Rep. Sara Feigenholtz

Filed: 10/23/2017

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 1322

2    AMENDMENT NO. ______. Amend Senate Bill 1322 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Nurse Practice Act is amended by changing
5Section 65-35 as follows:
 
6    (225 ILCS 65/65-35)   (was 225 ILCS 65/15-15)
7    (Text of Section before amendment by P.A. 100-513)
8    (Section scheduled to be repealed on January 1, 2028)
9    Sec. 65-35. Written collaborative agreements.
10    (a) A written collaborative agreement is required for all
11advanced practice nurses engaged in clinical practice, except
12for advanced practice nurses who are authorized to practice in
13a hospital, hospital affiliate, or ambulatory surgical
14treatment center.
15    (a-5) If an advanced practice nurse engages in clinical
16practice outside of a hospital, hospital affiliate, or

 

 

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1ambulatory surgical treatment center in which he or she is
2authorized to practice, the advanced practice nurse must have a
3written collaborative agreement.
4    (b) A written collaborative agreement shall describe the
5relationship of the advanced practice nurse with the
6collaborating physician or podiatric physician and shall
7describe the categories of care, treatment, or procedures to be
8provided by the advanced practice nurse. A collaborative
9agreement with a dentist must be in accordance with subsection
10(c-10) of this Section. Collaboration does not require an
11employment relationship between the collaborating physician or
12podiatric physician and advanced practice nurse.
13    The collaborative relationship under an agreement shall
14not be construed to require the personal presence of a
15physician or podiatric physician at the place where services
16are rendered. Methods of communication shall be available for
17consultation with the collaborating physician or podiatric
18physician in person or by telecommunications or electronic
19communications as set forth in the written agreement.
20    (b-5) Absent an employment relationship, a written
21collaborative agreement may not (1) restrict the categories of
22patients of an advanced practice nurse within the scope of the
23advanced practice nurses training and experience, (2) limit
24third party payors or government health programs, such as the
25medical assistance program or Medicare with which the advanced
26practice nurse contracts, or (3) limit the geographic area or

 

 

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1practice location of the advanced practice nurse in this State.
2    (c) In the case of anesthesia services provided by a
3certified registered nurse anesthetist, an anesthesiologist, a
4physician, a dentist, or a podiatric physician must participate
5through discussion of and agreement with the anesthesia plan
6and remain physically present and available on the premises
7during the delivery of anesthesia services for diagnosis,
8consultation, and treatment of emergency medical conditions.
9    (c-5) A certified registered nurse anesthetist, who
10provides anesthesia services outside of a hospital or
11ambulatory surgical treatment center shall enter into a written
12collaborative agreement with an anesthesiologist or the
13physician licensed to practice medicine in all its branches or
14the podiatric physician performing the procedure. Outside of a
15hospital or ambulatory surgical treatment center, the
16certified registered nurse anesthetist may provide only those
17services that the collaborating podiatric physician is
18authorized to provide pursuant to the Podiatric Medical
19Practice Act of 1987 and rules adopted thereunder. A certified
20registered nurse anesthetist may select, order, and administer
21medication, including controlled substances, and apply
22appropriate medical devices for delivery of anesthesia
23services under the anesthesia plan agreed with by the
24anesthesiologist or the operating physician or operating
25podiatric physician.
26    (c-10) A certified registered nurse anesthetist who

 

 

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1provides anesthesia services in a dental office shall enter
2into a written collaborative agreement with an
3anesthesiologist or the physician licensed to practice
4medicine in all its branches or the operating dentist
5performing the procedure. The agreement shall describe the
6working relationship of the certified registered nurse
7anesthetist and dentist and shall authorize the categories of
8care, treatment, or procedures to be performed by the certified
9registered nurse anesthetist. In a collaborating dentist's
10office, the certified registered nurse anesthetist may only
11provide those services that the operating dentist with the
12appropriate permit is authorized to provide pursuant to the
13Illinois Dental Practice Act and rules adopted thereunder. For
14anesthesia services, an anesthesiologist, physician, or
15operating dentist shall participate through discussion of and
16agreement with the anesthesia plan and shall remain physically
17present and be available on the premises during the delivery of
18anesthesia services for diagnosis, consultation, and treatment
19of emergency medical conditions. A certified registered nurse
20anesthetist may select, order, and administer medication,
21including controlled substances, and apply appropriate medical
22devices for delivery of anesthesia services under the
23anesthesia plan agreed with by the operating dentist.
24    (d) A copy of the signed, written collaborative agreement
25must be available to the Department upon request from both the
26advanced practice nurse and the collaborating physician,

 

 

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1dentist, or podiatric physician.
2    (e) Nothing in this Act shall be construed to limit the
3delegation of tasks or duties by a physician to a licensed
4practical nurse, a registered professional nurse, or other
5persons in accordance with Section 54.2 of the Medical Practice
6Act of 1987. Nothing in this Act shall be construed to limit
7the method of delegation that may be authorized by any means,
8including, but not limited to, oral, written, electronic,
9standing orders, protocols, guidelines, or verbal orders.
10Nothing in this Act shall be construed to authorize an advanced
11practice nurse to provide health care services required by law
12or rule to be performed by a physician.
13    (f) An advanced practice nurse shall inform each
14collaborating physician, dentist, or podiatric physician of
15all collaborative agreements he or she has signed and provide a
16copy of these to any collaborating physician, dentist, or
17podiatric physician upon request.
18    (g) (Blank).
19(Source: P.A. 98-192, eff. 1-1-14; 98-214, eff. 8-9-13; 98-756,
20eff. 7-16-14; 99-173, eff. 7-29-15.)
 
21    (Text of Section after amendment by P.A. 100-513)
22    (Section scheduled to be repealed on January 1, 2028)
23    Sec. 65-35. Written collaborative agreements.
24    (a) A written collaborative agreement is required for all
25advanced practice registered nurses engaged in clinical

 

 

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1practice prior to meeting the requirements of Section 65-43,
2except for advanced practice registered nurses who are
3privileged to practice in a hospital, hospital affiliate, or
4ambulatory surgical treatment center.
5    (a-5) If an advanced practice registered nurse engages in
6clinical practice outside of a hospital, hospital affiliate, or
7ambulatory surgical treatment center in which he or she is
8privileged to practice, the advanced practice registered nurse
9must have a written collaborative agreement, except as set
10forth in Section 65-43.
11    (b) A written collaborative agreement shall describe the
12relationship of the advanced practice registered nurse with the
13collaborating physician and shall describe the categories of
14care, treatment, or procedures to be provided by the advanced
15practice registered nurse. A collaborative agreement with a
16podiatric physician must be in accordance with subsection (c-5)
17or (c-15) of this Section. A collaborative agreement with a
18dentist must be in accordance with subsection (c-10) of this
19Section. A collaborative agreement with a podiatric physician
20must be in accordance with subsection (c-5) of this Section.
21Collaboration does not require an employment relationship
22between the collaborating physician and the advanced practice
23registered nurse.
24    The collaborative relationship under an agreement shall
25not be construed to require the personal presence of a
26collaborating physician at the place where services are

 

 

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1rendered. Methods of communication shall be available for
2consultation with the collaborating physician in person or by
3telecommunications or electronic communications as set forth
4in the written agreement.
5    (b-5) Absent an employment relationship, a written
6collaborative agreement may not (1) restrict the categories of
7patients of an advanced practice registered nurse within the
8scope of the advanced practice registered nurses training and
9experience, (2) limit third party payors or government health
10programs, such as the medical assistance program or Medicare
11with which the advanced practice registered nurse contracts, or
12(3) limit the geographic area or practice location of the
13advanced practice registered nurse in this State.
14    (c) In the case of anesthesia services provided by a
15certified registered nurse anesthetist, an anesthesiologist, a
16physician, a dentist, or a podiatric physician must participate
17through discussion of and agreement with the anesthesia plan
18and remain physically present and available on the premises
19during the delivery of anesthesia services for diagnosis,
20consultation, and treatment of emergency medical conditions.
21    (c-5) A certified registered nurse anesthetist, who
22provides anesthesia services outside of a hospital or
23ambulatory surgical treatment center shall enter into a written
24collaborative agreement with an anesthesiologist or the
25physician licensed to practice medicine in all its branches or
26the podiatric physician performing the procedure. Outside of a

 

 

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1hospital or ambulatory surgical treatment center, the
2certified registered nurse anesthetist may provide only those
3services that the collaborating podiatric physician is
4authorized to provide pursuant to the Podiatric Medical
5Practice Act of 1987 and rules adopted thereunder. A certified
6registered nurse anesthetist may select, order, and administer
7medication, including controlled substances, and apply
8appropriate medical devices for delivery of anesthesia
9services under the anesthesia plan agreed with by the
10anesthesiologist or the operating physician or operating
11podiatric physician.
12    (c-10) A certified registered nurse anesthetist who
13provides anesthesia services in a dental office shall enter
14into a written collaborative agreement with an
15anesthesiologist or the physician licensed to practice
16medicine in all its branches or the operating dentist
17performing the procedure. The agreement shall describe the
18working relationship of the certified registered nurse
19anesthetist and dentist and shall authorize the categories of
20care, treatment, or procedures to be performed by the certified
21registered nurse anesthetist. In a collaborating dentist's
22office, the certified registered nurse anesthetist may only
23provide those services that the operating dentist with the
24appropriate permit is authorized to provide pursuant to the
25Illinois Dental Practice Act and rules adopted thereunder. For
26anesthesia services, an anesthesiologist, physician, or

 

 

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1operating dentist shall participate through discussion of and
2agreement with the anesthesia plan and shall remain physically
3present and be available on the premises during the delivery of
4anesthesia services for diagnosis, consultation, and treatment
5of emergency medical conditions. A certified registered nurse
6anesthetist may select, order, and administer medication,
7including controlled substances, and apply appropriate medical
8devices for delivery of anesthesia services under the
9anesthesia plan agreed with by the operating dentist.
10    (c-15) An advanced practice registered nurse who had a
11written collaborative agreement with a podiatric physician
12immediately before the effective date of Public Act 100-513 may
13continue in that collaborative relationship under the
14requirements of this Section and Section 65-40, as those
15Sections existed immediately before the amendment of those
16Sections by Public Act 100-513 with regard to a written
17collaborative agreement between an advanced practice
18registered nurse and a podiatric physician, until the
19collaborative relationship between the advanced practice
20registered nurse and podiatric physician terminates.
21    (d) A copy of the signed, written collaborative agreement
22must be available to the Department upon request from both the
23advanced practice registered nurse and the collaborating
24physician, dentist, or podiatric physician.
25    (e) Nothing in this Act shall be construed to limit the
26delegation of tasks or duties by a physician to a licensed

 

 

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1practical nurse, a registered professional nurse, or other
2persons in accordance with Section 54.2 of the Medical Practice
3Act of 1987. Nothing in this Act shall be construed to limit
4the method of delegation that may be authorized by any means,
5including, but not limited to, oral, written, electronic,
6standing orders, protocols, guidelines, or verbal orders.
7    (e-5) Nothing in this Act shall be construed to authorize
8an advanced practice registered nurse to provide health care
9services required by law or rule to be performed by a
10physician, including those acts to be performed by a physician
11in Section 3.1 of the Illinois Abortion Law of 1975.
12    (f) An advanced practice registered nurse shall inform each
13collaborating physician, dentist, or podiatric physician of
14all collaborative agreements he or she has signed and provide a
15copy of these to any collaborating physician, dentist, or
16podiatric physician upon request.
17    (g) (Blank).
18(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18.)
 
19    Section 95. No acceleration or delay. Where this Act makes
20changes in a statute that is represented in this Act by text
21that is not yet or no longer in effect (for example, a Section
22represented by multiple versions), the use of that text does
23not accelerate or delay the taking effect of (i) the changes
24made by this Act or (ii) provisions derived from any other
25Public Act.
 

 

 

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1    Section 99. Effective date. This Act takes effect January
21, 2018.".