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91_HB1780eng HB1780 Engrossed LRB9105596ACtmA 1 AN ACT creating the Health Care Professional 2 Credentialing Act. 3 Be it enacted by the People of the State of Illinois, 4 represented in the General Assembly: 5 Section 1. Short title. This Act may be cited as the 6 Health Care Professional Credentialing Act. 7 Section 5. Purpose. The Legislature recognizes that an 8 efficient and effective health care professional 9 credentialing program helps to ensure access to quality 10 health care and also recognizes that health care professional 11 credentialing activities have increased significantly as a 12 result of recent changes in health care delivery and 13 financing systems. Moreover, the resulting duplication of 14 health care professional credentialing activities is 15 unnecessarily costly and cumbersome for both the health care 16 professional and the entity granting practice privileges. 17 Therefore, it is the intent of this Act that a voluntary 18 credentials verification program be established which 19 provides that once a health care professional's core 20 credentials data is collected, validated, maintained, and 21 stored they need not be collected and validated again. 22 Voluntary credentialing under this Act shall initially 23 include those individuals licensed under the Medical Practice 24 Act of 1987. However, the Department shall, with the 25 approval of the applicable board, include other health care 26 professionals under the jurisdiction of this credentialing 27 program. 28 Section 10. Definitions. As used in this Act: 29 "Advisory council" or "council" means the Credentials 30 Verification Advisory Council. HB1780 Engrossed -2- LRB9105596ACtmA 1 "Core credentials data" means any professional education, 2 professional training, peer references, licensure status, 3 Drug Enforcement Administration certification, Social 4 Security Number, board certification, Educational Commission 5 for Foreign Medical Graduates information, hospital 6 affiliations, Medicare and Medicaid participation 7 information, managed care organization affiliations, other 8 institutional affiliations, and professional society 9 memberships. 10 "Credentialing" means the process of assessing and 11 validating the qualifications of a health care professional. 12 "Credentials verification organization" means any 13 program, entity, or organization that: 14 (1) is organized for the express purpose of 15 collecting, verifying, maintaining, storing, and 16 providing to health care entities a health care 17 professional's total core credentials data, including all 18 corrections, updates, and modifications thereto, as 19 authorized by the health care professional and in 20 accordance with the provisions of this Act; and 21 (2) is accredited or certified by a nationally 22 recognized and accepted organization, including the 23 National Committee for Quality Assurance, the Joint 24 Commission on Accreditation of Health Care Organizations, 25 and the American Accreditation Health Care 26 Commission/URAC, and any other nationally recognized and 27 accepted organization approved by the Department for the 28 purpose of collecting, verifying, storing, and providing 29 to health care entities a health care professional's core 30 credentials data. 31 "Department" means the Department of Public Health. 32 "Designated credentials verification organization" means 33 the credentials verification organization collecting, 34 verifying, maintaining, storing, and providing to health care HB1780 Engrossed -3- LRB9105596ACtmA 1 entities a health care professional's total core credentials 2 data, including all integrated corrections, updates, and 3 modifications thereto, which is selected by the health care 4 professional as the credentials verification organization for 5 all inquiries into his or her core credentials data, if the 6 health care professional chooses to make such a designation. 7 "Director" means the Director of Public Health. 8 "Health care entity" means (i) a health care facility or 9 other health care organization licensed or certified to 10 provide approved medical and health services in Illinois; 11 (ii) a health care professional partnership, corporation, 12 limited liability company, professional services corporation, 13 or group practice; or (iii) any entity licensed by the 14 Department of Insurance as a prepaid health care plan or 15 health maintenance organization or as an insurer to provide 16 coverage for health care services through a network of 17 providers. 18 "Health care professional" means any person licensed 19 under the Medical Practice Act of 1987 or any person licensed 20 under any other Act subsequently made subject to this Act by 21 the Department with the approval of the applicable board. 22 "National accrediting organization" means an organization 23 that awards accreditation or certification to hospitals, 24 managed care organizations, or other health care 25 organizations, including, but not limited to, the Joint 26 Commission on Accreditation of Health Care Organizations, the 27 National Committee for Quality Assurance, and the American 28 Accreditation Health Care Commission/URAC. 29 "Primary source verification" means verification of 30 professional qualifications based on evidence obtained 31 directly from the issuing source of the applicable 32 qualification, such as the state licensing agency or hospital 33 medical staff that granted membership or privileges. 34 "Recredentialing" means the process by which a HB1780 Engrossed -4- LRB9105596ACtmA 1 credentials verification organization verifies the corrected, 2 updated, or modified credentials of a health care 3 professional whose core credentials data, including all 4 previous corrections, updates, and modifications thereto, if 5 any, are currently on file with the credentials verification 6 organization. 7 "Secondary source verification" means confirmation of a 8 professional qualification by means other than primary source 9 verification, as outlined and approved by national 10 accrediting organizations. 11 Section 15. Standardized credentials verification 12 program; Credentials Verification Advisory Council. 13 (a) In accordance with the provisions of this Act, the 14 Department shall develop a standardized system as well as 15 guidelines for collecting, verifying, maintaining, storing, 16 and providing core credentials data on health care 17 professionals through credentials verification organizations 18 for the purpose of eliminating duplication. Once the core 19 credentials data is submitted to a designated credentials 20 verification organization, the health care professional is 21 not required to resubmit this data when applying for practice 22 privileges with health care entities. However, as provided 23 in paragraph (d), each health care professional is 24 responsible for providing any corrections, updates, and 25 modifications to his or her core credentials data to ensure 26 that all credentialing data on the health care professional 27 remains current. Nothing in this subsection prevents the 28 designated credentials verification organization from 29 obtaining all necessary attestation and release form 30 signatures and dates. 31 (b) There is established a Credentials Verification 32 Advisory Council consisting of 9 members to assist with the 33 development of guidelines for establishment of the HB1780 Engrossed -5- LRB9105596ACtmA 1 standardized credentials verification program. The Director, 2 or his or her designee, shall serve as one member and chair 3 of the council and shall appoint the remaining 8 members. 4 One member shall represent hospitals, one member shall 5 represent health maintenance organizations, one member shall 6 represent health insurance entities, one member shall 7 represent credentials verification organizations, 2 members 8 shall represent physicians licensed to practice medicine in 9 all its branches, one member shall represent chiropractic 10 physicians, and one member shall represent the public. The 11 initial appointments of 4 of the members shall be for 2 12 years. All other appointments shall be for 4 years, with no 13 more than one 4-year reappointment. 14 (c) The Department, in consultation with the advisory 15 council, shall develop standardized forms for the initial 16 reporting of core credentials data for credentialing purposes 17 and for the subsequent reporting of corrections, updates, and 18 modifications thereto as well as any other necessary forms. 19 (d) Each health care professional licensed under the 20 Medical Practice Act of 1987 or any person licensed under an 21 Illinois law subsequently made subject to this Act may, but 22 is not required to, report core credentials data to his or 23 her designated credentials verification organization, if any. 24 Any correction, update, or modification to core credentials 25 data should be reported as soon as possible, but not later 26 than 60 days after any changes in the core credentials data. 27 (e) An individual applying for licensure under the 28 Medical Practice Act of 1987 or any person applying for 29 licensure under an Illinois law subsequently made subject to 30 this Act may, but is not required to, submit his or her 31 initial core credentials data to a credentials verification 32 organization. 33 (f) Health care professionals may decide which 34 credentials verification organization, if any, they want to HB1780 Engrossed -6- LRB9105596ACtmA 1 process and store their core credentials data. Health care 2 professionals may choose not to designate a credentials 3 verification organization. In addition, any health care 4 professional may choose to move his or her core credentials 5 data from one credentials verification organization to 6 another at any time. 7 (g) Any health care entity that employs, contracts with, 8 or allows health care professionals to provide medical or 9 health care services and requires health care professionals 10 to be credentialed must use the health care professional's 11 designated credentials verification organization to obtain 12 core credentials data on the health care professional 13 applying for privileges with that entity, if the health care 14 professional has made such a designation. Upon submission of 15 a notarized written consent for the health care 16 professional's non-core information, any non-core information 17 required by the health care entity's credentialing process 18 must be collected from the health care professional's 19 designated credentials verification organization, if the 20 health care professional has made a designation. This 21 non-core information shall be verified either by the health 22 care entity or by the health care professional's designated 23 credentials verification organization. Any non-core 24 credentials data collected by the health care entity or a 25 designated credentials verification organization shall be 26 designated confidential or trade secret and may not be 27 redisclosed to any person, court, tribunal board, or any 28 other entity without written consent of the health care 29 professional. 30 (h) A designated credentials verification organization 31 may charge each health care professional a reasonable fee not 32 to exceed $60 for initial reporting of core credentials data 33 and $30 annually to cover the costs for maintenance and 34 integration of all corrections, updates, and modifications HB1780 Engrossed -7- LRB9105596ACtmA 1 thereto. 2 (i) Nothing in this Act may be construed to restrict the 3 right of any health care entity to request additional 4 information necessary for credentialing. 5 (j) Nothing in this Act may be construed to restrict in 6 any way the authority of a health care entity to approve or 7 deny an application for hospital staff membership, clinical 8 privileges, or managed care network participation. 9 Section 20. Delegation by contract. A health care 10 entity may contract with any credentials verification 11 organization to perform credentialing verification for the 12 health care entity. The submission of a notarized form 13 developed by the Department by a health care professional 14 shall constitute authorization for the health care entity to 15 request the health care professional's core credentials data 16 with the health care professional's designated credentials 17 verification organization, if the health care professional 18 has made such a designation. 19 Section 25. Availability of data collected. 20 (a) Each credentials verification organization shall 21 make available all core credentials data it collects on the 22 health core professional to a health care entity the health 23 care professional has authorized to receive the data. 24 Authorization shall be submitted on notarized forms developed 25 by the Department. The credentials verification organization 26 may charge a reasonable fee for providing the credentials 27 data it collects on the health care professional. 28 (b) If a health care professional chooses to change 29 designated credentials verification organizations, the health 30 care professional's current designated credentials 31 verification organization shall make all core credentials 32 data it collected on the health care professional available HB1780 Engrossed -8- LRB9105596ACtmA 1 to the new credentials verification organization that the 2 health care professional has authorized to receive the data 3 at a charge not to exceed the current credentials 4 verification organization's actual cost of collecting, 5 storing, verifying, and providing the data. 6 Section 30. Duplication of data prohibited. 7 (a) A health care entity may not collect or attempt to 8 collect duplicate core credentials data from any health care 9 professional or from any primary source if the information is 10 already on file with the health care professional's 11 designated credentials verification organization. 12 (b) A credentials verification organization may not 13 attempt to collect duplicate credentials data from any health 14 care professional if the information is already on file with 15 a designated credentials verification organization. 16 Section 35. Reliability of data. Health care entities 17 may rely upon core credentials data provided by a credentials 18 verification organization when the designated credentials 19 verification organization certifies that the information was 20 obtained in accordance with primary source or secondary 21 source verification procedures. 22 Section 40. Standards and registration. Any credentials 23 verification organization that does business in Illinois must 24 meet the standards established by rule and must register with 25 the Department. The Department may charge a reasonable 26 registration fee not to exceed $150 for initial registration 27 and $75 annually for all modifications, changes, and 28 maintenance for such registration. Any entity that fails to 29 qualify as a credentials verification organization and any 30 credentials verification organization that fails to register 31 with the Department may not be selected as the designated HB1780 Engrossed -9- LRB9105596ACtmA 1 credentials verification organization for any health care 2 professional. 3 Section 45. Liability. No civil, criminal, or 4 administrative action may be instituted, and there shall be 5 no liability, against any health care entity on account of 6 its reliance on any data obtained from a credentials 7 verification organization. 8 Section 50. Review. Before releasing a health care 9 professional's core credentials data to any health care 10 entity, a designated credentials verification organization 11 must provide the health care professional up to 30 days to 12 review such data and make any corrections of fact. This 13 review shall be documented with appropriate forms signed by 14 the health care professional. 15 Section 55. Validation of credentials. All credentials 16 verification organizations must perform primary source 17 verification of all credentialing information submitted to 18 them pursuant to this Act; however, secondary source 19 verification may be utilized if there is a documented attempt 20 to contact primary sources. The validation procedures used 21 by the credentials verification organizations must meet the 22 standards established by rule pursuant to this Act. 23 Section 60. Rules. The Department, in consultation with 24 the council and applicable health care professional licensing 25 boards, shall adopt rules necessary to develop and implement 26 the standardized credentials verification program established 27 by this Act. 28 Section 65. Civil penalties. In addition to any other 29 penalty provided by law, any health care entity or HB1780 Engrossed -10- LRB9105596ACtmA 1 credentials verification organization that violates any 2 Section of this Act shall forfeit and pay to the Department a 3 civil penalty in an amount determined by the Department of 4 not more than $1,000 for the first offense and not more than 5 $5,000 for each subsequent offense. 6 Section 70. Administrative Procedure Act. The Illinois 7 Administrative Procedure Act is hereby expressly adopted and 8 incorporated herein as if all of the provisions of the Act 9 were included in the Act. For the purpose of this Act, the 10 notice required under Section 10-25 of the Administrative 11 Procedure Act is deemed sufficient when mailed to the last 12 known address of a party. 13 Section 75. Administrative Review Law. All final 14 administrative decisions of the Department are subject to 15 judicial review pursuant to the provisions of the 16 Administrative Review Law and all rules adopted pursuant 17 thereto. The term "administrative decision" is defined as in 18 Section 3-101 of the Code of Civil Procedure. 19 Section 99. This Act takes effect January 1, 2000.