093_HB3618ham002











                                     LRB093 10431 JAM 13757 a

 1                    AMENDMENT TO HOUSE BILL 3618

 2        AMENDMENT NO.     .  Amend House Bill 3618  by  replacing
 3    the title with the following:

 4        "AN ACT concerning public health."; and

 5    by  replacing  everything  after the enacting clause with the
 6    following:

 7        "Section 5.  The Ambulatory Surgical Treatment Center Act
 8    is amended by changing Section 6.5 as follows:

 9        (210 ILCS 5/6.5)
10        Sec. 6.5.  Clinical privileges; advanced practice nurses.
11    All ambulatory surgical  treatment  centers  (ASTC)  licensed
12    under this Act shall comply with the following requirements:
13        (1)  No  ASTC policy, rule, regulation, or practice shall
14    be inconsistent with the provision of adequate collaboration,
15    including medical direction  of  licensed  advanced  practice
16    nurses,  in  accordance  with  Section  54.5  of  the Medical
17    Practice Act of 1987.
18        (2)  Operative surgical  procedures  shall  be  performed
19    only  by a physician licensed to practice medicine in all its
20    branches under the Medical Practice Act of  1987,  a  dentist
 
                            -2-      LRB093 10431 JAM 13757 a
 1    licensed  under  the  Illinois  Dental  Practice  Act,  or  a
 2    podiatrist  licensed under the Podiatric Medical Practice Act
 3    of 1987, with medical staff membership and surgical  clinical
 4    privileges granted by the consulting committee of the ASTC. A
 5    licensed physician, dentist, or podiatrist may be assisted by
 6    a   physician  licensed  to  practice  medicine  in  all  its
 7    branches, dentist,  dental  assistant,  podiatrist,  licensed
 8    advanced   practice   nurse,  licensed  physician  assistant,
 9    licensed registered nurse, licensed practical nurse, surgical
10    assistant, surgical technician, or other individuals  granted
11    clinical  privileges  to  assist in surgery by the consulting
12    committee of the ASTC. Payment for services  rendered  by  an
13    assistant  in  surgery  who  is  not  an  ambulatory surgical
14    treatment center employee shall be paid  at  the  appropriate
15    non-physician  modifier  rate  if  the  payor would have made
16    payment had the same services been provided by a physician.
17        (3)   The anesthesia service shall be under the direction
18    of a physician licensed  to  practice  medicine  in  all  its
19    branches who has had specialized preparation or experience in
20    the  area or who has completed a residency in anesthesiology.
21    An anesthesiologist, Board certified or  Board  eligible,  is
22    recommended.  Anesthesia  services  may  only be administered
23    pursuant to the order of a  physician  licensed  to  practice
24    medicine  in  all its branches, licensed dentist, or licensed
25    podiatrist.
26             (A)  The individuals who, with  clinical  privileges
27        granted  by  the  medical  staff and ASTC, may administer
28        anesthesia services are limited to the following:
29                  (i)  an anesthesiologist; or
30                  (ii)  a physician licensed to practice medicine
31             in all its branches; or
32                  (iii)  a dentist with authority  to  administer
33             anesthesia  under Section 8.1 of the Illinois Dental
34             Practice Act; or
 
                            -3-      LRB093 10431 JAM 13757 a
 1                  (iv)  a  licensed  certified  registered  nurse
 2             anesthetist.
 3             (B)  For anesthesia  services,  an  anesthesiologist
 4        shall  participate  through  discussion  of and agreement
 5        with the anesthesia  plan  and  shall  remain  physically
 6        present  and  be  available  on  the  premises during the
 7        delivery   of   anesthesia   services   for    diagnosis,
 8        consultation,   and   treatment   of   emergency  medical
 9        conditions. In the absence  of  24-hour  availability  of
10        anesthesiologists  with clinical privileges, an alternate
11        policy   (requiring    participation,    presence,    and
12        availability of a physician licensed to practice medicine
13        in  all  its  branches) shall be developed by the medical
14        staff  consulting  committee  in  consultation  with  the
15        anesthesia service and  included  in  the  medical  staff
16        consulting committee policies.
17             (C)  A certified registered nurse anesthetist is not
18        required  to  possess prescriptive authority or a written
19        collaborative  agreement  meeting  the  requirements   of
20        Section  15-15  of  the  Nursing  and  Advanced  Practice
21        Nursing  Act  to provide anesthesia services ordered by a
22        licensed physician,  dentist,  or  podiatrist.   Licensed
23        certified registered nurse anesthetists are authorized to
24        select,   order,  and  administer  drugs  and  apply  the
25        appropriate  medical  devices   in   the   provision   of
26        anesthesia services under the anesthesia plan agreed with
27        by   the  anesthesiologist  or,  in  the  absence  of  an
28        available  anesthesiologist  with  clinical   privileges,
29        agreed   with   by  the  operating  physician,  operating
30        dentist, or operating podiatrist in accordance  with  the
31        medical staff consulting committee policies of a licensed
32        ambulatory surgical treatment center.
33    (Source: P.A. 90-742, eff. 8-13-98; 91-414, eff. 8-6-99.)
 
                            -4-      LRB093 10431 JAM 13757 a
 1        Section  10.  The  Hospital  Licensing  Act is amended by
 2    changing Section 10.7 as follows:

 3        (210 ILCS 85/10.7)
 4        Sec.  10.7.  Clinical   privileges;   advanced   practice
 5    nurses.    All hospitals licensed under this Act shall comply
 6    with the following requirements:
 7        (1)  No hospital policy, rule,  regulation,  or  practice
 8    shall   be   inconsistent  with  the  provision  of  adequate
 9    collaboration,  including  medical  direction   of   licensed
10    advanced  practice nurses, in accordance with Section 54.5 of
11    the Medical Practice Act of 1987.
12        (2)  Operative surgical  procedures  shall  be  performed
13    only  by a physician licensed to practice medicine in all its
14    branches under the Medical Practice Act of  1987,  a  dentist
15    licensed  under  the  Illinois  Dental  Practice  Act,  or  a
16    podiatrist  licensed under the Podiatric Medical Practice Act
17    of 1987, with medical staff membership and surgical  clinical
18    privileges  granted  at  the hospital.  A licensed physician,
19    dentist,  or  podiatrist  may  be  assisted  by  a  physician
20    licensed to practice medicine in all its  branches,  dentist,
21    dental  assistant,  podiatrist,  licensed  advanced  practice
22    nurse,  licensed  physician  assistant,  licensed  registered
23    nurse, licensed practical nurse, surgical assistant, surgical
24    technician,  or other individuals granted clinical privileges
25    to assist in surgery at the hospital.  Payment  for  services
26    rendered  by  an  assistant  in surgery who is not a hospital
27    employee shall  be  paid  at  the  appropriate  non-physician
28    modifier  rate  if  the payor would have made payment had the
29    same services been provided by a physician.
30        (3)  The anesthesia service shall be under the  direction
31    of  a  physician  licensed  to  practice  medicine in all its
32    branches who has had specialized preparation or experience in
33    the area or who has completed a residency in  anesthesiology.
 
                            -5-      LRB093 10431 JAM 13757 a
 1    An  anesthesiologist,  Board  certified or Board eligible, is
 2    recommended. Anesthesia services  may  only  be  administered
 3    pursuant  to  the  order  of a physician licensed to practice
 4    medicine in all its branches, licensed dentist,  or  licensed
 5    podiatrist.
 6             (A)  The  individuals  who, with clinical privileges
 7        granted  at  the  hospital,  may  administer   anesthesia
 8        services are limited to the following:
 9                  (i)  an anesthesiologist; or
10                  (ii)  a physician licensed to practice medicine
11             in all its branches; or
12                  (iii)  a  dentist  with authority to administer
13             anesthesia under Section 8.1 of the Illinois  Dental
14             Practice Act; or
15                  (iv)  a  licensed  certified  registered  nurse
16             anesthetist.
17             (B)  For  anesthesia  services,  an anesthesiologist
18        shall participate through  discussion  of  and  agreement
19        with  the  anesthesia  plan  and  shall remain physically
20        present and be  available  on  the  premises  during  the
21        delivery    of   anesthesia   services   for   diagnosis,
22        consultation,  and   treatment   of   emergency   medical
23        conditions.  In  the  absence  of 24-hour availability of
24        anesthesiologists  with  medical  staff  privileges,   an
25        alternate  policy (requiring participation, presence, and
26        availability of a physician licensed to practice medicine
27        in all its branches) shall be developed  by  the  medical
28        staff  and  licensed  hospital  in  consultation with the
29        anesthesia service.
30             (C)  A certified registered nurse anesthetist is not
31        required to possess prescriptive authority or  a  written
32        collaborative   agreement  meeting  the  requirements  of
33        Section  15-15  of  the  Nursing  and  Advanced  Practice
34        Nursing Act to provide anesthesia services ordered  by  a
 
                            -6-      LRB093 10431 JAM 13757 a
 1        licensed  physician,  dentist,  or  podiatrist.  Licensed
 2        certified registered nurse anesthetists are authorized to
 3        select,  order,  and  administer  drugs  and  apply   the
 4        appropriate   medical   devices   in   the  provision  of
 5        anesthesia services under the anesthesia plan agreed with
 6        by  the  anesthesiologist  or,  in  the  absence  of   an
 7        available   anesthesiologist  with  clinical  privileges,
 8        agreed  with  by  the  operating   physician,   operating
 9        dentist,  or  operating podiatrist in accordance with the
10        hospital's alternative policy.
11    (Source: P.A. 90-742, eff. 8-13-98; 91-414, eff. 8-6-99.)".