Public Act 097-1071
 
HB5104 EnrolledLRB097 19244 CEL 64486 b


  
    AN ACT concerning regulation.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  
 
    Section 1. The Ambulatory Surgical Treatment Center Act is 
amended by adding Section 6.6 as follows:
 
    (210 ILCS 5/6.6 new)
    Sec. 6.6. Clinical privileges; physician assistants. No 
ambulatory surgical treatment center (ASTC) licensed under 
this Act shall adopt any policy, rule, regulation, or practice 
inconsistent with the provision of adequate supervision in 
accordance with Section 54.5 of the Medical Practice Act of 
1987 and the Physician Assistant Practice Act of 1987.
 
    Section 3. The Hospital Licensing Act is amended by adding 
Section 10.11 as follows:
 
    (210 ILCS 85/10.11 new)
    Sec. 10.11. Clinical privileges; physician assistants. No 
hospital licensed under this Act shall adopt any policy, rule, 
regulation, or practice inconsistent with the provision of 
adequate supervision in accordance with Section 54.5 of the 
Medical Practice Act of 1987 and the Physician Assistant 
Practice Act of 1987.
 
    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    (Section scheduled to be repealed on December 31, 2012)

    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 5 
2 physician assistants as set forth in subsection (a) of  
Section 7 of the Physician Assistant Practice Act of 1987.

    (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 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. 96-618, eff. 1-1-10; 97-358, eff. 8-12-11.)

 
    Section 10. The Physician Assistant Practice Act of 1987 is 
amended  by changing Sections 4 and 7 and by adding Section 7.7 
as follows:
 



    (225 ILCS 95/4)  (from Ch. 111, par. 4604)


    (Section scheduled to be repealed on January 1, 2018)

    Sec. 4. In this Act: 

    1. "Department" means the Department of Financial and

Professional Regulation.

    2. "Secretary" means the Secretary
 of Financial and 
Professional Regulation.

    3. "Physician assistant" means any person not a physician 
who has been
certified as a physician assistant by the National 
Commission on the
Certification of Physician Assistants or 
equivalent successor agency and
performs procedures under the 
supervision of a physician as defined in this
Act.  A physician 
assistant may perform such procedures within the
specialty of 
the supervising physician, except that such physician shall

exercise such direction, supervision and control over such 
physician
assistants as will assure that patients shall receive 
quality medical
care.  Physician assistants shall be capable of 
performing a variety of tasks
within the specialty of medical 
care under the supervision of a physician.
Supervision of the 
physician assistant shall not be construed to
necessarily 
require the personal presence of the supervising physician at

all times at the place where services are rendered, as long as 
there is
communication available for consultation by radio, 
telephone or
telecommunications within established guidelines 
as determined by the
physician/physician assistant team.  The 
supervising physician may delegate
tasks and duties to the 
physician assistant.  Delegated tasks or duties
shall be 
consistent with physician assistant education, training, and

experience.  The delegated tasks or duties shall be specific to 
the
practice setting and shall be implemented and reviewed 
under a written supervision agreement
established by the 
physician or physician/physician assistant team.  A
physician 
assistant, acting as an agent of the physician, shall be

permitted to transmit the supervising physician's orders as 
determined by
the institution's by-laws, policies, procedures, 
or job description within
which the physician/physician 
assistant team practices.  Physician
assistants shall practice 
only in accordance with a written supervision agreement.

    4. "Board" means the Medical Licensing Board
constituted 
under the Medical Practice Act of 1987.

    5. "Disciplinary Board" means the Medical Disciplinary 
Board constituted
under the Medical Practice Act of 1987.

    6. "Physician" means, for purposes of this Act, a person 
licensed to
practice medicine in all its branches under the 
Medical Practice Act of 1987.

    7. "Supervising Physician" means, for the purposes of this 
Act, the
primary supervising physician of a physician 
assistant, who, within his
specialty and expertise may delegate 
a variety of tasks and procedures to
the physician assistant.  
Such tasks and procedures shall be delegated
in accordance with 
a written supervision agreement.  The supervising physician 
maintains the
final responsibility for the care of the patient 
and the performance of the
physician assistant.

    8. "Alternate supervising physician" means, for the 
purpose of this Act,
any physician designated by the 
supervising physician to provide
supervision in the event that 
he or she is unable to provide that supervision.  The Department 
may further define "alternate supervising physician" by rule.

    The alternate supervising physicians shall maintain all 
the same
responsibilities as the supervising physician.  
Nothing in this Act shall
be construed as relieving any 
physician of the professional or legal
responsibility for the 
care and treatment of persons attended by him or by
physician 
assistants under his supervision. Nothing in this Act shall be

construed as to limit the reasonable number of alternate 
supervising
physicians, provided they are designated by the 
supervising physician.
    9. "Address of record" means the designated address 
recorded by the Department in the applicant's or licensee's 
application file or license file maintained by the Department's 
licensure maintenance unit.  It is the duty of the applicant or 
licensee to inform the Department of any change of address, and 
such changes must be made either through the Department's 
website or by contacting the Department's licensure 
maintenance unit.


(Source: P.A. 95-703, eff. 12-31-07; 96-268, eff. 8-11-09.)

 



    (225 ILCS 95/7)  (from Ch. 111, par. 4607)


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

    Sec. 7. Supervision requirements. 
    (a) A supervising physician shall determine the number of 
physician assistants under his or her supervision provided the 
physician is able to provide adequate supervision as outlined 
in the written supervision agreement required under Section 7.5 
of this Act and consideration is given to the nature of the 
physician's practice, complexity of the patient population, 
and the experience of each supervised physician assistant. A 
supervising physician may supervise a maximum of 5 full-time 
equivalent physician assistants; provided,  however, this 
number of physician assistants shall be reduced by the number 
of collaborative agreements the supervising physician 
maintains. A No more than 2 physician
assistants shall be 
supervised
by
the supervising physician, although a physician 
assistant shall be able to
hold more than one professional 
position. A  Each supervising physician shall
file a notice of 
supervision of each such physician assistant according to the

rules of the Department.  However, the alternate supervising 
physician may
supervise more than 2 physician assistants when

the supervising
physician
is unable to provide such supervision 
consistent with the definition of
alternate physician in 
Section 4. It is the responsibility of the supervising 
physician to maintain documentation each time he or she has 
designated an alternative supervising physician.  This 
documentation shall include the date alternate supervisory 
control began, the date alternate supervisory control ended, 
and any other changes. A supervising physician shall provide a 
copy of this documentation to the Department, upon request.


    Physician assistants shall be supervised only by 
physicians as defined in
this Act
who are engaged in clinical 
practice, or in clinical practice in
public health or other 
community health facilities.

    Nothing in this Act shall be construed to limit the 
delegation of tasks or
duties by a physician to a nurse or 
other appropriately trained personnel.

    Nothing in this Act
shall be construed to prohibit the 
employment of physician assistants by
a hospital, nursing home 
or other health care facility where such physician
assistants 
function under the supervision of a supervising physician.

    Physician assistants may be employed by the Department of 
Corrections or
the Department of Human Services (as successor 
to the Department of Mental
Health and Developmental 
Disabilities) for service in
facilities maintained by such 
Departments and affiliated training
facilities in programs 
conducted under the authority of the Director of
Corrections or 
the Secretary of Human Services.  Each physician assistant

employed by the Department of Corrections or the Department of 
Human Services
(as successor to the Department of Mental Health 
and
Developmental Disabilities) shall be under the supervision 
of a physician
engaged in clinical practice and direct patient 
care.  Duties of each
physician assistant employed by such 
Departments are limited to those
within the scope of practice 
of the supervising physician who is fully
responsible for all 
physician assistant activities.

    A physician assistant may be employed by a practice group 
or other entity
employing multiple physicians at one or more 
locations.  In that case, one of
the
physicians practicing at a 
location shall be designated the supervising
physician.  The 
other physicians with that practice group or other entity who

practice in the same general type of practice or specialty
as 
the supervising physician may supervise the physician 
assistant with respect
to their patients without being deemed 
alternate supervising physicians for the
purpose of this Act.

    (b) A physician assistant licensed in this State, or 
licensed or authorized to practice in any other U.S. 
jurisdiction or credentialed by his or her federal employer as 
a physician assistant, who is responding to a need for medical 
care created by an emergency or by a state or local disaster 
may render such care that the physician assistant is able to 
provide without supervision as it is defined in this Section or 
with such supervision as is available.
For purposes of this 
Section, an "emergency situation" shall not include one that 
occurs in the place of one's employment.
    Any physician who supervises a physician assistant 
providing medical care in response to such an emergency or 
state or local disaster shall not be required to meet the 
requirements set forth in this Section for a supervising 
physician.
(Source: P.A. 95-703, eff. 12-31-07; 96-70, eff. 7-23-09.)

 
    (225 ILCS 95/7.7 new)
    Sec. 7.7. Physician assistants in hospitals, hospital 
affiliates, or ambulatory surgical treatment centers.
    (a) A physician assistant may provide services in a 
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 a written supervision agreement pursuant to Section 7.5 
of this Act. A physician assistant 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 physician 
assistants 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 physician assistants to select, order, and 
administer medications, including controlled substances, to 
provide delineated care. In a hospital, hospital affiliate, or 
ambulatory surgical treatment center, the attending physician 
shall determine a physician assistant's role in providing care 
for his or her patients, except as otherwise provided in the 
medical staff bylaws or consulting committee policies.
    (b) A physician assistant granted authority to order 
medications including controlled substances may complete 
discharge prescriptions provided the prescription is in the 
name of the physician assistant and the attending or 
discharging physician. 
    (c) Physician assistants practicing in a hospital, 
hospital affiliate, 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. 
  
 
    (225 ILCS 95/8 rep.)
    Section 15. The Physician Assistant Practice Act of 1987 is 
amended by repealing Section 8.
 

    Section 99. Effective date. This Act takes effect upon 
becoming law.