(410 ILCS 517/5)
(Text of Section from P.A. 103-96)
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 a process undertaken for a period not to exceed 3 years 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.
"Single credentialing cycle" means a process undertaken for a period not to exceed 3 years 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.
"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 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 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 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 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 a standardized form 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. 103-96, eff. 1-1-24.)
(Text of Section from P.A. 103-436)
Sec. 5. Definitions. As used in this Act:
"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
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 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 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 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 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 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 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. 103-436, eff. 8-4-23.)
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