94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
HB4329

 

Introduced 12/29/2005, by Rep. Rich Brauer

 

SYNOPSIS AS INTRODUCED:
 
210 ILCS 5/6.5
225 ILCS 60/54.7 new

    Amends the Ambulatory Surgical Treatment Center Act. In provisions concerning persons authorized to administer anesthesia services, provides that a registered nurse may administer conscious sedation under the following conditions: (1) the registered nurse has privileges granted by the medical staff and ambulatory surgical treatment center (ASTC) to administer conscious sedation; (2) the registered nurse is under the direct supervision of the operating physician or dentist during the delivery conscious sedation; (3) the registered nurse maintains current Advanced Cardiac Life Support certification; and (4) the operating physician has training and experience in the delivery of anesthesia services to patients by either possessing clinical privileges at the ASTC to administer anesthesia or completing a minimum of 8 hours of continuing education in the delivery of anesthesia, including the administration of conscious sedation within each 3-year license period. Also requires that a physician or dentist with authority to administer anesthesia maintain current Advanced Cardiac Life Support certification. Amends the Medical Practice Act of 1987. Provides that any physician may order and administer anesthesia services in accordance with his or her training or experience. Sets forth the conditions under which anesthesia services shall be administered in a hospital, in an ambulatory surgical treatment center, and in a physician's office. Defines "conscious sedation". Effective immediately.


LRB094 15818 DRJ 51034 b

 

 

A BILL FOR

 

HB4329 LRB094 15818 DRJ 51034 b

1     AN ACT in relation to regulation.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Ambulatory Surgical Treatment Center Act is
5 amended by changing Section 6.5 as follows:
 
6     (210 ILCS 5/6.5)
7     Sec. 6.5. Clinical privileges; advanced practice nurses.
8 All ambulatory surgical treatment centers (ASTC) licensed
9 under this Act shall comply with the following requirements:
10     (1) No ASTC policy, rule, regulation, or practice shall be
11 inconsistent with the provision of adequate collaboration,
12 including medical direction of licensed advanced practice
13 nurses, in accordance with Section 54.5 of the Medical Practice
14 Act of 1987.
15     (2) Operative surgical procedures shall be performed only
16 by a physician licensed to practice medicine in all its
17 branches under the Medical Practice Act of 1987, a dentist
18 licensed under the Illinois Dental Practice Act, or a
19 podiatrist licensed under the Podiatric Medical Practice Act of
20 1987, with medical staff membership and surgical clinical
21 privileges granted by the consulting committee of the ASTC. A
22 licensed physician, dentist, or podiatrist may be assisted by a
23 physician licensed to practice medicine in all its branches,
24 dentist, dental assistant, podiatrist, licensed advanced
25 practice nurse, licensed physician assistant, licensed
26 registered nurse, licensed practical nurse, surgical
27 assistant, surgical technician, or other individuals granted
28 clinical privileges to assist in surgery by the consulting
29 committee of the ASTC. Payment for services rendered by an
30 assistant in surgery who is not an ambulatory surgical
31 treatment center employee shall be paid at the appropriate
32 non-physician modifier rate if the payor would have made

 

 

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1 payment had the same services been provided by a physician.
2     (3) The anesthesia service shall be under the direction of
3 a physician licensed to practice medicine in all its branches
4 who has had specialized preparation or experience in the area
5 or who has completed a residency in anesthesiology. An
6 anesthesiologist, Board certified or Board eligible, is
7 recommended. Anesthesia services may only be administered
8 pursuant to the order of a physician licensed to practice
9 medicine in all its branches, licensed dentist, or licensed
10 podiatrist.
11         (A) The individuals who, with clinical privileges
12     granted by the medical staff and ASTC, may administer
13     anesthesia services are limited to the following:
14             (i) an anesthesiologist; or
15             (ii) a physician licensed to practice medicine in
16         all its branches; or
17             (iii) a dentist with authority to administer
18         anesthesia under Section 8.1 of the Illinois Dental
19         Practice Act; or
20             (iv) a licensed certified registered nurse
21         anesthetist; or
22             (v) a registered nurse under the conditions set
23         forth in item (D).
24         (B) For anesthesia services, an anesthesiologist shall
25     participate through discussion of and agreement with the
26     anesthesia plan and shall remain physically present and be
27     available on the premises during the delivery of anesthesia
28     services for diagnosis, consultation, and treatment of
29     emergency medical conditions. In the absence of 24-hour
30     availability of anesthesiologists with clinical
31     privileges, an alternate policy (requiring participation,
32     presence, and availability of a physician licensed to
33     practice medicine in all its branches) shall be developed
34     by the medical staff consulting committee in consultation
35     with the anesthesia service and included in the medical
36     staff consulting committee policies.

 

 

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1         (C) A certified registered nurse anesthetist is not
2     required to possess prescriptive authority or a written
3     collaborative agreement meeting the requirements of
4     Section 15-15 of the Nursing and Advanced Practice Nursing
5     Act to provide anesthesia services ordered by a licensed
6     physician, dentist, or podiatrist. Licensed certified
7     registered nurse anesthetists are authorized to select,
8     order, and administer drugs and apply the appropriate
9     medical devices in the provision of anesthesia services
10     under the anesthesia plan agreed with by the
11     anesthesiologist or, in the absence of an available
12     anesthesiologist with clinical privileges, agreed with by
13     the operating physician, operating dentist, or operating
14     podiatrist in accordance with the medical staff consulting
15     committee policies of a licensed ambulatory surgical
16     treatment center.
17         (D) A registered nurse may administer conscious
18     sedation, as defined in the Medical Practice Act of 1987,
19     under the following conditions:
20             (1) The registered nurse has privileges granted by
21         the medical staff and ASTC to administer conscious
22         sedation.
23             (2) The registered nurse is under the direct
24         supervision of the operating physician or dentist
25         during the delivery conscious sedation.
26             (3) The registered nurse maintains current
27         Advanced Cardiac Life Support certification.
28             (4) The operating physician has training and
29         experience in the delivery of anesthesia services to
30         patients by either possessing clinical privileges at
31         the ASTC to administer anesthesia or completing a
32         minimum of 8 hours of continuing education (CME) in the
33         delivery of anesthesia, including the administration
34         of conscious sedation within each 3-year license
35         period.
36     In addition, the operating physician or dentist with

 

 

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1 authority to administer anesthesia under Section 8.1 of the
2 Illinois Dental Practice Act must maintain current Advanced
3 Cardiac Life Support certification. This training and
4 experience must be documented in the operating physician or
5 dentist clinical privilege file.
6 (Source: P.A. 93-352, eff. 1-1-04.)
 
7     Section 10. The Medical Practice Act of 1987 is amended by
8 adding Section 54.7 as follows:
 
9     (225 ILCS 60/54.7 new)
10     Sec. 54.7. Anesthesia services.
11     (a) Any physician may order and administer anesthesia
12 services in accordance with his or her training or experience.
13     (b) In a hospital setting, anesthesia services shall be
14 administered in accordance with Section 10.7 of the Hospital
15 Licensing Act.
16     (c) In an ambulatory surgical treatment center, anesthesia
17 services shall be administered in accordance with Section 6.5
18 of the Ambulatory Surgical Treatment Center Act.
19     (d) In a physician's office, anesthesia services shall be
20 administered in accordance with the following:
21         (1) In a physician's office, the operating physician
22     shall have training and experience in the delivery of
23     anesthesia services in order to administer anesthesia or to
24     enter into a practice agreement with a certified registered
25     nurse anesthetist (CRNA) to provide anesthesia services in
26     the office pursuant to Section 54.5 of the Medical Practice
27     Act and Section 15-25 of the Nursing and Advanced Practice
28     Nursing Act. When an anesthesiologist is administering
29     anesthesia in a physician's office, the operating
30     physician is not required to have the training and
31     experience set forth in paragraph (2). A "physician's
32     office" is any practice location not regulated by Section
33     10.7 of the Hospital Licensing Act or Section 6.5 of the
34     Ambulatory Surgical Treatment Center Act.

 

 

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1         (2) The training and experience requirements may be met
2     in the manner specified in either subparagraph (A) or
3     subparagraph (B):
4             (A) The physician maintains clinic privileges to
5         administer anesthesia services in a hospital licensed
6         in accordance with the Hospital Licensing Act or an
7         ambulatory surgical treatment center licensed in
8         accordance with the Ambulatory Surgical Treatment
9         Center Act; or
10             (B) Completion of continuing medical education:
11                 (i) For conscious sedation only, the physician
12             shall complete a minimum of 8 hours of continuing
13             medical education (CME) in delivery of anesthesia,
14             including the administration of conscious sedation
15             within each 3-year license renewal period.
16                 (ii) For deep sedation, regional anesthesia,
17             or general anesthesia, or any combination of
18             those, a physician shall complete a minimum of 34
19             hours of continuing medical education in the
20             delivery of anesthesia services within each 3-year
21             license renewal period. Fulfillment of this
22             requirement shall satisfy the requirement of
23             subdivision (2)(B)(i) for the administration of
24             conscious sedation.
25                 (iii) A continuing medical education program
26             shall be conducted by a university, professional
27             association, or hospital as a formal CME program.
28         (3) In a physician's office where anesthesia is
29     administered, all operating physicians and
30     anesthesiologists shall obtain Advanced Cardiac Life
31     Support (ACLS) certification and shall thereafter maintain
32     current ACLS certification. If the physician enters into a
33     practice agreement with a CRNA, the CRNA shall also have a
34     current ACLS certification.
35         (4) The ACLS certification and the physician training
36     and experience required by this Section shall be documented

 

 

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1     in the written practice agreement between the physician and
2     the CRNA.
3         (5) The continuing medical education required in
4     paragraph (2) and the ACLS training required in paragraph
5     (3) may be applied to fulfillment of the 150 hours of
6     continuing medical education required for renewal of a
7     license.
8         (6) For the provision of anesthesia services, the
9     operating physician or dentist shall participate through
10     discussion of and agreement with the anesthesia plan and
11     shall remain physically present and be available on the
12     premises during the delivery of anesthesia services for
13     diagnosis, consultation, and treatment of emergency
14     medical conditions.
15     (e) "Conscious sedation" means a drug-induced depression
16 of consciousness during which patients respond purposefully to
17 verbal commands, either alone or accompanied by light tactile
18 stimulation. No interventions are required to maintain a patent
19 airway and spontaneous ventilation is adequate. Cardiovascular
20 function is maintained.
 
21     Section 99. Effective date. This Act takes effect upon
22 becoming law.