Public Act 098-0192
 
HB1052 EnrolledLRB098 05035 MGM 35066 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    (Section scheduled to be repealed on December 31, 2013)

    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 
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 or may provide in 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 or may provide 
    in to his or her patients in the normal course of clinical 
    medical 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. 
    (h) For the purposes of this Section, "generally provides 
or may provide in  his or her clinical medical practice" means 
categories of care or treatment, not specific tasks or duties, 
that the physician provides individually or through delegation 
to other persons so that the physician has the experience and 
ability to provide collaboration and consultation. This 
definition shall not be construed to prohibit an advanced 
practice nurse from providing primary health treatment or care 
within the scope of his or her training and experience, 
including, but not limited to, health screenings, patient 
histories, physical examinations, women's health examinations, 
or school physicals that may be provided as part of the routine 
practice of an advanced practice nurse or on a volunteer basis. 
(Source: P.A. 96-618, eff. 1-1-10; 97-358, eff. 8-12-11; 
97-1071, eff. 8-24-12.)

 
    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.  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 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 or may provide to his or her
patients in the 
normal course of his or her clinical medical or podiatric 
practice, except as set forth in subsections (b-5) or 
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 
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.

    (b-5) Absent an employment relationship, a written 
collaborative agreement may not (1) restrict the categories of 
patients of an advanced practice nurse within the scope of the 
advanced practice nurses training and experience, (2) limit 
third party payors or government health programs, such as the 
medical assistance program or Medicare with which the advanced 
practice nurse contracts, or (3) limit the geographic area or  
practice location of the advanced practice nurse in this State. 
    (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 with the 
    advanced practice nurse at least once a month. 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 or 
may provide in to his or her patients in the normal course of 
his or her clinical medical practice" means categories of care 
or treatment 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. This definition shall not be 
construed to prohibit an advanced practice nurse from providing 
primary health treatment or care within the scope of his or her 
training and experience, including, but not limited to, health 
screenings, patient histories, physical examinations, women's 
health examinations, or school physicals that may be provided 
as part of the routine practice of an advanced practice nurse 
or on a volunteer basis. 
    For the purposes of this Act, "generally provides to his or 
her patients in the normal course of his or her clinical 
podiatric practice" means services, not specific tasks or 
duties, that the podiatrist routinely provides individually or 
through delegation to other persons so that the podiatrist has 
the experience and ability to provide collaboration and 
consultation. 
(Source: P.A. 96-618, eff. 1-1-10; 97-358, eff. 8-12-11.)