Full Text of SB2566 102nd General Assembly
SB2566 102ND GENERAL ASSEMBLY |
| | 102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022 SB2566 Introduced 2/26/2021, by Sen. Melinda Bush SYNOPSIS AS INTRODUCED: |
| 225 ILCS 65/65-35 | was 225 ILCS 65/15-15 | 225 ILCS 65/65-45 | was 225 ILCS 65/15-25 |
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Amends the Nurse Practice Act. Replaces provisions concerning the written collaborative agreement required of a certified registered nurse anesthetist providing anesthesia services outside the hospital, ambulatory surgical treatment center, or hospital affiliate with provisions that require the certified registered nurse anesthetist to enter into a written collaborative agreement with a physician, podiatric physician, or dentist. Exempts the delivery of anesthesia during the surgical procedure performed by a physician, dentist, or podiatrist from the requirement that the collaborative
relationship under an agreement not be
construed to require the personal presence of a collaborating physician at the place where services are rendered. Makes corresponding changes. Effective immediately.
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| | A BILL FOR |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Nurse Practice Act is amended by changing | 5 | | Sections 65-35 and 65-45 as follows:
| 6 | | (225 ILCS 65/65-35)
(was 225 ILCS 65/15-15)
| 7 | | (Section scheduled to be repealed on January 1, 2028)
| 8 | | Sec. 65-35. Written collaborative
agreements. | 9 | | (a) A written collaborative agreement is required for all | 10 | | advanced practice registered nurses engaged in clinical | 11 | | practice prior to meeting the requirements of Section 65-43, | 12 | | except for advanced practice registered nurses who are | 13 | | privileged to practice in a hospital, hospital affiliate, or | 14 | | ambulatory surgical treatment center. | 15 | | (a-5) If an advanced practice registered nurse engages in | 16 | | clinical practice outside of a hospital, hospital affiliate, | 17 | | or ambulatory surgical treatment center in which he or she is | 18 | | privileged to practice, the advanced practice registered nurse | 19 | | must have a written collaborative agreement, except as set | 20 | | forth in Section 65-43.
| 21 | | (b) A written collaborative
agreement shall describe the | 22 | | relationship of the
advanced practice registered nurse with | 23 | | the collaborating
physician and shall describe the categories |
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| 1 | | of
care, treatment, or procedures to be provided by the | 2 | | advanced
practice registered nurse. A collaborative agreement | 3 | | with a podiatric physician must be in accordance with | 4 | | subsection (c-5) or (c-15) of this Section for an advanced | 5 | | practice registered nurse certified as a nurse practitioner, | 6 | | clinical nurse specialist, or certified nurse midwife. A | 7 | | certified registered nurse anesthetist providing anesthesia | 8 | | services outside the hospital, ambulatory surgical treatment | 9 | | center, or hospital affiliate shall enter into a written | 10 | | collaborative agreement with a physician, podiatric physician, | 11 | | or dentist . A collaborative agreement with a dentist must be | 12 | | in accordance with subsection (c-10) of this Section. A | 13 | | collaborative agreement with a podiatric physician must be in | 14 | | accordance with subsection (c-5) of this Section. | 15 | | Collaboration does not require an
employment relationship | 16 | | between the collaborating physician
and the advanced practice | 17 | | registered nurse.
| 18 | | The collaborative
relationship under an agreement shall | 19 | | not be
construed to require the personal presence of a | 20 | | collaborating physician at the place where services are | 21 | | rendered , except for the delivery of anesthesia during the | 22 | | surgical procedure performed by a physician, dentist, or | 23 | | podiatrist .
Methods of communication shall
be available for | 24 | | consultation with the collaborating
physician in person or by | 25 | | telecommunications or electronic communications as set forth | 26 | | in the written
agreement.
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| 1 | | (b-5) Absent an employment relationship, a written | 2 | | collaborative agreement may not (1) restrict the categories of | 3 | | patients of an advanced practice registered nurse within the | 4 | | scope of the advanced practice registered nurses training and | 5 | | experience, (2) limit third party payors or government health | 6 | | programs, such as the medical assistance program or Medicare | 7 | | with which the advanced practice registered nurse contracts, | 8 | | or (3) limit the geographic area or practice location of the | 9 | | advanced practice registered nurse in this State. | 10 | | (c) (Blank).
In the case of anesthesia services provided | 11 | | by a certified registered nurse anesthetist, an | 12 | | anesthesiologist, a physician, a dentist, or a podiatric | 13 | | physician must participate through discussion of and agreement | 14 | | with the anesthesia plan and remain physically present and | 15 | | available on the premises during the delivery of anesthesia | 16 | | services for diagnosis, consultation, and treatment of | 17 | | emergency medical conditions.
| 18 | | (c-5) (Blank). A certified registered nurse anesthetist, | 19 | | who provides anesthesia services outside of a hospital or | 20 | | ambulatory surgical treatment center shall enter into a | 21 | | written collaborative agreement with an anesthesiologist or | 22 | | the physician licensed to practice medicine in all its | 23 | | branches or the podiatric physician performing the procedure. | 24 | | Outside of a hospital or ambulatory surgical treatment center, | 25 | | the certified registered nurse anesthetist may provide only | 26 | | those services that the collaborating podiatric physician is |
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| 1 | | authorized to provide pursuant to the Podiatric Medical | 2 | | Practice Act of 1987 and rules adopted thereunder. A certified | 3 | | registered nurse anesthetist may select, order, and administer | 4 | | medication, including controlled substances, and apply | 5 | | appropriate medical devices for delivery of anesthesia | 6 | | services under the anesthesia plan agreed with by the | 7 | | anesthesiologist or the operating physician or operating | 8 | | podiatric physician. | 9 | | (c-10) (Blank). A certified registered nurse anesthetist | 10 | | who provides anesthesia services in a dental office shall | 11 | | enter into a written collaborative agreement with an | 12 | | anesthesiologist or the physician licensed to practice | 13 | | medicine in all its branches or the operating dentist | 14 | | performing the procedure. The agreement shall describe the | 15 | | working relationship of the certified registered nurse | 16 | | anesthetist and dentist and shall authorize the categories of | 17 | | care, treatment, or procedures to be performed by the | 18 | | certified registered nurse anesthetist. In a collaborating | 19 | | dentist's office, the certified registered nurse anesthetist | 20 | | may only provide those services that the operating dentist | 21 | | with the appropriate permit is authorized to provide pursuant | 22 | | to the Illinois Dental Practice Act and rules adopted | 23 | | thereunder. For anesthesia services, an anesthesiologist, | 24 | | physician, or operating dentist shall participate through | 25 | | discussion of and agreement with the anesthesia plan and shall | 26 | | remain physically present and be available on the premises |
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| 1 | | during the delivery of anesthesia services for diagnosis, | 2 | | consultation, and treatment of emergency medical conditions. A | 3 | | certified registered nurse anesthetist may select, order, and | 4 | | administer medication, including controlled substances, and | 5 | | apply appropriate medical devices for delivery of anesthesia | 6 | | services under the anesthesia plan agreed with by the | 7 | | operating dentist. | 8 | | (c-15) An advanced practice registered nurse who had a | 9 | | written collaborative agreement with a podiatric physician | 10 | | immediately before the effective date of Public Act 100-513 | 11 | | may continue in that collaborative relationship or enter into | 12 | | a new written collaborative relationship with a podiatric | 13 | | physician under the requirements of this Section and Section | 14 | | 65-40, as those Sections existed immediately before the | 15 | | amendment of those Sections by Public Act 100-513 with regard | 16 | | to a written collaborative agreement between an advanced | 17 | | practice registered nurse and a podiatric physician. | 18 | | (d) A copy of the signed, written collaborative agreement | 19 | | must be available
to the Department upon request from both the | 20 | | advanced practice registered nurse
and the collaborating | 21 | | physician, dentist, or podiatric physician. | 22 | | (e) Nothing in this Act shall be construed to limit the | 23 | | delegation of tasks or duties by a physician to a licensed | 24 | | practical nurse, a registered professional nurse, or other | 25 | | persons in accordance with Section 54.2 of the Medical | 26 | | Practice Act of 1987. Nothing in this Act shall be construed to |
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| 1 | | limit the method of delegation that may be authorized by any | 2 | | means, including, but not limited to, oral, written, | 3 | | electronic, standing orders, protocols, guidelines, or verbal | 4 | | orders. | 5 | | (e-5) Nothing in this Act shall be construed to authorize | 6 | | an advanced practice registered nurse to provide health care | 7 | | services required by law or rule to be performed by a | 8 | | physician. The scope of practice of an advanced practice | 9 | | registered nurse does not include operative surgery. Nothing | 10 | | in this Section shall be construed to preclude an advanced | 11 | | practice registered nurse from assisting in surgery. | 12 | | (f) An advanced
practice registered nurse shall inform | 13 | | each collaborating physician, dentist, or podiatric physician | 14 | | of all collaborative
agreements he or she
has signed and | 15 | | provide a copy of these to any collaborating physician, | 16 | | dentist, or podiatric physician upon
request.
| 17 | | (g) (Blank). | 18 | | (Source: P.A. 100-513, eff. 1-1-18; 100-577, eff. 1-26-18; | 19 | | 100-1096, eff. 8-26-18; 101-13, eff. 6-12-19.)
| 20 | | (225 ILCS 65/65-45)
(was 225 ILCS 65/15-25)
| 21 | | (Section scheduled to be repealed on January 1, 2028)
| 22 | | Sec. 65-45. Advanced practice registered nursing in | 23 | | hospitals, hospital affiliates, or ambulatory surgical | 24 | | treatment centers.
| 25 | | (a) An advanced practice registered nurse may provide
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| 1 | | services in a hospital or a hospital affiliate as those terms | 2 | | are defined in the Hospital Licensing Act or the University of | 3 | | Illinois Hospital Act or a licensed ambulatory surgical
| 4 | | treatment center without a written collaborative agreement | 5 | | pursuant to Section 65-35 of this Act. An advanced practice | 6 | | registered nurse must possess clinical privileges recommended | 7 | | by the hospital medical staff and granted by the hospital or | 8 | | the consulting medical staff committee and ambulatory surgical | 9 | | treatment center in order to provide services. The medical | 10 | | staff or consulting medical staff committee shall periodically | 11 | | review the services of all advanced practice registered nurses | 12 | | granted clinical privileges, including any care provided in a | 13 | | hospital affiliate. Authority may also be granted when | 14 | | recommended by the hospital medical staff and granted by the | 15 | | hospital or recommended by the consulting medical staff | 16 | | committee and ambulatory surgical treatment center to | 17 | | individual advanced practice registered nurses to select, | 18 | | order, and administer medications, including controlled | 19 | | substances, to provide delineated care. In a hospital, | 20 | | hospital affiliate, or ambulatory surgical treatment center, | 21 | | the attending physician shall determine an advanced practice | 22 | | registered nurse's role in providing care for his or her | 23 | | patients, except as otherwise provided in the medical staff | 24 | | bylaws or consulting committee policies.
| 25 | | (a-2) An advanced practice registered nurse privileged to | 26 | | order medications, including controlled substances, may |
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| 1 | | complete discharge prescriptions provided the prescription is | 2 | | in the name of the advanced practice registered nurse and the | 3 | | attending or discharging physician. | 4 | | (a-3) Advanced practice registered nurses practicing in a | 5 | | hospital or an ambulatory surgical treatment center are not | 6 | | required to obtain a mid-level controlled substance license to | 7 | | order controlled substances under Section 303.05 of the | 8 | | Illinois Controlled Substances Act. | 9 | | (a-4) An advanced practice registered nurse meeting the | 10 | | requirements of Section 65-43 may be privileged to complete | 11 | | discharge orders and prescriptions under the advanced practice | 12 | | registered nurse's name. | 13 | | (a-5) (Blank). For
anesthesia services provided by a | 14 | | certified registered nurse anesthetist, an anesthesiologist,
| 15 | | physician, dentist,
or podiatric physician shall participate | 16 | | through discussion of and agreement with the
anesthesia plan | 17 | | and shall
remain
physically present
and be available on the | 18 | | premises during the delivery of anesthesia services for
| 19 | | diagnosis, consultation, and treatment of
emergency medical | 20 | | conditions, unless hospital policy adopted pursuant to
clause | 21 | | (B) of subdivision (3) of Section 10.7 of the Hospital | 22 | | Licensing Act
or ambulatory surgical treatment center policy | 23 | | adopted pursuant to
clause (B) of subdivision (3) of Section | 24 | | 6.5 of the Ambulatory Surgical
Treatment Center Act
provides | 25 | | otherwise. A certified registered nurse anesthetist may | 26 | | select, order, and administer medication for anesthesia |
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| 1 | | services under the anesthesia plan agreed to by the | 2 | | anesthesiologist or the physician, in accordance with hospital | 3 | | alternative policy or the medical staff consulting committee | 4 | | policies of a licensed ambulatory surgical treatment center.
| 5 | | (b) An advanced practice registered nurse who provides
| 6 | | services in a hospital shall do so in accordance with Section | 7 | | 10.7 of the
Hospital
Licensing Act and, in an
ambulatory | 8 | | surgical treatment center, in accordance with Section 6.5 of | 9 | | the
Ambulatory
Surgical Treatment Center Act. Nothing in this | 10 | | Act shall be construed to require an advanced practice | 11 | | registered nurse to have a collaborative agreement to practice | 12 | | in a hospital, hospital affiliate, or ambulatory surgical | 13 | | treatment center.
| 14 | | (c) Advanced practice registered nurses certified as nurse | 15 | | practitioners, nurse midwives, or clinical nurse specialists | 16 | | practicing in a hospital affiliate may be, but are not | 17 | | required to be, privileged to prescribe Schedule II through V | 18 | | controlled substances when such authority is recommended by | 19 | | the appropriate physician committee of the hospital affiliate | 20 | | and granted by the hospital affiliate. This authority may, but | 21 | | is not required to, include prescription of, selection of, | 22 | | orders for, administration of, storage of, acceptance of | 23 | | samples of, and dispensing over-the-counter medications, | 24 | | legend drugs, medical gases, and controlled substances | 25 | | categorized as Schedule II through V controlled substances, as | 26 | | defined in Article II of the Illinois Controlled Substances |
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| 1 | | Act, and other preparations, including, but not limited to, | 2 | | botanical and herbal remedies. | 3 | | To prescribe controlled substances under this subsection | 4 | | (c), an advanced practice registered nurse certified as a | 5 | | nurse practitioner, nurse midwife, or clinical nurse | 6 | | specialist must obtain a controlled substance license. | 7 | | Medication orders shall be reviewed periodically by the | 8 | | appropriate hospital affiliate physicians committee or its | 9 | | physician designee. | 10 | | The hospital affiliate shall file with the Department | 11 | | notice of a grant of prescriptive authority consistent with | 12 | | this subsection (c) and termination of such a grant of | 13 | | authority, in accordance with rules of the Department. Upon | 14 | | receipt of this notice of grant of authority to prescribe any | 15 | | Schedule II through V controlled substances, the licensed | 16 | | advanced practice registered nurse certified as a nurse | 17 | | practitioner, nurse midwife, or clinical nurse specialist may | 18 | | register for a mid-level practitioner controlled substance | 19 | | license under Section 303.05 of the Illinois Controlled | 20 | | Substances Act. | 21 | | In addition, a hospital affiliate may, but is not required | 22 | | to, privilege an advanced practice registered nurse certified | 23 | | as a nurse practitioner, nurse midwife, or clinical nurse | 24 | | specialist to prescribe any Schedule II controlled substances, | 25 | | if all of the following conditions apply: | 26 | | (1) specific Schedule II controlled substances by oral |
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| 1 | | dosage or topical or transdermal application may be | 2 | | designated, provided that the designated Schedule II | 3 | | controlled substances are routinely prescribed by advanced | 4 | | practice registered nurses in their area of certification; | 5 | | the privileging documents must identify the specific | 6 | | Schedule II controlled substances by either brand name or | 7 | | generic name; privileges to prescribe or dispense Schedule | 8 | | II controlled substances to be delivered by injection or | 9 | | other route of administration may not be granted; | 10 | | (2) any privileges must be controlled substances | 11 | | limited to the practice of the advanced practice | 12 | | registered nurse; | 13 | | (3) any prescription must be limited to no more than a | 14 | | 30-day supply; | 15 | | (4) the advanced practice registered nurse must | 16 | | discuss the condition of any patients for whom a | 17 | | controlled substance is prescribed monthly with the | 18 | | appropriate physician committee of the hospital affiliate | 19 | | or its physician designee; and | 20 | | (5) the advanced practice registered nurse must meet | 21 | | the education requirements of Section 303.05 of the | 22 | | Illinois Controlled Substances Act. | 23 | | (d) An advanced practice registered nurse meeting the | 24 | | requirements of Section 65-43 may be privileged to prescribe | 25 | | controlled substances categorized as Schedule II through V in | 26 | | accordance with Section 65-43. |
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| 1 | | (Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18 .)
| 2 | | Section 99. Effective date. This Act takes effect upon | 3 | | becoming law.
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