State of Illinois
91st General Assembly
Legislation

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91_HB1780eng

 
HB1780 Engrossed                              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.
 
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 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 Health Care Organizations,
25        and    the    American    Accreditation    Health    Care
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
 
HB1780 Engrossed            -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 Health Care Organizations, the
27    National  Committee  for  Quality Assurance, and the American
28    Accreditation Health Care 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
 
HB1780 Engrossed            -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
 
HB1780 Engrossed            -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
 
HB1780 Engrossed            -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
 
HB1780 Engrossed            -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
 
HB1780 Engrossed            -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
 
HB1780 Engrossed            -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
 
HB1780 Engrossed            -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.

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