Healthcare credentials and data collection act

Public Act 0436 103RD GENERAL ASSEMBLY

 Public Act 103-0436  
HB2827 EnrolledLRB103 30778 CPF 57265 b
  AN ACT concerning health.  Be it enacted by the People of the State of Illinois, represented in the General Assembly:  Section 5. The Health Care Professional Credentials Data Collection Act is amended by changing Sections 5, 15, 20, 25, 30, and 35 as follows:  (410 ILCS 517/5)  Sec. 5. Definitions. As used in this Act:  "Council" means the Health Care Credentials Council.  "Credentials data" means those data, information, or answers to questions required by a health care entity, health care plan, or hospital to complete the credentialing or recredentialing of a health care professional.  "Credentialing" means the process of assessing and validating the qualifications of a health care professional.  "Department" means the Department of Public Health.  "Director" means the Director of the Department of Public Health.  "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. 
 "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. 
 "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. 
 "Hospital" means a hospital licensed under the Hospital 
Licensing Act or any hospital organized under the University 
of Illinois Hospital Act. 
 "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 
years. 
 "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. 
 "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. 
 "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. 
 "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. 
 "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 
recredentialing. 
 "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. 
 "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. 
 
 "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. 
 "Uniform updating form" means the a standardized form 
prescribed by the Department for reporting of corrections, 
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. 
(Source: P.A. 91-602, eff. 8-16-99.) 
 (410 ILCS 517/15) 
 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: 
 (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; 
 (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 
 
 collection of additional credentials data; 
 (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; 
 (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 
 (5) uniform updating forms. 
 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. 
 (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. 
 (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: 
 (1) the uniform health care credentials form; 
 (2) the uniform health care recredentials form; 
 (3) the uniform updating forms; and 
 (4) any additional credentials data requested; and . 
 (5) an online credential with required content as 
 required by forms under this Section. 
 (e) Beginning January 1, 2002, each hospital 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: 
 (1) the uniform hospital credentials form; 
 (2) the uniform hospital recredentials form; 
 (3) the uniform updating forms; and 
 (4) any additional credentials data requested; and . 
 (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 
credentials data. 
 (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 
the change. All updates shall be made on the uniform updating 
forms prescribed developed by the Department. 
 (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 
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, 
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. 
 (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. 
 (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. 
 (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. 
 (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. 
(Source: P.A. 92-193, eff. 1-1-02; 93-829, eff. 7-28-04.) 
 (410 ILCS 517/20) 
 Sec. 20. Single credentialing cycle. 
 (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. 
 (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. 
 
 (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 
health care entity or health care plan. 
 (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 
recredentialing as a result of patient or quality assurance 
issues. 
(Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.) 
 (410 ILCS 517/25) 
 Sec. 25. Single site survey. 
 (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. 
 (b) No later than July 1, 2002, the Department, in 
 
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 
established to ensure that all health care professionals in a 
group or at a site are reviewed during the same time period. 
 (c) Beginning January 1, 2003, health care entities and 
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. 
 (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 
survey is required by the health care entity or health care 
plan. 
 (e) Nothing in this Section prohibits health care entities 
and health care plans from choosing the independent party to 
conduct the single site survey. 
(Source: P.A. 91-602, eff. 8-16-99; 92-193, eff. 1-1-02.) 
 (410 ILCS 517/30) 
 Sec. 30. Study of coordinated credentials verification. 
 
 (a) The Department, in consultation with the council, 
shall study the need for coordinated credentials data 
verification. 
 (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. 
 (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. 
 (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. 
(Source: P.A. 91-602, eff. 8-16-99.) 
 (410 ILCS 517/35) 
 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. 
(Source: P.A. 91-602, eff. 8-16-99.) 
 (410 ILCS 517/10 rep.) 
 Section 10. The Health Care Professional Credentials Data 
Collection Act is amended by repealing Section 10. 
 Section 99. Effective date. This Act takes effect upon 
becoming law.