Sen. William R. Haine

Filed: 5/11/2011

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 2255

2    AMENDMENT NO. ______. Amend Senate Bill 2255 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Medical Practice Act of 1987 is amended by
5changing Section 54.5 as follows:
 
6    (225 ILCS 60/54.5)
7    (Section scheduled to be repealed on November 30, 2011)
8    Sec. 54.5. Physician delegation of authority to physician
9assistants and advanced practice nurses.
10    (a) Physicians licensed to practice medicine in all its
11branches may delegate care and treatment responsibilities to a
12physician assistant under guidelines in accordance with the
13requirements of the Physician Assistant Practice Act of 1987. A
14physician licensed to practice medicine in all its branches may
15enter into supervising physician agreements with no more than 2
16physician assistants.

 

 

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1    (b) A physician licensed to practice medicine in all its
2branches in active clinical practice may collaborate with an
3advanced practice nurse in accordance with the requirements of
4the Nurse Practice Act. Collaboration is for the purpose of
5providing medical consultation, and no employment relationship
6is required. A written collaborative agreement shall conform to
7the requirements of Section 65-35 of the Nurse Practice Act.
8The written collaborative agreement shall be for services the
9collaborating physician generally provides to his or her
10patients in the normal course of clinical medical practice. A
11written collaborative agreement shall be adequate with respect
12to collaboration with advanced practice nurses if all of the
13following apply:
14        (1) The agreement is written to promote the exercise of
15    professional judgment by the advanced practice nurse
16    commensurate with his or her education and experience. The
17    agreement need not describe the exact steps that an
18    advanced practice nurse must take with respect to each
19    specific condition, disease, or symptom, but must specify
20    those procedures that require a physician's presence as the
21    procedures are being performed.
22        (2) Practice guidelines and orders are developed and
23    approved jointly by the advanced practice nurse and
24    collaborating physician, as needed, based on the practice
25    of the practitioners. Such guidelines and orders and the
26    patient services provided thereunder are periodically

 

 

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1    reviewed by the collaborating physician.
2        (3) The advance practice nurse provides services the
3    collaborating physician generally provides to his or her
4    patients in the normal course of clinical practice, except
5    as set forth in subsection (b-5) of this Section. With
6    respect to labor and delivery, the collaborating physician
7    must provide delivery services in order to participate with
8    a certified nurse midwife.
9        (4) The collaborating physician and advanced practice
10    nurse consult meet in person at least once a month to
11    provide collaboration and consultation.
12        (5) Methods of communication are available with the
13    collaborating physician in person or through
14    telecommunications for consultation, collaboration, and
15    referral as needed to address patient care needs.
16        (6) The agreement contains provisions detailing notice
17    for termination or change of status involving a written
18    collaborative agreement, except when such notice is given
19    for just cause.
20    (b-5) An anesthesiologist or physician licensed to
21practice medicine in all its branches may collaborate with a
22certified registered nurse anesthetist in accordance with
23Section 65-35 of the Nurse Practice Act for the provision of
24anesthesia services. With respect to the provision of
25anesthesia services, the collaborating anesthesiologist or
26physician shall have training and experience in the delivery of

 

 

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1anesthesia services consistent with Department rules.
2Collaboration shall be adequate if:
3        (1) an anesthesiologist or a physician participates in
4    the joint formulation and joint approval of orders or
5    guidelines and periodically reviews such orders and the
6    services provided patients under such orders; and
7        (2) for anesthesia services, the anesthesiologist or
8    physician participates through discussion of and agreement
9    with the anesthesia plan and is physically present and
10    available on the premises during the delivery of anesthesia
11    services for diagnosis, consultation, and treatment of
12    emergency medical conditions. Anesthesia services in a
13    hospital shall be conducted in accordance with Section 10.7
14    of the Hospital Licensing Act and in an ambulatory surgical
15    treatment center in accordance with Section 6.5 of the
16    Ambulatory Surgical Treatment Center Act.
17    (b-10) The anesthesiologist or operating physician must
18agree with the anesthesia plan prior to the delivery of
19services.
20    (c) The supervising physician shall have access to the
21medical records of all patients attended by a physician
22assistant. The collaborating physician shall have access to the
23medical records of all patients attended to by an advanced
24practice nurse.
25    (d) (Blank).
26    (e) A physician shall not be liable for the acts or

 

 

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1omissions of a physician assistant or advanced practice nurse
2solely on the basis of having signed a supervision agreement or
3guidelines or a collaborative agreement, an order, a standing
4medical order, a standing delegation order, or other order or
5guideline authorizing a physician assistant or advanced
6practice nurse to perform acts, unless the physician has reason
7to believe the physician assistant or advanced practice nurse
8lacked the competency to perform the act or acts or commits
9willful and wanton misconduct.
10    (f) A collaborating physician may, but is not required to,
11delegate prescriptive authority to an advanced practice nurse
12as part of a written collaborative agreement, and the
13delegation of prescriptive authority shall conform to the
14requirements of Section 65-40 of the Nurse Practice Act.
15    (g) A supervising physician may, but is not required to,
16delegate prescriptive authority to a physician assistant as
17part of a written supervision agreement, and the delegation of
18prescriptive authority shall conform to the requirements of
19Section 7.5 of the Physician Assistant Practice Act of 1987.
20(Source: P.A. 95-639, eff. 10-5-07; 96-618, eff. 1-1-10.)
 
21    Section 10. The Nurse Practice Act is amended by changing
22Sections 65-35, 65-40, and 65-45 as follows:
 
23    (225 ILCS 65/65-35)   (was 225 ILCS 65/15-15)
24    (Section scheduled to be repealed on January 1, 2018)

 

 

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1    Sec. 65-35. Written collaborative agreements.
2    (a) A written collaborative agreement is required for all
3advanced practice nurses engaged in clinical practice, except
4for advanced practice nurses who are authorized to practice in
5a hospital or ambulatory surgical treatment center.
6    (a-5) If an advanced practice nurse engages in clinical
7practice outside of a hospital or ambulatory surgical treatment
8center in which he or she is authorized to practice, the
9advanced practice nurse must have a written collaborative
10agreement.
11    (b) A written collaborative agreement shall describe the
12working relationship of the advanced practice nurse with the
13collaborating physician or podiatrist and shall authorize the
14categories of care, treatment, or procedures to be performed by
15the advanced practice nurse. A collaborative agreement with a
16dentist must be in accordance with subsection (c-10) of this
17Section. Collaboration does not require an employment
18relationship between the collaborating physician and advanced
19practice nurse. Absent an employment relationship, an
20agreement may not restrict the categories of patients or
21third-party payment sources accepted by the advanced practice
22nurse. Collaboration means the relationship under which an
23advanced practice nurse works with a collaborating physician or
24podiatrist in an active clinical practice to deliver health
25care services in accordance with (i) the advanced practice
26nurse's training, education, and experience and (ii)

 

 

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1collaboration and consultation as documented in a jointly
2developed written collaborative agreement.
3    The agreement shall be defined to promote the exercise of
4professional judgment by the advanced practice nurse
5commensurate with his or her education and experience. The
6services to be provided by the advanced practice nurse shall be
7services that the collaborating physician or podiatrist is
8authorized to and generally provides to his or her patients in
9the normal course of his or her clinical medical practice,
10except as set forth in subsection (c-5) of this Section. The
11agreement need not describe the exact steps that an advanced
12practice nurse must take with respect to each specific
13condition, disease, or symptom but must specify which
14authorized procedures require the presence of the
15collaborating physician or podiatrist as the procedures are
16being performed. The collaborative relationship under an
17agreement shall not be construed to require the personal
18presence of a physician or podiatrist at all times at the place
19where services are rendered. Methods of communication shall be
20available for consultation with the collaborating physician or
21podiatrist in person or by telecommunications in accordance
22with established written guidelines as set forth in the written
23agreement.
24    (c) Collaboration and consultation under all collaboration
25agreements shall be adequate if a collaborating physician or
26podiatrist does each of the following:

 

 

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1        (1) Participates in the joint formulation and joint
2    approval of orders or guidelines with the advanced practice
3    nurse and he or she periodically reviews such orders and
4    the services provided patients under such orders in
5    accordance with accepted standards of medical practice or
6    podiatric practice and advanced practice nursing practice.
7        (2) Provides collaboration and consultation Meets in
8    person with the advanced practice nurse at least once a
9    month to provide collaboration and consultation. In the
10    case of anesthesia services provided by a certified
11    registered nurse anesthetist, an anesthesiologist,
12    physician, dentist, or podiatrist must participate through
13    discussion of and agreement with the anesthesia plan and
14    remain physically present and available on the premises
15    during the delivery of anesthesia services for diagnosis,
16    consultation, and treatment of emergency medical
17    conditions.
18        (3) Is available through telecommunications for
19    consultation on medical problems, complications, or
20    emergencies or patient referral. In the case of anesthesia
21    services provided by a certified registered nurse
22    anesthetist, an anesthesiologist, physician, dentist, or
23    podiatrist must participate through discussion of and
24    agreement with the anesthesia plan and remain physically
25    present and available on the premises during the delivery
26    of anesthesia services for diagnosis, consultation, and

 

 

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1    treatment of emergency medical conditions.
2    The agreement must contain provisions detailing notice for
3termination or change of status involving a written
4collaborative agreement, except when such notice is given for
5just cause.
6    (c-5) A certified registered nurse anesthetist, who
7provides anesthesia services outside of a hospital or
8ambulatory surgical treatment center shall enter into a written
9collaborative agreement with an anesthesiologist or the
10physician licensed to practice medicine in all its branches or
11the podiatrist performing the procedure. Outside of a hospital
12or ambulatory surgical treatment center, the certified
13registered nurse anesthetist may provide only those services
14that the collaborating podiatrist is authorized to provide
15pursuant to the Podiatric Medical Practice Act of 1987 and
16rules adopted thereunder. A certified registered nurse
17anesthetist may select, order, and administer medication,
18including controlled substances, and apply appropriate medical
19devices for delivery of anesthesia services under the
20anesthesia plan agreed with by the anesthesiologist or the
21operating physician or operating podiatrist.
22    (c-10) A certified registered nurse anesthetist who
23provides anesthesia services in a dental office shall enter
24into a written collaborative agreement with an
25anesthesiologist or the physician licensed to practice
26medicine in all its branches or the operating dentist

 

 

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1performing the procedure. The agreement shall describe the
2working relationship of the certified registered nurse
3anesthetist and dentist and shall authorize the categories of
4care, treatment, or procedures to be performed by the certified
5registered nurse anesthetist. In a collaborating dentist's
6office, the certified registered nurse anesthetist may only
7provide those services that the operating dentist with the
8appropriate permit is authorized to provide pursuant to the
9Illinois Dental Practice Act and rules adopted thereunder. For
10anesthesia services, an anesthesiologist, physician, or
11operating dentist shall participate through discussion of and
12agreement with the anesthesia plan and shall remain physically
13present and be available on the premises during the delivery of
14anesthesia services for diagnosis, consultation, and treatment
15of emergency medical conditions. A certified registered nurse
16anesthetist may select, order, and administer medication,
17including controlled substances, and apply appropriate medical
18devices for delivery of anesthesia services under the
19anesthesia plan agreed with by the operating dentist.
20    (d) A copy of the signed, written collaborative agreement
21must be available to the Department upon request from both the
22advanced practice nurse and the collaborating physician or
23podiatrist.
24    (e) Nothing in this Act shall be construed to limit the
25delegation of tasks or duties by a physician to a licensed
26practical nurse, a registered professional nurse, or other

 

 

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1persons in accordance with Section 54.2 of the Medical Practice
2Act of 1987. Nothing in this Act shall be construed to limit
3the method of delegation that may be authorized by any means,
4including, but not limited to, oral, written, electronic,
5standing orders, protocols, guidelines, or verbal orders.
6    (f) An advanced practice nurse shall inform each
7collaborating physician, dentist, or podiatrist of all
8collaborative agreements he or she has signed and provide a
9copy of these to any collaborating physician, dentist, or
10podiatrist upon request.
11    (g) For the purposes of this Act, "generally provides to
12his or her patients in the normal course of his or her clinical
13medical practice" means services, not specific tasks or duties,
14the physician or podiatrist routinely provides individually or
15through delegation to other persons so that the physician or
16podiatrist has the experience and ability to provide
17collaboration and consultation.
18(Source: P.A. 95-639, eff. 10-5-07; 96-618, eff. 1-1-10.)
 
19    (225 ILCS 65/65-40)   (was 225 ILCS 65/15-20)
20    (Section scheduled to be repealed on January 1, 2018)
21    Sec. 65-40. Written collaborative agreement; prescriptive
22Prescriptive authority.
23    (a) A collaborating physician or podiatrist may, but is not
24required to, delegate prescriptive authority to an advanced
25practice nurse as part of a written collaborative agreement.

 

 

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1This authority may, but is not required to, include
2prescription of, selection of, orders for, administration of,
3storage of, acceptance of samples of, and dispensing over the
4counter medications, legend drugs, medical gases, and
5controlled substances categorized as any Schedule III through V
6controlled substances, as defined in Article II of the Illinois
7Controlled Substances Act, and other preparations, including,
8but not limited to, botanical and herbal remedies. The
9collaborating physician or podiatrist must have a valid current
10Illinois controlled substance license and federal registration
11to delegate authority to prescribe delegated controlled
12substances.
13    (b) To prescribe controlled substances under this Section,
14an advanced practice nurse must obtain a mid-level practitioner
15controlled substance license. Medication orders shall be
16reviewed periodically by the collaborating physician or
17podiatrist.
18    (c) The collaborating physician or podiatrist shall file
19with the Department notice of delegation of prescriptive
20authority and termination of such delegation, in accordance
21with rules of the Department. Upon receipt of this notice
22delegating authority to prescribe any Schedule III through V
23controlled substances, the licensed advanced practice nurse
24shall be eligible to register for a mid-level practitioner
25controlled substance license under Section 303.05 of the
26Illinois Controlled Substances Act.

 

 

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1    (d) In addition to the requirements of subsections (a),
2(b), and (c) of this Section, a collaborating physician or
3podiatrist may, but is not required to, delegate authority to
4an advanced practice nurse to prescribe any Schedule II
5controlled substances, if all of the following conditions
6apply:
7        (1) Specific No more than 5 Schedule II controlled
8    substances by oral dosage or topical or transdermal
9    application may be delegated, provided that the delegated
10    Schedule II controlled substances are routinely prescribed
11    by the collaborating physician or podiatrist. This
12    delegation must identify the specific Schedule II
13    controlled substances by either brand name or generic name.
14    Schedule II controlled substances to be delivered by
15    injection or other route of administration may not be
16    delegated.
17        (2) Any delegation must be controlled substances that
18    the collaborating physician or podiatrist prescribes.
19        (3) Any prescription must be limited to no more than a
20    30-day supply oral dosage, with any continuation
21    authorized only after prior approval of the collaborating
22    physician or podiatrist.
23        (4) The advanced practice nurse must discuss the
24    condition of any patients for whom a controlled substance
25    is prescribed monthly with the delegating physician.
26        (5) The advanced practice nurse meets the education

 

 

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1    requirements of Section 303.05 of the Illinois Controlled
2    Substances Act.
3    (e) Nothing in this Act shall be construed to limit the
4delegation of tasks or duties by a physician to a licensed
5practical nurse, a registered professional nurse, or other
6persons. Nothing in this Act shall be construed to limit the
7method of delegation that may be authorized by any means,
8including, but not limited to, oral, written, electronic,
9standing orders, protocols, guidelines, or verbal orders.
10    (f) Nothing in this Section shall be construed to apply to
11any medication authority including Schedule II controlled
12substances of an advanced practice nurse for care provided in a
13hospital, hospital affiliate, or ambulatory surgical treatment
14center pursuant to Section 65-45.
15    (g) Any advanced practice nurse who writes a prescription
16for a controlled substance without having a valid appropriate
17authority may be fined by the Department not more than $50 per
18prescription, and the Department may take any other
19disciplinary action provided for in this Act.
20    (h) Nothing in this Section shall be construed to prohibit
21generic substitution.
22(Source: P.A. 95-639, eff. 10-5-07; 96-189, eff. 8-10-09.)
 
23    (225 ILCS 65/65-45)   (was 225 ILCS 65/15-25)
24    (Section scheduled to be repealed on January 1, 2018)
25    Sec. 65-45. Advanced practice nursing in hospitals,

 

 

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1hospital affiliates, or ambulatory surgical treatment centers.
2    (a) An advanced practice nurse may provide services in a
3licensed hospital or a hospital affiliate as those terms are
4defined in the Hospital Licensing Act or the University of
5Illinois Hospital Act or a licensed ambulatory surgical
6treatment center without prescriptive authority or a written
7collaborative agreement pursuant to Section 65-35 of this Act.
8An advanced practice nurse must possess clinical privileges
9recommended by the hospital medical staff and granted by the
10hospital or the consulting medical staff committee and
11ambulatory surgical treatment center in order to provide
12services. The medical staff or consulting medical staff
13committee shall periodically review the services of advanced
14practice nurses granted clinical privileges, including any
15care provided in a hospital affiliate. Authority may also be
16granted when recommended by the hospital medical staff and
17granted by the hospital or recommended by the consulting
18medical staff committee and ambulatory surgical treatment
19center to individual advanced practice nurses to select, order,
20and administer medications, including controlled substances,
21to provide delineated care. In a hospital, hospital affiliate,
22or ambulatory surgical treatment center, the The attending
23physician shall determine an advanced practice nurse's role in
24providing care for his or her patients, except as otherwise
25provided in the medical staff bylaws or consulting committee
26policies.

 

 

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1    (a-2) An advanced practice nurse granted authority to order
2medications including controlled substances may complete
3discharge prescriptions provided the prescription is in the
4name of the advanced practice nurse and the attending or
5discharging physician.
6    (a-3) Advanced practice nurses practicing in a hospital or
7an ambulatory surgical treatment center are not required to
8obtain a mid-level controlled substance license to order
9controlled substances under Section 303.05 of the Illinois
10Controlled Substances Act.
11    (a-5) For anesthesia services provided by a certified
12registered nurse anesthetist, an anesthesiologist, physician,
13dentist, or podiatrist shall participate through discussion of
14and agreement with the anesthesia plan and shall remain
15physically present and be available on the premises during the
16delivery of anesthesia services for diagnosis, consultation,
17and treatment of emergency medical conditions, unless hospital
18policy adopted pursuant to clause (B) of subdivision (3) of
19Section 10.7 of the Hospital Licensing Act or ambulatory
20surgical treatment center policy adopted pursuant to clause (B)
21of subdivision (3) of Section 6.5 of the Ambulatory Surgical
22Treatment Center Act provides otherwise. A certified
23registered nurse anesthetist may select, order, and administer
24medication for anesthesia services under the anesthesia plan
25agreed to by the anesthesiologist or the physician, in
26accordance with hospital alternative policy or the medical

 

 

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1staff consulting committee policies of a licensed ambulatory
2surgical treatment center.
3    (b) An advanced practice nurse who provides services in a
4hospital shall do so in accordance with Section 10.7 of the
5Hospital Licensing Act and, in an ambulatory surgical treatment
6center, in accordance with Section 6.5 of the Ambulatory
7Surgical Treatment Center Act.
8(Source: P.A. 95-639, eff. 10-5-07.)
 
9    Section 15. The Physician Assistant Practice Act of 1987 is
10amended by changing Section 7.5 as follows:
 
11    (225 ILCS 95/7.5)
12    (Section scheduled to be repealed on January 1, 2018)
13    Sec. 7.5. Prescriptions; written supervision agreements;
14prescriptive authority.
15    (a) A written supervision agreement is required for all
16physician assistants to practice in the State.
17        (1) A written supervision agreement shall describe the
18    working relationship of the physician assistant with the
19    supervising physician and shall authorize the categories
20    of care, treatment, or procedures to be performed by the
21    physician assistant. The written supervision agreement
22    shall be defined to promote the exercise of professional
23    judgment by the physician assistant commensurate with his
24    or her education and experience. The services to be

 

 

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1    provided by the physician assistant shall be services that
2    the supervising physician is authorized to and generally
3    provides to his or her patients in the normal course of his
4    or her clinical medical practice. The written supervision
5    agreement need not describe the exact steps that a
6    physician assistant must take with respect to each specific
7    condition, disease, or symptom but must specify which
8    authorized procedures require the presence of the
9    supervising physician as the procedures are being
10    performed. The supervision relationship under a written
11    supervision agreement shall not be construed to require the
12    personal presence of a physician at all times at the place
13    where services are rendered. Methods of communication
14    shall be available for consultation with the supervising
15    physician in person or by telecommunications in accordance
16    with established written guidelines as set forth in the
17    written supervision agreement. For the purposes of this
18    Act, "generally provides to his or her patients in the
19    normal course of his or her clinical medical practice"
20    means services, not specific tasks or duties, the
21    supervising physician routinely provides individually or
22    through delegation to other persons so that the physician
23    has the experience and ability to provide supervision and
24    consultation.
25        (2) The written supervision agreement shall be
26    adequate if a physician does each of the following:

 

 

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1            (A) Participates in the joint formulation and
2        joint approval of orders or guidelines with the
3        physician assistant and he or she periodically reviews
4        such orders and the services provided patients under
5        such orders in accordance with accepted standards of
6        medical practice and physician assistant practice.
7            (B) Provides supervision and consultation Meets in
8        person with the physician assistant at least once a
9        month to provide supervision.
10        (3) A copy of the signed, written supervision agreement
11    must be available to the Department upon request from both
12    the physician assistant and the supervising physician.
13        (4) A physician assistant shall inform each
14    supervising physician of all written supervision
15    agreements he or she has signed and provide a copy of these
16    to any supervising physician upon request.
17    (b) A supervising physician may, but is not required to,
18delegate prescriptive authority to a physician assistant as
19part of a written supervision agreement. This authority may,
20but is not required to, include prescription of, selection of,
21orders for, administration of, storage of, acceptance of
22samples of, and dispensing over the counter medications, legend
23drugs, medical gases, and controlled substances categorized as
24Schedule III through V controlled substances, as defined in
25Article II of the Illinois Controlled Substances Act, and other
26preparations, including, but not limited to, botanical and

 

 

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1herbal remedies. The supervising physician must have a valid,
2current Illinois controlled substance license and federal
3registration with the Drug Enforcement Agency to delegate the
4authority to prescribe controlled substances.
5        (1) To prescribe Schedule III, IV, or V controlled
6    substances under this Section, a physician assistant must
7    obtain a mid-level practitioner controlled substances
8    license. Medication orders issued by a physician assistant
9    shall be reviewed periodically by the supervising
10    physician.
11        (2) The supervising physician shall file with the
12    Department notice of delegation of prescriptive authority
13    to a physician assistant and termination of delegation,
14    specifying the authority delegated or terminated. Upon
15    receipt of this notice delegating authority to prescribe
16    Schedule III, IV, or V controlled substances, the physician
17    assistant shall be eligible to register for a mid-level
18    practitioner controlled substances license under Section
19    303.05 of the Illinois Controlled Substances Act. Nothing
20    in this Act shall be construed to limit the delegation of
21    tasks or duties by the supervising physician to a nurse or
22    other appropriately trained persons in accordance with
23    Section 54.2 of the Medical Practice Act of 1987.
24        (3) In addition to the requirements of subsection (b)
25    of this Section, a supervising physician may, but is not
26    required to, delegate authority to a physician assistant to

 

 

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1    prescribe Schedule II controlled substances, if all of the
2    following conditions apply:
3            (A) Specific No more than 5 Schedule II controlled
4        substances by oral dosage or topical or transdermal
5        application may be delegated, provided that the
6        delegated Schedule II controlled substances are
7        routinely prescribed by the supervising physician.
8        This delegation must identify the specific Schedule II
9        controlled substances by either brand name or generic
10        name. Schedule II controlled substances to be
11        delivered by injection or other route of
12        administration may not be delegated.
13            (B) Any delegation must be controlled substances
14        that the supervising physician prescribes.
15            (C) Any prescription must be limited to no more
16        than a 30-day supply oral dosage, with any continuation
17        authorized only after prior approval of the
18        supervising physician.
19            (D) The physician assistant must discuss the
20        condition of any patients for whom a controlled
21        substance is prescribed monthly with the supervising
22        physician.
23            (E) The physician assistant meets the education
24        requirements of Section 303.05 of the Illinois
25        Controlled Substances Act.
26    (c) Nothing in this Act shall be construed to limit the

 

 

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1delegation of tasks or duties by a physician to a licensed
2practical nurse, a registered professional nurse, or other
3persons. Nothing in this Act shall be construed to limit the
4method of delegation that may be authorized by any means,
5including, but not limited to, oral, written, electronic,
6standing orders, protocols, guidelines, or verbal orders.
7    (d) Any physician assistant who writes a prescription for a
8controlled substance without having a valid appropriate
9authority may be fined by the Department not more than $50 per
10prescription, and the Department may take any other
11disciplinary action provided for in this Act.
12    (e) Nothing in this Section shall be construed to prohibit
13generic substitution.
14(Source: P.A. 96-268, eff. 8-11-09; 96-618, eff. 1-1-10;
1596-1000, eff. 7-2-10.)
 
16    Section 20. The Podiatric Medical Practice Act of 1987 is
17amended by changing Section 20.5 as follows:
 
18    (225 ILCS 100/20.5)
19    (Section scheduled to be repealed on January 1, 2018)
20    Sec. 20.5. Delegation of authority to advanced practice
21nurses.
22    (a) A podiatrist in active clinical practice may
23collaborate with an advanced practice nurse in accordance with
24the requirements of the Nurse Practice Act. Collaboration shall

 

 

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1be for the purpose of providing podiatric consultation and no
2employment relationship shall be required. A written
3collaborative agreement shall conform to the requirements of
4Section 65-35 of the Nurse Practice Act. The written
5collaborative agreement shall be for services the
6collaborating podiatrist generally provides to his or her
7patients in the normal course of clinical podiatric practice,
8except as set forth in item (3) of this subsection (a). A
9written collaborative agreement and podiatric collaboration
10and consultation shall be adequate with respect to advanced
11practice nurses if all of the following apply:
12        (1) The agreement is written to promote the exercise of
13    professional judgment by the advanced practice nurse
14    commensurate with his or her education and experience. The
15    agreement need not describe the exact steps that an
16    advanced practice nurse must take with respect to each
17    specific condition, disease, or symptom, but must specify
18    which procedures require a podiatrist's presence as the
19    procedures are being performed.
20        (2) Practice guidelines and orders are developed and
21    approved jointly by the advanced practice nurse and
22    collaborating podiatrist, as needed, based on the practice
23    of the practitioners. Such guidelines and orders and the
24    patient services provided thereunder are periodically
25    reviewed by the collaborating podiatrist.
26        (3) The advance practice nurse provides services that

 

 

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1    the collaborating podiatrist generally provides to his or
2    her patients in the normal course of clinical practice.
3    With respect to the provision of anesthesia services by a
4    certified registered nurse anesthetist, the collaborating
5    podiatrist must have training and experience in the
6    delivery of anesthesia consistent with Department rules.
7        (4) The collaborating podiatrist and the advanced
8    practice nurse consult meet in person at least once a month
9    to provide collaboration and consultation.
10        (5) Methods of communication are available with the
11    collaborating podiatrist in person or through
12    telecommunications for consultation, collaboration, and
13    referral as needed to address patient care needs.
14        (6) With respect to the provision of anesthesia
15    services by a certified registered nurse anesthetist, an
16    anesthesiologist, physician, or podiatrist shall
17    participate through discussion of and agreement with the
18    anesthesia plan and shall remain physically present and be
19    available on the premises during the delivery of anesthesia
20    services for diagnosis, consultation, and treatment of
21    emergency medical conditions. The anesthesiologist or
22    operating podiatrist must agree with the anesthesia plan
23    prior to the delivery of services.
24        (7) The agreement contains provisions detailing notice
25    for termination or change of status involving a written
26    collaborative agreement, except when such notice is given

 

 

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1    for just cause.
2    (b) The collaborating podiatrist shall have access to the
3records of all patients attended to by an advanced practice
4nurse.
5    (c) Nothing in this Section shall be construed to limit the
6delegation of tasks or duties by a podiatrist to a licensed
7practical nurse, a registered professional nurse, or other
8appropriately trained persons.
9    (d) A podiatrist shall not be liable for the acts or
10omissions of an advanced practice nurse solely on the basis of
11having signed guidelines or a collaborative agreement, an
12order, a standing order, a standing delegation order, or other
13order or guideline authorizing an advanced practice nurse to
14perform acts, unless the podiatrist has reason to believe the
15advanced practice nurse lacked the competency to perform the
16act or acts or commits willful or wanton misconduct.
17    (f) A podiatrist, may, but is not required to delegate
18prescriptive authority to an advanced practice nurse as part of
19a written collaborative agreement and the delegation of
20prescriptive authority shall conform to the requirements of
21Section 65-40 of the Nurse Practice Act.
22(Source: P.A. 95-639, eff. 10-5-07; 96-618, eff. 1-1-10.)
 
23    Section 25. The Illinois Controlled Substances Act is
24amended by changing Section 303.05 as follows:
 

 

 

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1    (720 ILCS 570/303.05)
2    Sec. 303.05. Mid-level practitioner registration.
3    (a) The Department of Financial and Professional
4Regulation shall register licensed physician assistants and
5licensed advanced practice nurses to prescribe and dispense
6controlled substances under Section 303 and euthanasia
7agencies to purchase, store, or administer animal euthanasia
8drugs under the following circumstances:
9        (1) with respect to physician assistants,
10            (A) the physician assistant has been delegated
11        authority to prescribe any Schedule III through V
12        controlled substances by a physician licensed to
13        practice medicine in all its branches in accordance
14        with Section 7.5 of the Physician Assistant Practice
15        Act of 1987; and the physician assistant has completed
16        the appropriate application forms and has paid the
17        required fees as set by rule; or
18            (B) the physician assistant has been delegated
19        authority by a supervising physician licensed to
20        practice medicine in all its branches to prescribe or
21        dispense Schedule II controlled substances through a
22        written delegation of authority and under the
23        following conditions:
24                (i) Specific no more than 5 Schedule II
25            controlled substances by oral dosage or topical or
26            transdermal application may be delegated, provided

 

 

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1            that the delegated Schedule II controlled
2            substances are routinely prescribed by the
3            supervising physician. This delegation must
4            identify the specific Schedule II controlled
5            substances by either brand name or generic name.
6            Schedule II controlled substances to be delivered
7            by injection or other route of administration may
8            not be delegated;
9                (ii) any delegation must be of controlled
10            substances prescribed by the supervising
11            physician;
12                (iii) all prescriptions must be limited to no
13            more than a 30-day supply oral dosage, with any
14            continuation authorized only after prior approval
15            of the supervising physician;
16                (iv) the physician assistant must discuss the
17            condition of any patients for whom a controlled
18            substance is prescribed monthly with the
19            delegating physician; and
20                (v) the physician assistant must have
21            completed the appropriate application forms and
22            paid the required fees as set by rule;
23                (vi) the physician assistant must provide
24            evidence of satisfactory completion of 45 graduate
25            contact hours in pharmacology for any new license
26            issued with Schedule II authority after the

 

 

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1            effective date of this amendatory Act of the 97th
2            General Assembly; and
3                (vii) the physician assistant must annually
4            complete at least 5 hours of continuing education
5            in pharmacology.
6        (2) with respect to advanced practice nurses,
7            (A) the advanced practice nurse has been delegated
8        authority to prescribe any Schedule III through V
9        controlled substances by a collaborating physician
10        licensed to practice medicine in all its branches or a
11        collaborating podiatrist in accordance with Section
12        65-40 of the Nurse Practice Act. The advanced practice
13        nurse has completed the appropriate application forms
14        and has paid the required fees as set by rule; or
15            (B) the advanced practice nurse has been delegated
16        authority by a collaborating physician licensed to
17        practice medicine in all its branches or collaborating
18        podiatrist to prescribe or dispense Schedule II
19        controlled substances through a written delegation of
20        authority and under the following conditions:
21                (i) specific no more than 5 Schedule II
22            controlled substances by oral dosage or topical or
23            transdermal application may be delegated, provided
24            that the delegated Schedule II controlled
25            substances are routinely prescribed by the
26            collaborating physician or podiatrist. This

 

 

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1            delegation must identify the specific Schedule II
2            controlled substances by either brand name or
3            generic name. Schedule II controlled substances to
4            be delivered by injection or other route of
5            administration may not be delegated;
6                (ii) any delegation must be of controlled
7            substances prescribed by the collaborating
8            physician or podiatrist;
9                (iii) all prescriptions must be limited to no
10            more than a 30-day supply oral dosage, with any
11            continuation authorized only after prior approval
12            of the collaborating physician or podiatrist;
13                (iv) the advanced practice nurse must discuss
14            the condition of any patients for whom a controlled
15            substance is prescribed monthly with the
16            delegating physician or podiatrist; and
17                (v) the advanced practice nurse must have
18            completed the appropriate application forms and
19            paid the required fees as set by rule; or
20                (vi) the advanced practice nurse must provide
21            evidence of satisfactory completion of at least 45
22            graduate contact hours in pharmacology for any new
23            license issued with Schedule II authority after
24            the effective date of this amendatory Act of the
25            97th General Assembly; and
26                (vii) the advanced practice nurse must

 

 

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1            annually complete 5 hours of continuing education
2            in pharmacology; or
3        (3) with respect to animal euthanasia agencies, the
4    euthanasia agency has obtained a license from the
5    Department of Professional Regulation and obtained a
6    registration number from the Department.
7    (b) The mid-level practitioner shall only be licensed to
8prescribe those schedules of controlled substances for which a
9licensed physician or licensed podiatrist has delegated
10prescriptive authority, except that an animal euthanasia
11agency does not have any prescriptive authority. A physician
12assistant and an advanced practice nurse are prohibited from
13prescribing medications and controlled substances not set
14forth in the required written delegation of authority.
15    (c) Upon completion of all registration requirements,
16physician assistants, advanced practice nurses, and animal
17euthanasia agencies shall be issued a mid-level practitioner
18controlled substances license for Illinois.
19    (d) A collaborating physician or podiatrist may, but is not
20required to, delegate prescriptive authority to an advanced
21practice nurse as part of a written collaborative agreement,
22and the delegation of prescriptive authority shall conform to
23the requirements of Section 65-40 of the Nurse Practice Act.
24    (e) A supervising physician may, but is not required to,
25delegate prescriptive authority to a physician assistant as
26part of a written supervision agreement, and the delegation of

 

 

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1prescriptive authority shall conform to the requirements of
2Section 7.5 of the Physician Assistant Practice Act of 1987.
3    (f) Nothing in this Section shall be construed to prohibit
4generic substitution.
5(Source: P.A. 95-639, eff. 10-5-07; 96-189, eff. 8-10-09;
696-268, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
7    Section 99. Effective date. This Act takes effect July 1,
82011.".