99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB0408

 

Introduced , by Rep. Michael J. Zalewski

 

SYNOPSIS AS INTRODUCED:
 
225 ILCS 106/10
225 ILCS 106/15
225 ILCS 106/22 new

    Amends the Respiratory Care Practice Act. Makes changes in the definitions of "basic respiratory care activities", "licensed health care professional", and "respiratory care". Allows individuals without a license to practice respiratory care to perform basic screening spirometry if certified by the National Institute for Occupational Safety and Health, the American Association for Respiratory Care, or other similarly accepted certification programs. Allows respiratory care practitioners licensed in other jurisdictions to provide respiratory care in this State (i) in a declared emergency in this State, (ii) as a member of an organ procurement team, or (iii) as part of a medical transport team that is transporting a patient into or out of this State. Provides that unlicensed and non-credentialed individuals who deliver respiratory care equipment may deliver, set up, calibrate, and demonstrate the mechanical operation of the device to patients, family, and caregivers if the individuals received training and demonstrated competency using the specific devices under the supervision of a respiratory care practitioner licensed by this State or some other licensed practitioner operating within his or her scope of practice. Provides that patients, family, and caregivers must be taught to use the equipment for the intended clinical application by a licensed respiratory care practitioner or other licensed health care professional operating within his or her scope of practice. Provides that instructions to the patient regarding the clinical use of equipment, patient monitoring, patient assessment, or any other procedure used with the intent of evaluating the effectiveness of the treatment must be performed by a respiratory care practitioner licensed by this State or any other licensed practitioner operating within his or her scope of practice. Makes other changes.


LRB099 04331 AMC 24358 b

 

 

A BILL FOR

 

HB0408LRB099 04331 AMC 24358 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Respiratory Care Practice Act is amended by
5changing Sections 10 and 15 and by adding Section 22 as
6follows:
 
7    (225 ILCS 106/10)
8    (Section scheduled to be repealed on January 1, 2016)
9    Sec. 10. Definitions. In this Act:
10    "Advanced practice nurse" means an advanced practice nurse
11licensed under the Nurse Practice Act.
12    "Board" means the Respiratory Care Board appointed by the
13Director.
14    "Basic respiratory care activities" means and includes all
15of the following activities:
16         (1) Cleaning, disinfecting, and sterilizing equipment
17    used in the practice of respiratory care as delegated by a
18    licensed health care professional or other authorized
19    licensed personnel.
20        (2) Assembling equipment used in the practice of
21    respiratory care as delegated by a licensed health care
22    professional or other authorized licensed personnel.
23        (3) Collecting and reviewing patient data through

 

 

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1    non-invasive means, provided that the collection and
2    review does not include the individual's interpretation of
3    the clinical significance of the data. Collecting and
4    reviewing patient data includes the performance of pulse
5    oximetry and non-invasive monitoring procedures in order
6    to obtain vital signs and notification to licensed health
7    care professionals and other authorized licensed personnel
8    in a timely manner.
9        (4) Maintaining a nasal cannula or face mask for oxygen
10    therapy in the proper position on the patient's face.
11        (4.5) The transferring of oxygen devices, including,
12    but not limited to, nasal cannulas, face masks, or similar
13    devices, with a liter flow of 6 liters per minute or less,
14    as specified by a licensed health care professional, from
15    the wall flowmeter to the oxygen cylinder and back while
16    under the proximate supervision of a licensed health care
17    professional or other authorized licensed personnel if an
18    unlicensed practitioner has received the training required
19    under subsection (j) of Section 15 of this Act. This item
20    (4.5) does not include neonatal and pediatric oxygen
21    transports.
22        (5) Assembling a nasal cannula or face mask for oxygen
23    therapy at patient bedside in preparation for use.
24        (6) Maintaining a patient's natural airway by
25    physically manipulating the jaw and neck, suctioning the
26    oral cavity, or suctioning the mouth or nose with a bulb

 

 

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1    syringe.
2        (7) Performing assisted ventilation during emergency
3    resuscitation using a manual resuscitator.
4        (8) Using a manual resuscitator at the direction of a
5    licensed health care professional or other authorized
6    licensed personnel who is present and performing routine
7    airway suctioning. These activities do not include care of
8    a patient's artificial airway or the adjustment of
9    mechanical ventilator settings while a patient is
10    connected to the ventilator.
11"Basic respiratory care activities" does not mean activities
12that involve any of the following:
13        (1) Specialized knowledge that results from a course of
14    education or training in respiratory care.
15        (2) An unreasonable risk of a negative outcome for the
16    patient.
17        (3) The assessment or making of a decision concerning
18    patient care.
19        (4) The administration of aerosol medication or
20    medical gas oxygen.
21        (5) The insertion and maintenance of an artificial
22    airway.
23        (6) Mechanical ventilatory support.
24        (7) Patient assessment.
25        (8) Patient education.
26    "Department" means the Department of Professional

 

 

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1Regulation.
2    "Director" means the Director of Professional Regulation.
3    "Licensed" means that which is required to hold oneself out
4as a respiratory care practitioner as defined in this Act.
5    "Licensed health care professional" means a physician
6licensed to practice medicine in all its branches, a certified
7registered nurse anesthetist, an advanced practice nurse who
8has a written collaborative agreement with a collaborating
9physician that authorizes the advanced practice nurse to
10transmit orders to a respiratory care practitioner, or a
11physician assistant who has been delegated the authority to
12transmit orders to a respiratory care practitioner by his or
13her supervising physician.
14    "Order" means a written, oral, or telecommunicated
15authorization for respiratory care services for a patient by
16(i) a licensed health care professional who maintains medical
17supervision of the patient and makes a diagnosis or verifies
18that the patient's condition is such that it may be treated by
19a respiratory care practitioner or (ii) a certified registered
20nurse anesthetist in a licensed hospital or ambulatory surgical
21treatment center.
22    "Other authorized licensed personnel" means a licensed
23respiratory care practitioner, a licensed registered nurse, or
24a licensed practical nurse whose scope of practice authorizes
25the professional to supervise an individual who is not
26licensed, certified, or registered as a health professional.

 

 

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1    "Proximate supervision" means a situation in which an
2individual is responsible for directing the actions of another
3individual in the facility and is physically close enough to be
4readily available, if needed, by the supervised individual.
5    "Respiratory care" and "cardiorespiratory care" mean
6preventative services, evaluation and assessment services,
7therapeutic services, cardiopulmonary disease management, and
8rehabilitative services under the order of a licensed health
9care professional or a certified registered nurse anesthetist
10in a licensed hospital for an individual with a disorder,
11disease, or abnormality of the cardiopulmonary system. These
12terms include, but are not limited to, measuring, observing,
13assessing, and monitoring signs and symptoms, reactions,
14general behavior, and general physical response of individuals
15to respiratory care services, including the determination of
16whether those signs, symptoms, reactions, behaviors, or
17general physical responses exhibit abnormal characteristics;
18the administration of pharmacological and therapeutic agents
19and procedures related to respiratory care services; the
20collection of blood specimens and other bodily fluids and
21tissues for, and the performance of, cardiopulmonary
22diagnostic testing procedures, including, but not limited to,
23blood gas analysis; development, implementation, and
24modification of respiratory care treatment plans based on
25assessed abnormalities of the cardiopulmonary system,
26respiratory care guidelines, referrals, and orders of a

 

 

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1licensed health care professional; application, operation, and
2management of mechanical ventilatory support and other means of
3life support, including, but not limited to, hemodynamic
4cardiovascular support; and the initiation of emergency
5procedures under the rules promulgated by the Department. A
6respiratory care practitioner shall refer to a physician
7licensed to practice medicine in all its branches any patient
8whose condition, at the time of evaluation or treatment, is
9determined to be beyond the scope of practice of the
10respiratory care practitioner.
11    "Respiratory care education program" means a course of
12academic study leading to eligibility for registry or
13certification in respiratory care. The training is to be
14approved by an accrediting agency recognized by the Board and
15shall include an evaluation of competence through a
16standardized testing mechanism that is determined by the Board
17to be both valid and reliable.
18    "Respiratory care practitioner" means a person who is
19licensed by the Department of Professional Regulation and meets
20all of the following criteria:
21        (1) The person is engaged in the practice of
22    cardiorespiratory care and has the knowledge and skill
23    necessary to administer respiratory care.
24        (2) The person is capable of serving as a resource to
25    the licensed health care professional in relation to the
26    technical aspects of cardiorespiratory care and the safe

 

 

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1    and effective methods for administering cardiorespiratory
2    care modalities.
3        (3) The person is able to function in situations of
4    unsupervised patient contact requiring great individual
5    judgment.
6(Source: P.A. 94-523, eff. 1-1-06; 95-639, eff. 10-5-07.)
 
7    (225 ILCS 106/15)
8    (Section scheduled to be repealed on January 1, 2016)
9    Sec. 15. Exemptions.
10    (a) This Act does not prohibit a person legally regulated
11in this State by any other Act from engaging in any practice
12for which he or she is authorized.
13    (b) Nothing in this Act shall prohibit the practice of
14respiratory care by a person who is employed by the United
15States government or any bureau, division, or agency thereof
16while in the discharge of the employee's official duties.
17    (c) Nothing in this Act shall be construed to limit the
18activities and services of a person enrolled in an approved
19course of study leading to a degree or certificate of registry
20or certification eligibility in respiratory care if these
21activities and services constitute a part of a supervised
22course of study and if the person is designated by a title
23which clearly indicates his or her status as a student or
24trainee. Status as a student or trainee shall not exceed 3
25years from the date of enrollment in an approved course.

 

 

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1    (d) Nothing in this Act shall prohibit a person from
2treating ailments by spiritual means through prayer alone in
3accordance with the tenets and practices of a recognized church
4or religious denomination.
5    (e) Nothing in this Act shall be construed to prevent a
6person who is a registered nurse, an advanced practice nurse, a
7licensed practical nurse, a physician assistant, or a physician
8licensed to practice medicine in all its branches from
9providing respiratory care.
10    (f) Nothing in this Act shall limit a person who is
11credentialed by the National Society for Cardiopulmonary
12Technology or the National Board for Respiratory Care from
13performing pulmonary function tests and respiratory care
14procedures related to the pulmonary function test. Individuals
15who do not possess a license to practice respiratory care or a
16license in another health care field may perform basic
17screening spirometry limited to peak flow, forced vital
18capacity, slow vital capacity, and maximum voluntary
19ventilation if they possess spirometry certification from the
20National Institute for Occupational Safety and Health, an
21Office Spirometry Certificate from the American Association
22for Respiratory Care, or other similarly accepted
23certification training.
24    (g) Nothing in this Act shall prohibit the collection and
25analysis of blood by clinical laboratory personnel meeting the
26personnel standards of the Illinois Clinical Laboratory Act.

 

 

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1    (h) Nothing in this Act shall prohibit a polysomnographic
2technologist, technician, or trainee, as defined in the job
3descriptions jointly accepted by the American Academy of Sleep
4Medicine, the Association of Polysomnographic Technologists,
5the Board of Registered Polysomnographic Technologists, and
6the American Society of Electroneurodiagnostic Technologists,
7from performing activities within the scope of practice of
8polysomnographic technology while under the direction of a
9physician licensed in this State.
10    (i) Nothing in this Act shall prohibit a family member from
11providing respiratory care services to an ill person.
12    (j) Nothing in this Act shall be construed to limit an
13unlicensed practitioner in a licensed hospital who is working
14under the proximate supervision of a licensed health care
15professional or other authorized licensed personnel and
16providing direct patient care services from performing basic
17respiratory care activities if the unlicensed practitioner (i)
18has been trained to perform the basic respiratory care
19activities at the facility that employs or contracts with the
20individual and (ii) at a minimum, has annually received an
21evaluation of the unlicensed practitioner's performance of
22basic respiratory care activities documented by the facility.
23    (k) Nothing in this Act shall be construed to prohibit a
24person enrolled in a respiratory care education program or an
25approved course of study leading to a degree or certification
26in a health care-related discipline that provides respiratory

 

 

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1care activities within his or her scope of practice and
2employed in a licensed hospital in order to provide direct
3patient care services under the direction of other authorized
4licensed personnel from providing respiratory care activities.
5    (l) Nothing in this Act prohibits a person licensed as a
6respiratory care practitioner in another jurisdiction from
7providing respiratory care: (i) in a declared emergency in this
8State; (ii) as a member of an organ procurement team; or (iii)
9as part of a medical transport team that is transporting a
10patient into or out of this State.
11(Source: P.A. 96-456, eff. 8-14-09.)
 
12    (225 ILCS 106/22 new)
13    Sec. 22. Durable medical equipment use and training.
14    (a) Notwithstanding any other provision of this Act,
15unlicensed or non-credentialed individuals who deliver
16prescribed respiratory care equipment, including, but not
17limited to, oxygen, oxygen concentrators, pulmonary hygiene
18devices, aerosol compressors and generators, suction machines,
19positive airway pressure devices, and mechanical ventilators,
20may deliver, set up, calibrate, and demonstrate the mechanical
21operation of the device to the patient, family, and caregivers.
22Demonstration of the mechanical operation of the device
23includes demonstration of the on-off switches, emergency
24buttons, and alarm silence and reset buttons, as appropriate.
25In order for unlicensed or non-credentialed personnel to

 

 

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1deliver, set up, calibrate, and demonstrate the equipment as
2allowed in this subsection (a), the employer must document that
3the employee has both received training and demonstrated
4competency using the specific devices under the supervision of
5a respiratory care practitioner licensed by this State or some
6other licensed practitioner operating within his or her scope
7of practice.
8    Equipment demonstration is not to be interpreted as
9teaching, administration, or performance of respiratory care.
10Unlicensed or non-credentialed individuals may not attach the
11equipment to the patient or instruct the patient, family, or
12caregiver on the use of the equipment beyond the mechanical
13functions of the device.
14    (b) Patients, family, and caregivers must be taught to use
15the equipment for the intended clinical application by a
16licensed respiratory care practitioner or other licensed
17health care professional operating within his or her scope of
18practice. This instruction may occur through follow-up after
19delivery, with an identical model in the health care facility
20prior to discharge or with an identical model at the medical
21supply office. Instructions to the patient regarding the
22clinical use of equipment, patient monitoring, patient
23assessment, or any other procedure used with the intent of
24evaluating the effectiveness of the treatment must be performed
25by a respiratory care practitioner licensed by this State or
26any other licensed practitioner operating within his or her

 

 

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1scope of practice.