Full Text of HB5104 97th General Assembly
HB5104enr 97TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 1. The Ambulatory Surgical Treatment Center Act is | 5 | | amended by adding Section 6.6 as follows: | 6 | | (210 ILCS 5/6.6 new) | 7 | | Sec. 6.6. Clinical privileges; physician assistants. No | 8 | | ambulatory surgical treatment center (ASTC) licensed under | 9 | | this Act shall adopt any policy, rule, regulation, or practice | 10 | | inconsistent with the provision of adequate supervision in | 11 | | accordance with Section 54.5 of the Medical Practice Act of | 12 | | 1987 and the Physician Assistant Practice Act of 1987. | 13 | | Section 3. The Hospital Licensing Act is amended by adding | 14 | | Section 10.11 as follows: | 15 | | (210 ILCS 85/10.11 new) | 16 | | Sec. 10.11. Clinical privileges; physician assistants. No | 17 | | hospital licensed under this Act shall adopt any policy, rule, | 18 | | regulation, or practice inconsistent with the provision of | 19 | | adequate supervision in accordance with Section 54.5 of the | 20 | | Medical Practice Act of 1987 and the Physician Assistant | 21 | | Practice Act of 1987. |
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| 1 | | Section 5. The Medical Practice Act of 1987 is amended by | 2 | | changing Section 54.5 as follows:
| 3 | | (225 ILCS 60/54.5)
| 4 | | (Section scheduled to be repealed on December 31, 2012)
| 5 | | Sec. 54.5. Physician delegation of authority to physician | 6 | | assistants and advanced practice nurses.
| 7 | | (a) Physicians licensed to practice medicine in all its
| 8 | | branches may delegate care and treatment responsibilities to a
| 9 | | physician assistant under guidelines in accordance with the
| 10 | | requirements of the Physician Assistant Practice Act of
1987. A | 11 | | physician licensed to practice medicine in all its
branches may | 12 | | enter into supervising physician agreements with
no more than 5 | 13 | | 2 physician assistants as set forth in subsection (a) of | 14 | | Section 7 of the Physician Assistant Practice Act of 1987 .
| 15 | | (b) A physician licensed to practice medicine in all its
| 16 | | branches in active clinical practice may collaborate with an | 17 | | advanced practice
nurse in accordance with the requirements of | 18 | | the Nurse Practice Act. Collaboration
is for the purpose of | 19 | | providing medical consultation,
and no employment relationship | 20 | | is required. A
written collaborative agreement shall
conform to | 21 | | the requirements of Section 65-35 of the Nurse Practice Act. | 22 | | The written collaborative agreement shall
be for
services the | 23 | | collaborating physician generally provides to
his or her | 24 | | patients in the normal course of clinical medical practice.
A |
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| 1 | | written collaborative agreement shall be adequate with respect | 2 | | to collaboration
with advanced practice nurses if all of the | 3 | | following apply:
| 4 | | (1) The agreement is written to promote the exercise of | 5 | | professional judgment by the advanced practice nurse | 6 | | commensurate with his or her education and experience. The | 7 | | agreement need not describe the exact steps that an | 8 | | advanced practice nurse must take with respect to each | 9 | | specific condition, disease, or symptom, but must specify | 10 | | those procedures that require a physician's presence as the | 11 | | procedures are being performed.
| 12 | | (2) Practice guidelines and orders are developed and | 13 | | approved jointly by the advanced practice nurse and | 14 | | collaborating physician, as needed, based on the practice | 15 | | of the practitioners. Such guidelines and orders and the | 16 | | patient services provided thereunder are periodically | 17 | | reviewed by the collaborating physician.
| 18 | | (3) The advance practice nurse provides services the | 19 | | collaborating physician generally provides to his or her | 20 | | patients in the normal course of clinical practice, except | 21 | | as set forth in subsection (b-5) of this Section. With | 22 | | respect to labor and delivery, the collaborating physician | 23 | | must provide delivery services in order to participate with | 24 | | a certified nurse midwife. | 25 | | (4) The collaborating physician and advanced practice | 26 | | nurse consult at least once a month to provide |
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| 1 | | collaboration and consultation. | 2 | | (5) Methods of communication are available with the | 3 | | collaborating physician in person or through | 4 | | telecommunications for consultation, collaboration, and | 5 | | referral as needed to address patient care needs. | 6 | | (6) The agreement contains provisions detailing notice | 7 | | for termination or change of status involving a written | 8 | | collaborative agreement, except when such notice is given | 9 | | for just cause.
| 10 | | (b-5) An anesthesiologist or physician licensed to | 11 | | practice medicine in
all its branches may collaborate with a | 12 | | certified registered nurse anesthetist
in accordance with | 13 | | Section 65-35 of the Nurse Practice Act for the provision of | 14 | | anesthesia services. With respect to the provision of | 15 | | anesthesia services, the collaborating anesthesiologist or | 16 | | physician shall have training and experience in the delivery of | 17 | | anesthesia services consistent with Department rules. | 18 | | Collaboration shall be
adequate if:
| 19 | | (1) an anesthesiologist or a physician
participates in | 20 | | the joint formulation and joint approval of orders or
| 21 | | guidelines and periodically reviews such orders and the | 22 | | services provided
patients under such orders; and
| 23 | | (2) for anesthesia services, the anesthesiologist
or | 24 | | physician participates through discussion of and agreement | 25 | | with the
anesthesia plan and is physically present and | 26 | | available on the premises during
the delivery of anesthesia |
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| 1 | | services for
diagnosis, consultation, and treatment of | 2 | | emergency medical conditions.
Anesthesia services in a | 3 | | hospital shall be conducted in accordance with
Section 10.7 | 4 | | of the Hospital Licensing Act and in an ambulatory surgical
| 5 | | treatment center in accordance with Section 6.5 of the | 6 | | Ambulatory Surgical
Treatment Center Act.
| 7 | | (b-10) The anesthesiologist or operating physician must | 8 | | agree with the
anesthesia plan prior to the delivery of | 9 | | services.
| 10 | | (c) The supervising physician shall have access to the
| 11 | | medical records of all patients attended by a physician
| 12 | | assistant. The collaborating physician shall have access to
the | 13 | | medical records of all patients attended to by an
advanced | 14 | | practice nurse.
| 15 | | (d) (Blank).
| 16 | | (e) A physician shall not be liable for the acts or
| 17 | | omissions of a physician assistant or advanced practice
nurse | 18 | | solely on the basis of having signed a
supervision agreement or | 19 | | guidelines or a collaborative
agreement, an order, a standing | 20 | | medical order, a
standing delegation order, or other order or | 21 | | guideline
authorizing a physician assistant or advanced | 22 | | practice
nurse to perform acts, unless the physician has
reason | 23 | | to believe the physician assistant or advanced
practice nurse | 24 | | lacked the competency to perform
the act or acts or commits | 25 | | willful and wanton misconduct.
| 26 | | (f) A collaborating physician may, but is not required to, |
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| 1 | | delegate prescriptive authority to an advanced practice nurse | 2 | | as part of a written collaborative agreement, and the | 3 | | delegation of prescriptive authority shall conform to the | 4 | | requirements of Section 65-40 of the Nurse Practice Act. | 5 | | (g) A supervising physician may, but is not required to, | 6 | | delegate prescriptive authority to a physician assistant as | 7 | | part of a written supervision agreement, and the delegation of | 8 | | prescriptive authority shall conform to the requirements of | 9 | | Section 7.5 of the Physician Assistant Practice Act of 1987. | 10 | | (Source: P.A. 96-618, eff. 1-1-10; 97-358, eff. 8-12-11 .)
| 11 | | Section 10. The Physician Assistant Practice Act of 1987 is | 12 | | amended by changing Sections 4 and 7 and by adding Section 7.7 | 13 | | as follows:
| 14 | | (225 ILCS 95/4) (from Ch. 111, par. 4604)
| 15 | | (Section scheduled to be repealed on January 1, 2018)
| 16 | | Sec. 4. In this Act:
| 17 | | 1. "Department" means the Department of Financial and
| 18 | | Professional Regulation.
| 19 | | 2. "Secretary" means the Secretary
of Financial and | 20 | | Professional Regulation.
| 21 | | 3. "Physician assistant" means any person not a physician | 22 | | who has been
certified as a physician assistant by the National | 23 | | Commission on the
Certification of Physician Assistants or | 24 | | equivalent successor agency and
performs procedures under the |
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| 1 | | supervision of a physician as defined in this
Act. A physician | 2 | | assistant may perform such procedures within the
specialty of | 3 | | the supervising physician, except that such physician shall
| 4 | | exercise such direction, supervision and control over such | 5 | | physician
assistants as will assure that patients shall receive | 6 | | quality medical
care. Physician assistants shall be capable of | 7 | | performing a variety of tasks
within the specialty of medical | 8 | | care under the supervision of a physician.
Supervision of the | 9 | | physician assistant shall not be construed to
necessarily | 10 | | require the personal presence of the supervising physician at
| 11 | | all times at the place where services are rendered, as long as | 12 | | there is
communication available for consultation by radio, | 13 | | telephone or
telecommunications within established guidelines | 14 | | as determined by the
physician/physician assistant team. The | 15 | | supervising physician may delegate
tasks and duties to the | 16 | | physician assistant. Delegated tasks or duties
shall be | 17 | | consistent with physician assistant education, training, and
| 18 | | experience. The delegated tasks or duties shall be specific to | 19 | | the
practice setting and shall be implemented and reviewed | 20 | | under a written supervision agreement
established by the | 21 | | physician or physician/physician assistant team. A
physician | 22 | | assistant, acting as an agent of the physician, shall be
| 23 | | permitted to transmit the supervising physician's orders as | 24 | | determined by
the institution's by-laws, policies, procedures, | 25 | | or job description within
which the physician/physician | 26 | | assistant team practices. Physician
assistants shall practice |
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| 1 | | only in accordance with a written supervision agreement.
| 2 | | 4. "Board" means the Medical Licensing Board
constituted | 3 | | under the Medical Practice Act of 1987.
| 4 | | 5. "Disciplinary Board" means the Medical Disciplinary | 5 | | Board constituted
under the Medical Practice Act of 1987.
| 6 | | 6. "Physician" means, for purposes of this Act, a person | 7 | | licensed to
practice medicine in all its branches under the | 8 | | Medical Practice Act of 1987.
| 9 | | 7. "Supervising Physician" means, for the purposes of this | 10 | | Act, the
primary supervising physician of a physician | 11 | | assistant, who, within his
specialty and expertise may delegate | 12 | | a variety of tasks and procedures to
the physician assistant. | 13 | | Such tasks and procedures shall be delegated
in accordance with | 14 | | a written supervision agreement. The supervising physician | 15 | | maintains the
final responsibility for the care of the patient | 16 | | and the performance of the
physician assistant.
| 17 | | 8. "Alternate supervising physician" means, for the | 18 | | purpose of this Act,
any physician designated by the | 19 | | supervising physician to provide
supervision in the event that | 20 | | he or she is unable to provide that supervision. The Department | 21 | | may further define "alternate supervising physician" by rule.
| 22 | | The alternate supervising physicians shall maintain all | 23 | | the same
responsibilities as the supervising physician. | 24 | | Nothing in this Act shall
be construed as relieving any | 25 | | physician of the professional or legal
responsibility for the | 26 | | care and treatment of persons attended by him or by
physician |
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| 1 | | assistants under his supervision. Nothing in this Act shall be
| 2 | | construed as to limit the reasonable number of alternate | 3 | | supervising
physicians, provided they are designated by the | 4 | | supervising physician. | 5 | | 9. "Address of record" means the designated address | 6 | | recorded by the Department in the applicant's or licensee's | 7 | | application file or license file maintained by the Department's | 8 | | licensure maintenance unit. It is the duty of the applicant or | 9 | | licensee to inform the Department of any change of address, and | 10 | | such changes must be made either through the Department's | 11 | | website or by contacting the Department's licensure | 12 | | maintenance unit.
| 13 | | (Source: P.A. 95-703, eff. 12-31-07; 96-268, eff. 8-11-09.)
| 14 | | (225 ILCS 95/7) (from Ch. 111, par. 4607)
| 15 | | (Section scheduled to be repealed on January 1, 2018)
| 16 | | Sec. 7. Supervision requirements. | 17 | | (a) A supervising physician shall determine the number of | 18 | | physician assistants under his or her supervision provided the | 19 | | physician is able to provide adequate supervision as outlined | 20 | | in the written supervision agreement required under Section 7.5 | 21 | | of this Act and consideration is given to the nature of the | 22 | | physician's practice, complexity of the patient population, | 23 | | and the experience of each supervised physician assistant. A | 24 | | supervising physician may supervise a maximum of 5 full-time | 25 | | equivalent physician assistants; provided, however, this |
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| 1 | | number of physician assistants shall be reduced by the number | 2 | | of collaborative agreements the supervising physician | 3 | | maintains. A No more than 2 physician
assistants shall be | 4 | | supervised
by
the supervising physician, although a physician | 5 | | assistant shall be able to
hold more than one professional | 6 | | position. A Each supervising physician shall
file a notice of | 7 | | supervision of each such physician assistant according to the
| 8 | | rules of the Department. However, the alternate supervising | 9 | | physician may
supervise more than 2 physician assistants when
| 10 | | the supervising
physician
is unable to provide such supervision | 11 | | consistent with the definition of
alternate physician in | 12 | | Section 4. It is the responsibility of the supervising | 13 | | physician to maintain documentation each time he or she has | 14 | | designated an alternative supervising physician. This | 15 | | documentation shall include the date alternate supervisory | 16 | | control began, the date alternate supervisory control ended, | 17 | | and any other changes. A supervising physician shall provide a | 18 | | copy of this documentation to the Department, upon request.
| 19 | | Physician assistants shall be supervised only by | 20 | | physicians as defined in
this Act
who are engaged in clinical | 21 | | practice, or in clinical practice in
public health or other | 22 | | community health facilities.
| 23 | | Nothing in this Act shall be construed to limit the | 24 | | delegation of tasks or
duties by a physician to a nurse or | 25 | | other appropriately trained personnel.
| 26 | | Nothing in this Act
shall be construed to prohibit the |
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| 1 | | employment of physician assistants by
a hospital, nursing home | 2 | | or other health care facility where such physician
assistants | 3 | | function under the supervision of a supervising physician.
| 4 | | Physician assistants may be employed by the Department of | 5 | | Corrections or
the Department of Human Services (as successor | 6 | | to the Department of Mental
Health and Developmental | 7 | | Disabilities) for service in
facilities maintained by such | 8 | | Departments and affiliated training
facilities in programs | 9 | | conducted under the authority of the Director of
Corrections or | 10 | | the Secretary of Human Services. Each physician assistant
| 11 | | employed by the Department of Corrections or the Department of | 12 | | Human Services
(as successor to the Department of Mental Health | 13 | | and
Developmental Disabilities) shall be under the supervision | 14 | | of a physician
engaged in clinical practice and direct patient | 15 | | care. Duties of each
physician assistant employed by such | 16 | | Departments are limited to those
within the scope of practice | 17 | | of the supervising physician who is fully
responsible for all | 18 | | physician assistant activities.
| 19 | | A physician assistant may be employed by a practice group | 20 | | or other entity
employing multiple physicians at one or more | 21 | | locations. In that case, one of
the
physicians practicing at a | 22 | | location shall be designated the supervising
physician. The | 23 | | other physicians with that practice group or other entity who
| 24 | | practice in the same general type of practice or specialty
as | 25 | | the supervising physician may supervise the physician | 26 | | assistant with respect
to their patients without being deemed |
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| 1 | | alternate supervising physicians for the
purpose of this Act.
| 2 | | (b) A physician assistant licensed in this State, or | 3 | | licensed or authorized to practice in any other U.S. | 4 | | jurisdiction or credentialed by his or her federal employer as | 5 | | a physician assistant, who is responding to a need for medical | 6 | | care created by an emergency or by a state or local disaster | 7 | | may render such care that the physician assistant is able to | 8 | | provide without supervision as it is defined in this Section or | 9 | | with such supervision as is available.
For purposes of this | 10 | | Section, an "emergency situation" shall not include one that | 11 | | occurs in the place of one's employment. | 12 | | Any physician who supervises a physician assistant | 13 | | providing medical care in response to such an emergency or | 14 | | state or local disaster shall not be required to meet the | 15 | | requirements set forth in this Section for a supervising | 16 | | physician. | 17 | | (Source: P.A. 95-703, eff. 12-31-07; 96-70, eff. 7-23-09.)
| 18 | | (225 ILCS 95/7.7 new) | 19 | | Sec. 7.7. Physician assistants in hospitals, hospital | 20 | | affiliates, or ambulatory surgical treatment centers. | 21 | | (a) A physician assistant may provide services in a | 22 | | hospital or a hospital affiliate as those terms are defined in | 23 | | the Hospital Licensing Act or the University of Illinois | 24 | | Hospital Act or a licensed ambulatory surgical treatment center | 25 | | without a written supervision agreement pursuant to Section 7.5 |
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| 1 | | of this Act. A physician assistant must possess clinical | 2 | | privileges recommended by the hospital medical staff and | 3 | | granted by the hospital or the consulting medical staff | 4 | | committee and ambulatory surgical treatment center in order to | 5 | | provide services. The medical staff or consulting medical staff | 6 | | committee shall periodically review the services of physician | 7 | | assistants granted clinical privileges, including any care | 8 | | provided in a hospital affiliate. Authority may also be granted | 9 | | when recommended by the hospital medical staff and granted by | 10 | | the hospital or recommended by the consulting medical staff | 11 | | committee and ambulatory surgical treatment center to | 12 | | individual physician assistants to select, order, and | 13 | | administer medications, including controlled substances, to | 14 | | provide delineated care. In a hospital, hospital affiliate, or | 15 | | ambulatory surgical treatment center, the attending physician | 16 | | shall determine a physician assistant's role in providing care | 17 | | for his or her patients, except as otherwise provided in the | 18 | | medical staff bylaws or consulting committee policies. | 19 | | (b) A physician assistant granted authority to order | 20 | | medications including controlled substances may complete | 21 | | discharge prescriptions provided the prescription is in the | 22 | | name of the physician assistant and the attending or | 23 | | discharging physician. | 24 | | (c) Physician assistants practicing in a hospital, | 25 | | hospital affiliate, or an ambulatory surgical treatment center | 26 | | are not required to obtain a mid-level controlled substance |
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| 1 | | license to order controlled substances under Section 303.05 of | 2 | | the Illinois Controlled Substances Act.
| 3 | | (225 ILCS 95/8 rep.) | 4 | | Section 15. The Physician Assistant Practice Act of 1987 is | 5 | | amended by repealing Section 8.
| 6 | | Section 99. Effective date. This Act takes effect upon | 7 | | becoming law.
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