HB0313sam001 100TH GENERAL ASSEMBLY

Sen. Iris Y. Martinez

Filed: 5/23/2017

10000HB0313sam001 LRB100 04130 SMS 26839 a

AMENDMENT TO HOUSE BILL 313

AMENDMENT NO. ______. Amend House Bill 313 on page 286, line 22, after "nurses", by inserting "without full practice authority"; and

on page 290, immediately below line 16, by inserting the following:

"(j) As set forth in Section 22.2 of this Act, a licensee under this Act may not directly or indirectly divide, share, or split any professional fee or other form of compensation for professional services with anyone in exchange for a referral or otherwise, other than as provided in Section 22.2."; and

on page 290, line 23, after "65-55,", by inserting "65-60,"; and

on page 291, line 2, after "60-11", by inserting "65-43,"; and

on page 294, immediately below line 1, by inserting the following:

""Full practice authority" means the authority of an advanced practice registered nurse licensed in Illinois and certified as a nurse practitioner, clinical nurse specialist, or nurse midwife to practice without a written collaborative agreement and:

(1) to be fully accountable to patients for the quality of advanced nursing care rendered;

(2) to be fully accountable for recognizing limits of knowledge and experience and for planning for the management of situations beyond the advanced practice registered nurse's expertise; the full practice authority for advanced practice registered nurses includes accepting referrals from, consulting with, collaborating with, or referring to other health care professionals as warranted by the needs of the patient; and

(3) to possess the authority to prescribe medications, including Schedule II through V controlled substances, as provided in Section 65-43."; and

on page 365, on line 14, by replacing "2018" with "2023 2018"; and

on page 376, line 21, by replacing "practice," with "practice prior to meeting the requirements of Section 65-43,"; and

on page 376, line 22, by replacing "authorized" with "privileged authorized"; and

on page 377, line 2, by replacing "authorized" with "privileged authorized"; and

on page 377, line 3, after "agreement", by inserting ", except as set forth in Section 65-43"; and

on page 377, line 6, by replacing "or podiatric physician" with "or podiatric physician"; and

on page 377, line 10, after "Section.", by inserting "A collaborative agreement with a podiatric physician must be in accordance with subsection (c-5) of this Section."; and

on page 377, by replacing line 12 with "physician or podiatric physician and the advanced practice"; and

on page 377, by replacing line 16 with "collaborating physician or podiatric physician at the place where services"; and

on page 377, lines 18 and 19, by replacing "or podiatric physician" with "or podiatric physician"; and

on page 380, by replacing lines 12 through 14 with "Nothing in this Act shall be construed to authorize an advanced practice nurse to provide health care services required by law or rule to be performed by a physician."; and

on page 380, immediately below line 14, by inserting the following:

"(e-5) Nothing in this Act shall be construed to authorize an advanced practice registered nurse to provide health care services required by law or rule to be performed by a physician, including those acts to be performed by a physician in Section 3.1 of the Illinois Abortion Law of 1975."; and

on page 381, line 3, by replacing "or collaborating podiatrist" with "or collaborating podiatrist"; and

on page 381, line 15, by replacing "or podiatric physician" with "or podiatric physician"; and

on page 382, lines 1 and 2, by replacing "or podiatric physician" with "or podiatric physician"; and

on page 382, lines 9 and 10, by replacing "or podiatric physician" each time it appears with "or podiatric physician"; and

on page 382, line 11, after "Department", by inserting "and the Prescription Monitoring Program"; and

on page 382, lines 20 and 21, by replacing "or podiatric physician" with "or podiatric physician"; and

on page 383, lines 3 and 10, by replacing "or podiatric physician" each time it appears with "or podiatric physician"; and

on page 383, lines 14 and 15, by replacing "or podiatric physician" with "or podiatric physician"; and

on page 384, by replacing lines 9 through 13 with the following:

"(g) (Blank). 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."; and

on page 384, immediately below line 15, by inserting the following:

"(i) Nothing in this Section shall be construed to apply to an advanced practice registered nurse who meets the requirements of Section 65-43."; and

on page 384, immediately below line 16, by inserting the following:

"(225 ILCS 65/65-43 new)

Sec. 65-43. Full practice authority.

(a) An Illinois-licensed advanced practice registered nurse certified as a nurse practitioner, nurse midwife, or clinical nurse specialist shall be deemed by law to possess the ability to practice without a written collaborative agreement as set forth in this Section.

(b) An advanced practice registered nurse certified as a nurse midwife, clinical nurse specialist, or nurse practitioner who files with the Department a notarized attestation of completion of at least 250 hours of continuing education or training and at least 4,000 hours of clinical experience after first attaining national certification shall not require a written collaborative agreement, except as specified in subsection (c). Documentation of successful completion shall be provided to the Department upon request.

Continuing education or training hours required by subsection (b) shall be in the advanced practice registered nurse's area of certification as set forth by Department rule.

The clinical experience must be in the advanced practice registered nurse's area of certification. The clinical experience shall be in collaboration with a physician or physicians. Completion of the clinical experience must be attested to by the collaborating physician or physicians and the advanced practice registered nurse.

(c) The scope of practice of an advanced practice registered nurse with full practice authority includes:

(1) all matters included in subsection (c) of Section 65-30 of this Act;

(2) practicing without a written collaborative agreement in all practice settings consistent with national certification;

(3) authority to prescribe both legend drugs and Schedule II through V controlled substances; this authority includes prescription of, selection of, orders for, administration of, storage of, acceptance of samples of, and dispensing over the counter medications, legend drugs, and controlled substances categorized as any Schedule II 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;

(4) prescribing benzodiazepines or Schedule II narcotic drugs, such as opioids, only in a consultation relationship with a physician; this consultation relationship shall be recorded in the Prescription Monitoring Program website, pursuant to Section 316 of the Illinois Controlled Substances Act, by the physician and advanced practice registered nurse with full practice authority and is not required to be filed with the Department; the specific Schedule II narcotic drug must be identified by either brand name or generic name; the specific Schedule II narcotic drug, such as an opioid, may be administered by oral dosage or topical or transdermal application; delivery by injection or other route of administration is not permitted; at least monthly, the advanced practice registered nurse and the physician must discuss the condition of any patients for whom a benzodiazepine or opioid is prescribed; nothing in this subsection shall be construed to require a prescription by an advanced practice registered nurse with full practice authority to require a physician name;

(5) authority to obtain an Illinois controlled substance license and a federal Drug Enforcement Administration number; and

(6) use of only local anesthetic.

The scope of practice of an advanced practice registered nurse does not include operative surgery.

(d) The Department may adopt rules necessary to administer this Section, including, but not limited to, requiring the completion of forms and the payment of fees.

(e) Nothing in this Act shall be construed to authorize an advanced practice registered nurse with full practice authority to provide health care services required by law or rule to be performed by a physician, including, but not limited to, those acts to be performed by a physician in Section 3.1 of the Illinois Abortion Law of 1975."; and

on page 385, line 8, after "services of", by inserting "all"; and

on page 385, line 22, by replacing "granted" with "privileged granted"; and

on page 385, by replacing line 23 with "authority to order medications, including controlled substances,"; and

on page 386, immediately below line 5, by inserting the following:

"(a-4) An advanced practice registered nurse meeting the requirements of Section 65-43 may be privileged to complete discharge orders and prescriptions under the advanced practice registered nurse's name."; and

on page 387, line 2, after "Center Act.", by inserting "Nothing in this Act shall be construed to require an advanced practice registered nurse to have a collaborative agreement to practice in a hospital, hospital affiliate, or ambulatory surgical treatment center."; and

on page 387, line 6, by replacing "granted authority" with "privileged granted authority"; and

on page 387, line 21, by replacing "mid-level practitioner" with "mid-level practitioner"; and

on page 388, line 11, by replacing "grant authority to" with "privilege grant authority to"; and

on page 388, line 20, by replacing "this grant of authority" with "the privileging documents this grant of authority"; and

on page 388, line 22, by replacing "authority" with "privileges authority"; and

on page 388, line 25, by replacing "grant of authority" with privileges grant of authority"; and

on page 389, immediately below line 11, by inserting the following:

"(d) An advanced practice registered nurse meeting the requirements of Section 65-43 may be privileged to prescribe controlled substances categorized as Schedule II through V in accordance with Section 65-43."; and

on page 389, line 19, after "initials", by inserting ""Advanced Practice Registered Nurse","; and

on page 390, line 3, after "(a).", by inserting "No advanced practice registered nurse licensed under this Act may use the title "doctor" or "physician" in paid or approved advertising. Any advertising must contain the appropriate advanced practice registered nurse credentials."; and

on page 390, line 9, after "patient.", by inserting "If an advanced practice registered nurse has a doctorate degree, when identifying himself or herself as "doctor" in a clinical setting, the advanced practice registered nurse must clearly state that his or her educational preparation is not in medicine and that he or she is not a medical doctor or physician."; and

on page 391, line 2, by replacing "board" with "national board"; and

on page 391, by replacing line 5 with "physician's or , dentist's, or podiatric physician's name,"; and

on page 391, line 6, after "title,", by inserting "if such is required,"; and

on page 391, line 16, by replacing "as" with "as"; and

on page 391, by replacing line 17 with "an advanced practice nurse to use testimonials or"; and

on page 392, immediately below line 18, by inserting the following:

"(225 ILCS 65/65-60) (was 225 ILCS 65/15-45)

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

Sec. 65-60. Continuing education. The Department shall adopt rules of continuing education for persons licensed under this Article as advanced practice registered nurses that require 80 50 hours of continuing education per 2-year license renewal cycle. Completion of the 80 50 hours of continuing education shall be deemed to satisfy the continuing education requirements for renewal of a registered professional nurse license as required by this Act.

The 80 hours of continuing education required under this Section shall be completed as follows:

(1) A minimum of 50 hours of the continuing education shall be obtained in continuing education programs as determined by rule that shall include no less than 20 hours of pharmacotherapeutics, including 10 hours of opioid prescribing or substance abuse education. Continuing education programs may be conducted or endorsed by educational institutions, hospitals, specialist associations, facilities, or other organizations approved to offer continuing education under this Act or rules and shall be in the advanced practice registered nurse's specialty.

(2) A maximum of 30 hours of credit may be obtained by presentations in the advanced practice registered nurse's clinical specialty, evidence-based practice, or quality improvement projects, publications, research projects, or preceptor hours as determined by rule.

The rules adopted regarding continuing education shall be consistent to the extent possible with requirements of relevant national certifying bodies or State or national professional associations.

The rules shall not be inconsistent with requirements of relevant national certifying bodies or State or national professional associations. The rules shall also address variances in part or in whole for good cause, including but not limited to illness or hardship. The continuing education rules shall assure that licensees are given the opportunity to participate in programs sponsored by or through their State or national professional associations, hospitals, or other providers of continuing education. Each licensee is responsible for maintaining records of completion of continuing education and shall be prepared to produce the records when requested by the Department.

(Source: P.A. 95-639, eff. 10-5-07.)"; and

on page 685, line 10, by replacing "or" with "or"; and

on page 685, line 14, after "Section 303.05", by inserting ", or an advanced practice registered nurse certified as a nurse practitioner, nurse midwife, or clinical nurse specialist who has full practice authority pursuant to Section 65-43 of the Nurse Practice Act"; and

on page 686, line 7, by replacing "or" with "or"; and

on page 686, line 12, after "by law", by inserting ", or of an advanced practice registered nurse certified as a nurse practitioner, nurse midwife, or clinical nurse specialist who has full practice authority pursuant to Section 65-43 of the Nurse Practice Act"; and

on page 694, line 13, after "nurses", by inserting "who do not meet the requirements of Section 65-43 of the Nurse Practice Act"; and

on page 694, lines 25 and 26, by replacing "or collaborating podiatric physician" with "or collaborating podiatric physician"; and

on page 695, lines 9 and 17, by replacing "or podiatric physician" each time it appears with "or podiatric physician"; and

on page 695, lines 21 and 25, by replacing "or podiatric physician" each time it appears with "or podiatric physician"; and

on page 696, line 17, after "specialists" by inserting "who do not meet the requirements of Section 65-43 of the Nurse Practice Act"; and

on page 696, line 21, by replacing "granted authority" with "privileged granted authority"; and

on page 697, line 5, by replacing "granted authority" with "privileged granted authority"; and

on page 697, line 16, by replacing "this grant of authority" with "the privileging documents this grant of authority"; and

on page 697, line 18, by replacing "authority" with "privileges authority"; and

on page 697, line 22, by replacing "grant of authority" with "privileges grant of authority"; and

on page 698, line 24, by replacing "or licensed podiatric physician" with "or licensed podiatric physician"; and

on page 699, line 4, after "authority", by inserting "or as authorized by their practice Act"; and

on page 699, line 9, by replacing "or podiatric physician" with "or podiatric physician"; and

on page 737, line 25, after "effect", by inserting "January 1, 2018, except that this Section and Section 5 take effect".