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| Public Act 103-0436 | ||||
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AN ACT concerning health.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Health Care Professional Credentials Data | ||||
Collection Act is amended by changing Sections 5, 15, 20, 25, | ||||
30, and 35 as follows:
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(410 ILCS 517/5)
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Sec. 5. Definitions. As used in this Act:
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"Council" means the Health Care Credentials Council.
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"Credentials data" means those data, information, or | ||||
answers to questions
required by a health care entity, health
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care plan, or hospital to complete the credentialing or
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recredentialing of a health care professional.
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"Credentialing" means the process of assessing and | ||||
validating the
qualifications of a health care professional.
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"Department" means the Department of Public Health.
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"Director" means the Director of the Department of Public | ||||
Health.
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"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.
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"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.
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"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.
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"Hospital" means a hospital licensed under the Hospital | ||
Licensing Act or any
hospital organized under the University | ||
of Illinois
Hospital Act.
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"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 2
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years.
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"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 2 years.
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"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.
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"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.
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"Uniform health care credentials form" means the form | ||
prescribed 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.
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"Uniform health care recredentials form" means the form | ||
prescribed 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
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recredentialing.
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"Uniform hospital credentials form" means the form | ||
prescribed developed by the
Department
under Section 15 to | ||
collect the credentials data
commonly requested by hospitals | ||
for purposes of credentialing.
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"Uniform hospital recredentials form" means the form | ||
prescribed developed by the
Department under Section 15 to | ||
collect the credentials data commonly requested
by
hospitals | ||
for purposes of recredentialing.
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"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.
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"Uniform updating form" means the a standardized form | ||
prescribed by the Department for reporting of
corrections,
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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.
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(Source: P.A. 91-602, eff. 8-16-99.)
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(410 ILCS 517/15)
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Sec. 15. Development and use of uniform health care and | ||
hospital
credentials forms. | ||
(a) The Department, in consultation with the council, | ||
shall by rule
establish:
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(1) a uniform health care credentials form that shall | ||
include the
credentials data commonly requested by health | ||
care entities
and health care plans for purposes of | ||
credentialing and shall minimize the
need for the | ||
collection of
additional credentials data;
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(2) a uniform health care recredentials form that | ||
shall include the
credentials data commonly requested by | ||
health care entities and health care
plans for purposes of | ||
recredentialing and shall minimize the need for the
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collection of additional credentials data;
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(3) a uniform hospital credentials form that shall | ||
include the credentials
data commonly requested by | ||
hospitals for purposes of credentialing and
shall
minimize | ||
the need for the collection of additional credentials | ||
data;
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(4) a uniform hospital recredentials form that shall | ||
include the
credentials data commonly requested by | ||
hospitals for purposes of
recredentialing and shall | ||
minimize the need for collection of additional
credentials | ||
data; and
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(5) uniform updating forms.
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The forms described in this subsection may be prescribed | ||
in a print format, electronic format, or both as provided by | ||
the Department. | ||
(b) The uniform forms established by the Department under | ||
this Section in subsection (a) shall be coordinated to
reduce | ||
the need to provide redundant information.
Further, the forms | ||
shall be made available in both paper and electronic
formats | ||
upon request and in the format requested.
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(c) The Department, in consultation with the council, | ||
shall
establish by rule a process for the submittal of forms in | ||
an a date after which an electronic format with required | ||
content for may be
required by a health care entity, a health | ||
care plan, or a hospital, and a
health care professional may | ||
require acceptance of forms in an electronic
format by a | ||
health care entity, a health care plan, or a hospital.
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(d) Beginning January 1, 2002, each health care
entity or | ||
health
care plan that
employs, contracts with, or allows | ||
health care
professionals to provide medical or health care | ||
services and requires health
care professionals to be | ||
credentialed or recredentialed shall for
purposes of | ||
collecting credentials data only require:
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(1) the uniform health care credentials form;
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(2) the uniform health care recredentials form;
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(3) the uniform updating forms; and
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(4) any additional credentials data requested; and .
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(5) an online credential with required content as | ||
required by forms under this Section. | ||
(e) Beginning January 1, 2002, each hospital that
employs,
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contracts with, or
allows health care professionals to provide | ||
medical or
health care services and requires health care | ||
professionals to be credentialed
or recredentialed shall for | ||
purposes of collecting credentials
data only require:
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(1) the uniform hospital credentials form;
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(2) the uniform hospital recredentials form;
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(3) the uniform updating forms; and
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(4) any additional credentials data requested; and .
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(5) an online credential with required content as | ||
required by forms under this Section. | ||
(f) Each health care entity and health care plan shall | ||
complete the process
of verifying a health care professional's | ||
credentials data
in a timely fashion and shall complete the | ||
process of credentialing or
recredentialing of the health care | ||
professional within 60 days after
submission of all | ||
credentials data and completion of verification of the
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credentials data.
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(g) Each health care professional shall provide any | ||
corrections, updates,
and modifications to his or her | ||
credentials data to ensure
that all credentials data on the | ||
health care professional remains current.
Such corrections, | ||
updates, and modifications shall be provided within
5 business | ||
days for State health care professional license revocation, | ||
federal
Drug
Enforcement Agency license revocation,
Medicare | ||
or Medicaid sanctions, revocation of hospital privileges, any | ||
lapse
in professional liability coverage required by a health | ||
care entity, health
care plan, or hospital,
or conviction of a | ||
felony, and within 45 days for any
other
change in the | ||
information from the date the health care professional knew of
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the change. All updates shall be made on the uniform updating
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forms prescribed developed by the Department.
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(h) Any credentials data collected or obtained by the | ||
health care entity,
health care plan, or hospital shall be | ||
confidential, as provided by law,
and otherwise may not be | ||
redisclosed without written consent of the
health care | ||
professional, except that in any proceeding to challenge
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credentialing or recredentialing, or in any judicial review, | ||
the claim
of confidentiality shall not be invoked to deny a | ||
health care professional,
health care entity,
health care | ||
plan, or hospital access to or use of credentials data. | ||
Nothing in
this Section prevents a health
care entity, health | ||
care plan, or hospital from disclosing any credentials data
to | ||
its officers, directors, employees, agents, subcontractors,
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medical staff members, any committee of the health care | ||
entity, health care
plan, or hospital involved in the | ||
credentialing process, or
accreditation bodies or licensing | ||
agencies. However, any redisclosure of
credentials data | ||
contrary to this Section is prohibited.
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(i) Nothing in this Act shall be construed to restrict the | ||
right of any
health care entity, health care plan or hospital | ||
to request additional
information necessary for credentialing | ||
or recredentialing.
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(j) Nothing in this Act shall be construed to restrict in | ||
any way the
authority of any health care entity, health care | ||
plan or hospital to
approve, suspend or deny an application | ||
for hospital staff membership, clinical
privileges, or managed | ||
care network participation.
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(k) Nothing in this Act shall be construed to prohibit | ||
delegation of
credentialing and recredentialing activities as | ||
long as the delegated
entity follows the requirements set | ||
forth in this Act.
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(l) Nothing in this Act shall be construed to require any | ||
health care
entity or health care plan to credential or survey | ||
any health care
professional. | ||
(m) Nothing in this Act prohibits a hospital from granting | ||
disaster privileges pursuant to the provisions of Section 10.4 | ||
of the Hospital Licensing Act. When a hospital grants disaster | ||
privileges pursuant to Section 10.4 of the Hospital Licensing | ||
Act, that hospital is not required to collect credentials data | ||
pursuant to this Act.
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(Source: P.A. 92-193, eff. 1-1-02; 93-829, eff. 7-28-04.)
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(410 ILCS 517/20)
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Sec. 20. Single credentialing cycle.
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(a) The Department, in consultation with the council, | ||
shall by rule
establish a single credentialing cycle. The | ||
single credentialing cycle shall
be based on a specific | ||
variable or variables. To the extent possible the
single | ||
credentialing cycle shall be established to ensure that the | ||
credentials
data of all health care professionals in a group | ||
or at a single site
are collected during the same time period. | ||
However, nothing in this Act
shall be construed to require the | ||
single credentialing cycle to be established
to ensure that | ||
the credentials data of all health care professionals in a | ||
group
or at a single site are collected during the same time | ||
period.
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(b) Beginning July 1, 2002, all health care entities
and | ||
health care
plans shall obtain credentials data on all health | ||
care
professionals according to the established single | ||
credentialing cycle.
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(c) The Department, in consultation with the council, | ||
shall by rule
establish a process to exempt a small or unique | ||
health care entity
or small or unique health care plan from the | ||
single credentialing cycle if
the health
care entity or health | ||
care plan demonstrates to the Department that
adherence to the | ||
single credentialing cycle would be an undue hardship for the
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health care entity or health care plan.
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(d) The requirements of this Section shall not apply when | ||
a health care
professional submits initial credentials data to | ||
a health care
entity or health care plan outside of the | ||
established single credentialing
cycle, when a health care | ||
professional's credentials data change
substantively, or when | ||
a health care entity or health care plan requires
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recredentialing as a result of patient or quality assurance | ||
issues.
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(Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)
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(410 ILCS 517/25)
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Sec. 25. Single site survey.
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(a) The Department, in consultation with the council, | ||
shall by rule
establish a uniform site survey instrument | ||
taking into
account national accreditation standards and State | ||
requirements. The
uniform site survey instrument
shall include | ||
all the site survey data requested by health care
entities and | ||
health care plans.
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(b) No later than July 1, 2002, the Department, in
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consultation with
the council, shall publish, in rule, the | ||
variable or variables for completing
the
single site survey. | ||
To the extent possible, the single site survey shall be
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established to ensure that all health care professionals in a | ||
group or at a
site are reviewed during the same time period.
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(c) Beginning January 1, 2003, health care entities and
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health care plans
shall implement the single site survey, if a | ||
site
survey is required by any of the health care | ||
professional's health
care entities or health care plans. The | ||
site survey shall be completed using
the uniform site survey | ||
instrument.
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(d) The uniform site survey instrument shall be used when | ||
a health care
professional seeks initial credentialing by a | ||
health care entity
or health care plan, when a health care | ||
professional's credentials data
change substantively, or when | ||
a health care plan or health care entity requires
a site survey | ||
as a result of patient or quality assurance issues, if a site
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survey is required by the health care entity or
health care | ||
plan.
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(e) Nothing in this Section prohibits health care entities | ||
and health care
plans from choosing the independent party to | ||
conduct the
single site survey.
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(Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)
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(410 ILCS 517/30)
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Sec. 30. Study of coordinated credentials verification.
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(a) The Department, in consultation with the council, | ||
shall study the
need for coordinated credentials data | ||
verification.
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(b) The study shall address the need for, the advantages | ||
and disadvantages
of, and the costs and cost savings, if any, | ||
of coordinated
credentials verification.
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(c) The study also may address other changes to improve | ||
the credentialing
and recredentialing processes, to improve | ||
the timeliness
of the credentials data, and reduce the costs, | ||
time, and administrative burden
associated with the processes.
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(d) The Department shall make a recommendation to the | ||
General Assembly and
the Governor regarding the need for | ||
further
legislation no later than January 1, 2003.
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(Source: P.A. 91-602, eff. 8-16-99.)
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(410 ILCS 517/35)
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Sec. 35. Rules. The Department, in consultation with the | ||
council,
shall adopt rules necessary to develop and implement | ||
and enforce the
requirements established by this Act.
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(Source: P.A. 91-602, eff. 8-16-99.)
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(410 ILCS 517/10 rep.)
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Section 10. The Health Care Professional Credentials Data | ||
Collection Act is amended by repealing Section 10.
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Section 99. Effective date. This Act takes effect upon | ||
becoming law. | ||