103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB3653

 

Introduced 2/9/2024, by Sen. Lakesia Collins

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Ambulatory Surgical Treatment Center Act. Removes a provision which provides that, in ambulatory surgical treatment centers, anesthesia service shall be under the direction of a physician who has had specialized preparation or experience in the area or who has completed a residency in anesthesiology. Specifies that with respect to anesthesia service in an ambulatory surgical treatment center, a certified registered nurse anesthetist shall seek consultation regarding development of an anesthesia plan and treatment of patients as is appropriate to the certified registered nurse anesthetist's level of expertise and scope of practice and as is warranted by the needs of the patient. Removes a requirement that an anesthesiologist participate through discussion of and agreement with the anesthesia plan and remain physically present and be available on the premises. Provides that a certified registered nurse anesthetist with clinical privileges may perform acts of advanced assessment and diagnosis and may provide such functions for which the certified registered nurse anesthetist is educationally and experientially prepared. Makes conforming changes to the Hospital Licensing Act. Amends the Medical Practice Act of 1987. Provides that a written collaborative agreement shall be adequate with respect to collaboration with certified registered nurse anesthetists if all of the following apply: (1) the agreement is written to promote exercise of professional judgment by the certified registered nurse anesthetist commensurate with his or her education and experience; (2) the certified registered nurse anesthetist provides service based on a written collaborative agreement with the collaborating physician; and (3) 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. Amends the Nurse Practice Act. Provides that an Illinois-licensed advanced practice registered nurse certified as a certified registered nurse anesthetist shall be deemed by law to possess the ability to practice without a written collaborative agreement. Sets forth requirements of a certified registered nurse anesthetist. Makes conforming changes in the Illinois Dental Practice Act. Effective immediately.


LRB103 38272 CES 68407 b

 

 

A BILL FOR

 

SB3653LRB103 38272 CES 68407 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Ambulatory Surgical Treatment Center Act is
5amended by changing Section 6.5 as follows:
 
6    (210 ILCS 5/6.5)
7    Sec. 6.5. Clinical privileges; advanced practice
8registered nurses. All ambulatory surgical treatment centers
9(ASTC) licensed under this Act shall comply with the following
10requirements:
11        (1) No ASTC policy, rule, regulation, or practice
12    shall be inconsistent with the provision of adequate
13    collaboration and consultation in accordance with Section
14    54.5 of the Medical Practice Act of 1987.
15        (2) Operative surgical procedures shall be performed
16    only by a physician licensed to practice medicine in all
17    its branches under the Medical Practice Act of 1987, a
18    dentist licensed under the Illinois Dental Practice Act,
19    or a podiatric physician licensed under the Podiatric
20    Medical Practice Act of 1987, with medical staff
21    membership and surgical clinical privileges granted by the
22    consulting committee of the ASTC. A licensed physician,
23    dentist, or podiatric physician may be assisted by a

 

 

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1    physician licensed to practice medicine in all its
2    branches, dentist, dental assistant, podiatric physician,
3    licensed advanced practice registered nurse, licensed
4    physician assistant, licensed registered nurse, licensed
5    practical nurse, surgical assistant, surgical technician,
6    or other individuals granted clinical privileges to assist
7    in surgery by the consulting committee of the ASTC.
8    Payment for services rendered by an assistant in surgery
9    who is not an ambulatory surgical treatment center
10    employee shall be paid at the appropriate non-physician
11    modifier rate if the payor would have made payment had the
12    same services been provided by a physician.
13        (2.5) A registered nurse licensed under the Nurse
14    Practice Act and qualified by training and experience in
15    operating room nursing shall be present in the operating
16    room and function as the circulating nurse during all
17    invasive or operative procedures. For purposes of this
18    paragraph (2.5), "circulating nurse" means a registered
19    nurse who is responsible for coordinating all nursing
20    care, patient safety needs, and the needs of the surgical
21    team in the operating room during an invasive or operative
22    procedure.
23        (3) An advanced practice registered nurse is not
24    required to possess prescriptive authority or a written
25    collaborative agreement meeting the requirements of the
26    Nurse Practice Act to provide advanced practice registered

 

 

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1    nursing services in an ambulatory surgical treatment
2    center. An advanced practice registered nurse must possess
3    clinical privileges granted by the consulting medical
4    staff committee and ambulatory surgical treatment center
5    in order to provide services. Individual advanced practice
6    registered nurses may also be granted clinical privileges
7    to order, select, and administer medications, including
8    controlled substances, to provide delineated care. The
9    attending physician must determine the advanced practice
10    registered nurse's role in providing care for his or her
11    patients, except as otherwise provided in the consulting
12    staff policies. The consulting medical staff committee
13    shall periodically review the services of advanced
14    practice registered nurses granted privileges.
15        (4) (Blank). The anesthesia service shall be under the
16    direction of a physician licensed to practice medicine in
17    all its branches who has had specialized preparation or
18    experience in the area or who has completed a residency in
19    anesthesiology. An anesthesiologist, Board certified or
20    Board eligible, is recommended. Anesthesia services may
21    only be administered pursuant to the order of a physician
22    licensed to practice medicine in all its branches,
23    licensed dentist, or licensed podiatric physician.
24            (A) The individuals who, with clinical privileges
25        granted by the medical staff and ASTC, may administer
26        anesthesia services are limited to the following:

 

 

SB3653- 4 -LRB103 38272 CES 68407 b

1                (i) an anesthesiologist; or
2                (ii) a physician licensed to practice medicine
3            in all its branches; or
4                (iii) a dentist with authority to administer
5            anesthesia under Section 8.1 of the Illinois
6            Dental Practice Act; or
7                (iv) a licensed certified registered nurse
8            anesthetist; or
9                (v) a podiatric physician licensed under the
10            Podiatric Medical Practice Act of 1987.
11            (B) For anesthesia services, a certified
12        registered nurse anesthetist shall seek consultation
13        regarding development of an anesthesia plan and
14        treatment of patients as is appropriate to the
15        certified registered nurse anesthetist's level of
16        expertise and scope of practice and as is warranted by
17        the needs of the patient an anesthesiologist shall
18        participate through discussion of and agreement with
19        the anesthesia plan and shall remain physically
20        present and be available on the premises during the
21        delivery of anesthesia services for diagnosis,
22        consultation, and treatment of emergency medical
23        conditions. In the absence of 24-hour availability of
24        anesthesiologists with clinical privileges, an
25        alternate policy (requiring participation, presence,
26        and availability of a physician licensed to practice

 

 

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1        medicine in all its branches) shall be developed by
2        the medical staff consulting committee in consultation
3        with the anesthesia service and included in the
4        medical staff consulting committee policies.
5            (C) A certified registered nurse anesthetist is
6        not required to possess prescriptive authority or a
7        written collaborative agreement meeting the
8        requirements of Section 65-35 of the Nurse Practice
9        Act to provide anesthesia and related services ordered
10        by a licensed physician, dentist, or podiatric
11        physician. Licensed certified registered nurse
12        anesthetists are authorized to select, order, and
13        administer drugs and apply the appropriate medical
14        devices in the provision of anesthesia and related
15        services under the anesthesia plan agreed with by the
16        anesthesiologist or, in the absence of an available
17        anesthesiologist with clinical privileges, agreed with
18        by the operating physician, operating dentist, or
19        operating podiatric physician in accordance with the
20        medical staff consulting committee policies of a
21        licensed ambulatory surgical treatment center.
22            (D) In accordance with the medical staff
23        consulting committee policies of a licensed ambulatory
24        surgical treatment center, a certified registered
25        nurse anesthetist with clinical privileges may perform
26        acts of advanced assessment and diagnosis and may

 

 

SB3653- 6 -LRB103 38272 CES 68407 b

1        provide such functions for which the certified
2        registered nurse anesthetist is educationally and
3        experientially prepared. A certified registered nurse
4        anesthetist shall practice in accordance with the
5        scope and all standards of the appropriate national
6        professional nursing association.
7(Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18.)
 
8    Section 10. The Hospital Licensing Act is amended by
9changing Section 10.7 as follows:
 
10    (210 ILCS 85/10.7)
11    Sec. 10.7. Clinical privileges; advanced practice
12registered nurses. All hospitals licensed under this Act
13shall comply with the following requirements:
14        (1) No hospital policy, rule, regulation, or practice
15    shall be inconsistent with the provision of adequate
16    collaboration and consultation in accordance with Section
17    54.5 of the Medical Practice Act of 1987.
18        (2) Operative surgical procedures shall be performed
19    only by a physician licensed to practice medicine in all
20    its branches under the Medical Practice Act of 1987, a
21    dentist licensed under the Illinois Dental Practice Act,
22    or a podiatric physician licensed under the Podiatric
23    Medical Practice Act of 1987, with medical staff
24    membership and surgical clinical privileges granted at the

 

 

SB3653- 7 -LRB103 38272 CES 68407 b

1    hospital. A licensed physician, dentist, or podiatric
2    physician may be assisted by a physician licensed to
3    practice medicine in all its branches, dentist, dental
4    assistant, podiatric physician, licensed advanced practice
5    registered nurse, licensed physician assistant, licensed
6    registered nurse, licensed practical nurse, surgical
7    assistant, surgical technician, or other individuals
8    granted clinical privileges to assist in surgery at the
9    hospital. Payment for services rendered by an assistant in
10    surgery who is not a hospital employee shall be paid at the
11    appropriate non-physician modifier rate if the payor would
12    have made payment had the same services been provided by a
13    physician.
14        (2.5) A registered nurse licensed under the Nurse
15    Practice Act and qualified by training and experience in
16    operating room nursing shall be present in the operating
17    room and function as the circulating nurse during all
18    invasive or operative procedures. For purposes of this
19    paragraph (2.5), "circulating nurse" means a registered
20    nurse who is responsible for coordinating all nursing
21    care, patient safety needs, and the needs of the surgical
22    team in the operating room during an invasive or operative
23    procedure.
24        (3) An advanced practice registered nurse is not
25    required to possess prescriptive authority or a written
26    collaborative agreement meeting the requirements of the

 

 

SB3653- 8 -LRB103 38272 CES 68407 b

1    Nurse Practice Act to provide advanced practice registered
2    nursing services in a hospital. An advanced practice
3    registered nurse must possess clinical privileges
4    recommended by the medical staff and granted by the
5    hospital in order to provide services. Individual advanced
6    practice registered nurses may also be granted clinical
7    privileges to order, select, and administer medications,
8    including controlled substances, to provide delineated
9    care. The attending physician must determine the advanced
10    practice registered nurse's role in providing care for his
11    or her patients, except as otherwise provided in medical
12    staff bylaws. The medical staff shall periodically review
13    the services of advanced practice registered nurses
14    granted privileges. This review shall be conducted in
15    accordance with item (2) of subsection (a) of Section 10.8
16    of this Act for advanced practice registered nurses
17    employed by the hospital.
18        (4) (Blank). The anesthesia service shall be under the
19    direction of a physician licensed to practice medicine in
20    all its branches who has had specialized preparation or
21    experience in the area or who has completed a residency in
22    anesthesiology. An anesthesiologist, Board certified or
23    Board eligible, is recommended. Anesthesia services may
24    only be administered pursuant to the order of a physician
25    licensed to practice medicine in all its branches,
26    licensed dentist, or licensed podiatric physician.

 

 

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1            (A) The individuals who, with clinical privileges
2        granted at the hospital, may administer anesthesia
3        services are limited to the following:
4                (i) an anesthesiologist; or
5                (ii) a physician licensed to practice medicine
6            in all its branches; or
7                (iii) a dentist with authority to administer
8            anesthesia under Section 8.1 of the Illinois
9            Dental Practice Act; or
10                (iv) a licensed certified registered nurse
11            anesthetist; or
12                (v) a podiatric physician licensed under the
13            Podiatric Medical Practice Act of 1987.
14            (B) For anesthesia services, a certified
15        registered nurse anesthetist shall seek consultation
16        regarding development of an anesthesia plan and
17        treatment of patients as is appropriate to the
18        certified registered nurse anesthetist's level of
19        expertise and scope of practice and as is warranted by
20        the needs of the patient an anesthesiologist shall
21        participate through discussion of and agreement with
22        the anesthesia plan and shall remain physically
23        present and be available on the premises during the
24        delivery of anesthesia services for diagnosis,
25        consultation, and treatment of emergency medical
26        conditions. In the absence of 24-hour availability of

 

 

SB3653- 10 -LRB103 38272 CES 68407 b

1        anesthesiologists with medical staff privileges, an
2        alternate policy (requiring participation, presence,
3        and availability of a physician licensed to practice
4        medicine in all its branches) shall be developed by
5        the medical staff and licensed hospital in
6        consultation with the anesthesia service.
7            (C) A certified registered nurse anesthetist is
8        not required to possess prescriptive authority or a
9        written collaborative agreement meeting the
10        requirements of Section 65-35 of the Nurse Practice
11        Act to provide anesthesia and related services ordered
12        by a licensed physician, dentist, or podiatric
13        physician. Licensed certified registered nurse
14        anesthetists are authorized to select, order, and
15        administer drugs and apply the appropriate medical
16        devices in the provision of anesthesia and related
17        services under the anesthesia plan agreed with by the
18        anesthesiologist or, in the absence of an available
19        anesthesiologist with clinical privileges, agreed with
20        by the operating physician, operating dentist, or
21        operating podiatric physician in accordance with the
22        hospital's alternative policy.
23            (D) In accordance with the hospital's policies, a
24        certified registered nurse anesthetist with clinical
25        privileges may perform acts of advanced assessment and
26        diagnosis and may provide such functions for which the

 

 

SB3653- 11 -LRB103 38272 CES 68407 b

1        CRNA is educationally and experientially prepared. A
2        certified registered nurse anesthetist shall practice
3        in accordance with the scope and all standards of the
4        appropriate national professional nursing association.
5(Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18.)
 
6    Section 15. The Medical Practice Act of 1987 is amended by
7changing Section 54.5 as follows:
 
8    (225 ILCS 60/54.5)
9    (Section scheduled to be repealed on January 1, 2027)
10    Sec. 54.5. Physician delegation of authority to physician
11assistants, advanced practice registered nurses without full
12practice authority, and prescribing psychologists.
13    (a) Physicians licensed to practice medicine in all its
14branches may delegate care and treatment responsibilities to a
15physician assistant under guidelines in accordance with the
16requirements of the Physician Assistant Practice Act of 1987.
17A physician licensed to practice medicine in all its branches
18may enter into collaborative agreements with no more than 7
19full-time equivalent physician assistants, except in a
20hospital, hospital affiliate, or ambulatory surgical treatment
21center as set forth by Section 7.7 of the Physician Assistant
22Practice Act of 1987 and as provided in subsection (a-5).
23    (a-5) A physician licensed to practice medicine in all its
24branches may collaborate with more than 7 physician assistants

 

 

SB3653- 12 -LRB103 38272 CES 68407 b

1when the services are provided in a federal primary care
2health professional shortage area with a Health Professional
3Shortage Area score greater than or equal to 12, as determined
4by the United States Department of Health and Human Services.
5    The collaborating physician must keep appropriate
6documentation of meeting this exemption and make it available
7to the Department upon request.
8    (b) A physician licensed to practice medicine in all its
9branches in active clinical practice may collaborate with an
10advanced practice registered nurse in accordance with the
11requirements of the Nurse Practice Act. Collaboration is for
12the purpose of providing medical consultation, and no
13employment relationship is required. A written collaborative
14agreement shall conform to the requirements of Section 65-35
15of the Nurse Practice Act. The written collaborative agreement
16shall be for services for which the collaborating physician
17can provide adequate collaboration. A written collaborative
18agreement shall be adequate with respect to collaboration with
19advanced practice registered nurses if all of the following
20apply:
21        (1) The agreement is written to promote the exercise
22    of professional judgment by the advanced practice
23    registered nurse commensurate with his or her education
24    and experience.
25        (2) The advanced practice registered nurse provides
26    services based upon a written collaborative agreement with

 

 

SB3653- 13 -LRB103 38272 CES 68407 b

1    the collaborating physician, except as set forth in
2    subsection (b-5) of this Section. With respect to labor
3    and delivery, the collaborating physician must provide
4    delivery services in order to participate with a certified
5    nurse midwife.
6        (3) Methods of communication are available with the
7    collaborating physician in person or through
8    telecommunications for consultation, collaboration, and
9    referral as needed to address patient care needs.
10    (b-5) An anesthesiologist or physician licensed to
11practice medicine in all its branches may collaborate with a
12certified registered nurse anesthetist in accordance with
13Section 65-35 of the Nurse Practice Act for the provision of
14anesthesia and related services. A written collaborative
15agreement shall be adequate with respect to collaboration with
16certified registered nurse anesthetists if all of the
17following apply:
18        (1) The agreement is written to promote exercise of
19    professional judgment by the certified registered nurse
20    anesthetist commensurate with his or her education and
21    experience.
22        (2) The certified registered nurse anesthetist
23    provides service based on a written collaborative
24    agreement with the collaborating physician.
25        (3) Methods of communication are available with the
26    collaborating physician in person or through

 

 

SB3653- 14 -LRB103 38272 CES 68407 b

1    telecommunications for consultation, collaboration, and
2    referral as needed to address patient care needs. With
3    respect to the provision of anesthesia services, the
4    collaborating anesthesiologist or physician shall have
5    training and experience in the delivery of anesthesia
6    services consistent with Department rules. Collaboration
7    shall be adequate if:
8        (1) an anesthesiologist or a physician participates in
9    the joint formulation and joint approval of orders or
10    guidelines and periodically reviews such orders and the
11    services provided patients under such orders; and
12        (2) for anesthesia services, the anesthesiologist or
13    physician participates through discussion of and agreement
14    with the anesthesia plan and is physically present and
15    available on the premises during the delivery of
16    anesthesia services for diagnosis, consultation, and
17    treatment of emergency medical conditions. Collaboration
18    with respect to an anesthesia and related Anesthesia
19    services in a hospital shall be conducted in accordance
20    with Section 10.7 of the Hospital Licensing Act and in an
21    ambulatory surgical treatment center in accordance with
22    Section 6.5 of the Ambulatory Surgical Treatment Center
23    Act.
24    (b-10) For anesthesia services, a certified registered
25nurse anesthetist shall consult with the collaborating
26physician or other appropriate health care professionals

 

 

SB3653- 15 -LRB103 38272 CES 68407 b

1regarding development of an anesthesia plan and treatment of a
2patient as is appropriate to the certified registered nurse
3anesthetist's level of expertise and scope of practice and as
4is warranted by the needs of the patient The anesthesiologist
5or operating physician must agree with the anesthesia plan
6prior to the delivery of services.
7    (c) The collaborating physician shall have access to the
8medical records of all patients attended by a physician
9assistant. The collaborating physician shall have access to
10the medical records of all patients attended to by an advanced
11practice registered nurse.
12    (d) (Blank).
13    (e) A physician shall not be liable for the acts or
14omissions of a prescribing psychologist, physician assistant,
15or advanced practice registered nurse solely on the basis of
16having signed a supervision agreement or guidelines or a
17collaborative agreement, an order, a standing medical order, a
18standing delegation order, or other order or guideline
19authorizing a prescribing psychologist, physician assistant,
20or advanced practice registered nurse to perform acts, unless
21the physician has reason to believe the prescribing
22psychologist, physician assistant, or advanced practice
23registered nurse lacked the competency to perform the act or
24acts or commits willful and wanton misconduct.
25    (f) A collaborating physician may, but is not required to,
26delegate prescriptive authority to an advanced practice

 

 

SB3653- 16 -LRB103 38272 CES 68407 b

1registered nurse as part of a written collaborative agreement,
2and the delegation of prescriptive authority shall conform to
3the requirements of Section 65-40 of the Nurse Practice Act.
4    (g) A collaborating physician may, but is not required to,
5delegate prescriptive authority to a physician assistant as
6part of a written collaborative agreement, and the delegation
7of prescriptive authority shall conform to the requirements of
8Section 7.5 of the Physician Assistant Practice Act of 1987.
9    (h) (Blank).
10    (i) A collaborating physician shall delegate prescriptive
11authority to a prescribing psychologist as part of a written
12collaborative agreement, and the delegation of prescriptive
13authority shall conform to the requirements of Section 4.3 of
14the Clinical Psychologist Licensing Act.
15    (j) As set forth in Section 22.2 of this Act, a licensee
16under this Act may not directly or indirectly divide, share,
17or split any professional fee or other form of compensation
18for professional services with anyone in exchange for a
19referral or otherwise, other than as provided in Section 22.2.
20(Source: P.A. 103-228, eff. 1-1-24.)
 
21    Section 20. The Nurse Practice Act is amended by changing
22Sections 65-35 and 65-45 and by adding Section 65-70 as
23follows:
 
24    (225 ILCS 65/65-35)  (was 225 ILCS 65/15-15)

 

 

SB3653- 17 -LRB103 38272 CES 68407 b

1    (Section scheduled to be repealed on January 1, 2028)
2    Sec. 65-35. Written collaborative agreements.
3    (a) A written collaborative agreement is required for all
4advanced practice registered nurses engaged in clinical
5practice prior to meeting the requirements of Section 65-43,
6except for advanced practice registered nurses who are
7privileged to practice in a hospital, hospital affiliate, or
8ambulatory surgical treatment center.
9    (a-5) If an advanced practice registered nurse engages in
10clinical practice outside of a hospital, hospital affiliate,
11or ambulatory surgical treatment center in which he or she is
12privileged to practice, the advanced practice registered nurse
13must have a written collaborative agreement, except as set
14forth in Section 65-43 and 65-70.
15    (b) A written collaborative agreement shall describe the
16relationship of the advanced practice registered nurse with
17the collaborating physician and shall describe the categories
18of care, treatment, or procedures to be provided by the
19advanced practice registered nurse. A collaborative agreement
20with a podiatric physician must be in accordance with
21subsection (c-5) or (c-15) of this Section. A collaborative
22agreement with a dentist must be in accordance with subsection
23(c-10) of this Section. A collaborative agreement with a
24podiatric physician must be in accordance with subsection
25(c-5) of this Section. Collaboration does not require an
26employment relationship between the collaborating physician

 

 

SB3653- 18 -LRB103 38272 CES 68407 b

1and the advanced practice registered nurse.
2    The collaborative relationship under an agreement shall
3not be construed to require the personal presence of a
4collaborating physician at the place where services are
5rendered. Methods of communication shall be available for
6consultation with the collaborating physician in person or by
7telecommunications or electronic communications as set forth
8in the written agreement.
9    (b-5) Absent an employment relationship, a written
10collaborative agreement may not (1) restrict the categories of
11patients of an advanced practice registered nurse within the
12scope of the advanced practice registered nurses training and
13experience, (2) limit third party payors or government health
14programs, such as the medical assistance program or Medicare
15with which the advanced practice registered nurse contracts,
16or (3) limit the geographic area or practice location of the
17advanced practice registered nurse in this State.
18    (c) In the case of anesthesia services provided by a
19certified registered nurse anesthetist, a certified registered
20nurse anesthetist shall seek consultation regarding
21development of an anesthesia plan and treatment of patients as
22is appropriate to the certified registered nurse anesthetist's
23level of expertise and scope of practice and as is warranted by
24the needs of the patient an anesthesiologist, a physician, a
25dentist, or a podiatric physician must participate through
26discussion of and agreement with the anesthesia plan and

 

 

SB3653- 19 -LRB103 38272 CES 68407 b

1remain physically present and available on the premises during
2the delivery of anesthesia services for diagnosis,
3consultation, and treatment of emergency medical conditions.
4    (c-5) A certified registered nurse anesthetist, who
5provides anesthesia and related services outside of a hospital
6or ambulatory surgical treatment center shall enter into a
7written collaborative agreement with an anesthesiologist or
8the physician licensed to practice medicine in all its
9branches or the podiatric physician performing the procedure.
10The collaborative agreement may, but is not required to,
11include the following terms: (i) that the certified registered
12nurse anesthetist providing anesthesia services and the
13anesthesiologist, physician, or podiatric physician
14participate through discussion of and reach agreement on the
15anesthesia plan or (ii) that anesthesia services shall only be
16delivered when the anesthesiologist, physician, or podiatric
17physician is present and available on the premises for
18diagnosis, consultation, and treatment of emergency medical
19conditions. Outside of a hospital or ambulatory surgical
20treatment center, the certified registered nurse anesthetist
21may provide only those services that the collaborating
22podiatric physician is authorized to provide pursuant to the
23Podiatric Medical Practice Act of 1987 and rules adopted
24thereunder. A certified registered nurse anesthetist may
25select, order, and administer medication, including controlled
26substances, and apply appropriate medical devices for delivery

 

 

SB3653- 20 -LRB103 38272 CES 68407 b

1of anesthesia and related services under the anesthesia plan
2agreed with by the anesthesiologist or the operating physician
3or operating podiatric physician.
4    (c-10) A certified registered nurse anesthetist who
5provides anesthesia services in a dental office shall enter
6into a written collaborative agreement with an
7anesthesiologist or the physician licensed to practice
8medicine in all its branches or the operating dentist
9performing the procedure. The agreement shall describe the
10working relationship of the certified registered nurse
11anesthetist and dentist and shall authorize the categories of
12care, treatment, or procedures to be performed by the
13certified registered nurse anesthetist. The collaborative
14agreement may, but is not required to, include the following
15terms: (i) that the certified registered nurse anesthetist
16providing anesthesia services and the anesthesiologist,
17physician, or podiatric physician participate through
18discussion of and reach agreement on the anesthesia plan or
19(ii) that anesthesia services shall only be delivered when the
20anesthesiologist, physician, or podiatric physician is present
21and available on the premises for diagnosis, consultation, and
22treatment of emergency medical conditions. In a collaborating
23dentist's office, the certified registered nurse anesthetist
24may only provide those services that the operating dentist
25with the appropriate permit is authorized to provide pursuant
26to the Illinois Dental Practice Act and rules adopted

 

 

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1thereunder. For anesthesia services, a certified registered
2nurse anesthetist shall seek consultation regarding
3development of an anesthesia plan and treatment of patients as
4is appropriate to the certified registered nurse anesthetist's
5level of expertise and scope of practice and as is warranted by
6the needs of the patient an anesthesiologist, physician, or
7operating dentist shall participate through discussion of and
8agreement with the anesthesia plan and shall remain physically
9present and be available on the premises during the delivery
10of anesthesia services for diagnosis, consultation, and
11treatment of emergency medical conditions. A certified
12registered nurse anesthetist may select, order, and administer
13medication, including controlled substances, and apply
14appropriate medical devices for delivery of anesthesia and
15related services under the anesthesia plan agreed with by the
16operating dentist.
17    (c-15) An advanced practice registered nurse who had a
18written collaborative agreement with a podiatric physician
19immediately before the effective date of Public Act 100-513
20may continue in that collaborative relationship or enter into
21a new written collaborative relationship with a podiatric
22physician under the requirements of this Section and Section
2365-40, as those Sections existed immediately before the
24amendment of those Sections by Public Act 100-513 with regard
25to a written collaborative agreement between an advanced
26practice registered nurse and a podiatric physician.

 

 

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1    (d) A copy of the signed, written collaborative agreement
2must be available to the Department upon request from both the
3advanced practice registered nurse and the collaborating
4physician, dentist, or podiatric physician.
5    (e) Nothing in this Act shall be construed to limit the
6delegation of tasks or duties by a physician to a licensed
7practical nurse, a registered professional nurse, or other
8persons in accordance with Section 54.2 of the Medical
9Practice Act of 1987. Nothing in this Act shall be construed to
10limit the method of delegation that may be authorized by any
11means, including, but not limited to, oral, written,
12electronic, standing orders, protocols, guidelines, or verbal
13orders.
14    (e-5) Nothing in this Act shall be construed to authorize
15an advanced practice registered nurse to provide health care
16services required by law or rule to be performed by a
17physician. The scope of practice of an advanced practice
18registered nurse does not include operative surgery. Nothing
19in this Section shall be construed to preclude an advanced
20practice registered nurse from assisting in surgery.
21    (f) An advanced practice registered nurse shall inform
22each collaborating physician, dentist, or podiatric physician
23of all collaborative agreements he or she has signed and
24provide a copy of these to any collaborating physician,
25dentist, or podiatric physician upon request.
26    (g) (Blank).

 

 

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1(Source: P.A. 100-513, eff. 1-1-18; 100-577, eff. 1-26-18;
2100-1096, eff. 8-26-18; 101-13, eff. 6-12-19.)
 
3    (225 ILCS 65/65-45)  (was 225 ILCS 65/15-25)
4    (Section scheduled to be repealed on January 1, 2028)
5    Sec. 65-45. Advanced practice registered nursing in
6hospitals, hospital affiliates, or ambulatory surgical
7treatment centers.
8    (a) An advanced practice registered nurse may provide
9services in a hospital or a hospital affiliate as those terms
10are defined in the Hospital Licensing Act or the University of
11Illinois Hospital Act or a licensed ambulatory surgical
12treatment center without a written collaborative agreement
13pursuant to Section 65-35 of this Act. An advanced practice
14registered nurse must possess clinical privileges recommended
15by the hospital medical staff and granted by the hospital or
16the consulting medical staff committee and ambulatory surgical
17treatment center in order to provide services. The medical
18staff or consulting medical staff committee shall periodically
19review the services of all advanced practice registered nurses
20granted clinical privileges, including any care provided in a
21hospital affiliate. Authority may also be granted when
22recommended by the hospital medical staff and granted by the
23hospital or recommended by the consulting medical staff
24committee and ambulatory surgical treatment center to
25individual advanced practice registered nurses to select,

 

 

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1order, and administer medications, including controlled
2substances, to provide delineated care. In a hospital,
3hospital affiliate, or ambulatory surgical treatment center,
4the attending physician shall determine an advanced practice
5registered nurse's role in providing care for his or her
6patients, except as otherwise provided in the medical staff
7bylaws or consulting committee policies.
8    (a-2) An advanced practice registered nurse privileged to
9order medications, including controlled substances, may
10complete discharge prescriptions provided the prescription is
11in the name of the advanced practice registered nurse and the
12attending or discharging physician.
13    (a-3) Advanced practice registered nurses practicing in a
14hospital or an ambulatory surgical treatment center are not
15required to obtain a mid-level controlled substance license to
16order controlled substances under Section 303.05 of the
17Illinois Controlled Substances Act.
18    (a-4) An advanced practice registered nurse meeting the
19requirements of Section 65-43 or 65-70 may be privileged to
20complete discharge orders and prescriptions under the advanced
21practice registered nurse's name.
22    (a-5) For anesthesia services provided by a certified
23registered nurse anesthetist, certified registered nurse
24anesthetist shall seek consultation regarding development of
25an anesthesia plan and treatment of patients as is appropriate
26to the certified registered nurse anesthetist's level of

 

 

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1expertise and scope of practice and as is warranted by the
2needs of the patient an anesthesiologist, physician, dentist,
3or podiatric physician shall participate through discussion of
4and agreement with the anesthesia plan and shall remain
5physically present and be available on the premises during the
6delivery of anesthesia services for diagnosis, consultation,
7and treatment of emergency medical conditions, unless hospital
8policy adopted pursuant to clause (B) of subdivision (3) of
9Section 10.7 of the Hospital Licensing Act or ambulatory
10surgical treatment center policy adopted pursuant to clause
11(B) of subdivision (3) of Section 6.5 of the Ambulatory
12Surgical Treatment Center Act provides otherwise. A certified
13registered nurse anesthetist may select, order, and administer
14medication for anesthesia and related services under the
15anesthesia plan agreed to by the anesthesiologist or the
16physician, in accordance with hospital alternative policy or
17the medical staff consulting committee policies of a licensed
18ambulatory surgical treatment center.
19    (b) An advanced practice registered nurse who provides
20services in a hospital shall do so in accordance with Section
2110.7 of the Hospital Licensing Act and, in an ambulatory
22surgical treatment center, in accordance with Section 6.5 of
23the Ambulatory Surgical Treatment Center Act. Nothing in this
24Act shall be construed to require an advanced practice
25registered nurse to have a collaborative agreement to practice
26in a hospital, hospital affiliate, or ambulatory surgical

 

 

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1treatment center.
2    (c) Advanced practice registered nurses certified as nurse
3practitioners, nurse midwives, or clinical nurse specialists
4practicing in a hospital affiliate may be, but are not
5required to be, privileged to prescribe Schedule II through V
6controlled substances when such authority is recommended by
7the appropriate physician committee of the hospital affiliate
8and granted by the hospital affiliate. This authority may, but
9is not required to, include prescription of, selection of,
10orders for, administration of, storage of, acceptance of
11samples of, and dispensing over-the-counter medications,
12legend drugs, medical gases, and controlled substances
13categorized as Schedule II through V controlled substances, as
14defined in Article II of the Illinois Controlled Substances
15Act, and other preparations, including, but not limited to,
16botanical and herbal remedies.
17    To prescribe controlled substances under this subsection
18(c), an advanced practice registered nurse certified as a
19nurse practitioner, nurse midwife, or clinical nurse
20specialist must obtain a controlled substance license.
21Medication orders shall be reviewed periodically by the
22appropriate hospital affiliate physicians committee or its
23physician designee.
24    The hospital affiliate shall file with the Department
25notice of a grant of prescriptive authority consistent with
26this subsection (c) and termination of such a grant of

 

 

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1authority, in accordance with rules of the Department. Upon
2receipt of this notice of grant of authority to prescribe any
3Schedule II through V controlled substances, the licensed
4advanced practice registered nurse certified as a nurse
5practitioner, nurse midwife, or clinical nurse specialist may
6register for a mid-level practitioner controlled substance
7license under Section 303.05 of the Illinois Controlled
8Substances Act.
9    In addition, a hospital affiliate may, but is not required
10to, privilege an advanced practice registered nurse certified
11as a nurse practitioner, nurse midwife, or clinical nurse
12specialist to prescribe any Schedule II controlled substances,
13if all of the following conditions apply:
14        (1) specific Schedule II controlled substances by oral
15    dosage or topical or transdermal application may be
16    designated, provided that the designated Schedule II
17    controlled substances are routinely prescribed by advanced
18    practice registered nurses in their area of certification;
19    the privileging documents must identify the specific
20    Schedule II controlled substances by either brand name or
21    generic name; privileges to prescribe or dispense Schedule
22    II controlled substances to be delivered by injection or
23    other route of administration may not be granted;
24        (2) any privileges must be controlled substances
25    limited to the practice of the advanced practice
26    registered nurse;

 

 

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1        (3) any prescription must be limited to no more than a
2    30-day supply;
3        (4) the advanced practice registered nurse must
4    discuss the condition of any patients for whom a
5    controlled substance is prescribed monthly with the
6    appropriate physician committee of the hospital affiliate
7    or its physician designee; and
8        (5) the advanced practice registered nurse must meet
9    the education requirements of Section 303.05 of the
10    Illinois Controlled Substances Act.
11    (d) An advanced practice registered nurse meeting the
12requirements of Section 65-43 may be privileged to prescribe
13controlled substances categorized as Schedule II through V in
14accordance with Section 65-43.
15(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18.)
 
16    (225 ILCS 65/65-70 new)
17    Sec. 65-70. Conditions under
which a written collaborative
18agreement not required.
19    (a) An Illinois-licensed advanced practice registered
20nurse certified as a certified registered nurse anesthetist
21shall be deemed by law to possess the ability to practice
22without a written collaborative agreement as set forth in this
23Act.
24    (b) An advanced practice registered nurse certified as a
25certified registered nurse anesthetist who (i) has attained

 

 

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1national certification and completed a professional practice
2doctorate or (ii) files with the Department a notarized
3attestation of completion of at least 250 hours of continuing
4education or training and at least 4,000 hours of clinical
5experience after first attaining national certification, shall
6not require a written collaborative agreement. Documentation
7of successful completion shall be provided to the Department
8upon request. Continuing education or training hours required
9by this subsection shall be in the certified registered nurse
10anesthetist's area of certification as set forth by Department
11rule.
12    The clinical experience must be in the certified
13registered nurse anesthetist's area of certification. The
14clinical experience shall be in collaboration with a physician
15or physicians or a certified registered nurse anesthetist with
16full practice authority. Completion of the clinical experience
17must be attested to by the collaborating physician or
18physicians or employer, collaborating certified registered
19nurse anesthetist and the certified registered nurse
20anesthetist. If the collaborating physician or physicians
21collaborating certified nurse anesthetist, or employer is
22unable to attest to the completion of the clinical experience,
23the Department may accept other evidence of clinical
24experience as established by rule.
25    (c) The scope of practice of a certified registered nurse
26anesthetist with full practice authority includes:

 

 

SB3653- 30 -LRB103 38272 CES 68407 b

1        (1) all matters included in subsection (c) of Section
2    65-30 of this Act;
3        (2) practicing without a written collaborative
4    agreement in all practice settings consistent with
5    national certification;
6        (3) authority to prescribe both legend drugs and
7    Schedule II through V controlled substances; this
8    authority includes prescription of, selection of, orders
9    for, administration of, storage of, acceptance of samples
10    of, and dispensing over the counter medications, legend
11    drugs, and controlled substances categorized as any
12    Schedule II through V controlled substances, as defined in
13    Article II of the Illinois Controlled Substances Act, and
14    other preparations, including, but not limited to,
15    botanical and herbal remedies;
16        (4) prescribing benzodiazepines or Schedule II
17    narcotic drugs, such as opioids; and
18        (5) authority to obtain an Illinois controlled
19    substance license and a federal Drug Enforcement
20    Administration number.
21    (d) The Department may adopt rules necessary to administer
22this Section, including, but not limited to, requiring the
23completion of forms and the payment of fees.
24    (e) Nothing in this Act shall be construed to authorize a
25certified registered nurse anesthetist with full practice
26authority to provide health care services required by law or

 

 

SB3653- 31 -LRB103 38272 CES 68407 b

1rule to be performed by a physician.
 
2    Section 25. The Illinois Dental Practice Act is amended by
3changing Section 8.1 as follows:
 
4    (225 ILCS 25/8.1)  (from Ch. 111, par. 2308.1)
5    (Section scheduled to be repealed on January 1, 2026)
6    Sec. 8.1. Permit for the administration of anesthesia and
7sedation.
8    (a) No licensed dentist shall administer general
9anesthesia, deep sedation, or conscious sedation without first
10applying for and obtaining a permit for such purpose from the
11Department. The Department shall issue such permit only after
12ascertaining that the applicant possesses the minimum
13qualifications necessary to protect public safety. A person
14with a dental degree who administers anesthesia, deep
15sedation, or conscious sedation in an approved hospital
16training program under the supervision of either a licensed
17dentist holding such permit or a physician licensed to
18practice medicine in all its branches shall not be required to
19obtain such permit.
20    (b) In determining the minimum permit qualifications that
21are necessary to protect public safety, the Department, by
22rule, shall:
23        (1) establish the minimum educational and training
24    requirements necessary for a dentist to be issued an

 

 

SB3653- 32 -LRB103 38272 CES 68407 b

1    appropriate permit;
2        (2) establish the standards for properly equipped
3    dental facilities (other than licensed hospitals and
4    ambulatory surgical treatment centers) in which general
5    anesthesia, deep sedation, or conscious sedation is
6    administered, as necessary to protect public safety;
7        (3) establish minimum requirements for all persons who
8    assist the dentist in the administration of general
9    anesthesia, deep sedation, or conscious sedation,
10    including minimum training requirements for each member of
11    the dental team, monitoring requirements, recordkeeping
12    requirements, and emergency procedures;
13        (4) ensure that the dentist has completed and
14    maintains current certification in advanced cardiac life
15    support or pediatric advanced life support and all persons
16    assisting the dentist or monitoring the administration of
17    general anesthesia, deep sedation, or conscious sedation
18    maintain current certification in Basic Life Support
19    (BLS); and
20        (5) establish continuing education requirements in
21    sedation techniques and airway management for dentists who
22    possess a permit under this Section.
23    When establishing requirements under this Section, the
24Department shall consider the current American Dental
25Association guidelines on sedation and general anesthesia, the
26current "Guidelines for Monitoring and Management of Pediatric

 

 

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1Patients During and After Sedation for Diagnostic and
2Therapeutic Procedures" established by the American Academy of
3Pediatrics and the American Academy of Pediatric Dentistry,
4and the current parameters of care and Office Anesthesia
5Evaluation (OAE) Manual established by the American
6Association of Oral and Maxillofacial Surgeons.
7    (c) A licensed dentist must hold an appropriate permit
8issued under this Section in order to perform dentistry while
9a nurse anesthetist administers conscious sedation, and a
10valid written collaborative agreement must exist between the
11dentist and the nurse anesthetist, in accordance with the
12Nurse Practice Act, unless the nurse anesthetist has full
13practice authority under the requirements of Section 65-70.
14    A licensed dentist must hold an appropriate permit issued
15under this Section in order to perform dentistry while a nurse
16anesthetist administers deep sedation or general anesthesia,
17and a valid written collaborative agreement must exist between
18the dentist and the nurse anesthetist, in accordance with the
19Nurse Practice Act, unless the nurse anesthetist has full
20practice authority under the requirements of Section 65-70.
21    For the purposes of this subsection (c), "nurse
22anesthetist" means a licensed certified registered nurse
23anesthetist who holds a license as an advanced practice
24registered nurse.
25(Source: P.A. 100-201, eff. 8-18-17; 100-513, eff. 1-1-18;
26101-162, eff. 7-26-19.)
 

 

 

SB3653- 34 -LRB103 38272 CES 68407 b

1    Section 30. The Podiatric Medical Practice Act of 1987 is
2amended by changing Section 20.5 as follows:
 
3    (225 ILCS 100/20.5)
4    (Section scheduled to be repealed on January 1, 2028)
5    Sec. 20.5. Delegation of authority to advanced practice
6registered nurses.
7    (a) A podiatric physician in active clinical practice may
8collaborate with an advanced practice registered nurse in
9accordance with the requirements of the Nurse Practice Act.
10Collaboration shall be for the purpose of providing podiatric
11care and no employment relationship shall be required. A
12written collaborative agreement shall conform to the
13requirements of Section 65-35 of the Nurse Practice Act. A
14written collaborative agreement and podiatric physician
15collaboration and consultation shall be adequate with respect
16to advanced practice registered nurses if all of the following
17apply:
18        (1) With respect to the provision of anesthesia
19    services by a certified registered nurse anesthetist, the
20    collaborating podiatric physician must have training and
21    experience in the delivery of anesthesia consistent with
22    Department rules unless the certified registered nurse
23    anesthetist has full practice authority under the
24    requirements of Section 65-70.

 

 

SB3653- 35 -LRB103 38272 CES 68407 b

1        (2) Methods of communication are available with the
2    collaborating podiatric physician in person or through
3    telecommunications or electronic communications for
4    consultation, collaboration, and referral as needed to
5    address patient care needs.
6        (3) With respect to the provision of anesthesia
7    services by a certified registered nurse anesthetist,
8    certified registered nurse anesthetist shall seek
9    consultation regarding development of an anesthesia plan
10    and treatment of patients as is appropriate to the
11    certified registered nurse anesthetist's level of
12    expertise and scope of practice and as is warranted by the
13    needs of the patient an anesthesiologist, physician, or
14    podiatric physician shall participate through discussion
15    of and agreement with the anesthesia plan and shall remain
16    physically present and be available on the premises during
17    the delivery of anesthesia services for diagnosis,
18    consultation, and treatment of emergency medical
19    conditions. The anesthesiologist or operating podiatric
20    physician must agree with the anesthesia plan prior to the
21    delivery of services.
22    (b) The collaborating podiatric physician shall have
23access to the records of all patients attended to by an
24advanced practice registered nurse.
25    (c) Nothing in this Section shall be construed to limit
26the delegation of tasks or duties by a podiatric physician to a

 

 

SB3653- 36 -LRB103 38272 CES 68407 b

1licensed practical nurse, a registered professional nurse, or
2other appropriately trained persons.
3    (d) A podiatric physician shall not be liable for the acts
4or omissions of an advanced practice registered nurse solely
5on the basis of having signed guidelines or a collaborative
6agreement, an order, a standing order, a standing delegation
7order, or other order or guideline authorizing an advanced
8practice registered nurse to perform acts, unless the
9podiatric physician has reason to believe the advanced
10practice registered nurse lacked the competency to perform the
11act or acts or commits willful or wanton misconduct.
12    (e) A podiatric physician, may, but is not required to
13delegate prescriptive authority to an advanced practice
14registered nurse as part of a written collaborative agreement
15and the delegation of prescriptive authority shall conform to
16the requirements of Section 65-40 of the Nurse Practice Act.
17(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18.)
 
18    Section 99. Effective date. This Act takes effect upon
19becoming law.

 

 

SB3653- 37 -LRB103 38272 CES 68407 b

1 INDEX
2 Statutes amended in order of appearance
3    210 ILCS 5/6.5
4    210 ILCS 85/10.7
5    225 ILCS 60/54.5
6    225 ILCS 65/65-35was 225 ILCS 65/15-15
7    225 ILCS 65/65-45was 225 ILCS 65/15-25
8    225 ILCS 65/65-70 new
9    225 ILCS 25/8.1from Ch. 111, par. 2308.1
10    225 ILCS 100/20.5