HB5104 EnrolledLRB097 19244 CEL 64486 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 1. The Ambulatory Surgical Treatment Center Act is
5amended by adding Section 6.6 as follows:
 
6    (210 ILCS 5/6.6 new)
7    Sec. 6.6. Clinical privileges; physician assistants. No
8ambulatory surgical treatment center (ASTC) licensed under
9this Act shall adopt any policy, rule, regulation, or practice
10inconsistent with the provision of adequate supervision in
11accordance with Section 54.5 of the Medical Practice Act of
121987 and the Physician Assistant Practice Act of 1987.
 
13    Section 3. The Hospital Licensing Act is amended by adding
14Section 10.11 as follows:
 
15    (210 ILCS 85/10.11 new)
16    Sec. 10.11. Clinical privileges; physician assistants. No
17hospital licensed under this Act shall adopt any policy, rule,
18regulation, or practice inconsistent with the provision of
19adequate supervision in accordance with Section 54.5 of the
20Medical Practice Act of 1987 and the Physician Assistant
21Practice Act of 1987.
 

 

 

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1    Section 5. The Medical Practice Act of 1987 is amended by
2changing Section 54.5 as follows:
 
3    (225 ILCS 60/54.5)
4    (Section scheduled to be repealed on December 31, 2012)
5    Sec. 54.5. Physician delegation of authority to physician
6assistants and advanced practice nurses.
7    (a) Physicians licensed to practice medicine in all its
8branches may delegate care and treatment responsibilities to a
9physician assistant under guidelines in accordance with the
10requirements of the Physician Assistant Practice Act of 1987. A
11physician licensed to practice medicine in all its branches may
12enter into supervising physician agreements with no more than 5
132 physician assistants as set forth in subsection (a) of
14Section 7 of the Physician Assistant Practice Act of 1987.
15    (b) A physician licensed to practice medicine in all its
16branches in active clinical practice may collaborate with an
17advanced practice nurse in accordance with the requirements of
18the Nurse Practice Act. Collaboration is for the purpose of
19providing medical consultation, and no employment relationship
20is required. A written collaborative agreement shall conform to
21the requirements of Section 65-35 of the Nurse Practice Act.
22The written collaborative agreement shall be for services the
23collaborating physician generally provides to his or her
24patients in the normal course of clinical medical practice. A

 

 

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1written collaborative agreement shall be adequate with respect
2to collaboration with advanced practice nurses if all of the
3following apply:
4        (1) The agreement is written to promote the exercise of
5    professional judgment by the advanced practice nurse
6    commensurate with his or her education and experience. The
7    agreement need not describe the exact steps that an
8    advanced practice nurse must take with respect to each
9    specific condition, disease, or symptom, but must specify
10    those procedures that require a physician's presence as the
11    procedures are being performed.
12        (2) Practice guidelines and orders are developed and
13    approved jointly by the advanced practice nurse and
14    collaborating physician, as needed, based on the practice
15    of the practitioners. Such guidelines and orders and the
16    patient services provided thereunder are periodically
17    reviewed by the collaborating physician.
18        (3) The advance practice nurse provides services the
19    collaborating physician generally provides to his or her
20    patients in the normal course of clinical practice, except
21    as set forth in subsection (b-5) of this Section. With
22    respect to labor and delivery, the collaborating physician
23    must provide delivery services in order to participate with
24    a certified nurse midwife.
25        (4) The collaborating physician and advanced practice
26    nurse consult at least once a month to provide

 

 

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1    collaboration and consultation.
2        (5) Methods of communication are available with the
3    collaborating physician in person or through
4    telecommunications for consultation, collaboration, and
5    referral as needed to address patient care needs.
6        (6) The agreement contains provisions detailing notice
7    for termination or change of status involving a written
8    collaborative agreement, except when such notice is given
9    for just cause.
10    (b-5) An anesthesiologist or physician licensed to
11practice medicine in all its branches may collaborate with a
12certified registered nurse anesthetist in accordance with
13Section 65-35 of the Nurse Practice Act for the provision of
14anesthesia services. With respect to the provision of
15anesthesia services, the collaborating anesthesiologist or
16physician shall have training and experience in the delivery of
17anesthesia services consistent with Department rules.
18Collaboration shall be adequate if:
19        (1) an anesthesiologist or a physician participates in
20    the joint formulation and joint approval of orders or
21    guidelines and periodically reviews such orders and the
22    services provided patients under such orders; and
23        (2) for anesthesia services, the anesthesiologist or
24    physician participates through discussion of and agreement
25    with the anesthesia plan and is physically present and
26    available on the premises during the delivery of anesthesia

 

 

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1    services for diagnosis, consultation, and treatment of
2    emergency medical conditions. Anesthesia services in a
3    hospital shall be conducted in accordance with Section 10.7
4    of the Hospital Licensing Act and in an ambulatory surgical
5    treatment center in accordance with Section 6.5 of the
6    Ambulatory Surgical Treatment Center Act.
7    (b-10) The anesthesiologist or operating physician must
8agree with the anesthesia plan prior to the delivery of
9services.
10    (c) The supervising physician shall have access to the
11medical records of all patients attended by a physician
12assistant. The collaborating physician shall have access to the
13medical records of all patients attended to by an advanced
14practice nurse.
15    (d) (Blank).
16    (e) A physician shall not be liable for the acts or
17omissions of a physician assistant or advanced practice nurse
18solely on the basis of having signed a supervision agreement or
19guidelines or a collaborative agreement, an order, a standing
20medical order, a standing delegation order, or other order or
21guideline authorizing a physician assistant or advanced
22practice nurse to perform acts, unless the physician has reason
23to believe the physician assistant or advanced practice nurse
24lacked the competency to perform the act or acts or commits
25willful and wanton misconduct.
26    (f) A collaborating physician may, but is not required to,

 

 

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1delegate prescriptive authority to an advanced practice nurse
2as part of a written collaborative agreement, and the
3delegation of prescriptive authority shall conform to the
4requirements of Section 65-40 of the Nurse Practice Act.
5    (g) A supervising physician may, but is not required to,
6delegate prescriptive authority to a physician assistant as
7part of a written supervision agreement, and the delegation of
8prescriptive authority shall conform to the requirements of
9Section 7.5 of the Physician Assistant Practice Act of 1987.
10(Source: P.A. 96-618, eff. 1-1-10; 97-358, eff. 8-12-11.)
 
11    Section 10. The Physician Assistant Practice Act of 1987 is
12amended by changing Sections 4 and 7 and by adding Section 7.7
13as follows:
 
14    (225 ILCS 95/4)  (from Ch. 111, par. 4604)
15    (Section scheduled to be repealed on January 1, 2018)
16    Sec. 4. In this Act:
17    1. "Department" means the Department of Financial and
18Professional Regulation.
19    2. "Secretary" means the Secretary of Financial and
20Professional Regulation.
21    3. "Physician assistant" means any person not a physician
22who has been certified as a physician assistant by the National
23Commission on the Certification of Physician Assistants or
24equivalent successor agency and performs procedures under the

 

 

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1supervision of a physician as defined in this Act. A physician
2assistant may perform such procedures within the specialty of
3the supervising physician, except that such physician shall
4exercise such direction, supervision and control over such
5physician assistants as will assure that patients shall receive
6quality medical care. Physician assistants shall be capable of
7performing a variety of tasks within the specialty of medical
8care under the supervision of a physician. Supervision of the
9physician assistant shall not be construed to necessarily
10require the personal presence of the supervising physician at
11all times at the place where services are rendered, as long as
12there is communication available for consultation by radio,
13telephone or telecommunications within established guidelines
14as determined by the physician/physician assistant team. The
15supervising physician may delegate tasks and duties to the
16physician assistant. Delegated tasks or duties shall be
17consistent with physician assistant education, training, and
18experience. The delegated tasks or duties shall be specific to
19the practice setting and shall be implemented and reviewed
20under a written supervision agreement established by the
21physician or physician/physician assistant team. A physician
22assistant, acting as an agent of the physician, shall be
23permitted to transmit the supervising physician's orders as
24determined by the institution's by-laws, policies, procedures,
25or job description within which the physician/physician
26assistant team practices. Physician assistants shall practice

 

 

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1only in accordance with a written supervision agreement.
2    4. "Board" means the Medical Licensing Board constituted
3under the Medical Practice Act of 1987.
4    5. "Disciplinary Board" means the Medical Disciplinary
5Board constituted under the Medical Practice Act of 1987.
6    6. "Physician" means, for purposes of this Act, a person
7licensed to practice medicine in all its branches under the
8Medical Practice Act of 1987.
9    7. "Supervising Physician" means, for the purposes of this
10Act, the primary supervising physician of a physician
11assistant, who, within his specialty and expertise may delegate
12a variety of tasks and procedures to the physician assistant.
13Such tasks and procedures shall be delegated in accordance with
14a written supervision agreement. The supervising physician
15maintains the final responsibility for the care of the patient
16and the performance of the physician assistant.
17    8. "Alternate supervising physician" means, for the
18purpose of this Act, any physician designated by the
19supervising physician to provide supervision in the event that
20he or she is unable to provide that supervision. The Department
21may further define "alternate supervising physician" by rule.
22    The alternate supervising physicians shall maintain all
23the same responsibilities as the supervising physician.
24Nothing in this Act shall be construed as relieving any
25physician of the professional or legal responsibility for the
26care and treatment of persons attended by him or by physician

 

 

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1assistants under his supervision. Nothing in this Act shall be
2construed as to limit the reasonable number of alternate
3supervising physicians, provided they are designated by the
4supervising physician.
5    9. "Address of record" means the designated address
6recorded by the Department in the applicant's or licensee's
7application file or license file maintained by the Department's
8licensure maintenance unit. It is the duty of the applicant or
9licensee to inform the Department of any change of address, and
10such changes must be made either through the Department's
11website or by contacting the Department's licensure
12maintenance unit.
13(Source: P.A. 95-703, eff. 12-31-07; 96-268, eff. 8-11-09.)
 
14    (225 ILCS 95/7)  (from Ch. 111, par. 4607)
15    (Section scheduled to be repealed on January 1, 2018)
16    Sec. 7. Supervision requirements.
17    (a) A supervising physician shall determine the number of
18physician assistants under his or her supervision provided the
19physician is able to provide adequate supervision as outlined
20in the written supervision agreement required under Section 7.5
21of this Act and consideration is given to the nature of the
22physician's practice, complexity of the patient population,
23and the experience of each supervised physician assistant. A
24supervising physician may supervise a maximum of 5 full-time
25equivalent physician assistants; provided, however, this

 

 

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1number of physician assistants shall be reduced by the number
2of collaborative agreements the supervising physician
3maintains. A No more than 2 physician assistants shall be
4supervised by the supervising physician, although a physician
5assistant shall be able to hold more than one professional
6position. A Each supervising physician shall file a notice of
7supervision of each such physician assistant according to the
8rules of the Department. However, the alternate supervising
9physician may supervise more than 2 physician assistants when
10the supervising physician is unable to provide such supervision
11consistent with the definition of alternate physician in
12Section 4. It is the responsibility of the supervising
13physician to maintain documentation each time he or she has
14designated an alternative supervising physician. This
15documentation shall include the date alternate supervisory
16control began, the date alternate supervisory control ended,
17and any other changes. A supervising physician shall provide a
18copy of this documentation to the Department, upon request.
19    Physician assistants shall be supervised only by
20physicians as defined in this Act who are engaged in clinical
21practice, or in clinical practice in public health or other
22community health facilities.
23    Nothing in this Act shall be construed to limit the
24delegation of tasks or duties by a physician to a nurse or
25other appropriately trained personnel.
26    Nothing in this Act shall be construed to prohibit the

 

 

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1employment of physician assistants by a hospital, nursing home
2or other health care facility where such physician assistants
3function under the supervision of a supervising physician.
4    Physician assistants may be employed by the Department of
5Corrections or the Department of Human Services (as successor
6to the Department of Mental Health and Developmental
7Disabilities) for service in facilities maintained by such
8Departments and affiliated training facilities in programs
9conducted under the authority of the Director of Corrections or
10the Secretary of Human Services. Each physician assistant
11employed by the Department of Corrections or the Department of
12Human Services (as successor to the Department of Mental Health
13and Developmental Disabilities) shall be under the supervision
14of a physician engaged in clinical practice and direct patient
15care. Duties of each physician assistant employed by such
16Departments are limited to those within the scope of practice
17of the supervising physician who is fully responsible for all
18physician assistant activities.
19    A physician assistant may be employed by a practice group
20or other entity employing multiple physicians at one or more
21locations. In that case, one of the physicians practicing at a
22location shall be designated the supervising physician. The
23other physicians with that practice group or other entity who
24practice in the same general type of practice or specialty as
25the supervising physician may supervise the physician
26assistant with respect to their patients without being deemed

 

 

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1alternate supervising physicians for the purpose of this Act.
2    (b) A physician assistant licensed in this State, or
3licensed or authorized to practice in any other U.S.
4jurisdiction or credentialed by his or her federal employer as
5a physician assistant, who is responding to a need for medical
6care created by an emergency or by a state or local disaster
7may render such care that the physician assistant is able to
8provide without supervision as it is defined in this Section or
9with such supervision as is available. For purposes of this
10Section, an "emergency situation" shall not include one that
11occurs in the place of one's employment.
12    Any physician who supervises a physician assistant
13providing medical care in response to such an emergency or
14state or local disaster shall not be required to meet the
15requirements set forth in this Section for a supervising
16physician.
17(Source: P.A. 95-703, eff. 12-31-07; 96-70, eff. 7-23-09.)
 
18    (225 ILCS 95/7.7 new)
19    Sec. 7.7. Physician assistants in hospitals, hospital
20affiliates, or ambulatory surgical treatment centers.
21    (a) A physician assistant may provide services in a
22hospital or a hospital affiliate as those terms are defined in
23the Hospital Licensing Act or the University of Illinois
24Hospital Act or a licensed ambulatory surgical treatment center
25without a written supervision agreement pursuant to Section 7.5

 

 

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1of this Act. A physician assistant must possess clinical
2privileges recommended by the hospital medical staff and
3granted by the hospital or the consulting medical staff
4committee and ambulatory surgical treatment center in order to
5provide services. The medical staff or consulting medical staff
6committee shall periodically review the services of physician
7assistants granted clinical privileges, including any care
8provided in a hospital affiliate. Authority may also be granted
9when recommended by the hospital medical staff and granted by
10the hospital or recommended by the consulting medical staff
11committee and ambulatory surgical treatment center to
12individual physician assistants to select, order, and
13administer medications, including controlled substances, to
14provide delineated care. In a hospital, hospital affiliate, or
15ambulatory surgical treatment center, the attending physician
16shall determine a physician assistant's role in providing care
17for his or her patients, except as otherwise provided in the
18medical staff bylaws or consulting committee policies.
19    (b) A physician assistant granted authority to order
20medications including controlled substances may complete
21discharge prescriptions provided the prescription is in the
22name of the physician assistant and the attending or
23discharging physician.
24    (c) Physician assistants practicing in a hospital,
25hospital affiliate, or an ambulatory surgical treatment center
26are not required to obtain a mid-level controlled substance

 

 

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1license to order controlled substances under Section 303.05 of
2the Illinois Controlled Substances Act.
 
3    (225 ILCS 95/8 rep.)
4    Section 15. The Physician Assistant Practice Act of 1987 is
5amended by repealing Section 8.
 
6    Section 99. Effective date. This Act takes effect upon
7becoming law.