Public Act 097-0358
 
SB2255 EnrolledLRB097 09159 CEL 49294 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 as follows:
 



    (225 ILCS 60/54.5)


    (Section scheduled to be repealed on November 30, 2011)

    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 consult 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).

    (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.

    (f) A collaborating physician may, but is not required to, 
delegate prescriptive authority to an advanced practice nurse 
as part of a written collaborative agreement, and the 
delegation of prescriptive authority shall conform to the 
requirements of Section 65-40 of the Nurse Practice Act. 
    (g) A supervising physician may, but is not required to, 
delegate prescriptive authority to a physician assistant as 
part of a written supervision agreement, and the delegation of 
prescriptive authority shall conform to the requirements of 
Section 7.5 of the Physician Assistant Practice Act of 1987. 
(Source: P.A. 95-639, eff. 10-5-07; 96-618, eff. 1-1-10.)

 
    Section 10. The Nurse Practice Act is amended  by changing 
Sections 65-35, 65-40, and 65-45 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.  Absent an employment relationship, an 
agreement may not restrict the categories of patients or 
third-party payment sources accepted by the 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 or 
    podiatric practice and advanced practice nursing practice.


        (2) Provides collaboration and consultation 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. Nothing in this Act shall be construed to limit 
the method of delegation that may be authorized by any means, 
including, but not limited to, oral, written, electronic, 
standing orders, protocols, guidelines, or verbal orders. 
    (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.

    (g) For the purposes of this Act, "generally provides to 
his or her patients in the normal course of his or her clinical 
medical practice" means services, not specific tasks or duties, 
the physician or podiatrist routinely provides individually or 
through delegation to other persons so that the physician or 
podiatrist has the experience and ability to provide 
collaboration and consultation. 
(Source: P.A. 95-639, eff. 10-5-07; 96-618, eff. 1-1-10.)

 



    (225 ILCS 65/65-40)
  (was 225 ILCS 65/15-20)


    (Section scheduled to be repealed on January 1, 2018)

    Sec. 65-40. Written collaborative agreement; prescriptive 
Prescriptive authority. 

    (a) A collaborating
physician or podiatrist may, but is not 
required to,  delegate
prescriptive authority to an advanced 
practice
nurse as part of a written collaborative agreement.  
This authority may, but is
not required to, include

prescription of, selection of, orders for, administration of, 
storage of, acceptance of samples of, and dispensing over the 
counter medications, legend drugs, medical gases, and 
controlled
substances categorized as
any Schedule III through V 
controlled substances, as defined in Article II of the
Illinois 
Controlled Substances Act, and other preparations, including, 
but not limited to, botanical and herbal remedies.  The 
collaborating physician or podiatrist must have a valid current 
Illinois controlled substance license and federal registration 
to delegate authority to prescribe delegated controlled 
substances.

    (b) To prescribe controlled
substances under this Section, 
an advanced practice
nurse must obtain a mid-level practitioner 
controlled substance license.
 Medication orders shall be

reviewed
periodically by the collaborating physician or 
podiatrist.

    (c) The collaborating physician or podiatrist shall file 
with the
Department notice of delegation of prescriptive 
authority
and
termination of such delegation, in accordance 
with  rules of the Department.
 Upon receipt of this notice 
delegating authority to prescribe any Schedule III through V 
controlled substances, the licensed advanced practice nurse 
shall be
eligible to register for a mid-level practitioner 
controlled substance license
under Section 303.05 of the 
Illinois Controlled Substances Act.

    (d) In addition to the requirements of subsections (a), 
(b), and (c) of this Section, a collaborating physician or 
podiatrist may, but is not required to, delegate authority to 
an advanced practice nurse to prescribe any Schedule II 
controlled substances, if all of  the following conditions 
apply:
        (1) Specific No more than 5 Schedule II controlled 
    substances by oral dosage or topical or transdermal 
    application may be delegated, provided that the delegated 
    Schedule II controlled substances are routinely prescribed 
    by the collaborating physician or podiatrist. This 
    delegation must identify the specific Schedule II 
    controlled substances by either brand name or generic name. 
    Schedule II controlled substances to be delivered by 
    injection or other route of administration may not be 
    delegated. 
        (2) Any delegation must be controlled substances that 
    the collaborating physician or podiatrist prescribes.
        (3) Any prescription must be limited to no more than a 
    30-day supply oral dosage, with any continuation 
    authorized only after prior approval of the collaborating 
    physician or podiatrist.
        (4) The advanced practice nurse must discuss the 
    condition of any patients for whom a controlled substance 
    is prescribed monthly with the delegating physician.
        (5) The advanced practice nurse meets the education 
    requirements of Section 303.05 of the Illinois Controlled 
    Substances Act.

    (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. Nothing in this Act shall be construed to limit the 
method of delegation that may be authorized by any means, 
including, but not limited to, oral, written, electronic, 
standing orders, protocols, guidelines, or verbal orders. 

    (f) Nothing in this Section shall be construed to apply to 
any medication authority including Schedule II controlled 
substances of an advanced practice nurse for care provided in a 
hospital, hospital affiliate, or ambulatory surgical treatment 
center pursuant to Section 65-45. 
    (g) Any advanced practice nurse who writes a prescription 
for a controlled substance without having a valid appropriate 
authority may be fined by the Department not more than $50 per 
prescription, and the Department may take any other 
disciplinary action provided for in this Act. 
    (h) Nothing in this Section shall be construed to prohibit 
generic substitution. 
(Source: P.A. 95-639, eff. 10-5-07; 96-189, eff. 8-10-09.)

 



    (225 ILCS 65/65-45)
  (was 225 ILCS 65/15-25)


    (Section scheduled to be repealed on January 1, 2018)

    Sec. 65-45. Advanced practice nursing in hospitals, 
hospital affiliates, or ambulatory surgical treatment centers. 

    (a) An advanced practice nurse may provide
services in a 
licensed hospital or a hospital affiliate as those terms are 
defined in the Hospital Licensing Act or the University of 
Illinois Hospital Act or a licensed ambulatory surgical

treatment center without prescriptive authority or a written 
collaborative agreement pursuant to Section 65-35 of this Act.  
An advanced practice nurse must possess clinical privileges 
recommended by the hospital medical staff and granted by the 
hospital or the consulting medical staff committee and 
ambulatory surgical treatment center in order to provide 
services.  The medical staff or consulting medical staff 
committee shall periodically review the services of advanced 
practice nurses granted clinical privileges, including any 
care provided in a hospital affiliate.  Authority may also be 
granted when recommended by the hospital medical staff and 
granted by the hospital or recommended by the consulting 
medical staff committee and ambulatory surgical treatment 
center to individual advanced practice nurses to select, order, 
and administer medications, including controlled substances, 
to provide delineated care.  In a hospital, hospital affiliate, 
or ambulatory surgical treatment center, the The attending 
physician shall determine an advanced practice nurse's role in 
providing care for his or her patients, except as otherwise 
provided in the medical staff bylaws or consulting committee 
policies.
 
    (a-2) An advanced practice nurse granted authority to order 
medications including controlled substances may complete 
discharge prescriptions provided the prescription is in the 
name of the advanced practice nurse and the attending or 
discharging physician.
    (a-3) Advanced practice nurses practicing in a hospital or 
an ambulatory surgical treatment center are not required to 
obtain a mid-level controlled substance license to order 
controlled substances under Section 303.05 of the Illinois 
Controlled Substances Act. 
    (a-5) For
anesthesia services provided by a certified 
registered nurse anesthetist, an anesthesiologist,
physician, 
dentist,
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, unless hospital 
policy adopted pursuant to
clause (B) of subdivision (3) of 
Section 10.7 of the Hospital Licensing Act
or ambulatory 
surgical treatment center policy adopted pursuant to
clause (B) 
of subdivision (3) of Section 6.5 of the Ambulatory Surgical

Treatment Center Act
provides otherwise. A certified 
registered nurse anesthetist  may select, order, and administer 
medication for anesthesia services under the anesthesia plan 
agreed to by the anesthesiologist or the physician, in 
accordance with hospital alternative policy or the medical 
staff consulting committee policies of a licensed ambulatory 
surgical treatment center.

    (b) An advanced practice nurse who provides
services in a 
hospital shall do so 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.




(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; written supervision agreements; 
prescriptive authority. 
    (a) A written supervision agreement is required for all 
physician assistants to practice in the State.
        (1) A written supervision agreement shall describe the 
    working relationship of the physician assistant with the 
    supervising physician and shall authorize the categories 
    of care, treatment, or procedures to be performed by the 
    physician assistant.
The written supervision agreement 
    shall be defined to promote the exercise of professional 
    judgment by the physician assistant commensurate with his 
    or her education and experience.  The services to be 
    provided by the physician assistant shall be services that 
    the supervising physician is authorized to and generally 
    provides to his or her patients in the normal course of his 
    or her clinical medical practice.  The written supervision 
    agreement need not describe the exact steps that a 
    physician assistant must take with respect to each specific 
    condition, disease, or symptom but must specify which 
    authorized procedures require the presence of the 
    supervising physician as the procedures are being 
    performed.  The supervision relationship under a written 
    supervision agreement shall not be construed to require the 
    personal presence of a physician at all times at the place 
    where services are rendered.  Methods of communication 
    shall be available for consultation with the supervising 
    physician in person or by telecommunications in accordance 
    with established written guidelines as set forth in the 
    written supervision agreement. For the purposes of this 
    Act, "generally provides to his or her patients in the 
    normal course of his or her clinical medical practice" 
    means services, not specific tasks or duties, the 
    supervising physician routinely provides individually or 
    through delegation to other persons so that the physician 
    has the experience and ability to provide supervision and 
    consultation. 
        (2) The written supervision agreement shall be 
    adequate if a physician does each of the following:
            (A)  Participates in the joint formulation and 
        joint approval of orders or guidelines with the 
        physician assistant 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 physician assistant practice.
            (B)  Provides supervision and consultation Meets in 
        person with the physician assistant at least once a 
        month to provide supervision. 
        (3) A copy of the signed, written supervision agreement 
    must be available to the Department upon request from both 
    the physician assistant and the supervising physician.
        (4) A physician assistant shall inform each 
    supervising physician of all written supervision 
    agreements he or she has signed and provide a copy of these 
    to any supervising physician upon request.
    (b) A supervising physician may, but is not required to, 
delegate prescriptive authority to a physician assistant as 
part of a written supervision agreement.  This authority may, 
but is not required to, include prescription of, selection of, 
orders for, administration of, storage of, acceptance of 
samples of, and dispensing over the counter medications, legend 
drugs, medical gases, and controlled substances categorized as 
Schedule III through V controlled substances, as defined in 
Article II of the Illinois Controlled Substances Act, and other 
preparations, including, but not limited to, botanical and 
herbal remedies.  The supervising physician must have a valid, 
current Illinois controlled substance license and federal 
registration with the Drug Enforcement Agency to delegate the 
authority to prescribe controlled substances. 
        (1) 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. 
        (2) 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.

        (3)  In addition to the requirements of subsection (b) 
    of this Section, a supervising physician may, but is not 
    required to, delegate authority to a physician assistant to 
    prescribe Schedule II controlled substances, if all of the 
    following conditions apply:
            (A) Specific  No more than 5 Schedule II controlled 
        substances by oral dosage or topical or transdermal 
        application may be delegated, provided that the 
        delegated Schedule II controlled substances are 
        routinely prescribed by the supervising physician. 
        This delegation must identify the specific Schedule II 
        controlled substances by either brand name or generic 
        name. Schedule II controlled substances to be 
        delivered by injection or other route of 
        administration may not be delegated.
            (B)  Any delegation must be controlled substances 
        that the supervising physician prescribes.
            (C)  Any prescription must be limited to no more 
        than a 30-day supply oral dosage, with any continuation 
        authorized only after prior approval of the 
        supervising physician.
            (D) The physician assistant must discuss the 
        condition of any patients for whom a controlled 
        substance is prescribed monthly with the supervising 
        physician.
            (E) The physician assistant meets the education 
        requirements of Section 303.05 of the Illinois 
        Controlled Substances Act. 
    (c) 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. Nothing in this Act shall be construed to limit the 
method of delegation that may be authorized by any means, 
including, but not limited to, oral, written, electronic, 
standing orders, protocols, guidelines, or verbal orders.


    (d) Any physician assistant who writes a prescription for a 
controlled substance without having a valid appropriate 
authority may be fined by the Department not more than $50 per 
prescription, and the Department may take any other 
disciplinary action provided for in this Act. 
    (e) Nothing in this Section shall be construed to prohibit 
generic substitution. 
(Source: P.A. 96-268, eff. 8-11-09; 96-618, eff. 1-1-10; 
96-1000, eff. 7-2-10.)

 
    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 consult 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.

    (f) A podiatrist, may, but is not required to delegate 
prescriptive authority to an advanced practice nurse as part of 
a written collaborative agreement and the delegation of 
prescriptive authority shall conform to the requirements of 
Section 65-40 of the Nurse Practice Act. 
(Source: P.A. 95-639, eff. 10-5-07; 96-618, eff. 1-1-10.)
 
    Section 25. The Illinois Controlled Substances Act is 
amended by changing Section 303.05 as follows:
 


    (720 ILCS 570/303.05)


    Sec. 303.05. Mid-level practitioner registration.

    (a) The Department of Financial and Professional 
Regulation shall register licensed
physician assistants and 
licensed advanced practice nurses to prescribe and
dispense 
controlled substances under Section 303 and euthanasia

agencies to purchase, store, or administer animal euthanasia 
drugs under the
following circumstances:


        (1) with respect to physician assistants,


            (A) the physician assistant has been
delegated
 
        authority to prescribe any Schedule III through V 
        controlled substances by a physician licensed to 
        practice medicine in all its
branches in accordance 
        with Section 7.5 of the Physician Assistant Practice 
        Act
of 1987;
and
the physician assistant has
completed 
        the
appropriate application forms and has paid the 
        required fees as set by rule;
or


            (B) the physician assistant has been delegated

        authority by a supervising physician licensed to 
        practice medicine in all its branches to prescribe or 
        dispense Schedule II controlled substances through a 
        written delegation of authority and under the 
        following conditions:
                (i) Specific no more than 5 Schedule II 
            controlled substances by oral dosage or topical or 
            transdermal application may be delegated, provided 
            that the delegated Schedule II controlled 
            substances are routinely prescribed by the 
            supervising physician. This delegation must 
            identify the specific Schedule II controlled 
            substances by either brand name or generic name. 
            Schedule II controlled substances to be delivered 
            by injection or other route of administration may 
            not be delegated;
                (ii) any delegation must be of controlled 
            substances prescribed by the supervising 
            physician;
                (iii) all prescriptions must be limited to no 
            more than a 30-day supply oral dosage, with any 
            continuation authorized only after prior approval 
            of the supervising physician;
                (iv) the physician assistant must discuss the 
            condition of any patients for whom a controlled 
            substance is prescribed monthly with the 
            delegating physician; and
                (v) the physician assistant must have 
            completed the appropriate application forms and 
            paid the required fees as set by rule;
                (vi) the physician assistant must provide 
            evidence of satisfactory completion of 45 contact 
            hours in pharmacology from any physician assistant 
            program accredited by the Accreditation Review 
            Commission on Education for the Physician 
            Assistant (ARC-PA), or its predecessor agency, for 
            any new license issued with Schedule II authority 
            after the effective date of this amendatory Act of 
            the 97th General Assembly; and
                (vii) the physician assistant must annually 
            complete at least 5 hours of continuing education 
            in pharmacology. 
        (2) with respect to advanced practice nurses,
            (A) the advanced practice nurse has been delegated

        authority to prescribe any Schedule III through V 
        controlled substances by a collaborating physician 
        licensed to practice medicine in all its branches or a 
        collaborating podiatrist in accordance with Section 
        65-40 of the Nurse Practice
Act.  The advanced practice 
        nurse has completed the
appropriate application forms 
        and has paid the required
fees as set by rule; or
            (B) the advanced practice nurse has been delegated

        authority by a collaborating physician licensed to 
        practice medicine in all its branches or collaborating 
        podiatrist to prescribe or dispense Schedule II 
        controlled substances through a written delegation of 
        authority and under the following conditions:
                (i) specific no more than 5 Schedule II 
            controlled substances by oral dosage or topical or 
            transdermal application may be delegated, provided 
            that the delegated Schedule II controlled 
            substances are routinely prescribed by the 
            collaborating physician or podiatrist. This 
            delegation must identify the specific Schedule II 
            controlled substances by either brand name or 
            generic name. Schedule II controlled substances to 
            be delivered by injection or other route of 
            administration may not be delegated;
                (ii) any delegation must be of controlled 
            substances prescribed by the collaborating 
            physician or podiatrist;
                (iii) all prescriptions must be limited to no 
            more than a 30-day supply oral dosage, with any 
            continuation authorized only after prior approval 
            of the collaborating physician or podiatrist;
                (iv) the advanced practice nurse must discuss 
            the condition of any patients for whom a controlled 
            substance is prescribed monthly with the 
            delegating physician or podiatrist; and
                (v) the advanced practice nurse must have 
            completed the appropriate application forms and 
            paid the required fees as set by rule; or 
                (vi) the advanced practice nurse must provide 
            evidence of satisfactory completion of at least 45 
            graduate contact hours in pharmacology for any new 
            license issued with Schedule II authority after 
            the effective date of this amendatory Act of the 
            97th General Assembly; and
                (vii) the advanced practice nurse must 
            annually complete 5 hours of continuing education 
            in pharmacology; or 
        (3) with respect to animal euthanasia agencies, the 
    euthanasia agency has
obtained a license from the 
    Department of
Professional Regulation and obtained a 
    registration number from the
Department.


    (b) The mid-level practitioner shall only be licensed to 
prescribe those
schedules of controlled substances for which a 
licensed physician or licensed podiatrist has delegated

prescriptive authority, except that an animal euthanasia 
agency does not have any
prescriptive authority.
A physician 
assistant and an advanced practice nurse are prohibited from 
prescribing medications and controlled substances not set 
forth in the required written delegation of authority. 

    (c) Upon completion of all registration requirements, 
physician
assistants, advanced practice nurses, and animal 
euthanasia agencies shall be issued a
mid-level practitioner

controlled substances license for Illinois.



    (d) A collaborating physician or podiatrist may, but is not 
required to, delegate prescriptive authority to an advanced 
practice nurse as part of a written collaborative agreement, 
and the delegation of prescriptive authority shall conform to 
the requirements of Section 65-40 of the Nurse Practice Act. 
    (e) A supervising physician may, but is not required to, 
delegate prescriptive authority to a physician assistant as 
part of a written supervision agreement, and the delegation of 
prescriptive authority shall conform to the requirements of 
Section 7.5 of the Physician Assistant Practice Act of 1987. 
    (f) Nothing in this Section shall be construed to prohibit 
generic substitution. 
(Source: P.A. 95-639, eff. 10-5-07; 96-189, eff. 8-10-09; 
96-268, eff. 8-11-09; 96-1000, eff. 7-2-10.)

 

    Section 99. Effective date. This Act takes effect July 1, 
2011.