Rep. Kelly M. Cassidy

Filed: 3/20/2019





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2    AMENDMENT NO. ______. Amend House Bill 2495 by replacing
3line 23 on page 2 through line 8 on page 3 with the following:
4    ""Health care professional" means a person who is licensed
5as a physician, advanced practice registered nurse, or
6physician assistant."; and
7on page 3, line 13, by deleting "be of high quality,"; and
8on page 6, line 4, by deleting "best"; and
9on page 6, by replacing line 6 with the following: "standards
10of clinical practice consistent with the scope of his or her
11practice under the Medical Practice Act of 1987, the Nurse
12Practice Act, or the Physician Assistant Practice Act of
131987."; and
14on page 6, by replacing line 16 with the following: "patients



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1and health care professionals."; and
2on page 66, by replacing lines 8 through 11 with the following:
3    "(b) Coverage for abortion care may not impose any
4deductible, coinsurance, waiting period, or other cost-sharing
5limitation that is greater than that required for other
6pregnancy-related benefits covered by the policy."; and
7on page 96, line 22, after the period, by inserting the
8following: "The scope of practice of an advanced practice
9registered nurse does not include operative surgery. Nothing in
10this Section shall be construed to preclude an advanced
11practice registered nurse from assisting in surgery."; and
12on page 99, by replacing lines 23 through 26 with the
13following: "nurse does not include operative surgery."; and
14on page 100, immediately below line 10, by inserting the
16    "Section 910-53. The Physician Assistant Practice Act of
171987 is amended by changing Section 7.5 as follows:
18    (225 ILCS 95/7.5)
19    (Section scheduled to be repealed on January 1, 2028)
20    Sec. 7.5. Written collaborative agreements; prescriptive



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2    (a) A written collaborative agreement is required for all
3physician assistants to practice in the State, except as
4provided in Section 7.7 of this Act.
5        (1) A written collaborative agreement shall describe
6    the working relationship of the physician assistant with
7    the collaborating physician and shall describe the
8    categories of care, treatment, or procedures to be provided
9    by the physician assistant. The written collaborative
10    agreement shall promote the exercise of professional
11    judgment by the physician assistant commensurate with his
12    or her education and experience. The services to be
13    provided by the physician assistant shall be services that
14    the collaborating physician is authorized to and generally
15    provides to his or her patients in the normal course of his
16    or her clinical medical practice. The written
17    collaborative agreement need not describe the exact steps
18    that a physician assistant must take with respect to each
19    specific condition, disease, or symptom but must specify
20    which authorized procedures require the presence of the
21    collaborating physician as the procedures are being
22    performed. The relationship under a written collaborative
23    agreement shall not be construed to require the personal
24    presence of a physician at the place where services are
25    rendered. Methods of communication shall be available for
26    consultation with the collaborating physician in person or



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1    by telecommunications or electronic communications as set
2    forth in the written collaborative agreement. For the
3    purposes of this Act, "generally provides to his or her
4    patients in the normal course of his or her clinical
5    medical practice" means services, not specific tasks or
6    duties, the collaborating physician routinely provides
7    individually or through delegation to other persons so that
8    the physician has the experience and ability to collaborate
9    and provide consultation.
10        (2) The written collaborative agreement shall be
11    adequate if a physician does each of the following:
12            (A) Participates in the joint formulation and
13        joint approval of orders or guidelines with the
14        physician assistant and he or she periodically reviews
15        such orders and the services provided patients under
16        such orders in accordance with accepted standards of
17        medical practice and physician assistant practice.
18            (B) Provides consultation at least once a month.
19        (3) A copy of the signed, written collaborative
20    agreement must be available to the Department upon request
21    from both the physician assistant and the collaborating
22    physician.
23        (4) A physician assistant shall inform each
24    collaborating physician of all written collaborative
25    agreements he or she has signed and provide a copy of these
26    to any collaborating physician upon request.



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1    (b) A collaborating physician may, but is not required to,
2delegate prescriptive authority to a physician assistant as
3part of a written collaborative agreement. This authority may,
4but is not required to, include prescription of, selection of,
5orders for, administration of, storage of, acceptance of
6samples of, and dispensing medical devices, over the counter
7medications, legend drugs, medical gases, and controlled
8substances categorized as Schedule II through V controlled
9substances, as defined in Article II of the Illinois Controlled
10Substances Act, and other preparations, including, but not
11limited to, botanical and herbal remedies. The collaborating
12physician must have a valid, current Illinois controlled
13substance license and federal registration with the Drug
14Enforcement Agency to delegate the authority to prescribe
15controlled substances.
16        (1) To prescribe Schedule II, III, IV, or V controlled
17    substances under this Section, a physician assistant must
18    obtain a mid-level practitioner controlled substances
19    license. Medication orders issued by a physician assistant
20    shall be reviewed periodically by the collaborating
21    physician.
22        (2) The collaborating physician shall file with the
23    Department notice of delegation of prescriptive authority
24    to a physician assistant and termination of delegation,
25    specifying the authority delegated or terminated. Upon
26    receipt of this notice delegating authority to prescribe



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1    controlled substances, the physician assistant shall be
2    eligible to register for a mid-level practitioner
3    controlled substances license under Section 303.05 of the
4    Illinois Controlled Substances Act. Nothing in this Act
5    shall be construed to limit the delegation of tasks or
6    duties by the collaborating physician to a nurse or other
7    appropriately trained persons in accordance with Section
8    54.2 of the Medical Practice Act of 1987.
9        (3) In addition to the requirements of this subsection
10    (b), a collaborating physician may, but is not required to,
11    delegate authority to a physician assistant to prescribe
12    Schedule II controlled substances, if all of the following
13    conditions apply:
14            (A) Specific Schedule II controlled substances by
15        oral dosage or topical or transdermal application may
16        be delegated, provided that the delegated Schedule II
17        controlled substances are routinely prescribed by the
18        collaborating physician. This delegation must identify
19        the specific Schedule II controlled substances by
20        either brand name or generic name. Schedule II
21        controlled substances to be delivered by injection or
22        other route of administration may not be delegated.
23            (B) (Blank).
24            (C) Any prescription must be limited to no more
25        than a 30-day supply, with any continuation authorized
26        only after prior approval of the collaborating



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1        physician.
2            (D) The physician assistant must discuss the
3        condition of any patients for whom a controlled
4        substance is prescribed monthly with the collaborating
5        physician.
6            (E) The physician assistant meets the education
7        requirements of Section 303.05 of the Illinois
8        Controlled Substances Act.
9    (c) Nothing in this Act shall be construed to limit the
10delegation of tasks or duties by a physician to a licensed
11practical nurse, a registered professional nurse, or other
12persons. Nothing in this Act shall be construed to limit the
13method of delegation that may be authorized by any means,
14including, but not limited to, oral, written, electronic,
15standing orders, protocols, guidelines, or verbal orders.
16Nothing in this Act shall be construed to authorize a physician
17assistant to provide health care services required by law or
18rule to be performed by a physician. Nothing in this Act shall
19be construed to authorize the delegation or performance of
20operative surgery. Nothing in this Section shall be construed
21to preclude a physician assistant from assisting in surgery.
22    (c-5) Nothing in this Section shall be construed to apply
23to any medication authority, including Schedule II controlled
24substances of a licensed physician assistant for care provided
25in a hospital, hospital affiliate, or ambulatory surgical
26treatment center pursuant to Section 7.7 of this Act.



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1    (d) (Blank).
2    (e) Nothing in this Section shall be construed to prohibit
3generic substitution.
4(Source: P.A. 100-453, eff. 8-25-17.)"; and
5on page 116, immediately below line 14, by inserting the
7    "Section 910-73. The Health Care Right of Conscience Act is
8amended by changing Section 3 as follows:
9    (745 ILCS 70/3)  (from Ch. 111 1/2, par. 5303)
10    Sec. 3. Definitions. As used in this Act, unless the
11context clearly otherwise requires:
12        (a) "Health care" means any phase of patient care,
13    including but not limited to, testing; diagnosis;
14    prognosis; ancillary research; instructions; family
15    planning, counselling, referrals, or any other advice in
16    connection with the use or procurement of contraceptives
17    and sterilization or abortion procedures; medication; or
18    surgery or other care or treatment rendered by a physician
19    or physicians, nurses, paraprofessionals or health care
20    facility, intended for the physical, emotional, and mental
21    well-being of persons; or an abortion as defined by the
22    Reproductive Health Act;
23        (b) "Physician" means any person who is licensed by the



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1    State of Illinois under the Medical Practice Act of 1987;
2        (c) "Health care personnel" means any nurse, nurses'
3    aide, medical school student, professional,
4    paraprofessional or any other person who furnishes, or
5    assists in the furnishing of, health care services;
6        (d) "Health care facility" means any public or private
7    hospital, clinic, center, medical school, medical training
8    institution, laboratory or diagnostic facility,
9    physician's office, infirmary, dispensary, ambulatory
10    surgical treatment center or other institution or location
11    wherein health care services are provided to any person,
12    including physician organizations and associations,
13    networks, joint ventures, and all other combinations of
14    those organizations;
15        (e) "Conscience" means a sincerely held set of moral
16    convictions arising from belief in and relation to God, or
17    which, though not so derived, arises from a place in the
18    life of its possessor parallel to that filled by God among
19    adherents to religious faiths;
20        (f) "Health care payer" means a health maintenance
21    organization, insurance company, management services
22    organization, or any other entity that pays for or arranges
23    for the payment of any health care or medical care service,
24    procedure, or product; and
25        (g) "Undue delay" means unreasonable delay that causes
26    impairment of the patient's health.



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1    The above definitions include not only the traditional
2combinations and forms of these persons and organizations but
3also all new and emerging forms and combinations of these
4persons and organizations.
5(Source: P.A. 99-690, eff. 1-1-17.)".