State of Illinois
92nd General Assembly
Legislation

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[ Introduced ][ Enrolled ][ House Amendment 001 ]


92_HB1954eng

 
HB1954 Engrossed                               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 Data
 6    Collection Act is amended by changing Sections 15, 20, and 25
 7    as 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

 
HB1954 Engrossed            -2-                LRB9200934ACcd
 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  January  July  1,  2002 2000, each health
14    care entity or health care plan that employs, contracts with,
15    or allows health care professionals  to  provide  medical  or
16    health  care  services and requires health care professionals
17    to be 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  January  July 1, 2002 2000, each hospital
24    that  employs,  contracts  with,  or   allows   health   care
25    professionals  to provide medical or health care services and
26    requires health care  professionals  to  be  credentialed  or
27    recredentialed  shall  for purposes of collecting credentials
28    data only require:
29             (1)  the uniform hospital credentials form;
30             (2)  the uniform hospital recredentials form;
31             (3)  the uniform updating forms; and
32             (4)  any additional credentials data requested.
33        (f)  Each health care entity and health care  plan  shall
34    complete   the   process   of   verifying   a   health   care
 
HB1954 Engrossed            -3-                LRB9200934ACcd
 1    professional's credentials data in a timely fashion and shall
 2    complete  the  process of credentialing or recredentialing of
 3    the health care professional within 60 days after  submission
 4    of all credentials data and completion of verification of the
 5    credentials data.
 6        (g)  Each  health  care  professional  shall  provide any
 7    corrections,  updates,  and  modifications  to  his  or   her
 8    credentials  data  to ensure that all credentials data on the
 9    health care professional remains current.  Such  corrections,
10    updates,   and  modifications  shall  be  provided  within  5
11    business days for  State  health  care  professional  license
12    revocation,   federal   Drug   Enforcement   Agency   license
13    revocation,  Medicare  or  Medicaid  sanctions, revocation of
14    hospital privileges,  any  lapse  in  professional  liability
15    coverage  required by a health care entity, health care plan,
16    or hospital, or conviction of a felony, and  within  45  days
17    for  any  other  change  in the information from the date the
18    health care professional knew of  the  change.   All  updates
19    shall  be made on the uniform updating forms developed by the
20    Department.
21        (h)  Any credentials data collected or  obtained  by  the
22    health  care  entity,  health care plan, or hospital shall be
23    confidential, as provided by law, and otherwise  may  not  be
24    redisclosed  without  written  consent  of  the  health  care
25    professional,  except  that  in  any  proceeding to challenge
26    credentialing or recredentialing, or in any judicial  review,
27    the  claim  of confidentiality shall not be invoked to deny a
28    health care professional, health  care  entity,  health  care
29    plan,  or  hospital  access  to  or  use of credentials data.
30    Nothing in this Section prevents a health care entity, health
31    care plan, or hospital from disclosing any  credentials  data
32    to    its    officers,    directors,    employees,    agents,
33    subcontractors,  medical  staff members, any committee of the
34    health care entity, health care plan, or hospital involved in
 
HB1954 Engrossed            -4-                LRB9200934ACcd
 1    the  credentialing  process,  or  accreditation   bodies   or
 2    licensing agencies.  However, any redisclosure of credentials
 3    data contrary to this Section is prohibited.
 4        (i)  Nothing  in  this Act shall be construed to restrict
 5    the right of any health care  entity,  health  care  plan  or
 6    hospital  to  request  additional  information  necessary for
 7    credentialing or recredentialing.
 8        (j)  Nothing in this Act shall be construed  to  restrict
 9    in  any  way  the authority of any health care entity, health
10    care  plan  or  hospital  to  approve,  suspend  or  deny  an
11    application   for   hospital   staff   membership,   clinical
12    privileges, or managed care network participation.
13        (k)  Nothing in this Act shall be construed  to  prohibit
14    delegation of credentialing and recredentialing activities as
15    long  as  the  delegated  entity follows the requirements set
16    forth in this Act.
17        (l)  Nothing in this Act shall be  construed  to  require
18    any  health  care entity or health care plan to credential or
19    survey any health care professional.
20    (Source: P.A. 91-602, eff. 8-16-99.)

21        (410 ILCS 517/20)
22        Sec. 20.  Single credentialing cycle.
23        (a)  The Department, in consultation  with  the  council,
24    shall  by  rule  establish a single credentialing cycle.  The
25    single credentialing cycle  shall  be  based  on  a  specific
26    variable  or  variables.   To  the extent possible the single
27    credentialing cycle shall be established to ensure  that  the
28    credentials  data of all health care professionals in a group
29    or at a single  site  are  collected  during  the  same  time
30    period.   However,  nothing in this Act shall be construed to
31    require the single credentialing cycle to be  established  to
32    ensure   that   the  credentials  data  of  all  health  care
33    professionals in a group or at a single  site  are  collected
 
HB1954 Engrossed            -5-                LRB9200934ACcd
 1    during the same time period.
 2        (b)  Beginning  July  1, 2002 January 1, 2001, all health
 3    care entities and health care plans shall obtain  credentials
 4    data  on  all  health  care  professionals  according  to the
 5    established single credentialing cycle.
 6        (c)  The Department, in consultation  with  the  council,
 7    shall by rule establish a process to exempt a small or unique
 8    health  care  entity or small or unique health care plan from
 9    the single credentialing cycle if the health care  entity  or
10    health   care   plan  demonstrates  to  the  Department  that
11    adherence to the single credentialing cycle would be an undue
12    hardship for the health care entity or health care plan.
13        (d)  The requirements of this  Section  shall  not  apply
14    when  a  health care professional submits initial credentials
15    data to a health care entity or health care plan  outside  of
16    the  established  single  credentialing  cycle, when a health
17    care professional's credentials data change substantively, or
18    when a health  care  entity  or  health  care  plan  requires
19    recredentialing  as  a result of patient or quality assurance
20    issues.
21    (Source: P.A. 91-602, eff. 8-16-99.)

22        (410 ILCS 517/25)
23        Sec. 25.  Single site survey.
24        (a)  The Department, in consultation  with  the  council,
25    shall  by  rule  establish  a  uniform site survey instrument
26    taking into  account  national  accreditation  standards  and
27    State requirements.  The uniform site survey instrument shall
28    include  all  the  site  survey data requested by health care
29    entities and health care plans.
30        (b)  No later than July 1,  2002  January  1,  2001,  the
31    Department,  in consultation with the council, shall publish,
32    in rule, the variable or variables for completing the  single
33    site  survey.  To the extent possible, the single site survey
 
HB1954 Engrossed            -6-                LRB9200934ACcd
 1    shall  be  established  to  ensure  that  all   health   care
 2    professionals in a group or at a site are reviewed during the
 3    same time period.
 4        (c)  Beginning  January 1, 2003 July 1, 2001, health care
 5    entities and health care plans  shall  implement  the  single
 6    site  survey,  if  a  site  survey  is required by any of the
 7    health care professional's health  care  entities  or  health
 8    care  plans.   The  site  survey shall be completed using the
 9    uniform site survey instrument.
10        (d)  The uniform site survey  instrument  shall  be  used
11    when  a  health care professional seeks initial credentialing
12    by a health care entity or health care plan,  when  a  health
13    care professional's credentials data change substantively, or
14    when a health care plan or health care entity requires a site
15    survey as a result of patient or quality assurance issues, if
16    a site survey is required by the health care entity or health
17    care plan.
18        (e)  Nothing   in  this  Section  prohibits  health  care
19    entities and health care plans from choosing the  independent
20    party to conduct the single site survey.
21    (Source: P.A. 91-602, eff. 8-16-99.)

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