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92_HB1954
LRB9200934ACcd
1 AN ACT to amend 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 5. The Health Care Professional Credentials
6 Data Collection Act is amended by changing Section 15 as
7 follows:
8 (410 ILCS 517/15)
9 Sec. 15. Development and use of uniform health care and
10 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
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1 credentials data; and
2 (5) uniform updating forms.
3 (b) The uniform forms established in subsection (a)
4 shall be coordinated to reduce the need to provide redundant
5 information. Further, the forms shall be made available in
6 both paper and electronic formats.
7 (c) The Department, in consultation with the council,
8 shall establish by rule a date after which an electronic
9 format may be required by a health care entity, a health care
10 plan, or a hospital, and a health care professional may
11 require acceptance of an electronic format by a health care
12 entity, a health care plan, or a hospital.
13 (d) Beginning July 1, 2000, each health care entity or
14 health care plan that employs, contracts with, or allows
15 health care professionals to provide medical or health care
16 services and requires health care professionals to be
17 credentialed or recredentialed shall for purposes of
18 collecting credentials data only require:
19 (1) the uniform health care credentials form;
20 (2) the uniform health care recredentials form;
21 (3) the uniform updating forms; and
22 (4) any additional credentials data requested.
23 (e) Beginning July 1, 2000, each hospital that employs,
24 contracts with, or allows health care professionals to
25 provide medical or health care services and requires health
26 care professionals to be credentialed or recredentialed shall
27 for purposes of collecting credentials data only require:
28 (1) the uniform hospital credentials form;
29 (2) the uniform hospital recredentials form;
30 (3) the uniform updating forms; and
31 (4) any additional credentials data requested.
32 (f) Each health care entity and health care plan shall
33 complete the process of verifying a health care
34 professional's credentials data in a timely fashion and shall
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1 complete the process of credentialing or recredentialing of
2 the health care professional within 60 days after submission
3 of all credentials data and completion of verification of the
4 credentials data. If credentialing is not completed within 30
5 days after submission of the credentials data, then temporary
6 credentials shall be granted if the applicant provides
7 assurance of the following: (1) current state licensure and
8 (2) either credentials from a group practice, an Independent
9 Practice Association, or a Physician Hospital Organization or
10 current medical staff membership at a licensed hospital.
11 Temporary credentials shall expire upon the health care
12 professional being granted permanent credentials or 30 days
13 after written notice that credentials will not be granted.
14 (g) Each health care professional shall provide any
15 corrections, updates, and modifications to his or her
16 credentials data to ensure that all credentials data on the
17 health care professional remains current. Such corrections,
18 updates, and modifications shall be provided within 5
19 business days for State health care professional license
20 revocation, federal Drug Enforcement Agency license
21 revocation, Medicare or Medicaid sanctions, revocation of
22 hospital privileges, any lapse in professional liability
23 coverage required by a health care entity, health care plan,
24 or hospital, or conviction of a felony, and within 45 days
25 for any other change in the information from the date the
26 health care professional knew of the change. All updates
27 shall be made on the uniform updating forms developed by the
28 Department.
29 (h) Any credentials data collected or obtained by the
30 health care entity, health care plan, or hospital shall be
31 confidential, as provided by law, and otherwise may not be
32 redisclosed without written consent of the health care
33 professional, except that in any proceeding to challenge
34 credentialing or recredentialing, or in any judicial review,
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1 the claim of confidentiality shall not be invoked to deny a
2 health care professional, health care entity, health care
3 plan, or hospital access to or use of credentials data.
4 Nothing in this Section prevents a health care entity, health
5 care plan, or hospital from disclosing any credentials data
6 to its officers, directors, employees, agents,
7 subcontractors, medical staff members, any committee of the
8 health care entity, health care plan, or hospital involved in
9 the credentialing process, or accreditation bodies or
10 licensing agencies. However, any redisclosure of credentials
11 data contrary to this Section is prohibited.
12 (i) Nothing in this Act shall be construed to restrict
13 the right of any health care entity, health care plan or
14 hospital to request additional information necessary for
15 credentialing or recredentialing.
16 (j) Nothing in this Act shall be construed to restrict
17 in any way the authority of any health care entity, health
18 care plan or hospital to approve, suspend or deny an
19 application for hospital staff membership, clinical
20 privileges, or managed care network participation.
21 (k) Nothing in this Act shall be construed to prohibit
22 delegation of credentialing and recredentialing activities as
23 long as the delegated entity follows the requirements set
24 forth in this Act.
25 (l) Nothing in this Act shall be construed to require
26 any health care entity or health care plan to credential or
27 survey any health care professional.
28 (Source: P.A. 91-602, eff. 8-16-99.)
29 Section 99. Effective date. This Act takes effect upon
30 becoming law.