Section 140.435  Advanced Practice Registered Nurse Services

a)         For purposes of enrollment in the Medical Assistance Program, an advanced practice registered nurse (APRN) means a person who is licensed as a registered professional nurse, holds a valid license in the state of practice and is legally authorized under state law or rule to practice as an advanced practice registered nurse, so long as that practice is not in conflict with the Nurse Practice Act [225 ILCS 65], the Medical Practice Act of 1987 [225 ILCS 60] and the administrative rules implementing the Nurse Practice Act (68 Ill. Adm. Code 1300) and the Medical Practice Act of 1987 (68 Ill. Adm. Code 1285).  Categories of APRNs include:

1)         Certified Registered Nurse Anesthetist (CRNA);

2)         Certified Nurse Midwife (CNM);

3)         Certified Nurse Practitioner (CNP); and

4)         Clinical Nurse Specialist (CNS).

b)         APRNs licensed with full practice authority under 68 Ill. Adm. Code 1300.465 are not required to have a collaborative agreement with a collaborating physician or practitioner. A written collaborative agreement with a collaborating physician or practitioner is required for all APRNs not licensed with full practice authority who are engaged in clinical practice, except for those APRNs who practice in a hospital, hospital affiliate or ambulatory surgical treatment center under Section 65-45 of the Nurse Practice Act.

c)         The collaborative agreement or agreements required under subsection (b) shall comply with all requirements described in the Nurse Practice Act and 68 Ill. Adm. Code 1300.  Agreements required under the Act and 68 Ill. Adm. Code 1300 must be updated, be maintained on file at each practice location, and be available upon the Department's request.

d)         The APRN must notify the Department if a collaborative agreement is dissolved prior to or immediately following the date of dissolution. The APRN must also notify the Department if a change occurs in the collaborating physician, dentist or podiatric physician under the agreement.  Upon notification or knowledge thereof, the Department will re-evaluate the APRN's enrollment status.  The Department will also withhold payment for services provided to eligible clients as of that date of dissolution or the change in the collaborative agreement, unless the APRN and/or the former or new collaborating physician, dentist or podiatric physician show reasonable cause for the payment arrangement to continue without interruption.

e)         The collaborating physician, dentist or podiatric physician is not required to be enrolled with the Department.  However, the collaborating physician or practitioner may not be terminated, suspended or barred by the Department from participating in the Medical Assistance Program. The Department will re-evaluate the APRN's enrollment status.  The Department will also withhold payment for services provided to eligible clients as of that date of the termination, suspension or barring of the collaborative physician or practitioner unless the APRN shows reasonable cause for the payment arrangement to continue without interruption.

f)         An APRN must submit the following information in their initial application for enrollment:

1)         An APRN who is not required to maintain a collaborative or written practice agreement under Section 140.431(b) must provide the names and addresses of the hospitals or ambulatory surgical treatment centers where the APRN practices; or

2)         An APRN who is required to maintain a collaborative or written practice agreement under Section 140.431 (b) must provide the following:

A)        Documentation of specialty of practice.

B)        Name and address of collaborating physician, dentist or podiatric physician.

C)        Federal Employer Identification Number (FEIN) of collaborating physician, dentist or podiatric physician.

D)        Medical license number of collaborating physician, dentist or podiatric physician.

E)        State of licensure, if other than Illinois, and address of collaborating physician, dentist or podiatric physician.

g)         To be eligible for reimbursement for individual psychiatric services, as defined in the American Medical Association Current Procedural Terminology (CPT) book, CPT code range 90791 through 90899, the rendering APRN must hold a current certification in Psychiatric and Mental Health Nursing.

h)         An APRN with a collaborative agreement, and enrolled with the Department, who later receives full practice authority licensure must notify the Department of this change.

(Source:  Amended at 46 Ill. Reg. 5725, effective March 25, 2022)