Full Text of SB2255 97th General Assembly
SB2255sam002 97TH GENERAL ASSEMBLY | 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 | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Medical Practice Act of 1987 is amended by | 5 | | changing 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| 7 | | (Section scheduled to be repealed on November 30, 2011)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 | 9 | | assistants and advanced practice nurses.
| 10 | | (a) Physicians licensed to practice medicine in all its
| 11 | | branches may delegate care and treatment responsibilities to a
| 12 | | physician assistant under guidelines in accordance with the
| 13 | | requirements of the Physician Assistant Practice Act of
1987. A | 14 | | physician licensed to practice medicine in all its
branches may | 15 | | enter into supervising physician agreements with
no more than 2 | 16 | | physician assistants.
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| 1 | | (b) A physician licensed to practice medicine in all its
| 2 | | branches in active clinical practice may collaborate with an | 3 | | advanced practice
nurse in accordance with the requirements of | 4 | | the Nurse Practice Act. Collaboration
is for the purpose of | 5 | | providing medical consultation,
and no employment relationship | 6 | | is required. A
written collaborative agreement shall
conform to | 7 | | the requirements of Section 65-35 of the Nurse Practice Act. | 8 | | The written collaborative agreement shall
be for
services the | 9 | | collaborating physician generally provides to
his or her | 10 | | patients in the normal course of clinical medical practice.
A | 11 | | written collaborative agreement shall be adequate with respect | 12 | | to collaboration
with advanced practice nurses if all of the | 13 | | following 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 | 21 | | practice medicine in
all its branches may collaborate with a | 22 | | certified registered nurse anesthetist
in accordance with | 23 | | Section 65-35 of the Nurse Practice Act for the provision of | 24 | | anesthesia services. With respect to the provision of | 25 | | anesthesia services, the collaborating anesthesiologist or | 26 | | physician shall have training and experience in the delivery of |
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| 1 | | anesthesia services consistent with Department rules. | 2 | | Collaboration 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 | 18 | | agree with the
anesthesia plan prior to the delivery of | 19 | | services.
| 20 | | (c) The supervising physician shall have access to the
| 21 | | medical records of all patients attended by a physician
| 22 | | assistant. The collaborating physician shall have access to
the | 23 | | medical records of all patients attended to by an
advanced | 24 | | practice nurse.
| 25 | | (d) (Blank).
| 26 | | (e) A physician shall not be liable for the acts or
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| 1 | | omissions of a physician assistant or advanced practice
nurse | 2 | | solely on the basis of having signed a
supervision agreement or | 3 | | guidelines or a collaborative
agreement, an order, a standing | 4 | | medical order, a
standing delegation order, or other order or | 5 | | guideline
authorizing a physician assistant or advanced | 6 | | practice
nurse to perform acts, unless the physician has
reason | 7 | | to believe the physician assistant or advanced
practice nurse | 8 | | lacked the competency to perform
the act or acts or commits | 9 | | willful and wanton misconduct.
| 10 | | (f) A collaborating physician may, but is not required to, | 11 | | delegate prescriptive authority to an advanced practice nurse | 12 | | as part of a written collaborative agreement, and the | 13 | | delegation of prescriptive authority shall conform to the | 14 | | requirements of Section 65-40 of the Nurse Practice Act. | 15 | | (g) A supervising physician may, but is not required to, | 16 | | delegate prescriptive authority to a physician assistant as | 17 | | part of a written supervision agreement, and the delegation of | 18 | | prescriptive authority shall conform to the requirements of | 19 | | Section 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 | 22 | | Sections 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 | 3 | | advanced practice nurses engaged in clinical practice, except | 4 | | for advanced practice nurses who are authorized to practice in | 5 | | a hospital or ambulatory surgical treatment center. | 6 | | (a-5) If an advanced practice nurse engages in clinical | 7 | | practice outside of a hospital or ambulatory surgical treatment | 8 | | center in which he or she is authorized to practice, the | 9 | | advanced practice nurse must have a written collaborative | 10 | | agreement.
| 11 | | (b) A written collaborative
agreement shall describe the | 12 | | working relationship of the
advanced practice nurse with the | 13 | | collaborating
physician or podiatrist and shall authorize the | 14 | | categories of
care, treatment, or procedures to be performed by | 15 | | the advanced
practice nurse. A collaborative agreement with a | 16 | | dentist must be in accordance with subsection (c-10) of this | 17 | | Section. Collaboration does not require an
employment | 18 | | relationship between the collaborating physician
and advanced | 19 | | practice nurse. Absent an employment relationship, an | 20 | | agreement may not restrict the categories of patients or | 21 | | third-party payment sources accepted by the advanced practice | 22 | | nurse. Collaboration means
the relationship under
which an | 23 | | advanced practice nurse works with a collaborating
physician or | 24 | | podiatrist in an active clinical practice to deliver health | 25 | | care services in
accordance with
(i) the advanced practice | 26 | | nurse's training, education,
and experience and (ii) |
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| 1 | | collaboration and consultation as documented in a
jointly | 2 | | developed written collaborative
agreement.
| 3 | | The agreement shall be defined to promote the
exercise of | 4 | | professional judgment by the advanced practice
nurse | 5 | | commensurate with his or her education and
experience. The | 6 | | services to be provided by the advanced
practice nurse shall be | 7 | | services that the
collaborating physician or podiatrist is | 8 | | authorized to and generally provides to his or her
patients in | 9 | | the normal course of his or her clinical medical practice, | 10 | | except as set forth in subsection (c-5) of this Section.
The | 11 | | agreement need not describe the exact steps that an advanced | 12 | | practice
nurse must take with respect to each specific | 13 | | condition, disease, or symptom
but must specify
which | 14 | | authorized procedures require the presence of the | 15 | | collaborating physician or podiatrist as
the procedures are | 16 | | being performed. The collaborative
relationship under an | 17 | | agreement shall not be
construed to require the personal | 18 | | presence of a physician or podiatrist at
all times at the place | 19 | | where services are rendered.
Methods of communication shall
be | 20 | | available for consultation with the collaborating
physician or | 21 | | podiatrist in person or by telecommunications in accordance | 22 | | with
established written guidelines as set forth in the written
| 23 | | agreement.
| 24 | | (c) Collaboration and consultation under all collaboration | 25 | | agreements
shall be adequate if a
collaborating physician or | 26 | | podiatrist 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 | 3 | | termination or change of status involving a written | 4 | | collaborative agreement, except when such notice is given for | 5 | | just cause. | 6 | | (c-5) A certified registered nurse anesthetist, who | 7 | | provides anesthesia services outside of a hospital or | 8 | | ambulatory surgical treatment center shall enter into a written | 9 | | collaborative agreement with an anesthesiologist or the | 10 | | physician licensed to practice medicine in all its branches or | 11 | | the podiatrist performing the procedure. Outside of a hospital | 12 | | or ambulatory surgical treatment center, the certified | 13 | | registered nurse anesthetist may provide only those services | 14 | | that the collaborating podiatrist is authorized to provide | 15 | | pursuant to the Podiatric Medical Practice Act of 1987 and | 16 | | rules adopted thereunder. A certified registered nurse | 17 | | anesthetist may select, order, and administer medication, | 18 | | including controlled substances, and apply appropriate medical | 19 | | devices for delivery of anesthesia services under the | 20 | | anesthesia plan agreed with by the anesthesiologist or the | 21 | | operating physician or operating podiatrist. | 22 | | (c-10) A certified registered nurse anesthetist who | 23 | | provides anesthesia services in a dental office shall enter | 24 | | into a written collaborative agreement with an | 25 | | anesthesiologist or the physician licensed to practice | 26 | | medicine in all its branches or the operating dentist |
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| 1 | | performing the procedure. The agreement shall describe the | 2 | | working relationship of the certified registered nurse | 3 | | anesthetist and dentist and shall authorize the categories of | 4 | | care, treatment, or procedures to be performed by the certified | 5 | | registered nurse anesthetist. In a collaborating dentist's | 6 | | office, the certified registered nurse anesthetist may only | 7 | | provide those services that the operating dentist with the | 8 | | appropriate permit is authorized to provide pursuant to the | 9 | | Illinois Dental Practice Act and rules adopted thereunder. For | 10 | | anesthesia services, an anesthesiologist, physician, or | 11 | | operating dentist shall participate through discussion of and | 12 | | agreement with the anesthesia plan and shall remain physically | 13 | | present and be available on the premises during the delivery of | 14 | | anesthesia services for diagnosis, consultation, and treatment | 15 | | of emergency medical conditions. A certified registered nurse | 16 | | anesthetist may select, order, and administer medication, | 17 | | including controlled substances, and apply appropriate medical | 18 | | devices for delivery of anesthesia services under the | 19 | | anesthesia plan agreed with by the operating dentist. | 20 | | (d) A copy of the signed, written collaborative agreement | 21 | | must be available
to the Department upon request from both the | 22 | | advanced practice nurse
and the collaborating physician or | 23 | | podiatrist. | 24 | | (e) Nothing in this Act shall be construed to limit the | 25 | | delegation of tasks or duties by a physician to a licensed | 26 | | practical nurse, a registered professional nurse, or other |
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| 1 | | persons in accordance with Section 54.2 of the Medical Practice | 2 | | Act of 1987. Nothing in this Act shall be construed to limit | 3 | | the method of delegation that may be authorized by any means, | 4 | | including, but not limited to, oral, written, electronic, | 5 | | standing orders, protocols, guidelines, or verbal orders. | 6 | | (f) An advanced
practice nurse shall inform each | 7 | | collaborating physician, dentist, or podiatrist of all | 8 | | collaborative
agreements he or she
has signed and provide a | 9 | | copy of these to any collaborating physician, dentist, or | 10 | | podiatrist upon
request.
| 11 | | (g) For the purposes of this Act, "generally provides to | 12 | | his or her patients in the normal course of his or her clinical | 13 | | medical practice" means services, not specific tasks or duties, | 14 | | the physician or podiatrist routinely provides individually or | 15 | | through delegation to other persons so that the physician or | 16 | | podiatrist has the experience and ability to provide | 17 | | collaboration 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 | 22 | | Prescriptive authority.
| 23 | | (a) A collaborating
physician or podiatrist may, but is not | 24 | | required to, delegate
prescriptive authority to an advanced | 25 | | practice
nurse as part of a written collaborative agreement. |
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| 1 | | This authority may, but is
not required to, include
| 2 | | prescription of, selection of, orders for, administration of, | 3 | | storage of, acceptance of samples of, and dispensing over the | 4 | | counter medications, legend drugs, medical gases, and | 5 | | controlled
substances categorized as
any Schedule III through V | 6 | | controlled substances, as defined in Article II of the
Illinois | 7 | | Controlled Substances Act, and other preparations, including, | 8 | | but not limited to, botanical and herbal remedies. The | 9 | | collaborating physician or podiatrist must have a valid current | 10 | | Illinois controlled substance license and federal registration | 11 | | to delegate authority to prescribe delegated controlled | 12 | | substances.
| 13 | | (b) To prescribe controlled
substances under this Section, | 14 | | an advanced practice
nurse must obtain a mid-level practitioner | 15 | | controlled substance license.
Medication orders shall be
| 16 | | reviewed
periodically by the collaborating physician or | 17 | | podiatrist.
| 18 | | (c) The collaborating physician or podiatrist shall file | 19 | | with the
Department notice of delegation of prescriptive | 20 | | authority
and
termination of such delegation, in accordance | 21 | | with rules of the Department.
Upon receipt of this notice | 22 | | delegating authority to prescribe any Schedule III through V | 23 | | controlled substances, the licensed advanced practice nurse | 24 | | shall be
eligible to register for a mid-level practitioner | 25 | | controlled substance license
under Section 303.05 of the | 26 | | Illinois 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 | 3 | | podiatrist may, but is not required to, delegate authority to | 4 | | an advanced practice nurse to prescribe any Schedule II | 5 | | controlled substances, if all of the following conditions | 6 | | apply: | 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 | 4 | | delegation of tasks
or duties by a physician to a licensed | 5 | | practical nurse, a registered
professional nurse, or other | 6 | | persons. Nothing in this Act shall be construed to limit the | 7 | | method of delegation that may be authorized by any means, | 8 | | including, but not limited to, oral, written, electronic, | 9 | | standing orders, protocols, guidelines, or verbal orders.
| 10 | | (f) Nothing in this Section shall be construed to apply to | 11 | | any medication authority including Schedule II controlled | 12 | | substances of an advanced practice nurse for care provided in a | 13 | | hospital, hospital affiliate, or ambulatory surgical treatment | 14 | | center pursuant to Section 65-45. | 15 | | (g) Any advanced practice nurse who writes a prescription | 16 | | for a controlled substance without having a valid appropriate | 17 | | authority may be fined by the Department not more than $50 per | 18 | | prescription, and the Department may take any other | 19 | | disciplinary action provided for in this Act. | 20 | | (h) Nothing in this Section shall be construed to prohibit | 21 | | generic 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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| 1 | | hospital affiliates, or ambulatory surgical treatment centers.
| 2 | | (a) An advanced practice nurse may provide
services in a | 3 | | licensed hospital or a hospital affiliate as those terms are | 4 | | defined in the Hospital Licensing Act or the University of | 5 | | Illinois Hospital Act or a licensed ambulatory surgical
| 6 | | treatment center without prescriptive authority or a written | 7 | | collaborative agreement pursuant to Section 65-35 of this Act. | 8 | | An advanced practice nurse must possess clinical privileges | 9 | | recommended by the hospital medical staff and granted by the | 10 | | hospital or the consulting medical staff committee and | 11 | | ambulatory surgical treatment center in order to provide | 12 | | services. The medical staff or consulting medical staff | 13 | | committee shall periodically review the services of advanced | 14 | | practice nurses granted clinical privileges , including any | 15 | | care provided in a hospital affiliate . Authority may also be | 16 | | granted when recommended by the hospital medical staff and | 17 | | granted by the hospital or recommended by the consulting | 18 | | medical staff committee and ambulatory surgical treatment | 19 | | center to individual advanced practice nurses to select, order, | 20 | | and administer medications, including controlled substances, | 21 | | to provide delineated care. In a hospital, hospital affiliate, | 22 | | or ambulatory surgical treatment center, the The attending | 23 | | physician shall determine an advanced practice nurse's role in | 24 | | providing care for his or her patients, except as otherwise | 25 | | provided in the medical staff bylaws or consulting committee | 26 | | policies.
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| 1 | | (a-2) An advanced practice nurse granted authority to order | 2 | | medications including controlled substances may complete | 3 | | discharge prescriptions provided the prescription is in the | 4 | | name of the advanced practice nurse and the attending or | 5 | | discharging physician. | 6 | | (a-3) Advanced practice nurses practicing in a hospital or | 7 | | an ambulatory surgical treatment center are not required to | 8 | | obtain a mid-level controlled substance license to order | 9 | | controlled substances under Section 303.05 of the Illinois | 10 | | Controlled Substances Act. | 11 | | (a-5) For
anesthesia services provided by a certified | 12 | | registered nurse anesthetist, an anesthesiologist,
physician, | 13 | | dentist,
or podiatrist shall participate through discussion of | 14 | | and agreement with the
anesthesia plan and shall
remain
| 15 | | physically present
and be available on the premises during the | 16 | | delivery of anesthesia services for
diagnosis, consultation, | 17 | | and treatment of
emergency medical conditions, unless hospital | 18 | | policy adopted pursuant to
clause (B) of subdivision (3) of | 19 | | Section 10.7 of the Hospital Licensing Act
or ambulatory | 20 | | surgical treatment center policy adopted pursuant to
clause (B) | 21 | | of subdivision (3) of Section 6.5 of the Ambulatory Surgical
| 22 | | Treatment Center Act
provides otherwise. A certified | 23 | | registered nurse anesthetist may select, order, and administer | 24 | | medication for anesthesia services under the anesthesia plan | 25 | | agreed to by the anesthesiologist or the physician, in | 26 | | accordance with hospital alternative policy or the medical |
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| 1 | | staff consulting committee policies of a licensed ambulatory | 2 | | surgical treatment center.
| 3 | | (b) An advanced practice nurse who provides
services in a | 4 | | hospital shall do so in accordance with Section 10.7 of the
| 5 | | Hospital
Licensing Act and, in an
ambulatory surgical treatment | 6 | | center, in accordance with Section 6.5 of the
Ambulatory
| 7 | | Surgical Treatment Center Act.
| 8 | | (Source: P.A. 95-639, eff. 10-5-07.)
| 9 | | Section 15. The Physician Assistant Practice Act of 1987 is | 10 | | amended 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; | 14 | | prescriptive authority. | 15 | | (a) A written supervision agreement is required for all | 16 | | physician 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, | 18 | | delegate prescriptive authority to a physician assistant as | 19 | | part of a written supervision agreement. This authority may, | 20 | | but is not required to, include prescription of, selection of, | 21 | | orders for, administration of, storage of, acceptance of | 22 | | samples of, and dispensing over the counter medications, legend | 23 | | drugs, medical gases, and controlled substances categorized as | 24 | | Schedule III through V controlled substances, as defined in | 25 | | Article II of the Illinois Controlled Substances Act, and other | 26 | | preparations, including, but not limited to, botanical and |
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| 1 | | herbal remedies. The supervising physician must have a valid, | 2 | | current Illinois controlled substance license and federal | 3 | | registration with the Drug Enforcement Agency to delegate the | 4 | | authority 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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| 1 | | delegation of tasks or duties by a physician to a licensed | 2 | | practical nurse, a registered professional nurse, or other | 3 | | persons. Nothing in this Act shall be construed to limit the | 4 | | method of delegation that may be authorized by any means, | 5 | | including, but not limited to, oral, written, electronic, | 6 | | standing orders, protocols, guidelines, or verbal orders.
| 7 | | (d) Any physician assistant who writes a prescription for a | 8 | | controlled substance without having a valid appropriate | 9 | | authority may be fined by the Department not more than $50 per | 10 | | prescription, and the Department may take any other | 11 | | disciplinary action provided for in this Act. | 12 | | (e) Nothing in this Section shall be construed to prohibit | 13 | | generic substitution. | 14 | | (Source: P.A. 96-268, eff. 8-11-09; 96-618, eff. 1-1-10; | 15 | | 96-1000, eff. 7-2-10.)
| 16 | | Section 20. The Podiatric Medical Practice Act of 1987 is | 17 | | amended 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 | 21 | | nurses.
| 22 | | (a) A podiatrist in active clinical practice may | 23 | | collaborate with an advanced practice nurse in accordance with | 24 | | the requirements of the Nurse Practice Act. Collaboration shall |
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| 1 | | be for the purpose of providing podiatric consultation and no | 2 | | employment relationship shall be required. A written | 3 | | collaborative agreement shall conform to the requirements of | 4 | | Section 65-35 of the Nurse Practice Act. The written | 5 | | collaborative agreement shall be for services the | 6 | | collaborating podiatrist generally provides to his or her | 7 | | patients in the normal course of clinical podiatric practice, | 8 | | except as set forth in item (3) of this subsection (a). A | 9 | | written collaborative agreement and podiatric collaboration | 10 | | and consultation shall be adequate with respect to advanced | 11 | | practice 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 | 3 | | records of all patients attended to by an advanced practice | 4 | | nurse. | 5 | | (c) Nothing in this Section shall be construed to limit the | 6 | | delegation of tasks or duties by a podiatrist to a licensed | 7 | | practical nurse, a registered professional nurse, or other | 8 | | appropriately trained persons. | 9 | | (d) A podiatrist shall not be liable for the acts or | 10 | | omissions of an advanced practice nurse solely on the basis of | 11 | | having signed guidelines or a collaborative agreement, an | 12 | | order, a standing order, a standing delegation order, or other | 13 | | order or guideline authorizing an advanced practice nurse to | 14 | | perform acts, unless the podiatrist has reason to believe the | 15 | | advanced practice nurse lacked the competency to perform the | 16 | | act or acts or commits willful or wanton misconduct.
| 17 | | (f) A podiatrist, may, but is not required to delegate | 18 | | prescriptive authority to an advanced practice nurse as part of | 19 | | a written collaborative agreement and the delegation of | 20 | | prescriptive authority shall conform to the requirements of | 21 | | Section 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 | 24 | | amended 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 | 4 | | Regulation shall register licensed
physician assistants and | 5 | | licensed advanced practice nurses to prescribe and
dispense | 6 | | controlled substances under Section 303 and euthanasia
| 7 | | agencies to purchase, store, or administer animal euthanasia | 8 | | drugs 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 | 8 | | prescribe those
schedules of controlled substances for which a | 9 | | licensed physician or licensed podiatrist has delegated
| 10 | | prescriptive authority, except that an animal euthanasia | 11 | | agency does not have any
prescriptive authority.
A physician | 12 | | assistant and an advanced practice nurse are prohibited from | 13 | | prescribing medications and controlled substances not set | 14 | | forth in the required written delegation of authority.
| 15 | | (c) Upon completion of all registration requirements, | 16 | | physician
assistants, advanced practice nurses, and animal | 17 | | euthanasia agencies shall be issued a
mid-level practitioner
| 18 | | controlled substances license for Illinois.
| 19 | | (d) A collaborating physician or podiatrist may, but is not | 20 | | required to, delegate prescriptive authority to an advanced | 21 | | practice nurse as part of a written collaborative agreement, | 22 | | and the delegation of prescriptive authority shall conform to | 23 | | the requirements of Section 65-40 of the Nurse Practice Act. | 24 | | (e) A supervising physician may, but is not required to, | 25 | | delegate prescriptive authority to a physician assistant as | 26 | | part of a written supervision agreement, and the delegation of |
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| 1 | | prescriptive authority shall conform to the requirements of | 2 | | Section 7.5 of the Physician Assistant Practice Act of 1987. | 3 | | (f) Nothing in this Section shall be construed to prohibit | 4 | | generic substitution. | 5 | | (Source: P.A. 95-639, eff. 10-5-07; 96-189, eff. 8-10-09; | 6 | | 96-268, eff. 8-11-09; 96-1000, eff. 7-2-10.)
| 7 | | Section 99. Effective date. This Act takes effect July 1, | 8 | | 2011.".
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