Section 99. Effective Date. This Act takes effect upon 23 becoming law.