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91_HB1780sam002
LRB9105596ACtmam01
1 AMENDMENT TO HOUSE BILL 1780
2 AMENDMENT NO. . Amend House Bill 1780, AS AMENDED,
3 by replacing the title with the following:
4 "AN ACT creating the Health Care Professional Credentials
5 Data Collection Act."; and
6 by replacing everything after the enacting clause with the
7 following:
8 "Section 1. Short title. This Act may be cited as the
9 Health Care Professional Credentials Data Collection Act.
10 Section 5. Definitions. As used in this Act:
11 "Council" means the Health Care Credentials Council.
12 "Credentials data" means those data, information, or
13 answers to questions required by a health care entity, health
14 care plan, or hospital to complete the credentialing or
15 recredentialing of a health care professional.
16 "Credentialing" means the process of assessing and
17 validating the qualifications of a health care professional.
18 "Department" means the Department of Public Health.
19 "Director" means the Director of the Department of Public
20 Health.
21 "Health care entity" means any of the following which
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1 require the submission of credentials data: (i) a health care
2 facility or other health care organization licensed or
3 certified to provide medical or health services in Illinois,
4 other than a hospital; (ii) a health care professional
5 partnership, corporation, limited liability company,
6 professional services corporation or group practice; or (iii)
7 an independent practice association or physician hospital
8 organization. Nothing in this definition shall be construed
9 to mean that a hospital is a health care entity.
10 "Health care plan" means any entity licensed by the
11 Department of Insurance as a prepaid health care plan or
12 health maintenance organization or as an insurer which
13 requires the submission of credentials data.
14 "Health care professional" means any person licensed
15 under the Medical Practice Act of 1987 or any person licensed
16 under any other Act subsequently made subject to this Act by
17 the Department.
18 "Hospital" means a hospital licensed under the Hospital
19 Licensing Act or any hospital organized under the University
20 of Illinois Hospital Act.
21 "Recredentialing" means the process by which a health
22 care entity, health care plan or hospital ensures that a
23 health care professional who is currently credentialed by the
24 health care entity, health care plan or hospital continues to
25 meet the credentialing criteria used by the health care
26 entity, health care plan, or hospital no more than once every
27 2 years.
28 "Single credentialing cycle" means a process whereby for
29 purposes of recredentialing each health care professional's
30 credentials data are collected by all health care entities
31 and health care plans that credential the health care
32 professional during the same time period and only once every
33 2 years.
34 "Site survey" means a process by which a health care
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1 entity or health care plan assesses the office locations and
2 medical record keeping practices of a health care
3 professional.
4 "Single site survey" means a process by which, for
5 purposes of recredentialing, each health care professional
6 receives a site visit only once every two years.
7 "Uniform health care credentials form" means the form
8 developed by the Department under Section 15 to collect the
9 credentials data commonly requested by health care entities
10 and health care plans for purposes of credentialing.
11 "Uniform health care recredentials form" means the form
12 developed by the Department under Section 15 to collect the
13 credentials data commonly requested by health care entities
14 and health care plans for purposes of recredentialing.
15 "Uniform hospital credentials form" means the form
16 developed by the Department under Section 15 to collect the
17 credentials data commonly requested by hospitals for purposes
18 of credentialing.
19 "Uniform hospital recredentials form" means the form
20 developed by the Department under Section 15 to collect the
21 credentials data commonly requested by hospitals for purposes
22 of recredentialing.
23 "Uniform site survey instrument" means the instrument
24 developed by the Department under Section 25 to complete a
25 single site survey as part of a credentialing or
26 recredentialing process.
27 "Uniform updating form" means a standardized form for
28 reporting of corrections, updates, and modifications to
29 credentials data to health care entities, health care plans,
30 and hospitals when those data change following credentialing
31 or recredentialing of a health care professional.
32 Section 10. Health Care Credentials Council.
33 (a) There is established a Health Care Credentials
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1 Council, consisting of 13 members, to assist the Department
2 in accordance with Sections 15, 20, 25, and 30 of this Act.
3 The Director, or his or her designee, shall serve as one
4 member and chair of the council and the Governor shall
5 appoint the remaining 12 members. Three members shall
6 represent hospitals, 3 members shall represent health
7 maintenance organizations, one member shall represent health
8 insurance entities, 3 members shall represent physicians
9 licensed to practice medicine in all its branches, one member
10 shall represent chiropractic physicians, and one member shall
11 represent ambulatory surgical treatment centers. In making
12 these appointments, the Governor shall take into
13 consideration the recommendations of various organizations
14 representing hospitals, health maintenance organizations,
15 insurers, ambulatory surgical treatment centers, and
16 physicians. The initial appointments of 6 of the members
17 shall be for 2 years. All other appointments shall be for 4
18 years, with no more than one 4-year reappointment. The
19 hospital representatives shall not vote on the development of
20 guidelines to implement Sections 20 and 25 of this Act.
21 (b) On July 1, 2003, the council is abolished.
22 Section 15. Development and use of uniform health care
23 and hospital credentials forms.
24 (a) The Department, in consultation with the council,
25 shall by rule establish:
26 (1) a uniform health care credentials form that
27 shall include the credentials data commonly requested by
28 health care entities and health care plans for purposes
29 of credentialing and shall minimize the need for the
30 collection of additional credentials data;
31 (2) a uniform health care recredentials form that
32 shall include the credentials data commonly requested by
33 health care entities and health care plans for purposes
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1 of recredentialing and shall minimize the need for the
2 collection of additional credentials data;
3 (3) a uniform hospital credentials form that shall
4 include the credentials data commonly requested by
5 hospitals for purposes of credentialing and shall
6 minimize the need for the collection of additional
7 credentials data;
8 (4) a uniform hospital recredentials form that
9 shall include the credentials data commonly requested by
10 hospitals for purposes of recredentialing and shall
11 minimize the need for collection of additional
12 credentials data; and
13 (5) uniform updating forms.
14 (b) The uniform forms established in subsection (a)
15 shall be coordinated to reduce the need to provide redundant
16 information. Further, the forms shall be made available in
17 both paper and electronic formats.
18 (c) The Department, in consultation with the council,
19 shall establish by rule a date after which an electronic
20 format may be required by a health care entity, a health care
21 plan, or a hospital, and a health care professional may
22 require acceptance of an electronic format by a health care
23 entity, a health care plan, or a hospital.
24 (d) Beginning July 1, 2000, each health care entity or
25 health care plan that employs, contracts with, or allows
26 health care professionals to provide medical or health care
27 services and requires health care professionals to be
28 credentialed or recredentialed shall for purposes of
29 collecting credentials data only require:
30 (1) the uniform health care credentials form;
31 (2) the uniform health care recredentials form;
32 (3) the uniform updating forms; and
33 (4) any additional credentials data requested.
34 (e) Beginning July 1, 2000, each hospital that employs,
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1 contracts with, or allows health care professionals to
2 provide medical or health care services and requires health
3 care professionals to be credentialed or recredentialed shall
4 for purposes of collecting credentials data only require:
5 (1) the uniform hospital credentials form;
6 (2) the uniform hospital recredentials form;
7 (3) the uniform updating forms; and
8 (4) any additional credentials data requested.
9 (f) Each health care entity and health care plan shall
10 complete the process of verifying a health care
11 professional's credentials data in a timely fashion and shall
12 complete the process of credentialing or recredentialing of
13 the health care professional within 60 days after submission
14 of all credentials data and completion of verification of the
15 credentials data.
16 (g) Each health care professional shall provide any
17 corrections, updates, and modifications to his or her
18 credentials data to ensure that all credentials data on the
19 health care professional remains current. Such corrections,
20 updates, and modifications shall be provided within 5
21 business days for State health care professional license
22 revocation, federal Drug Enforcement Agency license
23 revocation, Medicare or Medicaid sanctions, revocation of
24 hospital privileges, any lapse in professional liability
25 coverage required by a health care entity, health care plan,
26 or hospital, or conviction of a felony, and within 45 days
27 for any other change in the information from the date the
28 health care professional knew of the change. All updates
29 shall be made on the uniform updating forms developed by the
30 Department.
31 (h) Any credentials data collected or obtained by the
32 health care entity, health care plan, or hospital shall be
33 confidential, as provided by law, and otherwise may not be
34 redisclosed without written consent of the health care
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1 professional, except that in any proceeding to challenge
2 credentialing or recredentialing, or in any judicial review
3 thereof, the claim of confidentiality shall not be invoked to
4 deny a health care entity, health care plan, or hospital
5 access to or use of credentials data. Nothing in this
6 Section prevents a health care entity, health care plan, or
7 hospital from disclosing any credentials data to its
8 officers, directors, employees, agents, subcontractors,
9 medical staff members, any committee of the health care
10 entity, health care plan, or hospital involved in the
11 credentialing process, or accreditation bodies or licensing
12 agencies. However, any redisclosure of credentials data
13 contrary to this Section is prohibited.
14 (i) Nothing in this Act shall be construed to restrict
15 the right of any health care entity, health care plan or
16 hospital to request additional information necessary for
17 credentialing or recredentialing.
18 (j) Nothing in this Act shall be construed to restrict
19 in any way the authority of any health care entity, health
20 care plan or hospital to approve, suspend or deny an
21 application for hospital staff membership, clinical
22 privileges, or managed care network participation.
23 (k) Nothing in this Act shall be construed to prohibit
24 delegation of credentialing and recredentialing activities as
25 long as the delegated entity follows the requirements set
26 forth in this Act.
27 (l) Nothing in this Act shall be construed to require
28 any health care entity or health care plan to credential or
29 survey any health care professional.
30 Section 20. Single credentialing cycle.
31 (a) The Department, in consultation with the council,
32 shall by rule establish a single credentialing cycle. The
33 single credentialing cycle shall be based on a specific
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1 variable or variables. To the extent possible the single
2 credentialing cycle shall be established to ensure that the
3 credentials data of all health care professionals in a group
4 or at a single site are collected during the same time
5 period. However, nothing in this Act shall be construed to
6 require the single credentialing cycle to be established to
7 ensure that the credentials data of all health care
8 professionals in a group or at a single site are collected
9 during the same time period.
10 (b) Beginning January 1, 2001, all health care entities
11 and health care plans shall obtain credentials data on all
12 health care professionals according to the established single
13 credentialing cycle.
14 (c) The Department, in consultation with the council,
15 shall by rule establish a process to exempt a small or unique
16 health care entity or small or unique health care plan from
17 the single credentialing cycle if the health care entity or
18 health care plan demonstrates to the Department that
19 adherence to the single credentialing cycle would be an undue
20 hardship for the health care entity or health care plan.
21 (d) The requirements of this Section shall not apply
22 when a health care professional submits initial credentials
23 data to a health care entity or health care plan outside of
24 the established single credentialing cycle, when a health
25 care professional's credentials data change substantively, or
26 when a health care entity or health care plan requires
27 recredentialing as a result of patient or quality assurance
28 issues.
29 Section 25. Single site survey.
30 (a) The Department, in consultation with the council,
31 shall by rule establish a uniform site survey instrument
32 taking into account national accreditation standards and
33 State requirements. The uniform site survey instrument shall
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1 include all the site survey data requested by health care
2 entities and health care plans.
3 (b) No later than January 1, 2001, the Department, in
4 consultation with the council, shall publish, in rule, the
5 variable or variables for completing the single site survey.
6 To the extent possible, the single site survey shall be
7 established to ensure that all health care professionals in a
8 group or at a site are reviewed during the same time period.
9 (c) Beginning July 1, 2001, health care entities and
10 health care plans shall implement the single site survey, if
11 a site survey is required by any of the health care
12 professional's health care entities or health care plans.
13 The site survey shall be completed using the uniform site
14 survey instrument.
15 (d) The uniform site survey instrument shall be used
16 when a health care professional seeks initial credentialing
17 by a health care entity or health care plan, when a health
18 care professional's credentials data change substantively, or
19 when a health care plan or health care entity requires a site
20 survey as a result of patient or quality assurance issues, if
21 a site survey is required by the health care entity or health
22 care plan.
23 (e) Nothing in this Section prohibits health care
24 entities and health care plans from choosing the independent
25 party to conduct the single site survey.
26 Section 30. Study of coordinated credentials
27 verification.
28 (a) The Department, in consultation with the council,
29 shall study the need for coordinated credentials data
30 verification.
31 (b) The study shall address the need for, the advantages
32 and disadvantages of, and the costs and cost savings, if any,
33 of coordinated credentials verification.
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1 (c) The study also may address other changes to improve
2 the credentialing and recredentialing processes, to improve
3 the timeliness of the credentials data, and reduce the costs,
4 time, and administrative burden associated with the
5 processes.
6 (d) The Department shall make a recommendation to the
7 General Assembly and the Governor regarding the need for
8 further legislation no later than January 1, 2003.
9 Section 35. Rules. The Department, in consultation with
10 the council, shall adopt rules necessary to develop and
11 implement and enforce the requirements established by this
12 Act.
13 Section 40. Enforcement. The Department has authority to
14 enforce the provisions of the Act. In addition to any other
15 penalty provided by law, any health care entity, health care
16 plan, hospital, or health care professional that violates any
17 Section of this Act shall forfeit and pay to the Department a
18 fine in an amount determined by the Department of not more
19 than $1,000 for the first offense and not more than $5,000
20 for each subsequent offense.
21 Section 45. Administrative Procedure Act. The Illinois
22 Administrative Procedure Act is hereby expressly adopted and
23 incorporated herein as if all the provisions of the Act were
24 included in the Act. For the purpose of this Act, the notice
25 required under Section 10-25 of the Administrative Procedure
26 Act is deemed sufficient when mailed to the last known
27 address of a party.
28 Section 50. Administrative Review Law. All final
29 administrative decisions of the Department are subject to
30 judicial review pursuant to the provisions of the
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1 Administrative Review Law and all rules adopted pursuant
2 thereto. The term "administrative decision" is defined as in
3 Section 3-101 of the Code of Civil Procedure.
4 Section 99. Effective Date. This Act takes effect upon
5 becoming law.".