Illinois General Assembly - Full Text of HB3129
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Full Text of HB3129  93rd General Assembly

HB3129 93rd General Assembly


093_HB3129

 
                                     LRB093 05223 AMC 11813 b

 1        AN ACT concerning midwives.

 2        Be  it  enacted  by  the People of the State of Illinois,
 3    represented in the General Assembly:

 4        Section 1. Short title. This Act  may  be  cited  as  the
 5    Certified Professional Midwife Licensure Act.

 6        Section  5. Findings and purpose. This Act is intended to
 7    establish a licensing procedure  for  certified  professional
 8    midwives in Illinois. The General Assembly finds and declares
 9    the following:
10             (1)  The  intent  of  this  Act  is to encourage and
11        enable   the   practice   of   midwifery   by   certified
12        professional midwives so  that  this  profession  can  be
13        recognized  and regulated independently, according to the
14        principles recommended  by  the  Pew  Health  Professions
15        Commission and the American Public Health Association, to
16        increase   the  availability  of  midwives  to  meet  the
17        maternal-child health needs of Illinois families.
18             (2)  Consumers  continue  to  request  the  care  of
19        direct-entry midwives.
20             (3)  Direct-entry midwives have continued to provide
21        services  to   families   in   Illinois   despite   being
22        unregulated  since 1963 and have participated in national
23        credentialing organized to meet professional standards.
24             (4)  The Midwives Model of Care, as defined  by  the
25        Midwifery   Task   Force,  includes  (i)  monitoring  the
26        physical, psychological  and  social  well-being  of  the
27        mother  throughout the childbearing cycle, (ii) providing
28        the mother with individualized education, counseling, and
29        prenatal  care,  continuous  hands-on  assistance  during
30        labor  and  delivery,  and  postpartum   support,   (iii)
31        minimizing    technological   interventions,   and   (iv)
 
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 1        identifying and referring women who  require  obstetrical
 2        attention.  The  application of this woman-centered model
 3        of care has been proven to reduce the incidence of  birth
 4        injury, trauma, and cesarean section.
 5             (5)  In  recognition of major changes in health care
 6        regulation  and  practice,  the  Pew  Health  Professions
 7        Commission,  through  its  Taskforce   on   Health   Care
 8        Workforce  Regulation,  recommends  that  "until national
 9        models for  scopes  of  practice  can  be  developed  and
10        adopted, states should explore and develop mechanisms for
11        existing  professions  to evolve their existing scopes of
12        practice  and  for   new   professions   (or   previously
13        unregulated   professions)   to   emerge",   and  further
14        recommends that "a number of professions and  disciplines
15        that  use non-mainstream therapies safely and effectively
16        should be recognized and regulated as appropriate".
17             (6)  In  its  April  1999  report,  the  Pew  Health
18        Professions Commission, in conjunction  with  the  Center
19        for  the  Health  Professions, recommended that "midwives
20        should be recognized  as  independent  and  collaborative
21        practitioners"  and  recommended "legislative action that
22        ensures: appropriate entry-to-practice standards" and the
23        "elimination of requirements that midwives be directed or
24        supervised by other health care professionals".
25             (7)  In  its  resolution,  "Increasing   access   to
26        out-of-hospital    maternity    care   services   through
27        state-regulated  and  nationally-certified   direct-entry
28        midwives",  the  American  Public  Health Association (i)
29        supports efforts to increase  access  to  out-of-hospital
30        maternity care services and increase the range of quality
31        maternity  care  choices  available to consumers, through
32        recognition  that  legally   regulated   and   nationally
33        certified   direct-entry   midwives   can  serve  clients
34        desiring safe, planned,  out-of-hospital  maternity  care
 
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 1        services,   and   (ii)  encourages  the  development  and
 2        implementation  of  guidelines  for  the  licensing   and
 3        certification  of  direct-entry midwives and the practice
 4        of midwifery for use by state and local health  agencies,
 5        health    planners,   maternity   care   providers,   and
 6        professional organizations.

 7        Section 10.  Definitions. As used in this Act:
 8        "Approved  program  of  midwifery  education"  means   an
 9    education   program   accredited   or   pre-accredited  by  a
10    direct-entry midwifery accreditation agency recognized by the
11    United States Department of  Education,  i.e.  the  Midwifery
12    Education Accreditation Council (MEAC) or its successor.
13        "Certified  professional  midwife" means a person who has
14    met the standards for certification set by the North American
15    Registry of Midwives or its successor and  has  been  awarded
16    this credential.
17        "Consultation"  means  the  process  whereby  a  licensed
18    midwife seeks the advice or opinion of a physician or another
19    member of a health care team.
20        "Council" means the Licensed Midwife Council.
21        "Department"   means   the   Department  of  Professional
22    Regulation.
23        "Director" means the Director of Professional Regulation.
24        "Informed consent" means a document that includes, but is
25    not limited to, disclosure of the midwife's education,  skill
26    level,  liability  insurance  coverage,  and written plan for
27    medical emergencies.
28        "Licensed midwife" means a person who is  licensed  under
29    this Act.
30        "Midwifery"  means  the  provision, on a continuing basis
31    and  within  a  health  care   system   that   provides   for
32    consultation  and  referral  as needed, of the necessary care
33    and education to  women  during  pregnancy,  labor,  and  the
 
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 1    postpartum and interpartum periods; attending deliveries that
 2    the individual is responsible for; and caring for the newborn
 3    infant. "Midwifery" also includes the provision of additional
 4    primary  health  care  services  to women and their families,
 5    which  include,  but   are   not   limited   to,   well-woman
 6    gynecological  services  such  as  non-pharmacological family
 7    planning and routine pap smears.
 8        "North American Registry of Midwives" or "NARM" means the
 9    international agency, or its successor, that has  established
10    and   has  continued  to  administer  certification  for  the
11    credentialing of certified professional midwives.
12        "Peer review" means  an  educational  review  process  in
13    accordance  with  current  NARM  peer  review  standards that
14    includes a certificate of participation document.
15        "Referral" means the process whereby a  licensed  midwife
16    directs  the  client  to  a  physician  or  other health care
17    professional for management of a particular problem or aspect
18    of the client's care.

19        Section 15. License required.
20        (a)  Beginning July 1, 2005,  no  person  shall  practice
21    midwifery  in  this  State  without a license under this Act,
22    except as provided in Section 20.
23        (b)  No person shall use in connection with the  person's
24    name  any  letters, words, or insignia indicating or implying
25    that the person is a licensed midwife unless  the  person  is
26    licensed  in  accordance  with this Act. A person so licensed
27    may use  the  abbreviation  "L.M."  in  connection  with  the
28    person's name.

29        Section  20.  Exemptions.  Nothing  in  this Act shall be
30    construed to prohibit or to require registration  under  this
31    Act, with regard to any of the following:
32        (1)  The gratuitous rendering of services.
 
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 1        (2)  The  rendering  of  services  by  a  person  if such
 2    attendance is in accordance with the person's religious faith
 3    and is rendered to persons with a similar religious faith.
 4        (3)  Certified  nurse  midwives  authorized   under   the
 5    Advanced Practice Nursing Board to practice in Illinois.
 6        (4)  Licensed  physicians  or  other licensed health care
 7    providers authorized to provide maternity care.
 8        (5)  Midwifery  that  is  included  in  the   educational
 9    programs of student midwives enrolled in approved programs of
10    midwifery education.

11        Section  25.  Licensed  Midwife  Council.  There shall be
12    established within the Department of Professional  Regulation
13    a Licensed Midwife Council composed of 7 members appointed by
14    the  Director.  The  appointed  members  of the Council shall
15    include 4 licensed midwives and 3 consumers.  A consumer is a
16    person who (i) has never been a midwife nor studied to  be  a
17    midwife,  (ii)  has  no financial interest in the practice of
18    midwifery or in any health care facility, agency, or insurer,
19    and (iii)  has  engaged  a  provider  who  practices  or  has
20    practiced  as  a midwife in an out-of-hospital birth setting.
21    Of the members first appointed  to  the  Council,  3  members
22    shall  be appointed for a term of 3 years, 2 members shall be
23    appointed for a term of 2  years,  and  2  members  shall  be
24    appointed  for  a  term  of one year. Thereafter, all members
25    shall serve 3-year  terms.  In  making  appointments  to  the
26    Council,  the  Director shall consider the recommendations of
27    individuals  and   organizations   directly   involved   with
28    midwifery in this State. A vacancy in an unexpired term shall
29    be filled in the same manner as the original appointment. The
30    Director   may   remove  a  Council  member  for  misconduct,
31    incapacity, or neglect of duty, but only after notice  and  a
32    public  hearing,  unless the notice and hearing are waived by
33    the member in writing.  The  Council  shall  elect  from  its
 
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 1    membership a chairperson. The Council may meet as needed, but
 2    shall meet at least twice a year.

 3        Section  30.  Powers of the Council. The Licensed Midwife
 4    Council is authorized to:
 5        (1)  Recommend and approve the adoption and  revision  of
 6    any  rules  that may be necessary to carry out the provisions
 7    of this Act that are designed to protect the health,  safety,
 8    and  welfare of the public. The rules shall include the scope
 9    of practice  and  services  provided  regarding  the  use  of
10    equipment, procedures, and medications.
11        (2)  Conduct  hearings  and  disciplinary  conferences on
12    disciplinary charges of those licensed as provided in Section
13    70 and those in violation of Section 15.
14        (3)  Report to  the  Department,  upon  completion  of  a
15    hearing,  the  disciplinary  actions  recommended to be taken
16    against a person violating this Act.
17        (4)   Approve, deny, or  withdraw  approval  of  required
18    education and continuing educational programs.

19        Section  35.  Council  members;  immunity  from suit. The
20    members of the Council are immune from  suit  in  any  action
21    based  upon  disciplinary proceedings or other acts performed
22    as members of the Council, except those involving willful  or
23    wanton misconduct.

24        Section 40. Council members; compensation. Members of the
25    Council  shall  serve  without  compensation,  but  shall  be
26    reimbursed  for  actual  expenses necessarily incurred in the
27    discharge of their duties.

28        Section 45. Powers and duties of the Department.
29        (a)  The Department shall exercise the powers and  duties
30    necessary to effectuate the purposes of this Act. None of the

 
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 1    functions,  powers,  or duties of the Department with respect
 2    to licensure shall be exercised by the Department except upon
 3    review and approval by the Council.
 4        (b)  The  Department  shall  have   the   authority   and
 5    responsibility to:
 6             (1)  license individuals who qualify for licensure;
 7             (2)  issue  quarterly  reports to the Council on the
 8        status of all formal complaints filed by  the  Department
 9        and  on  significant issues as determined by the Council;
10        and
11             (3)  promulgate rules for  licensure  of  candidates
12        authorized to practice under this Act.

13        Section 50. Eligibility.
14        (a)  A  person is eligible to be licensed as a midwife if
15    that person meets the following qualifications:
16             (1)  holds the credential of certified  professional
17        midwife;
18             (2)  has  completed an approved program of midwifery
19        education with a minimum of 1,800 contact  hours  or  its
20        equivalent;
21             (3)  is  in  good  standing  with the North American
22        Registry of Midwives;
23             (4)  participates in peer review at least twice  per
24        year; and
25             (5)  provides   the   Department  with  an  annually
26        updated informed consent document.
27        (b)  For a period of 5 years following the effective date
28    of this  Act,  the  Council  shall  have  the  authority  and
29    discretion to license applicants who have practiced midwifery
30    prior  to  the  effective  date  of  this Act and have had an
31    application  accepted  by  the  North  American  Registry  of
32    Midwives for  certification.  Such  license  shall  terminate
33    automatically  2  years after the date of registration unless
 
                            -8-      LRB093 05223 AMC 11813 b
 1    the applicant has, by such time, successfully  completed  the
 2    examination  provided  by  the  North  American  Registry  of
 3    Midwives.

 4        Section 55. Scope of practice; informed consent.
 5        (a)  A  licensed midwife may perform any of the midwifery
 6    services  and  skills  established  by  the  North   American
 7    Registry   of   Midwives,  including,  but  not  limited  to,
 8    antepartum,  intrapartum,  and  postpartum  care  of   women;
 9    newborn  assessment  and  care  of  newborns;  and well-woman
10    gynecology and non-prescriptive  family  planning.   However,
11    the  midwife  must practice within the standards for practice
12    and  code  of  ethics  of  the  North  American  Registry  of
13    Midwives.
14        (b)  A copy of the informed consent document, signed  and
15    dated by the client, must be kept in each client's chart.

16        Section 60. Application for license. A person shall apply
17    for  licensure  as  a  midwife  to  the  Director  on  a form
18    furnished  by  the  Department.  The  application  shall   be
19    accompanied by payment of the specified fee and evidence that
20    the person meets the eligibility requirements of this Act.

21        Section  65.  Renewals. A midwife license must be renewed
22    every 3 years. An applicant for renewal shall submit  to  the
23    Department  (i)  a renewal application on the prescribed form
24    furnished by  the  Department  and  (ii)  a  renewal  fee  as
25    prescribed by the Department.

26        Section 70. Fees. The Department shall have the authority
27    to  (i) charge each candidate for licensure a fee, which must
28    be submitted with his or her   application  and  (ii)  charge
29    each  licensed  midwife  a  fee  for  renewal  of  his or her
30    license.
 
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 1        Section 75. Disciplinary action.
 2        (a)  A  licensed  midwife  or  applicant  for  licensure,
 3    renewal, or reinstatement shall not engage in  unprofessional
 4    conduct, which includes:
 5             (1)  fraudulently procuring or using a license;
 6             (2)  willfully  making  or  filing  false reports or
 7        records, willfully impeding or obstructing the filing  of
 8        reports or records, or willfully failing to file required
 9        reports or records in the practice of midwifery;
10             (3)  using dishonest or misleading advertising;
11             (4)  failing  to comply with any statutes related to
12        the practice of midwifery;
13             (5)  conviction of a crime related to  the  practice
14        of midwifery as described in this Act;
15             (6)  failing  to provide, in a timely manner, copies
16        of all records of the care provided to a person  after  a
17        written  request is received from the person who received
18        care; and
19             (7)  engaging in gross or repeated malpractice.
20        (b)  After a  hearing,  and  upon  making  a  finding  of
21    unprofessional  conduct,  the  Licensed Midwife Council shall
22    (i) reprimand the licensed midwife or applicant, (ii)  revoke
23    the  license  or refuse to issue or renew a license, or (iii)
24    seek an injunction against the continuation of the conduct.

25        Section 80. Penalties. A person  who  knowingly  violates
26    any  of  the  provisions  of  this Act is guilty of a Class A
27    misdemeanor.

28        Section 85. Reimbursement. A midwife licensed to practice
29    midwifery is eligible for compensation as  a  provider  under
30    the  Illinois  Medicaid  program  and  any  other third party
31    reimbursement plan, including Medicare, subject to  the  laws
32    of this State and applicable federal law.
 
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 1        Section 90. Advertising. A person licensed under this Act
 2    may  advertise  the  availability of professional services in
 3    the public media or on the premises where  such  professional
 4    services  are  rendered,  provided  that  the  advertising is
 5    truthful and not misleading.

 6        Section 95. Women's rights regarding  the  birth  of  the
 7    baby.  Women  have  a right to give birth where and with whom
 8    they choose. This Act does not  prohibit  the  attendance  at
 9    birth  of  the  mother's choice of family, friends, and other
10    persons.

11        Section 100.  Liability of  licensed  midwives.  Licensed
12    midwives  shall  be liable for their acts or omissions in the
13    performance  of  the  services  that  they  provide,  and  no
14    physician, nurse, pre-hospital emergency personnel, or health
15    care institution shall be liable  for  any  act  or  omission
16    resulting from the administration of services by any licensed
17    midwife. The provisions of this Section shall not relieve any
18    other   licensed   midwife,  physician,  nurse,  pre-hospital
19    emergency  personnel,  or  health   care   institution   from
20    liability  for  any  willful or wanton act or omission or any
21    act or  omission  constituting  gross  negligence,  or  under
22    circumstances   where  a  licensed  midwife  has  a  business
23    relationship  with  any  such  licensed  midwife,  physician,
24    nurse,  pre-hospital  emergency  personnel,  or  health  care
25    institution.  A  physician,  nurse,  pre-hospital   emergency
26    personnel,  or health care institution shall not be deemed to
27    have established a business relationship solely by  providing
28    consultation  or  accepting  a  referral  from the midwife in
29    accordance with this Act.

30        Section 105. Promulgation of rules by the Department. The
31    Department  shall  promulgate  rules  for  the  licensure  of
 
                            -11-     LRB093 05223 AMC 11813 b
 1    midwives under this Act by January 1, 2004.

 2        Section 900.  The Regulatory Sunset  Act  is  amended  by
 3    changing Section 4.24 as follows:

 4        (5 ILCS 80/4.24)
 5        Sec.  4.24.  Acts  repealed  on  January  1,  2014.   The
 6    following Acts are repealed on January 1, 2014:
 7        The Certified Professional Midwife Licensure Act.
 8        The Electrologist Licensing Act.
 9        The Illinois Public Accounting Act.
10    (Source: P.A. 92-457, eff. 8-21-01; 92-750, eff. 1-1-03.)

11        Section   905.   The  Medical  Practice  Act  of  1987 is
12    amended by changing Section 4 as follows:

13        (225 ILCS 60/4) (from Ch. 111, par. 4400-4)
14        (Section scheduled to be repealed on January 1, 2007)
15        Sec. 4.  Exemptions.
16        (a)  This Act does not apply to:
17             (1)  persons lawfully carrying on  their  particular
18        profession   or   business   under   any  valid  existing
19        regulatory Act of this State;
20             (2)  persons rendering gratuitous services in  cases
21        of emergency;
22             (3)  persons  treating  human  ailments by prayer or
23        spiritual means as an exercise or enjoyment of  religious
24        freedom.
25        (b)  Section 22 of this Act does not apply to persons who
26    carry  out  or  assist in the implementation of a court order
27    effecting the provisions of Section  119-5  of  the  Code  of
28    Criminal Procedure of 1963.
29        (c)  Nothing   in   this   Act   shall  be  construed  as
30    prohibiting the practice of  midwifery  by  persons  licensed
 
                            -12-     LRB093 05223 AMC 11813 b
 1    under the Certified Professional Midwife Licensure Act.
 2    (Source: P.A. 89-8, eff. 3-21-95.)

 3        Section   910.  The Nursing and Advanced Practice Nursing
 4    Act is amended by changing Section 5-15 as follows:

 5        (225 ILCS 65/5-15)
 6        (Section scheduled to be repealed on January 1, 2008)
 7        Sec. 5-15. Policy; application of Act. For the protection
 8    of life and the promotion of health, and  the  prevention  of
 9    illness  and  communicable diseases, any person practicing or
10    offering to practice professional and  practical  nursing  in
11    Illinois shall submit evidence that he or she is qualified to
12    practice,  and  shall be licensed as provided under this Act.
13    No person shall practice or offer to practice professional or
14    practical nursing in Illinois or use any title, sign, card or
15    device  to  indicate  that  such  a  person   is   practicing
16    professional or practical nursing unless such person has been
17    licensed under the provisions of this Act.
18        This Act does not prohibit the following:
19             (a)  The  practice  of nursing in Federal employment
20        in the discharge of the employee's duties by a person who
21        is employed  by  the  United  States  government  or  any
22        bureau,  division  or  agency  thereof  and  is a legally
23        qualified  and  licensed  nurse  of  another   state   or
24        territory  and not in conflict with Sections 10-5, 10-30,
25        and 10-45 of this Act.
26             (b)  Nursing that is included in  their  program  of
27        study  by  students enrolled in programs of nursing or in
28        current nurse practice update  courses  approved  by  the
29        Department.
30             (c)  The  furnishing  of  nursing  assistance  in an
31        emergency.
32             (d)  The practice of nursing by a nurse who holds an
 
                            -13-     LRB093 05223 AMC 11813 b
 1        active license in another state when  providing  services
 2        to patients in Illinois during a bonafide emergency or in
 3        immediate preparation for or during interstate transit.
 4             (e)  The  incidental  care of the sick by members of
 5        the family, domestic servants or housekeepers, or care of
 6        the sick where treatment is by prayer or spiritual means.
 7             (f)  Persons from being employed as  nursing  aides,
 8        attendants,  orderlies,  and  other  auxiliary workers in
 9        private homes,  long  term  care  facilities,  nurseries,
10        hospitals or other institutions.
11             (g)  The  practice  of  practical nursing by one who
12        has applied in writing to  the  Department  in  form  and
13        substance  satisfactory  to the Department, for a license
14        as a licensed practical nurse and who has  complied  with
15        all  the  provisions  under  Section  10-30,  except  the
16        passing  of an examination to be eligible to receive such
17        license, until:  the decision of the Department that  the
18        applicant   has   failed   to  pass  the  next  available
19        examination authorized by the Department or  has  failed,
20        without  an  approved  excuse, to take the next available
21        examination authorized by the  Department  or  until  the
22        withdrawal  of  the  application,  but  not  to  exceed 3
23        months.  No applicant for licensure practicing under  the
24        provisions  of  this  paragraph  shall practice practical
25        nursing  except  under  the  direct  supervision   of   a
26        registered  professional nurse licensed under this Act or
27        a licensed  physician,  dentist  or  podiatrist.   In  no
28        instance shall any such applicant practice or be employed
29        in any supervisory capacity.
30             (h)  The practice of practical nursing by one who is
31        a licensed practical nurse under the laws of another U.S.
32        jurisdiction   and   has   applied   in  writing  to  the
33        Department, in form and  substance  satisfactory  to  the
34        Department,  for  a license as a licensed practical nurse
 
                            -14-     LRB093 05223 AMC 11813 b
 1        and who  is  qualified  to  receive  such  license  under
 2        Section 10-30, until (1) the expiration of 6 months after
 3        the   filing   of   such  written  application,  (2)  the
 4        withdrawal of such application, or (3) the denial of such
 5        application by the Department.
 6             (i)  The practice of professional nursing by one who
 7        has applied in writing to  the  Department  in  form  and
 8        substance satisfactory to the Department for a license as
 9        a registered professional nurse and has complied with all
10        the  provisions under Section 10-30 except the passing of
11        an examination to be eligible to  receive  such  license,
12        until   the decision of the Department that the applicant
13        has  failed  to  pass  the  next  available   examination
14        authorized  by  the  Department or has failed, without an
15        approved excuse, to take the next  available  examination
16        authorized  by  the Department or until the withdrawal of
17        the  application,  but  not  to  exceed  3  months.    No
18        applicant  for  licensure practicing under the provisions
19        of this paragraph  shall  practice  professional  nursing
20        except  under  the  direct  supervision  of  a registered
21        professional  nurse  licensed  under  this  Act.   In  no
22        instance shall any such applicant practice or be employed
23        in any supervisory capacity.
24             (j)  The practice of professional nursing by one who
25        is a registered professional  nurse  under  the  laws  of
26        another  state, territory of the United States or country
27        and has applied in writing to the Department, in form and
28        substance satisfactory to the Department, for  a  license
29        as  a  registered professional nurse and who is qualified
30        to receive such license under Section 10-30,  until   (1)
31        the  expiration  of  6  months  after  the filing of such
32        written  application,  (2)   the   withdrawal   of   such
33        application, or (3) the denial of such application by the
34        Department.
 
                            -15-     LRB093 05223 AMC 11813 b
 1             (k)  The  practice  of  professional nursing that is
 2        included in a program of study by one who is a registered
 3        professional nurse under the laws  of  another  state  or
 4        territory  of  the  United  States  or  foreign  country,
 5        territory  or  province and who is enrolled in a graduate
 6        nursing education program or a program for the completion
 7        of a baccalaureate nursing degree in  this  State,  which
 8        includes clinical supervision by faculty as determined by
 9        the  educational institution offering the program and the
10        health care organization where the  practice  of  nursing
11        occurs.   The  educational institution will file with the
12        Department each academic term a list  of  the  names  and
13        origin  of  license of all professional nurses practicing
14        nursing as part of their programs under this provision.
15             (l)  Any person licensed in  this  State  under  any
16        other  Act from engaging in the practice for which she or
17        he is licensed.
18             (m)  Delegation  to  authorized  direct  care  staff
19        trained under Section  15.4  of  the  Mental  Health  and
20        Developmental Disabilities Administrative Act.
21             (n)  The  practice  of midwifery by persons licensed
22        under the Certified Professional Midwife Licensure Act.
23        An applicant for license practicing under the  exceptions
24    set  forth  in  subparagraphs  (g), (h), (i), and (j) of this
25    Section shall use the title R.N. Lic. Pend.  or  L.P.N.  Lic.
26    Pend. respectively and no other.
27    (Source:  P.A.  90-61,  eff.  12-30-97;  90-248, eff. 1-1-98;
28    90-655, eff. 7-30-98;  90-742,  eff.  8-13-98;  91-630,  eff.
29    8-19-99.)

30        Section  999.  Effective date. This Act takes effect upon
31    becoming law.