TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 140 MEDICAL PAYMENT
SECTION 140.435 ADVANCED PRACTICE NURSE SERVICES


 

Section 140.435  Advanced Practice Nurse Services

 

a)         For purposes of enrollment in the Medical Assistance Program, an advanced practice nurse (APN) means a person who is licensed as a registered professional nurse, holds a valid license in the state of practice and is legally authorized under state law or rule to practice as an advanced practice nurse, so long as that practice is not in conflict with the Nurse Practice Act [225 ILCS 65], the Medical Practice Act of 1987 [225 ILCS 60] and implementing rules (68 Ill. Adm. Code 1305).  Categories of APNs include:

 

1)         Certified Registered Nurse Anesthetist (CRNA);

 

2)         Certified Nurse Midwife (CNM);

 

3)         Certified Nurse Practitioner (CNP); and

 

4)         Clinical Nurse Specialist (CNS).

 

b)         A written collaborative agreement with a collaborating physician or practitioner is required for all APNs engaged in clinical practice, except for APNs practicing in a hospital, a hospital affiliate or an Ambulatory Surgical Treatment Center.

 

c)         The agreement or agreements required under subsection (b) shall comply with all requirements described in the Nurse Practice Act and 68 Ill. Adm. Code 1300.  Agreements required under the Act and 68 Ill. Adm. Code 1300 must be updated, be maintained on file at each practice location, and be available upon the Department's request.

 

d)         The APN must notify the Department within 10 business days if an agreement is dissolved or if a change occurs in the collaborating physician, dentist or podiatric physician under the agreement.  The Department will then re-evaluate the APN's enrollment status.

 

e)         The collaborating physician, dentist or podiatric physician is not required to be enrolled with the Department.  However, the collaborating physician or practitioner may not be terminated, suspended or barred by the Department from participating in the Medical Assistance Program.

 

f)         An APN who is required to maintain a collaborative or written practice agreement must submit the following information with the initial application for enrollment:

 

1)         Documentation of specialty of practice.

 

2)         Name and address of collaborating physician, dentist or podiatric physician.

 

3)         Federal Employer Identification Number (FEIN) of collaborating physician, dentist or podiatric physician.

 

4)         Medical license number of collaborating physician, dentist or podiatric physician.

 

5)         State of licensure, if other than Illinois, and address of collaborating physician, dentist or podiatric physician.

 

h)         An APN who is not required to maintain a collaborative or written practice agreement and who provides services in a hospital, hospital affiliate or Ambulatory Surgical Treatment Center setting must submit with the initial application for enrollment the names and addresses of the hospitals or Ambulatory Surgical Treatment Centers where he or she practices.

 

i)          To be eligible for reimbursement for individual psychiatric services, as defined in the American Medical Association Current Procedural Terminology (CPT) book, CPT code range 90791 through 90899, the rendering APN must hold a current certification in Psychiatric and Mental Health Nursing as set forth in 68 Ill. Adm. Code 1300.Appendix A.

 

(Source:  Amended at 41 Ill. Reg. 999, effective January 19, 2017)