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Public Act 096-0618


 

Public Act 0618 96TH GENERAL ASSEMBLY



 


 
Public Act 096-0618
 
SB0318 Enrolled LRB096 08980 ASK 19119 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Medical Practice Act of 1987 is amended by
changing Section 54.5 and by adding Section 54.2 as follows:
 
    (225 ILCS 60/54.2 new)
    (Section scheduled to be repealed on December 31, 2010)
    Sec. 54.2. Physician delegation of authority.
    (a) Nothing in this Act shall be construed to limit the
delegation of patient care tasks or duties by a physician, to a
licensed practical nurse, a registered professional nurse, or
other licensed person practicing within the scope of his or her
individual licensing Act. Delegation by a physician licensed to
practice medicine in all its branches to physician assistants
or advanced practice nurses is also addressed in Section 54.5
of this Act. No physician may delegate any patient care task or
duty that is statutorily or by rule mandated to be performed by
a physician.
    (b) In an office or practice setting and within a
physician-patient relationship, a physician may delegate
patient care tasks or duties to an unlicensed person who
possesses appropriate training and experience provided a
health care professional, who is practicing within the scope of
such licensed professional's individual licensing Act, is on
site to provide assistance.
    (c) Any such patient care task or duty delegated to a
licensed or unlicensed person must be within the scope of
practice, education, training, or experience of the delegating
physician and within the context of a physician-patient
relationship.
    (d) Nothing in this Section shall be construed to affect
referrals for professional services required by law.
    (e) The Department shall have the authority to promulgate
rules concerning a physician's delegation, including but not
limited to, the use of light emitting devices for patient care
or treatment.
 
    (225 ILCS 60/54.5)
    (Section scheduled to be repealed on December 31, 2010)
    Sec. 54.5. Physician delegation of authority to physician
assistants and advanced practice nurses.
    (a) Physicians licensed to practice medicine in all its
branches may delegate care and treatment responsibilities to a
physician assistant under guidelines in accordance with the
requirements of the Physician Assistant Practice Act of 1987. A
physician licensed to practice medicine in all its branches may
enter into supervising physician agreements with no more than 2
physician assistants.
    (b) A physician licensed to practice medicine in all its
branches in active clinical practice may collaborate with an
advanced practice nurse in accordance with the requirements of
the Nurse Practice Act. Collaboration is for the purpose of
providing medical consultation, and no employment relationship
is required. A written collaborative agreement shall conform to
the requirements of Section 65-35 of the Nurse Practice Act.
The written collaborative agreement shall be for services the
collaborating physician generally provides to his or her
patients in the normal course of clinical medical practice. A
written collaborative agreement shall be adequate with respect
to collaboration with advanced practice nurses if all of the
following apply:
        (1) The agreement is written to promote the exercise of
    professional judgment by the advanced practice nurse
    commensurate with his or her education and experience. The
    agreement need not describe the exact steps that an
    advanced practice nurse must take with respect to each
    specific condition, disease, or symptom, but must specify
    those procedures that require a physician's presence as the
    procedures are being performed.
        (2) Practice guidelines and orders are developed and
    approved jointly by the advanced practice nurse and
    collaborating physician, as needed, based on the practice
    of the practitioners. Such guidelines and orders and the
    patient services provided thereunder are periodically
    reviewed by the collaborating physician.
        (3) The advance practice nurse provides services the
    collaborating physician generally provides to his or her
    patients in the normal course of clinical practice, except
    as set forth in subsection (b-5) of this Section. With
    respect to labor and delivery, the collaborating physician
    must provide delivery services in order to participate with
    a certified nurse midwife.
        (4) The collaborating physician and advanced practice
    nurse meet in person at least once a month to provide
    collaboration and consultation.
        (5) Methods of communication are available with the
    collaborating physician in person or through
    telecommunications for consultation, collaboration, and
    referral as needed to address patient care needs.
        (6) The agreement contains provisions detailing notice
    for termination or change of status involving a written
    collaborative agreement, except when such notice is given
    for just cause.
    (b-5) An anesthesiologist or physician licensed to
practice medicine in all its branches may collaborate with a
certified registered nurse anesthetist in accordance with
Section 65-35 of the Nurse Practice Act for the provision of
anesthesia services. With respect to the provision of
anesthesia services, the collaborating anesthesiologist or
physician shall have training and experience in the delivery of
anesthesia services consistent with Department rules.
Collaboration shall be adequate if:
        (1) an anesthesiologist or a physician participates in
    the joint formulation and joint approval of orders or
    guidelines and periodically reviews such orders and the
    services provided patients under such orders; and
        (2) for anesthesia services, the anesthesiologist or
    physician participates through discussion of and agreement
    with the anesthesia plan and is physically present and
    available on the premises during the delivery of anesthesia
    services for diagnosis, consultation, and treatment of
    emergency medical conditions. Anesthesia services in a
    hospital shall be conducted in accordance with Section 10.7
    of the Hospital Licensing Act and in an ambulatory surgical
    treatment center in accordance with Section 6.5 of the
    Ambulatory Surgical Treatment Center Act.
    (b-10) The anesthesiologist or operating physician must
agree with the anesthesia plan prior to the delivery of
services.
    (c) The supervising physician shall have access to the
medical records of all patients attended by a physician
assistant. The collaborating physician shall have access to the
medical records of all patients attended to by an advanced
practice nurse.
    (d) (Blank). Nothing in this Act shall be construed to
limit the delegation of tasks or duties by a physician licensed
to practice medicine in all its branches to a licensed
practical nurse, a registered professional nurse, or other
persons.
    (e) A physician shall not be liable for the acts or
omissions of a physician assistant or advanced practice nurse
solely on the basis of having signed a supervision agreement or
guidelines or a collaborative agreement, an order, a standing
medical order, a standing delegation order, or other order or
guideline authorizing a physician assistant or advanced
practice nurse to perform acts, unless the physician has reason
to believe the physician assistant or advanced practice nurse
lacked the competency to perform the act or acts or commits
willful and wanton misconduct.
(Source: P.A. 95-639, eff. 10-5-07.)
 
    Section 10. The Nurse Practice Act is amended by changing
Section 65-35 as follows:
 
    (225 ILCS 65/65-35)   (was 225 ILCS 65/15-15)
    (Section scheduled to be repealed on January 1, 2018)
    Sec. 65-35. Written collaborative agreements.
    (a) A written collaborative agreement is required for all
advanced practice nurses engaged in clinical practice, except
for advanced practice nurses who are authorized to practice in
a hospital or ambulatory surgical treatment center.
    (a-5) If an advanced practice nurse engages in clinical
practice outside of a hospital or ambulatory surgical treatment
center in which he or she is authorized to practice, the
advanced practice nurse must have a written collaborative
agreement.
    (b) A written collaborative agreement shall describe the
working relationship of the advanced practice nurse with the
collaborating physician or podiatrist and shall authorize the
categories of care, treatment, or procedures to be performed by
the advanced practice nurse. A collaborative agreement with a
dentist must be in accordance with subsection (c-10) of this
Section. Collaboration does not require an employment
relationship between the collaborating physician and advanced
practice nurse. Collaboration means the relationship under
which an advanced practice nurse works with a collaborating
physician or podiatrist in an active clinical practice to
deliver health care services in accordance with (i) the
advanced practice nurse's training, education, and experience
and (ii) collaboration and consultation as documented in a
jointly developed written collaborative agreement.
    The agreement shall be defined to promote the exercise of
professional judgment by the advanced practice nurse
commensurate with his or her education and experience. The
services to be provided by the advanced practice nurse shall be
services that the collaborating physician or podiatrist is
authorized to and generally provides to his or her patients in
the normal course of his or her clinical medical practice,
except as set forth in subsection (c-5) of this Section. The
agreement need not describe the exact steps that an advanced
practice nurse must take with respect to each specific
condition, disease, or symptom but must specify which
authorized procedures require the presence of the
collaborating physician or podiatrist as the procedures are
being performed. The collaborative relationship under an
agreement shall not be construed to require the personal
presence of a physician or podiatrist at all times at the place
where services are rendered. Methods of communication shall be
available for consultation with the collaborating physician or
podiatrist in person or by telecommunications in accordance
with established written guidelines as set forth in the written
agreement.
    (c) Collaboration and consultation under all collaboration
agreements shall be adequate if a collaborating physician or
podiatrist does each of the following:
        (1) Participates in the joint formulation and joint
    approval of orders or guidelines with the advanced practice
    nurse and he or she periodically reviews such orders and
    the services provided patients under such orders in
    accordance with accepted standards of medical practice and
    advanced practice nursing practice.
        (2) Meets in person with the advanced practice nurse at
    least once a month to provide collaboration and
    consultation. In the case of anesthesia services provided
    by a certified registered nurse anesthetist, an
    anesthesiologist, physician, dentist, or podiatrist must
    participate through discussion of and agreement with the
    anesthesia plan and remain physically present and
    available on the premises during the delivery of anesthesia
    services for diagnosis, consultation, and treatment of
    emergency medical conditions.
        (3) Is available through telecommunications for
    consultation on medical problems, complications, or
    emergencies or patient referral. In the case of anesthesia
    services provided by a certified registered nurse
    anesthetist, an anesthesiologist, physician, dentist, or
    podiatrist must participate through discussion of and
    agreement with the anesthesia plan and remain physically
    present and available on the premises during the delivery
    of anesthesia services for diagnosis, consultation, and
    treatment of emergency medical conditions.
    The agreement must contain provisions detailing notice for
termination or change of status involving a written
collaborative agreement, except when such notice is given for
just cause.
    (c-5) A certified registered nurse anesthetist, who
provides anesthesia services outside of a hospital or
ambulatory surgical treatment center shall enter into a written
collaborative agreement with an anesthesiologist or the
physician licensed to practice medicine in all its branches or
the podiatrist performing the procedure. Outside of a hospital
or ambulatory surgical treatment center, the certified
registered nurse anesthetist may provide only those services
that the collaborating podiatrist is authorized to provide
pursuant to the Podiatric Medical Practice Act of 1987 and
rules adopted thereunder. A certified registered nurse
anesthetist may select, order, and administer medication,
including controlled substances, and apply appropriate medical
devices for delivery of anesthesia services under the
anesthesia plan agreed with by the anesthesiologist or the
operating physician or operating podiatrist.
    (c-10) A certified registered nurse anesthetist who
provides anesthesia services in a dental office shall enter
into a written collaborative agreement with an
anesthesiologist or the physician licensed to practice
medicine in all its branches or the operating dentist
performing the procedure. The agreement shall describe the
working relationship of the certified registered nurse
anesthetist and dentist and shall authorize the categories of
care, treatment, or procedures to be performed by the certified
registered nurse anesthetist. In a collaborating dentist's
office, the certified registered nurse anesthetist may only
provide those services that the operating dentist with the
appropriate permit is authorized to provide pursuant to the
Illinois Dental Practice Act and rules adopted thereunder. For
anesthesia services, an anesthesiologist, physician, or
operating dentist shall participate through discussion of and
agreement with the anesthesia plan and shall remain physically
present and be available on the premises during the delivery of
anesthesia services for diagnosis, consultation, and treatment
of emergency medical conditions. A certified registered nurse
anesthetist may select, order, and administer medication,
including controlled substances, and apply appropriate medical
devices for delivery of anesthesia services under the
anesthesia plan agreed with by the operating dentist.
    (d) A copy of the signed, written collaborative agreement
must be available to the Department upon request from both the
advanced practice nurse and the collaborating physician or
podiatrist.
    (e) Nothing in this Act shall be construed to limit the
delegation of tasks or duties by a physician to a licensed
practical nurse, a registered professional nurse, or other
persons in accordance with Section 54.2 of the Medical Practice
Act of 1987.
    (f) An advanced practice nurse shall inform each
collaborating physician, dentist, or podiatrist of all
collaborative agreements he or she has signed and provide a
copy of these to any collaborating physician, dentist, or
podiatrist upon request.
(Source: P.A. 95-639, eff. 10-5-07.)
 
    Section 15. The Physician Assistant Practice Act of 1987 is
amended by changing Section 7.5 as follows:
 
    (225 ILCS 95/7.5)
    (Section scheduled to be repealed on January 1, 2018)
    Sec. 7.5. Prescriptions. A supervising physician may
delegate limited prescriptive authority to a physician
assistant. This authority may, but is not required to, include
prescription and dispensing of legend drugs and legend
controlled substances categorized as Schedule III, IV, or V
controlled substances, as defined in Article II of the Illinois
Controlled Substances Act, as delegated in the written
guidelines required by this Act. To prescribe Schedule III, IV,
or V controlled substances under this Section, a physician
assistant must obtain a mid-level practitioner controlled
substances license. Medication orders issued by a physician
assistant shall be reviewed periodically by the supervising
physician. The supervising physician shall file with the
Department notice of delegation of prescriptive authority to a
physician assistant and termination of delegation, specifying
the authority delegated or terminated. Upon receipt of this
notice delegating authority to prescribe Schedule III, IV, or V
controlled substances, the physician assistant shall be
eligible to register for a mid-level practitioner controlled
substances license under Section 303.05 of the Illinois
Controlled Substances Act. Nothing in this Act shall be
construed to limit the delegation of tasks or duties by the
supervising physician to a nurse or other appropriately trained
persons in accordance with Section 54.2 of the Medical Practice
Act of 1987 personnel.
    The Department shall establish by rule the minimum
requirements for written guidelines to be followed under this
Section.
(Source: P.A. 90-116, eff. 7-14-97; 90-818, eff. 3-23-99.)
 
    Section 20. The Podiatric Medical Practice Act of 1987 is
amended by changing Section 20.5 as follows:
 
    (225 ILCS 100/20.5)
    (Section scheduled to be repealed on January 1, 2018)
    Sec. 20.5. Delegation of authority to advanced practice
nurses.
    (a) A podiatrist in active clinical practice may
collaborate with an advanced practice nurse in accordance with
the requirements of the Nurse Practice Act. Collaboration shall
be for the purpose of providing podiatric consultation and no
employment relationship shall be required. A written
collaborative agreement shall conform to the requirements of
Section 65-35 of the Nurse Practice Act. The written
collaborative agreement shall be for services the
collaborating podiatrist generally provides to his or her
patients in the normal course of clinical podiatric practice,
except as set forth in item (3) of this subsection (a). A
written collaborative agreement and podiatric collaboration
and consultation shall be adequate with respect to advanced
practice nurses if all of the following apply:
        (1) The agreement is written to promote the exercise of
    professional judgment by the advanced practice nurse
    commensurate with his or her education and experience. The
    agreement need not describe the exact steps that an
    advanced practice nurse must take with respect to each
    specific condition, disease, or symptom, but must specify
    which procedures require a podiatrist's presence as the
    procedures are being performed.
        (2) Practice guidelines and orders are developed and
    approved jointly by the advanced practice nurse and
    collaborating podiatrist, as needed, based on the practice
    of the practitioners. Such guidelines and orders and the
    patient services provided thereunder are periodically
    reviewed by the collaborating podiatrist.
        (3) The advance practice nurse provides services that
    the collaborating podiatrist generally provides to his or
    her patients in the normal course of clinical practice.
    With respect to the provision of anesthesia services by a
    certified registered nurse anesthetist, the collaborating
    podiatrist must have training and experience in the
    delivery of anesthesia consistent with Department rules.
        (4) The collaborating podiatrist and the advanced
    practice nurse meet in person at least once a month to
    provide collaboration and consultation.
        (5) Methods of communication are available with the
    collaborating podiatrist in person or through
    telecommunications for consultation, collaboration, and
    referral as needed to address patient care needs.
        (6) With respect to the provision of anesthesia
    services by a certified registered nurse anesthetist, an
    anesthesiologist, physician, or podiatrist shall
    participate through discussion of and agreement with the
    anesthesia plan and shall remain physically present and be
    available on the premises during the delivery of anesthesia
    services for diagnosis, consultation, and treatment of
    emergency medical conditions. The anesthesiologist or
    operating podiatrist must agree with the anesthesia plan
    prior to the delivery of services.
        (7) The agreement contains provisions detailing notice
    for termination or change of status involving a written
    collaborative agreement, except when such notice is given
    for just cause.
    (b) The collaborating podiatrist shall have access to the
records of all patients attended to by an advanced practice
nurse.
    (c) Nothing in this Section shall be construed to limit the
delegation of tasks or duties by a podiatrist to a licensed
practical nurse, a registered professional nurse, or other
appropriately trained persons.
    (d) A podiatrist shall not be liable for the acts or
omissions of an advanced practice nurse solely on the basis of
having signed guidelines or a collaborative agreement, an
order, a standing order, a standing delegation order, or other
order or guideline authorizing an advanced practice nurse to
perform acts, unless the podiatrist has reason to believe the
advanced practice nurse lacked the competency to perform the
act or acts or commits willful or wanton misconduct.
(Source: P.A. 95-639, eff. 10-5-07.)
 
    Section 99. Effective date. This Act takes effect January
1, 2010.

Effective Date: 1/1/2010