SB2255 EngrossedLRB097 09159 CEL 49294 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 Medical Practice Act of 1987 is amended by
5changing Section 54.5 as follows:
 
6    (225 ILCS 60/54.5)
7    (Section scheduled to be repealed on November 30, 2011)
8    Sec. 54.5. Physician delegation of authority to physician
9assistants and advanced practice nurses.
10    (a) Physicians licensed to practice medicine in all its
11branches may delegate care and treatment responsibilities to a
12physician assistant under guidelines in accordance with the
13requirements of the Physician Assistant Practice Act of 1987. A
14physician licensed to practice medicine in all its branches may
15enter into supervising physician agreements with no more than 2
16physician assistants.
17    (b) A physician licensed to practice medicine in all its
18branches in active clinical practice may collaborate with an
19advanced practice nurse in accordance with the requirements of
20the Nurse Practice Act. Collaboration is for the purpose of
21providing medical consultation, and no employment relationship
22is required. A written collaborative agreement shall conform to
23the requirements of Section 65-35 of the Nurse Practice Act.

 

 

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1The written collaborative agreement shall be for services the
2collaborating physician generally provides to his or her
3patients in the normal course of clinical medical practice. A
4written collaborative agreement shall be adequate with respect
5to collaboration with advanced practice nurses if all of the
6following apply:
7        (1) The agreement is written to promote the exercise of
8    professional judgment by the advanced practice nurse
9    commensurate with his or her education and experience. The
10    agreement need not describe the exact steps that an
11    advanced practice nurse must take with respect to each
12    specific condition, disease, or symptom, but must specify
13    those procedures that require a physician's presence as the
14    procedures are being performed.
15        (2) Practice guidelines and orders are developed and
16    approved jointly by the advanced practice nurse and
17    collaborating physician, as needed, based on the practice
18    of the practitioners. Such guidelines and orders and the
19    patient services provided thereunder are periodically
20    reviewed by the collaborating physician.
21        (3) The advance practice nurse provides services the
22    collaborating physician generally provides to his or her
23    patients in the normal course of clinical practice, except
24    as set forth in subsection (b-5) of this Section. With
25    respect to labor and delivery, the collaborating physician
26    must provide delivery services in order to participate with

 

 

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1    a certified nurse midwife.
2        (4) The collaborating physician and advanced practice
3    nurse consult meet in person at least once a month to
4    provide collaboration and consultation.
5        (5) Methods of communication are available with the
6    collaborating physician in person or through
7    telecommunications for consultation, collaboration, and
8    referral as needed to address patient care needs.
9        (6) The agreement contains provisions detailing notice
10    for termination or change of status involving a written
11    collaborative agreement, except when such notice is given
12    for just cause.
13    (b-5) An anesthesiologist or physician licensed to
14practice medicine in all its branches may collaborate with a
15certified registered nurse anesthetist in accordance with
16Section 65-35 of the Nurse Practice Act for the provision of
17anesthesia services. With respect to the provision of
18anesthesia services, the collaborating anesthesiologist or
19physician shall have training and experience in the delivery of
20anesthesia services consistent with Department rules.
21Collaboration shall be adequate if:
22        (1) an anesthesiologist or a physician participates in
23    the joint formulation and joint approval of orders or
24    guidelines and periodically reviews such orders and the
25    services provided patients under such orders; and
26        (2) for anesthesia services, the anesthesiologist or

 

 

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1    physician participates through discussion of and agreement
2    with the anesthesia plan and is physically present and
3    available on the premises during the delivery of anesthesia
4    services for diagnosis, consultation, and treatment of
5    emergency medical conditions. Anesthesia services in a
6    hospital shall be conducted in accordance with Section 10.7
7    of the Hospital Licensing Act and in an ambulatory surgical
8    treatment center in accordance with Section 6.5 of the
9    Ambulatory Surgical Treatment Center Act.
10    (b-10) The anesthesiologist or operating physician must
11agree with the anesthesia plan prior to the delivery of
12services.
13    (c) The supervising physician shall have access to the
14medical records of all patients attended by a physician
15assistant. The collaborating physician shall have access to the
16medical records of all patients attended to by an advanced
17practice nurse.
18    (d) (Blank).
19    (e) A physician shall not be liable for the acts or
20omissions of a physician assistant or advanced practice nurse
21solely on the basis of having signed a supervision agreement or
22guidelines or a collaborative agreement, an order, a standing
23medical order, a standing delegation order, or other order or
24guideline authorizing a physician assistant or advanced
25practice nurse to perform acts, unless the physician has reason
26to believe the physician assistant or advanced practice nurse

 

 

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1lacked the competency to perform the act or acts or commits
2willful and wanton misconduct.
3    (f) A collaborating physician may, but is not required to,
4delegate prescriptive authority to an advanced practice nurse
5as part of a written collaborative agreement, and the
6delegation of prescriptive authority shall conform to the
7requirements of Section 65-40 of the Nurse Practice Act.
8    (g) A supervising physician may, but is not required to,
9delegate prescriptive authority to a physician assistant as
10part of a written supervision agreement, and the delegation of
11prescriptive authority shall conform to the requirements of
12Section 7.5 of the Physician Assistant Practice Act of 1987.
13(Source: P.A. 95-639, eff. 10-5-07; 96-618, eff. 1-1-10.)
 
14    Section 10. The Nurse Practice Act is amended by changing
15Sections 65-35, 65-40, and 65-45 as follows:
 
16    (225 ILCS 65/65-35)   (was 225 ILCS 65/15-15)
17    (Section scheduled to be repealed on January 1, 2018)
18    Sec. 65-35. Written collaborative agreements.
19    (a) A written collaborative agreement is required for all
20advanced practice nurses engaged in clinical practice, except
21for advanced practice nurses who are authorized to practice in
22a hospital or ambulatory surgical treatment center.
23    (a-5) If an advanced practice nurse engages in clinical
24practice outside of a hospital or ambulatory surgical treatment

 

 

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1center in which he or she is authorized to practice, the
2advanced practice nurse must have a written collaborative
3agreement.
4    (b) A written collaborative agreement shall describe the
5working relationship of the advanced practice nurse with the
6collaborating physician or podiatrist and shall authorize the
7categories of care, treatment, or procedures to be performed by
8the advanced practice nurse. A collaborative agreement with a
9dentist must be in accordance with subsection (c-10) of this
10Section. Collaboration does not require an employment
11relationship between the collaborating physician and advanced
12practice nurse. Absent an employment relationship, an
13agreement may not restrict the categories of patients or
14third-party payment sources accepted by the advanced practice
15nurse. Collaboration means the relationship under which an
16advanced practice nurse works with a collaborating physician or
17podiatrist in an active clinical practice to deliver health
18care services in accordance with (i) the advanced practice
19nurse's training, education, and experience and (ii)
20collaboration and consultation as documented in a jointly
21developed written collaborative agreement.
22    The agreement shall be defined to promote the exercise of
23professional judgment by the advanced practice nurse
24commensurate with his or her education and experience. The
25services to be provided by the advanced practice nurse shall be
26services that the collaborating physician or podiatrist is

 

 

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1authorized to and generally provides to his or her patients in
2the normal course of his or her clinical medical practice,
3except as set forth in subsection (c-5) of this Section. The
4agreement need not describe the exact steps that an advanced
5practice nurse must take with respect to each specific
6condition, disease, or symptom but must specify which
7authorized procedures require the presence of the
8collaborating physician or podiatrist as the procedures are
9being performed. The collaborative relationship under an
10agreement shall not be construed to require the personal
11presence of a physician or podiatrist at all times at the place
12where services are rendered. Methods of communication shall be
13available for consultation with the collaborating physician or
14podiatrist in person or by telecommunications in accordance
15with established written guidelines as set forth in the written
16agreement.
17    (c) Collaboration and consultation under all collaboration
18agreements shall be adequate if a collaborating physician or
19podiatrist does each of the following:
20        (1) Participates in the joint formulation and joint
21    approval of orders or guidelines with the advanced practice
22    nurse and he or she periodically reviews such orders and
23    the services provided patients under such orders in
24    accordance with accepted standards of medical practice or
25    podiatric practice and advanced practice nursing practice.
26        (2) Provides collaboration and consultation Meets in

 

 

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1    person with the advanced practice nurse at least once a
2    month to provide collaboration and consultation. In the
3    case of anesthesia services provided by a certified
4    registered nurse anesthetist, an anesthesiologist,
5    physician, dentist, or podiatrist must participate through
6    discussion of and agreement with the anesthesia plan and
7    remain physically present and available on the premises
8    during the delivery of anesthesia services for diagnosis,
9    consultation, and treatment of emergency medical
10    conditions.
11        (3) Is available through telecommunications for
12    consultation on medical problems, complications, or
13    emergencies or patient referral. In the case of anesthesia
14    services provided by a certified registered nurse
15    anesthetist, an anesthesiologist, physician, dentist, or
16    podiatrist must participate through discussion of and
17    agreement with the anesthesia plan and remain physically
18    present and available on the premises during the delivery
19    of anesthesia services for diagnosis, consultation, and
20    treatment of emergency medical conditions.
21    The agreement must contain provisions detailing notice for
22termination or change of status involving a written
23collaborative agreement, except when such notice is given for
24just cause.
25    (c-5) A certified registered nurse anesthetist, who
26provides anesthesia services outside of a hospital or

 

 

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1ambulatory surgical treatment center shall enter into a written
2collaborative agreement with an anesthesiologist or the
3physician licensed to practice medicine in all its branches or
4the podiatrist performing the procedure. Outside of a hospital
5or ambulatory surgical treatment center, the certified
6registered nurse anesthetist may provide only those services
7that the collaborating podiatrist is authorized to provide
8pursuant to the Podiatric Medical Practice Act of 1987 and
9rules adopted thereunder. A certified registered nurse
10anesthetist may select, order, and administer medication,
11including controlled substances, and apply appropriate medical
12devices for delivery of anesthesia services under the
13anesthesia plan agreed with by the anesthesiologist or the
14operating physician or operating podiatrist.
15    (c-10) A certified registered nurse anesthetist who
16provides anesthesia services in a dental office shall enter
17into a written collaborative agreement with an
18anesthesiologist or the physician licensed to practice
19medicine in all its branches or the operating dentist
20performing the procedure. The agreement shall describe the
21working relationship of the certified registered nurse
22anesthetist and dentist and shall authorize the categories of
23care, treatment, or procedures to be performed by the certified
24registered nurse anesthetist. In a collaborating dentist's
25office, the certified registered nurse anesthetist may only
26provide those services that the operating dentist with the

 

 

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1appropriate permit is authorized to provide pursuant to the
2Illinois Dental Practice Act and rules adopted thereunder. For
3anesthesia services, an anesthesiologist, physician, or
4operating dentist shall participate through discussion of and
5agreement with the anesthesia plan and shall remain physically
6present and be available on the premises during the delivery of
7anesthesia services for diagnosis, consultation, and treatment
8of emergency medical conditions. A certified registered nurse
9anesthetist may select, order, and administer medication,
10including controlled substances, and apply appropriate medical
11devices for delivery of anesthesia services under the
12anesthesia plan agreed with by the operating dentist.
13    (d) A copy of the signed, written collaborative agreement
14must be available to the Department upon request from both the
15advanced practice nurse and the collaborating physician or
16podiatrist.
17    (e) Nothing in this Act shall be construed to limit the
18delegation of tasks or duties by a physician to a licensed
19practical nurse, a registered professional nurse, or other
20persons in accordance with Section 54.2 of the Medical Practice
21Act of 1987. Nothing in this Act shall be construed to limit
22the method of delegation that may be authorized by any means,
23including, but not limited to, oral, written, electronic,
24standing orders, protocols, guidelines, or verbal orders.
25    (f) An advanced practice nurse shall inform each
26collaborating physician, dentist, or podiatrist of all

 

 

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1collaborative agreements he or she has signed and provide a
2copy of these to any collaborating physician, dentist, or
3podiatrist upon request.
4    (g) For the purposes of this Act, "generally provides to
5his or her patients in the normal course of his or her clinical
6medical practice" means services, not specific tasks or duties,
7the physician or podiatrist routinely provides individually or
8through delegation to other persons so that the physician or
9podiatrist has the experience and ability to provide
10collaboration and consultation.
11(Source: P.A. 95-639, eff. 10-5-07; 96-618, eff. 1-1-10.)
 
12    (225 ILCS 65/65-40)   (was 225 ILCS 65/15-20)
13    (Section scheduled to be repealed on January 1, 2018)
14    Sec. 65-40. Written collaborative agreement; prescriptive
15Prescriptive authority.
16    (a) A collaborating physician or podiatrist may, but is not
17required to, delegate prescriptive authority to an advanced
18practice nurse as part of a written collaborative agreement.
19This authority may, but is not required to, include
20prescription of, selection of, orders for, administration of,
21storage of, acceptance of samples of, and dispensing over the
22counter medications, legend drugs, medical gases, and
23controlled substances categorized as any Schedule III through V
24controlled substances, as defined in Article II of the Illinois
25Controlled Substances Act, and other preparations, including,

 

 

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1but not limited to, botanical and herbal remedies. The
2collaborating physician or podiatrist must have a valid current
3Illinois controlled substance license and federal registration
4to delegate authority to prescribe delegated controlled
5substances.
6    (b) To prescribe controlled substances under this Section,
7an advanced practice nurse must obtain a mid-level practitioner
8controlled substance license. Medication orders shall be
9reviewed periodically by the collaborating physician or
10podiatrist.
11    (c) The collaborating physician or podiatrist shall file
12with the Department notice of delegation of prescriptive
13authority and termination of such delegation, in accordance
14with rules of the Department. Upon receipt of this notice
15delegating authority to prescribe any Schedule III through V
16controlled substances, the licensed advanced practice nurse
17shall be eligible to register for a mid-level practitioner
18controlled substance license under Section 303.05 of the
19Illinois Controlled Substances Act.
20    (d) In addition to the requirements of subsections (a),
21(b), and (c) of this Section, a collaborating physician or
22podiatrist may, but is not required to, delegate authority to
23an advanced practice nurse to prescribe any Schedule II
24controlled substances, if all of the following conditions
25apply:
26        (1) Specific No more than 5 Schedule II controlled

 

 

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1    substances by oral dosage or topical or transdermal
2    application may be delegated, provided that the delegated
3    Schedule II controlled substances are routinely prescribed
4    by the collaborating physician or podiatrist. This
5    delegation must identify the specific Schedule II
6    controlled substances by either brand name or generic name.
7    Schedule II controlled substances to be delivered by
8    injection or other route of administration may not be
9    delegated.
10        (2) Any delegation must be controlled substances that
11    the collaborating physician or podiatrist prescribes.
12        (3) Any prescription must be limited to no more than a
13    30-day supply oral dosage, with any continuation
14    authorized only after prior approval of the collaborating
15    physician or podiatrist.
16        (4) The advanced practice nurse must discuss the
17    condition of any patients for whom a controlled substance
18    is prescribed monthly with the delegating physician.
19        (5) The advanced practice nurse meets the education
20    requirements of Section 303.05 of the Illinois Controlled
21    Substances Act.
22    (e) Nothing in this Act shall be construed to limit the
23delegation of tasks or duties by a physician to a licensed
24practical nurse, a registered professional nurse, or other
25persons. Nothing in this Act shall be construed to limit the
26method of delegation that may be authorized by any means,

 

 

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1including, but not limited to, oral, written, electronic,
2standing orders, protocols, guidelines, or verbal orders.
3    (f) Nothing in this Section shall be construed to apply to
4any medication authority including Schedule II controlled
5substances of an advanced practice nurse for care provided in a
6hospital, hospital affiliate, or ambulatory surgical treatment
7center pursuant to Section 65-45.
8    (g) Any advanced practice nurse who writes a prescription
9for a controlled substance without having a valid appropriate
10authority may be fined by the Department not more than $50 per
11prescription, and the Department may take any other
12disciplinary action provided for in this Act.
13    (h) Nothing in this Section shall be construed to prohibit
14generic substitution.
15(Source: P.A. 95-639, eff. 10-5-07; 96-189, eff. 8-10-09.)
 
16    (225 ILCS 65/65-45)   (was 225 ILCS 65/15-25)
17    (Section scheduled to be repealed on January 1, 2018)
18    Sec. 65-45. Advanced practice nursing in hospitals,
19hospital affiliates, or ambulatory surgical treatment centers.
20    (a) An advanced practice nurse may provide services in a
21licensed hospital or a hospital affiliate as those terms are
22defined in the Hospital Licensing Act or the University of
23Illinois Hospital Act or a licensed ambulatory surgical
24treatment center without prescriptive authority or a written
25collaborative agreement pursuant to Section 65-35 of this Act.

 

 

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1An advanced practice nurse must possess clinical privileges
2recommended by the hospital medical staff and granted by the
3hospital or the consulting medical staff committee and
4ambulatory surgical treatment center in order to provide
5services. The medical staff or consulting medical staff
6committee shall periodically review the services of advanced
7practice nurses granted clinical privileges, including any
8care provided in a hospital affiliate. Authority may also be
9granted when recommended by the hospital medical staff and
10granted by the hospital or recommended by the consulting
11medical staff committee and ambulatory surgical treatment
12center to individual advanced practice nurses to select, order,
13and administer medications, including controlled substances,
14to provide delineated care. In a hospital, hospital affiliate,
15or ambulatory surgical treatment center, the The attending
16physician shall determine an advanced practice nurse's role in
17providing care for his or her patients, except as otherwise
18provided in the medical staff bylaws or consulting committee
19policies.
20    (a-2) An advanced practice nurse granted authority to order
21medications including controlled substances may complete
22discharge prescriptions provided the prescription is in the
23name of the advanced practice nurse and the attending or
24discharging physician.
25    (a-3) Advanced practice nurses practicing in a hospital or
26an ambulatory surgical treatment center are not required to

 

 

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1obtain a mid-level controlled substance license to order
2controlled substances under Section 303.05 of the Illinois
3Controlled Substances Act.
4    (a-5) For anesthesia services provided by a certified
5registered nurse anesthetist, an anesthesiologist, physician,
6dentist, or podiatrist shall participate through discussion of
7and agreement with the anesthesia plan and shall remain
8physically present and be available on the premises during the
9delivery of anesthesia services for diagnosis, consultation,
10and treatment of emergency medical conditions, unless hospital
11policy adopted pursuant to clause (B) of subdivision (3) of
12Section 10.7 of the Hospital Licensing Act or ambulatory
13surgical treatment center policy adopted pursuant to clause (B)
14of subdivision (3) of Section 6.5 of the Ambulatory Surgical
15Treatment Center Act provides otherwise. A certified
16registered nurse anesthetist may select, order, and administer
17medication for anesthesia services under the anesthesia plan
18agreed to by the anesthesiologist or the physician, in
19accordance with hospital alternative policy or the medical
20staff consulting committee policies of a licensed ambulatory
21surgical treatment center.
22    (b) An advanced practice nurse who provides services in a
23hospital shall do so in accordance with Section 10.7 of the
24Hospital Licensing Act and, in an ambulatory surgical treatment
25center, in accordance with Section 6.5 of the Ambulatory
26Surgical Treatment Center Act.

 

 

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1(Source: P.A. 95-639, eff. 10-5-07.)
 
2    Section 15. The Physician Assistant Practice Act of 1987 is
3amended by changing Section 7.5 as follows:
 
4    (225 ILCS 95/7.5)
5    (Section scheduled to be repealed on January 1, 2018)
6    Sec. 7.5. Prescriptions; written supervision agreements;
7prescriptive authority.
8    (a) A written supervision agreement is required for all
9physician assistants to practice in the State.
10        (1) A written supervision agreement shall describe the
11    working relationship of the physician assistant with the
12    supervising physician and shall authorize the categories
13    of care, treatment, or procedures to be performed by the
14    physician assistant. The written supervision agreement
15    shall be defined to promote the exercise of professional
16    judgment by the physician assistant commensurate with his
17    or her education and experience. The services to be
18    provided by the physician assistant shall be services that
19    the supervising physician is authorized to and generally
20    provides to his or her patients in the normal course of his
21    or her clinical medical practice. The written supervision
22    agreement need not describe the exact steps that a
23    physician assistant must take with respect to each specific
24    condition, disease, or symptom but must specify which

 

 

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1    authorized procedures require the presence of the
2    supervising physician as the procedures are being
3    performed. The supervision relationship under a written
4    supervision agreement shall not be construed to require the
5    personal presence of a physician at all times at the place
6    where services are rendered. Methods of communication
7    shall be available for consultation with the supervising
8    physician in person or by telecommunications in accordance
9    with established written guidelines as set forth in the
10    written supervision agreement. For the purposes of this
11    Act, "generally provides to his or her patients in the
12    normal course of his or her clinical medical practice"
13    means services, not specific tasks or duties, the
14    supervising physician routinely provides individually or
15    through delegation to other persons so that the physician
16    has the experience and ability to provide supervision and
17    consultation.
18        (2) The written supervision agreement shall be
19    adequate if a physician does each of the following:
20            (A) Participates in the joint formulation and
21        joint approval of orders or guidelines with the
22        physician assistant and he or she periodically reviews
23        such orders and the services provided patients under
24        such orders in accordance with accepted standards of
25        medical practice and physician assistant practice.
26            (B) Provides supervision and consultation Meets in

 

 

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1        person with the physician assistant at least once a
2        month to provide supervision.
3        (3) A copy of the signed, written supervision agreement
4    must be available to the Department upon request from both
5    the physician assistant and the supervising physician.
6        (4) A physician assistant shall inform each
7    supervising physician of all written supervision
8    agreements he or she has signed and provide a copy of these
9    to any supervising physician upon request.
10    (b) A supervising physician may, but is not required to,
11delegate prescriptive authority to a physician assistant as
12part of a written supervision agreement. This authority may,
13but is not required to, include prescription of, selection of,
14orders for, administration of, storage of, acceptance of
15samples of, and dispensing over the counter medications, legend
16drugs, medical gases, and controlled substances categorized as
17Schedule III through V controlled substances, as defined in
18Article II of the Illinois Controlled Substances Act, and other
19preparations, including, but not limited to, botanical and
20herbal remedies. The supervising physician must have a valid,
21current Illinois controlled substance license and federal
22registration with the Drug Enforcement Agency to delegate the
23authority to prescribe controlled substances.
24        (1) To prescribe Schedule III, IV, or V controlled
25    substances under this Section, a physician assistant must
26    obtain a mid-level practitioner controlled substances

 

 

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1    license. Medication orders issued by a physician assistant
2    shall be reviewed periodically by the supervising
3    physician.
4        (2) The supervising physician shall file with the
5    Department notice of delegation of prescriptive authority
6    to a physician assistant and termination of delegation,
7    specifying the authority delegated or terminated. Upon
8    receipt of this notice delegating authority to prescribe
9    Schedule III, IV, or V controlled substances, the physician
10    assistant shall be eligible to register for a mid-level
11    practitioner controlled substances license under Section
12    303.05 of the Illinois Controlled Substances Act. Nothing
13    in this Act shall be construed to limit the delegation of
14    tasks or duties by the supervising physician to a nurse or
15    other appropriately trained persons in accordance with
16    Section 54.2 of the Medical Practice Act of 1987.
17        (3) In addition to the requirements of subsection (b)
18    of this Section, a supervising physician may, but is not
19    required to, delegate authority to a physician assistant to
20    prescribe Schedule II controlled substances, if all of the
21    following conditions apply:
22            (A) Specific No more than 5 Schedule II controlled
23        substances by oral dosage or topical or transdermal
24        application may be delegated, provided that the
25        delegated Schedule II controlled substances are
26        routinely prescribed by the supervising physician.

 

 

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1        This delegation must identify the specific Schedule II
2        controlled substances by either brand name or generic
3        name. Schedule II controlled substances to be
4        delivered by injection or other route of
5        administration may not be delegated.
6            (B) Any delegation must be controlled substances
7        that the supervising physician prescribes.
8            (C) Any prescription must be limited to no more
9        than a 30-day supply oral dosage, with any continuation
10        authorized only after prior approval of the
11        supervising physician.
12            (D) The physician assistant must discuss the
13        condition of any patients for whom a controlled
14        substance is prescribed monthly with the supervising
15        physician.
16            (E) The physician assistant meets the education
17        requirements of Section 303.05 of the Illinois
18        Controlled Substances Act.
19    (c) Nothing in this Act shall be construed to limit the
20delegation of tasks or duties by a physician to a licensed
21practical nurse, a registered professional nurse, or other
22persons. Nothing in this Act shall be construed to limit the
23method of delegation that may be authorized by any means,
24including, but not limited to, oral, written, electronic,
25standing orders, protocols, guidelines, or verbal orders.
26    (d) Any physician assistant who writes a prescription for a

 

 

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1controlled substance without having a valid appropriate
2authority may be fined by the Department not more than $50 per
3prescription, and the Department may take any other
4disciplinary action provided for in this Act.
5    (e) Nothing in this Section shall be construed to prohibit
6generic substitution.
7(Source: P.A. 96-268, eff. 8-11-09; 96-618, eff. 1-1-10;
896-1000, eff. 7-2-10.)
 
9    Section 20. The Podiatric Medical Practice Act of 1987 is
10amended by changing Section 20.5 as follows:
 
11    (225 ILCS 100/20.5)
12    (Section scheduled to be repealed on January 1, 2018)
13    Sec. 20.5. Delegation of authority to advanced practice
14nurses.
15    (a) A podiatrist in active clinical practice may
16collaborate with an advanced practice nurse in accordance with
17the requirements of the Nurse Practice Act. Collaboration shall
18be for the purpose of providing podiatric consultation and no
19employment relationship shall be required. A written
20collaborative agreement shall conform to the requirements of
21Section 65-35 of the Nurse Practice Act. The written
22collaborative agreement shall be for services the
23collaborating podiatrist generally provides to his or her
24patients in the normal course of clinical podiatric practice,

 

 

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1except as set forth in item (3) of this subsection (a). A
2written collaborative agreement and podiatric collaboration
3and consultation shall be adequate with respect to advanced
4practice nurses if all of the following apply:
5        (1) The agreement is written to promote the exercise of
6    professional judgment by the advanced practice nurse
7    commensurate with his or her education and experience. The
8    agreement need not describe the exact steps that an
9    advanced practice nurse must take with respect to each
10    specific condition, disease, or symptom, but must specify
11    which procedures require a podiatrist's presence as the
12    procedures are being performed.
13        (2) Practice guidelines and orders are developed and
14    approved jointly by the advanced practice nurse and
15    collaborating podiatrist, as needed, based on the practice
16    of the practitioners. Such guidelines and orders and the
17    patient services provided thereunder are periodically
18    reviewed by the collaborating podiatrist.
19        (3) The advance practice nurse provides services that
20    the collaborating podiatrist generally provides to his or
21    her patients in the normal course of clinical practice.
22    With respect to the provision of anesthesia services by a
23    certified registered nurse anesthetist, the collaborating
24    podiatrist must have training and experience in the
25    delivery of anesthesia consistent with Department rules.
26        (4) The collaborating podiatrist and the advanced

 

 

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1    practice nurse consult meet in person at least once a month
2    to provide collaboration and consultation.
3        (5) Methods of communication are available with the
4    collaborating podiatrist in person or through
5    telecommunications for consultation, collaboration, and
6    referral as needed to address patient care needs.
7        (6) With respect to the provision of anesthesia
8    services by a certified registered nurse anesthetist, an
9    anesthesiologist, physician, or podiatrist shall
10    participate through discussion of and agreement with the
11    anesthesia plan and shall remain physically present and be
12    available on the premises during the delivery of anesthesia
13    services for diagnosis, consultation, and treatment of
14    emergency medical conditions. The anesthesiologist or
15    operating podiatrist must agree with the anesthesia plan
16    prior to the delivery of services.
17        (7) The agreement contains provisions detailing notice
18    for termination or change of status involving a written
19    collaborative agreement, except when such notice is given
20    for just cause.
21    (b) The collaborating podiatrist shall have access to the
22records of all patients attended to by an advanced practice
23nurse.
24    (c) Nothing in this Section shall be construed to limit the
25delegation of tasks or duties by a podiatrist to a licensed
26practical nurse, a registered professional nurse, or other

 

 

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1appropriately trained persons.
2    (d) A podiatrist shall not be liable for the acts or
3omissions of an advanced practice nurse solely on the basis of
4having signed guidelines or a collaborative agreement, an
5order, a standing order, a standing delegation order, or other
6order or guideline authorizing an advanced practice nurse to
7perform acts, unless the podiatrist has reason to believe the
8advanced practice nurse lacked the competency to perform the
9act or acts or commits willful or wanton misconduct.
10    (f) A podiatrist, may, but is not required to delegate
11prescriptive authority to an advanced practice nurse as part of
12a written collaborative agreement and the delegation of
13prescriptive authority shall conform to the requirements of
14Section 65-40 of the Nurse Practice Act.
15(Source: P.A. 95-639, eff. 10-5-07; 96-618, eff. 1-1-10.)
 
16    Section 25. The Illinois Controlled Substances Act is
17amended by changing Section 303.05 as follows:
 
18    (720 ILCS 570/303.05)
19    Sec. 303.05. Mid-level practitioner registration.
20    (a) The Department of Financial and Professional
21Regulation shall register licensed physician assistants and
22licensed advanced practice nurses to prescribe and dispense
23controlled substances under Section 303 and euthanasia
24agencies to purchase, store, or administer animal euthanasia

 

 

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1drugs under the following circumstances:
2        (1) with respect to physician assistants,
3            (A) the physician assistant has been delegated
4        authority to prescribe any Schedule III through V
5        controlled substances by a physician licensed to
6        practice medicine in all its branches in accordance
7        with Section 7.5 of the Physician Assistant Practice
8        Act of 1987; and the physician assistant has completed
9        the appropriate application forms and has paid the
10        required fees as set by rule; or
11            (B) the physician assistant has been delegated
12        authority by a supervising physician licensed to
13        practice medicine in all its branches to prescribe or
14        dispense Schedule II controlled substances through a
15        written delegation of authority and under the
16        following conditions:
17                (i) Specific no more than 5 Schedule II
18            controlled substances by oral dosage or topical or
19            transdermal application may be delegated, provided
20            that the delegated Schedule II controlled
21            substances are routinely prescribed by the
22            supervising physician. This delegation must
23            identify the specific Schedule II controlled
24            substances by either brand name or generic name.
25            Schedule II controlled substances to be delivered
26            by injection or other route of administration may

 

 

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1            not be delegated;
2                (ii) any delegation must be of controlled
3            substances prescribed by the supervising
4            physician;
5                (iii) all prescriptions must be limited to no
6            more than a 30-day supply oral dosage, with any
7            continuation authorized only after prior approval
8            of the supervising physician;
9                (iv) the physician assistant must discuss the
10            condition of any patients for whom a controlled
11            substance is prescribed monthly with the
12            delegating physician; and
13                (v) the physician assistant must have
14            completed the appropriate application forms and
15            paid the required fees as set by rule;
16                (vi) the physician assistant must provide
17            evidence of satisfactory completion of 45 contact
18            hours in pharmacology from any physician assistant
19            program accredited by the Accreditation Review
20            Commission on Education for the Physician
21            Assistant (ARC-PA), or its predecessor agency, for
22            any new license issued with Schedule II authority
23            after the effective date of this amendatory Act of
24            the 97th General Assembly; and
25                (vii) the physician assistant must annually
26            complete at least 5 hours of continuing education

 

 

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1            in pharmacology.
2        (2) with respect to advanced practice nurses,
3            (A) the advanced practice nurse has been delegated
4        authority to prescribe any Schedule III through V
5        controlled substances by a collaborating physician
6        licensed to practice medicine in all its branches or a
7        collaborating podiatrist in accordance with Section
8        65-40 of the Nurse Practice Act. The advanced practice
9        nurse has completed the appropriate application forms
10        and has paid the required fees as set by rule; or
11            (B) the advanced practice nurse has been delegated
12        authority by a collaborating physician licensed to
13        practice medicine in all its branches or collaborating
14        podiatrist to prescribe or dispense Schedule II
15        controlled substances through a written delegation of
16        authority and under the following conditions:
17                (i) specific no more than 5 Schedule II
18            controlled substances by oral dosage or topical or
19            transdermal application may be delegated, provided
20            that the delegated Schedule II controlled
21            substances are routinely prescribed by the
22            collaborating physician or podiatrist. This
23            delegation must identify the specific Schedule II
24            controlled substances by either brand name or
25            generic name. Schedule II controlled substances to
26            be delivered by injection or other route of

 

 

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1            administration may not be delegated;
2                (ii) any delegation must be of controlled
3            substances prescribed by the collaborating
4            physician or podiatrist;
5                (iii) all prescriptions must be limited to no
6            more than a 30-day supply oral dosage, with any
7            continuation authorized only after prior approval
8            of the collaborating physician or podiatrist;
9                (iv) the advanced practice nurse must discuss
10            the condition of any patients for whom a controlled
11            substance is prescribed monthly with the
12            delegating physician or podiatrist; and
13                (v) the advanced practice nurse must have
14            completed the appropriate application forms and
15            paid the required fees as set by rule; or
16                (vi) the advanced practice nurse must provide
17            evidence of satisfactory completion of at least 45
18            graduate contact hours in pharmacology for any new
19            license issued with Schedule II authority after
20            the effective date of this amendatory Act of the
21            97th General Assembly; and
22                (vii) the advanced practice nurse must
23            annually complete 5 hours of continuing education
24            in pharmacology; or
25        (3) with respect to animal euthanasia agencies, the
26    euthanasia agency has obtained a license from the

 

 

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1    Department of Professional Regulation and obtained a
2    registration number from the Department.
3    (b) The mid-level practitioner shall only be licensed to
4prescribe those schedules of controlled substances for which a
5licensed physician or licensed podiatrist has delegated
6prescriptive authority, except that an animal euthanasia
7agency does not have any prescriptive authority. A physician
8assistant and an advanced practice nurse are prohibited from
9prescribing medications and controlled substances not set
10forth in the required written delegation of authority.
11    (c) Upon completion of all registration requirements,
12physician assistants, advanced practice nurses, and animal
13euthanasia agencies shall be issued a mid-level practitioner
14controlled substances license for Illinois.
15    (d) A collaborating physician or podiatrist may, but is not
16required to, delegate prescriptive authority to an advanced
17practice nurse as part of a written collaborative agreement,
18and the delegation of prescriptive authority shall conform to
19the requirements of Section 65-40 of the Nurse Practice Act.
20    (e) A supervising physician may, but is not required to,
21delegate prescriptive authority to a physician assistant as
22part of a written supervision agreement, and the delegation of
23prescriptive authority shall conform to the requirements of
24Section 7.5 of the Physician Assistant Practice Act of 1987.
25    (f) Nothing in this Section shall be construed to prohibit
26generic substitution.

 

 

SB2255 Engrossed- 31 -LRB097 09159 CEL 49294 b

1(Source: P.A. 95-639, eff. 10-5-07; 96-189, eff. 8-10-09;
296-268, eff. 8-11-09; 96-1000, eff. 7-2-10.)
 
3    Section 99. Effective date. This Act takes effect July 1,
42011.