Rep. Theresa Mah
Filed: 3/15/2023
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1 | AMENDMENT TO HOUSE BILL 2827
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2 | AMENDMENT NO. ______. Amend House Bill 2827 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Health Care Professional Credentials Data | ||||||
5 | Collection Act is amended by changing Sections 5, 15, 20, 25, | ||||||
6 | 30, and 35 as follows:
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7 | (410 ILCS 517/5)
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8 | Sec. 5. Definitions. As used in this Act:
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9 | "Council" means the Health Care Credentials Council.
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10 | "Credentials data" means those data, information, or | ||||||
11 | answers to questions
required by a health care entity, health
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12 | care plan, or hospital to complete the credentialing or
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13 | recredentialing of a health care professional.
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14 | "Credentialing" means the process of assessing and | ||||||
15 | validating the
qualifications of a health care professional.
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16 | "Department" means the Department of Public Health.
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1 | "Director" means the Director of the Department of Public | ||||||
2 | Health.
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3 | "Health care entity" means any of the following which | ||||||
4 | require the submission
of credentials data: (i) a health care | ||||||
5 | facility or other
health care organization licensed or | ||||||
6 | certified to provide medical or
health services in Illinois, | ||||||
7 | other than a hospital; (ii) a health care
professional | ||||||
8 | partnership, corporation, limited liability company, | ||||||
9 | professional
services corporation or group practice; or (iii) | ||||||
10 | an independent
practice association or physician hospital | ||||||
11 | organization. Nothing in this
definition shall be construed to | ||||||
12 | mean that a hospital is a health care
entity.
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13 | "Health care plan" means any entity licensed by the | ||||||
14 | Department of Insurance
as a prepaid health care plan or | ||||||
15 | health maintenance
organization or as an insurer
which | ||||||
16 | requires the submission of
credentials data.
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17 | "Health care professional" means any person licensed under | ||||||
18 | the Medical
Practice Act of 1987 or any person licensed under | ||||||
19 | any
other Act subsequently made subject to this Act by the | ||||||
20 | Department.
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21 | "Hospital" means a hospital licensed under the Hospital | ||||||
22 | Licensing Act or any
hospital organized under the University | ||||||
23 | of Illinois
Hospital Act.
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24 | "Recredentialing" means the process by which a health care | ||||||
25 | entity, health
care plan or hospital ensures that a health | ||||||
26 | care professional
who is currently credentialed by the health |
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1 | care entity, health care plan or
hospital continues to meet | ||||||
2 | the credentialing criteria used by the
health care entity, | ||||||
3 | health care plan, or hospital no more than once every 3 2
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4 | years.
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5 | "Single credentialing cycle" means a process whereby for | ||||||
6 | purposes of
recredentialing each health care professional's | ||||||
7 | credentials
data are collected by all health care entities and | ||||||
8 | health care plans that
credential the health care professional | ||||||
9 | during the same time period and
only once every 3 2 years.
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10 | "Site survey" means a process by which a health care | ||||||
11 | entity or health care
plan assesses the office locations and | ||||||
12 | medical record
keeping practices of a health care | ||||||
13 | professional.
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14 | "Single site survey" means a process by which, for | ||||||
15 | purposes of
recredentialing, each health care professional | ||||||
16 | receives a site visit only
once every two years.
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17 | "Uniform health care credentials form" means the form | ||||||
18 | prescribed developed by the
Department under Section 15 to | ||||||
19 | collect the credentials
data commonly requested by health care | ||||||
20 | entities and health care plans for
purposes of credentialing.
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21 | "Uniform health care recredentials form" means the form | ||||||
22 | prescribed developed by the
Department under Section 15 to | ||||||
23 | collect the credentials data commonly requested
by health care | ||||||
24 | entities and health care plans for purposes of
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25 | recredentialing.
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26 | "Uniform hospital credentials form" means the form |
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1 | prescribed developed by the
Department
under Section 15 to | ||||||
2 | collect the credentials data
commonly requested by hospitals | ||||||
3 | for purposes of credentialing.
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4 | "Uniform hospital recredentials form" means the form | ||||||
5 | prescribed developed by the
Department under Section 15 to | ||||||
6 | collect the credentials data commonly requested
by
hospitals | ||||||
7 | for purposes of recredentialing.
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8 | "Uniform site survey instrument" means the instrument | ||||||
9 | developed by the
Department under Section 25 to complete a | ||||||
10 | single site
survey as part of a credentialing or | ||||||
11 | recredentialing process.
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12 | "Uniform updating form" means the a standardized form | ||||||
13 | prescribed by the Department for reporting of
corrections,
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14 | updates, and modifications to credentials data to
health care | ||||||
15 | entities, health care plans, and hospitals when those data | ||||||
16 | change
following credentialing or recredentialing of a health | ||||||
17 | care
professional.
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18 | (Source: P.A. 91-602, eff. 8-16-99.)
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19 | (410 ILCS 517/15)
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20 | Sec. 15. Development and use of uniform health care and | ||||||
21 | hospital
credentials forms. | ||||||
22 | (a) The Department , in consultation with the council, | ||||||
23 | shall by rule
establish:
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24 | (1) a uniform health care credentials form that shall | ||||||
25 | include the
credentials data commonly requested by health |
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1 | care entities
and health care plans for purposes of | ||||||
2 | credentialing and shall minimize the
need for the | ||||||
3 | collection of
additional credentials data;
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4 | (2) a uniform health care recredentials form that | ||||||
5 | shall include the
credentials data commonly requested by | ||||||
6 | health care entities and health care
plans for purposes of | ||||||
7 | recredentialing and shall minimize the need for the
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8 | collection of additional credentials data;
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9 | (3) a uniform hospital credentials form that shall | ||||||
10 | include the credentials
data commonly requested by | ||||||
11 | hospitals for purposes of credentialing and
shall
minimize | ||||||
12 | the need for the collection of additional credentials | ||||||
13 | data;
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14 | (4) a uniform hospital recredentials form that shall | ||||||
15 | include the
credentials data commonly requested by | ||||||
16 | hospitals for purposes of
recredentialing and shall | ||||||
17 | minimize the need for collection of additional
credentials | ||||||
18 | data; and
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19 | (5) uniform updating forms.
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20 | The forms described in this subsection may be prescribed | ||||||
21 | in a print format, electronic format, or both as provided by | ||||||
22 | the Department. | ||||||
23 | (b) The uniform forms established by the Department under | ||||||
24 | this Section in subsection (a) shall be coordinated to
reduce | ||||||
25 | the need to provide redundant information.
Further, the forms | ||||||
26 | shall be made available in both paper and electronic
formats |
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1 | upon request and in the format requested .
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2 | (c) The Department , in consultation with the council, | ||||||
3 | shall
establish by rule a process for the submittal of forms in | ||||||
4 | an a date after which an electronic format with required | ||||||
5 | content for may be
required by a health care entity, a health | ||||||
6 | care plan, or a hospital, and a
health care professional may | ||||||
7 | require acceptance of forms in an electronic
format by a | ||||||
8 | health care entity, a health care plan, or a hospital.
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9 | (d) Beginning January 1, 2002, each health care
entity or | ||||||
10 | health
care plan that
employs, contracts with, or allows | ||||||
11 | health care
professionals to provide medical or health care | ||||||
12 | services and requires health
care professionals to be | ||||||
13 | credentialed or recredentialed shall for
purposes of | ||||||
14 | collecting credentials data only require:
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15 | (1) the uniform health care credentials form;
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16 | (2) the uniform health care recredentials form;
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17 | (3) the uniform updating forms; and
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18 | (4) any additional credentials data requested ; and .
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19 | (5) an online credential with required content as | ||||||
20 | required by forms under this Section. | ||||||
21 | (e) Beginning January 1, 2002, each hospital that
employs,
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22 | contracts with, or
allows health care professionals to provide | ||||||
23 | medical or
health care services and requires health care | ||||||
24 | professionals to be credentialed
or recredentialed shall for | ||||||
25 | purposes of collecting credentials
data only require:
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26 | (1) the uniform hospital credentials form;
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1 | (2) the uniform hospital recredentials form;
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2 | (3) the uniform updating forms; and
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3 | (4) any additional credentials data requested ; and .
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4 | (5) an online credential with required content as | ||||||
5 | required by forms under this Section. | ||||||
6 | (f) Each health care entity and health care plan shall | ||||||
7 | complete the process
of verifying a health care professional's | ||||||
8 | credentials data
in a timely fashion and shall complete the | ||||||
9 | process of credentialing or
recredentialing of the health care | ||||||
10 | professional within 60 days after
submission of all | ||||||
11 | credentials data and completion of verification of the
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12 | credentials data.
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13 | (g) Each health care professional shall provide any | ||||||
14 | corrections, updates,
and modifications to his or her | ||||||
15 | credentials data to ensure
that all credentials data on the | ||||||
16 | health care professional remains current.
Such corrections, | ||||||
17 | updates, and modifications shall be provided within
5 business | ||||||
18 | days for State health care professional license revocation, | ||||||
19 | federal
Drug
Enforcement Agency license revocation,
Medicare | ||||||
20 | or Medicaid sanctions, revocation of hospital privileges, any | ||||||
21 | lapse
in professional liability coverage required by a health | ||||||
22 | care entity, health
care plan, or hospital,
or conviction of a | ||||||
23 | felony, and within 45 days for any
other
change in the | ||||||
24 | information from the date the health care professional knew of
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25 | the change. All updates shall be made on the uniform updating
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26 | forms prescribed developed by the Department.
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1 | (h) Any credentials data collected or obtained by the | ||||||
2 | health care entity,
health care plan, or hospital shall be | ||||||
3 | confidential, as provided by law,
and otherwise may not be | ||||||
4 | redisclosed without written consent of the
health care | ||||||
5 | professional, except that in any proceeding to challenge
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6 | credentialing or recredentialing, or in any judicial review, | ||||||
7 | the claim
of confidentiality shall not be invoked to deny a | ||||||
8 | health care professional,
health care entity,
health care | ||||||
9 | plan, or hospital access to or use of credentials data. | ||||||
10 | Nothing in
this Section prevents a health
care entity, health | ||||||
11 | care plan, or hospital from disclosing any credentials data
to | ||||||
12 | its officers, directors, employees, agents, subcontractors,
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13 | medical staff members, any committee of the health care | ||||||
14 | entity, health care
plan, or hospital involved in the | ||||||
15 | credentialing process, or
accreditation bodies or licensing | ||||||
16 | agencies. However, any redisclosure of
credentials data | ||||||
17 | contrary to this Section is prohibited.
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18 | (i) Nothing in this Act shall be construed to restrict the | ||||||
19 | right of any
health care entity, health care plan or hospital | ||||||
20 | to request additional
information necessary for credentialing | ||||||
21 | or recredentialing.
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22 | (j) Nothing in this Act shall be construed to restrict in | ||||||
23 | any way the
authority of any health care entity, health care | ||||||
24 | plan or hospital to
approve, suspend or deny an application | ||||||
25 | for hospital staff membership, clinical
privileges, or managed | ||||||
26 | care network participation.
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1 | (k) Nothing in this Act shall be construed to prohibit | ||||||
2 | delegation of
credentialing and recredentialing activities as | ||||||
3 | long as the delegated
entity follows the requirements set | ||||||
4 | forth in this Act.
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5 | (l) Nothing in this Act shall be construed to require any | ||||||
6 | health care
entity or health care plan to credential or survey | ||||||
7 | any health care
professional. | ||||||
8 | (m) Nothing in this Act prohibits a hospital from granting | ||||||
9 | disaster privileges pursuant to the provisions of Section 10.4 | ||||||
10 | of the Hospital Licensing Act. When a hospital grants disaster | ||||||
11 | privileges pursuant to Section 10.4 of the Hospital Licensing | ||||||
12 | Act, that hospital is not required to collect credentials data | ||||||
13 | pursuant to this Act.
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14 | (Source: P.A. 92-193, eff. 1-1-02; 93-829, eff. 7-28-04.)
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15 | (410 ILCS 517/20)
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16 | Sec. 20. Single credentialing cycle.
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17 | (a) The Department , in consultation with the council, | ||||||
18 | shall by rule
establish a single credentialing cycle. The | ||||||
19 | single credentialing cycle shall
be based on a specific | ||||||
20 | variable or variables. To the extent possible the
single | ||||||
21 | credentialing cycle shall be established to ensure that the | ||||||
22 | credentials
data of all health care professionals in a group | ||||||
23 | or at a single site
are collected during the same time period. | ||||||
24 | However, nothing in this Act
shall be construed to require the | ||||||
25 | single credentialing cycle to be established
to ensure that |
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1 | the credentials data of all health care professionals in a | ||||||
2 | group
or at a single site are collected during the same time | ||||||
3 | period.
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4 | (b) Beginning July 1, 2002, all health care entities
and | ||||||
5 | health care
plans shall obtain credentials data on all health | ||||||
6 | care
professionals according to the established single | ||||||
7 | credentialing cycle.
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8 | (c) The Department , in consultation with the council, | ||||||
9 | shall by rule
establish a process to exempt a small or unique | ||||||
10 | health care entity
or small or unique health care plan from the | ||||||
11 | single credentialing cycle if
the health
care entity or health | ||||||
12 | care plan demonstrates to the Department that
adherence to the | ||||||
13 | single credentialing cycle would be an undue hardship for the
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14 | health care entity or health care plan.
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15 | (d) The requirements of this Section shall not apply when | ||||||
16 | a health care
professional submits initial credentials data to | ||||||
17 | a health care
entity or health care plan outside of the | ||||||
18 | established single credentialing
cycle, when a health care | ||||||
19 | professional's credentials data change
substantively, or when | ||||||
20 | a health care entity or health care plan requires
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21 | recredentialing as a result of patient or quality assurance | ||||||
22 | issues.
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23 | (Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)
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24 | (410 ILCS 517/25)
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25 | Sec. 25. Single site survey.
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1 | (a) The Department , in consultation with the council, | ||||||
2 | shall by rule
establish a uniform site survey instrument | ||||||
3 | taking into
account national accreditation standards and State | ||||||
4 | requirements. The
uniform site survey instrument
shall include | ||||||
5 | all the site survey data requested by health care
entities and | ||||||
6 | health care plans.
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7 | (b) No later than July 1, 2002, the Department , in
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8 | consultation with
the council, shall publish, in rule, the | ||||||
9 | variable or variables for completing
the
single site survey. | ||||||
10 | To the extent possible, the single site survey shall be
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11 | established to ensure that all health care professionals in a | ||||||
12 | group or at a
site are reviewed during the same time period.
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13 | (c) Beginning January 1, 2003, health care entities and
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14 | health care plans
shall implement the single site survey, if a | ||||||
15 | site
survey is required by any of the health care | ||||||
16 | professional's health
care entities or health care plans. The | ||||||
17 | site survey shall be completed using
the uniform site survey | ||||||
18 | instrument.
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19 | (d) The uniform site survey instrument shall be used when | ||||||
20 | a health care
professional seeks initial credentialing by a | ||||||
21 | health care entity
or health care plan, when a health care | ||||||
22 | professional's credentials data
change substantively, or when | ||||||
23 | a health care plan or health care entity requires
a site survey | ||||||
24 | as a result of patient or quality assurance issues, if a site
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25 | survey is required by the health care entity or
health care | ||||||
26 | plan.
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1 | (e) Nothing in this Section prohibits health care entities | ||||||
2 | and health care
plans from choosing the independent party to | ||||||
3 | conduct the
single site survey.
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4 | (Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.)
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5 | (410 ILCS 517/30)
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6 | Sec. 30. Study of coordinated credentials verification.
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7 | (a) The Department , in consultation with the council, | ||||||
8 | shall study the
need for coordinated credentials data | ||||||
9 | verification.
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10 | (b) The study shall address the need for, the advantages | ||||||
11 | and disadvantages
of, and the costs and cost savings, if any, | ||||||
12 | of coordinated
credentials verification.
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13 | (c) The study also may address other changes to improve | ||||||
14 | the credentialing
and recredentialing processes, to improve | ||||||
15 | the timeliness
of the credentials data, and reduce the costs, | ||||||
16 | time, and administrative burden
associated with the processes.
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17 | (d) The Department shall make a recommendation to the | ||||||
18 | General Assembly and
the Governor regarding the need for | ||||||
19 | further
legislation no later than January 1, 2003.
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20 | (Source: P.A. 91-602, eff. 8-16-99.)
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21 | (410 ILCS 517/35)
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22 | Sec. 35. Rules. The Department , in consultation with the | ||||||
23 | council,
shall adopt rules necessary to develop and implement | ||||||
24 | and enforce the
requirements established by this Act.
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1 | (Source: P.A. 91-602, eff. 8-16-99.)
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2 | (410 ILCS 517/10 rep.)
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3 | Section 10. The Health Care Professional Credentials Data | ||||||
4 | Collection Act is amended by repealing Section 10.".
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5 | Section 99. Effective date. This Act takes effect upon | ||||||
6 | becoming law.".
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