HB1052 EngrossedLRB098 05035 MGM 35066 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 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7    (Section scheduled to be repealed on December 31, 2013)
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 5
16physician assistants as set forth in subsection (a) of Section
177 of the Physician Assistant Practice Act of 1987.
18    (b) A physician licensed to practice medicine in all its
19branches in active clinical practice may collaborate with an
20advanced practice nurse in accordance with the requirements of
21the Nurse Practice Act. Collaboration is for the purpose of
22providing medical consultation, and no employment relationship
23is required. A written collaborative agreement shall conform to

 

 

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1the requirements of Section 65-35 of the Nurse Practice Act.
2The written collaborative agreement shall be for services the
3collaborating physician generally provides or may provide in to
4his or her patients in the normal course of clinical medical
5practice. A written collaborative agreement shall be adequate
6with respect to collaboration with advanced practice nurses if
7all of the following apply:
8        (1) The agreement is written to promote the exercise of
9    professional judgment by the advanced practice nurse
10    commensurate with his or her education and experience. The
11    agreement need not describe the exact steps that an
12    advanced practice nurse must take with respect to each
13    specific condition, disease, or symptom, but must specify
14    those procedures that require a physician's presence as the
15    procedures are being performed.
16        (2) Practice guidelines and orders are developed and
17    approved jointly by the advanced practice nurse and
18    collaborating physician, as needed, based on the practice
19    of the practitioners. Such guidelines and orders and the
20    patient services provided thereunder are periodically
21    reviewed by the collaborating physician.
22        (3) The advance practice nurse provides services the
23    collaborating physician generally provides or may provide
24    in to his or her patients in the normal course of clinical
25    medical practice, except as set forth in subsection (b-5)
26    of this Section. With respect to labor and delivery, the

 

 

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

 

 

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

 

 

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1to believe the physician assistant or advanced practice nurse
2lacked the competency to perform the act or acts or commits
3willful and wanton misconduct.
4    (f) A collaborating physician may, but is not required to,
5delegate prescriptive authority to an advanced practice nurse
6as part of a written collaborative agreement, and the
7delegation of prescriptive authority shall conform to the
8requirements of Section 65-40 of the Nurse Practice Act.
9    (g) A supervising physician may, but is not required to,
10delegate prescriptive authority to a physician assistant as
11part of a written supervision agreement, and the delegation of
12prescriptive authority shall conform to the requirements of
13Section 7.5 of the Physician Assistant Practice Act of 1987.
14    (h) For the purposes of this Section, "generally provides
15or may provide in his or her clinical medical practice" means
16categories of care or treatment, not specific tasks or duties,
17that the physician provides individually or through delegation
18to other persons so that the physician has the experience and
19ability to provide collaboration and consultation. This
20definition shall not be construed to prohibit an advanced
21practice nurse from providing primary health treatment or care
22within the scope of his or her training and experience,
23including, but not limited to, health screenings, patient
24histories, physical examinations, women's health examinations,
25or school physicals that may be provided as part of the routine
26practice of an advanced practice nurse or on a volunteer basis.

 

 

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1(Source: P.A. 96-618, eff. 1-1-10; 97-358, eff. 8-12-11;
297-1071, eff. 8-24-12.)
 
3    Section 10. The Nurse Practice Act is amended by changing
4Section 65-35 as follows:
 
5    (225 ILCS 65/65-35)   (was 225 ILCS 65/15-15)
6    (Section scheduled to be repealed on January 1, 2018)
7    Sec. 65-35. Written collaborative agreements.
8    (a) A written collaborative agreement is required for all
9advanced practice nurses engaged in clinical practice, except
10for advanced practice nurses who are authorized to practice in
11a hospital or ambulatory surgical treatment center.
12    (a-5) If an advanced practice nurse engages in clinical
13practice outside of a hospital or ambulatory surgical treatment
14center in which he or she is authorized to practice, the
15advanced practice nurse must have a written collaborative
16agreement.
17    (b) A written collaborative agreement shall describe the
18working relationship of the advanced practice nurse with the
19collaborating physician or podiatrist and shall authorize the
20categories of care, treatment, or procedures to be performed by
21the advanced practice nurse. A collaborative agreement with a
22dentist must be in accordance with subsection (c-10) of this
23Section. Collaboration does not require an employment
24relationship between the collaborating physician and advanced

 

 

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1practice nurse. Absent an employment relationship, an
2agreement may not restrict the categories of patients or
3third-party payment sources accepted by the advanced practice
4nurse. Collaboration means the relationship under which an
5advanced practice nurse works with a collaborating physician or
6podiatrist in an active clinical practice to deliver health
7care services in accordance with (i) the advanced practice
8nurse's training, education, and experience and (ii)
9collaboration and consultation as documented in a jointly
10developed written collaborative agreement.
11    The agreement shall promote the exercise of professional
12judgment by the advanced practice nurse commensurate with his
13or her education and experience. The services to be provided by
14the advanced practice nurse shall be services that the
15collaborating physician or podiatrist is authorized to and
16generally provides or may provide to his or her patients in the
17normal course of his or her clinical medical or podiatric
18practice, except as set forth in subsections (b-5) or
19subsection (c-5) of this Section. The agreement need not
20describe the exact steps that an advanced practice nurse must
21take with respect to each specific condition, disease, or
22symptom but must specify which authorized procedures require
23the presence of the collaborating physician or podiatrist as
24the procedures are being performed. The collaborative
25relationship under an agreement shall not be construed to
26require the personal presence of a physician or podiatrist at

 

 

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1the place where services are rendered. Methods of communication
2shall be available for consultation with the collaborating
3physician or podiatrist in person or by telecommunications in
4accordance with established written guidelines as set forth in
5the written agreement.
6    (b-5) Absent an employment relationship, a written
7collaborative agreement may not (1) restrict the categories of
8patients of an advanced practice nurse within the scope of the
9advanced practice nurses training and experience, (2) limit
10third party payors or government health programs, such as the
11medical assistance program or Medicare with which the advanced
12practice nurse contracts, or (3) limit the geographic area or
13practice location of the advanced practice nurse in this State.
14    (c) Collaboration and consultation under all collaboration
15agreements shall be adequate if a collaborating physician or
16podiatrist does each of the following:
17        (1) Participates in the joint formulation and joint
18    approval of orders or guidelines with the advanced practice
19    nurse and he or she periodically reviews such orders and
20    the services provided patients under such orders in
21    accordance with accepted standards of medical practice or
22    podiatric practice and advanced practice nursing practice.
23        (2) Provides collaboration and consultation with the
24    advanced practice nurse at least once a month. In the case
25    of anesthesia services provided by a certified registered
26    nurse anesthetist, an anesthesiologist, physician,

 

 

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1    dentist, or podiatrist must participate through discussion
2    of and agreement with the anesthesia plan and remain
3    physically present and available on the premises during the
4    delivery of anesthesia services for diagnosis,
5    consultation, and treatment of emergency medical
6    conditions.
7        (3) Is available through telecommunications for
8    consultation on medical problems, complications, or
9    emergencies or patient referral. In the case of anesthesia
10    services provided by a certified registered nurse
11    anesthetist, an anesthesiologist, physician, dentist, or
12    podiatrist must participate through discussion of and
13    agreement with the anesthesia plan and remain physically
14    present and available on the premises during the delivery
15    of anesthesia services for diagnosis, consultation, and
16    treatment of emergency medical conditions.
17    The agreement must contain provisions detailing notice for
18termination or change of status involving a written
19collaborative agreement, except when such notice is given for
20just cause.
21    (c-5) A certified registered nurse anesthetist, who
22provides anesthesia services outside of a hospital or
23ambulatory surgical treatment center shall enter into a written
24collaborative agreement with an anesthesiologist or the
25physician licensed to practice medicine in all its branches or
26the podiatrist performing the procedure. Outside of a hospital

 

 

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1or ambulatory surgical treatment center, the certified
2registered nurse anesthetist may provide only those services
3that the collaborating podiatrist is authorized to provide
4pursuant to the Podiatric Medical Practice Act of 1987 and
5rules adopted thereunder. A certified registered nurse
6anesthetist may select, order, and administer medication,
7including controlled substances, and apply appropriate medical
8devices for delivery of anesthesia services under the
9anesthesia plan agreed with by the anesthesiologist or the
10operating physician or operating podiatrist.
11    (c-10) A certified registered nurse anesthetist who
12provides anesthesia services in a dental office shall enter
13into a written collaborative agreement with an
14anesthesiologist or the physician licensed to practice
15medicine in all its branches or the operating dentist
16performing the procedure. The agreement shall describe the
17working relationship of the certified registered nurse
18anesthetist and dentist and shall authorize the categories of
19care, treatment, or procedures to be performed by the certified
20registered nurse anesthetist. In a collaborating dentist's
21office, the certified registered nurse anesthetist may only
22provide those services that the operating dentist with the
23appropriate permit is authorized to provide pursuant to the
24Illinois Dental Practice Act and rules adopted thereunder. For
25anesthesia services, an anesthesiologist, physician, or
26operating dentist shall participate through discussion of and

 

 

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1agreement with the anesthesia plan and shall remain physically
2present and be available on the premises during the delivery of
3anesthesia services for diagnosis, consultation, and treatment
4of emergency medical conditions. A certified registered nurse
5anesthetist may select, order, and administer medication,
6including controlled substances, and apply appropriate medical
7devices for delivery of anesthesia services under the
8anesthesia plan agreed with by the operating dentist.
9    (d) A copy of the signed, written collaborative agreement
10must be available to the Department upon request from both the
11advanced practice nurse and the collaborating physician or
12podiatrist.
13    (e) Nothing in this Act shall be construed to limit the
14delegation of tasks or duties by a physician to a licensed
15practical nurse, a registered professional nurse, or other
16persons in accordance with Section 54.2 of the Medical Practice
17Act of 1987. Nothing in this Act shall be construed to limit
18the method of delegation that may be authorized by any means,
19including, but not limited to, oral, written, electronic,
20standing orders, protocols, guidelines, or verbal orders.
21    (f) An advanced practice nurse shall inform each
22collaborating physician, dentist, or podiatrist of all
23collaborative agreements he or she has signed and provide a
24copy of these to any collaborating physician, dentist, or
25podiatrist upon request.
26    (g) For the purposes of this Act, "generally provides or

 

 

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1may provide in to his or her patients in the normal course of
2his or her clinical medical practice" means categories of care
3or treatment services, not specific tasks or duties, the
4physician or podiatrist routinely provides individually or
5through delegation to other persons so that the physician or
6podiatrist has the experience and ability to provide
7collaboration and consultation. This definition shall not be
8construed to prohibit an advanced practice nurse from providing
9primary health treatment or care within the scope of his or her
10training and experience, including, but not limited to, health
11screenings, patient histories, physical examinations, women's
12health examinations, or school physicals that may be provided
13as part of the routine practice of an advanced practice nurse
14or on a volunteer basis.
15    For the purposes of this Act, "generally provides to his or
16her patients in the normal course of his or her clinical
17podiatric practice" means services, not specific tasks or
18duties, that the podiatrist routinely provides individually or
19through delegation to other persons so that the podiatrist has
20the experience and ability to provide collaboration and
21consultation.
22(Source: P.A. 96-618, eff. 1-1-10; 97-358, eff. 8-12-11.)