Full Text of SB2255 97th General Assembly
SB2255eng 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 5. The Medical Practice Act of 1987 is amended by | 5 | | changing 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| 7 | | (Section scheduled to be repealed on November 30, 2011)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 | 9 | | assistants and advanced practice nurses.
| 10 | | (a) Physicians licensed to practice medicine in all its
| 11 | | branches may delegate care and treatment responsibilities to a
| 12 | | physician assistant under guidelines in accordance with the
| 13 | | requirements of the Physician Assistant Practice Act of
1987. A | 14 | | physician licensed to practice medicine in all its
branches may | 15 | | enter into supervising physician agreements with
no more than 2 | 16 | | physician assistants.
| 17 | | (b) A physician licensed to practice medicine in all its
| 18 | | branches in active clinical practice may collaborate with an | 19 | | advanced practice
nurse in accordance with the requirements of | 20 | | the Nurse Practice Act. Collaboration
is for the purpose of | 21 | | providing medical consultation,
and no employment relationship | 22 | | is required. A
written collaborative agreement shall
conform to | 23 | | the requirements of Section 65-35 of the Nurse Practice Act. |
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| 1 | | The written collaborative agreement shall
be for
services the | 2 | | collaborating physician generally provides to
his or her | 3 | | patients in the normal course of clinical medical practice.
A | 4 | | written collaborative agreement shall be adequate with respect | 5 | | to collaboration
with advanced practice nurses if all of the | 6 | | following 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 | 14 | | practice medicine in
all its branches may collaborate with a | 15 | | certified registered nurse anesthetist
in accordance with | 16 | | Section 65-35 of the Nurse Practice Act for the provision of | 17 | | anesthesia services. With respect to the provision of | 18 | | anesthesia services, the collaborating anesthesiologist or | 19 | | physician shall have training and experience in the delivery of | 20 | | anesthesia services consistent with Department rules. | 21 | | Collaboration 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 | 11 | | agree with the
anesthesia plan prior to the delivery of | 12 | | services.
| 13 | | (c) The supervising physician shall have access to the
| 14 | | medical records of all patients attended by a physician
| 15 | | assistant. The collaborating physician shall have access to
the | 16 | | medical records of all patients attended to by an
advanced | 17 | | practice nurse.
| 18 | | (d) (Blank).
| 19 | | (e) A physician shall not be liable for the acts or
| 20 | | omissions of a physician assistant or advanced practice
nurse | 21 | | solely on the basis of having signed a
supervision agreement or | 22 | | guidelines or a collaborative
agreement, an order, a standing | 23 | | medical order, a
standing delegation order, or other order or | 24 | | guideline
authorizing a physician assistant or advanced | 25 | | practice
nurse to perform acts, unless the physician has
reason | 26 | | to believe the physician assistant or advanced
practice nurse |
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| 1 | | lacked the competency to perform
the act or acts or commits | 2 | | willful and wanton misconduct.
| 3 | | (f) A collaborating physician may, but is not required to, | 4 | | delegate prescriptive authority to an advanced practice nurse | 5 | | as part of a written collaborative agreement, and the | 6 | | delegation of prescriptive authority shall conform to the | 7 | | requirements of Section 65-40 of the Nurse Practice Act. | 8 | | (g) A supervising physician may, but is not required to, | 9 | | delegate prescriptive authority to a physician assistant as | 10 | | part of a written supervision agreement, and the delegation of | 11 | | prescriptive authority shall conform to the requirements of | 12 | | Section 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 | 15 | | Sections 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 | 20 | | advanced practice nurses engaged in clinical practice, except | 21 | | for advanced practice nurses who are authorized to practice in | 22 | | a hospital or ambulatory surgical treatment center. | 23 | | (a-5) If an advanced practice nurse engages in clinical | 24 | | practice outside of a hospital or ambulatory surgical treatment |
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| 1 | | center in which he or she is authorized to practice, the | 2 | | advanced practice nurse must have a written collaborative | 3 | | agreement.
| 4 | | (b) A written collaborative
agreement shall describe the | 5 | | working relationship of the
advanced practice nurse with the | 6 | | collaborating
physician or podiatrist and shall authorize the | 7 | | categories of
care, treatment, or procedures to be performed by | 8 | | the advanced
practice nurse. A collaborative agreement with a | 9 | | dentist must be in accordance with subsection (c-10) of this | 10 | | Section. Collaboration does not require an
employment | 11 | | relationship between the collaborating physician
and advanced | 12 | | practice nurse. Absent an employment relationship, an | 13 | | agreement may not restrict the categories of patients or | 14 | | third-party payment sources accepted by the advanced practice | 15 | | nurse. Collaboration means
the relationship under
which an | 16 | | advanced practice nurse works with a collaborating
physician or | 17 | | podiatrist in an active clinical practice to deliver health | 18 | | care services in
accordance with
(i) the advanced practice | 19 | | nurse's training, education,
and experience and (ii) | 20 | | collaboration and consultation as documented in a
jointly | 21 | | developed written collaborative
agreement.
| 22 | | The agreement shall be defined to promote the
exercise of | 23 | | professional judgment by the advanced practice
nurse | 24 | | commensurate with his or her education and
experience. The | 25 | | services to be provided by the advanced
practice nurse shall be | 26 | | services that the
collaborating physician or podiatrist is |
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| 1 | | authorized to and generally provides to his or her
patients in | 2 | | the normal course of his or her clinical medical practice, | 3 | | except as set forth in subsection (c-5) of this Section.
The | 4 | | agreement need not describe the exact steps that an advanced | 5 | | practice
nurse must take with respect to each specific | 6 | | condition, disease, or symptom
but must specify
which | 7 | | authorized procedures require the presence of the | 8 | | collaborating physician or podiatrist as
the procedures are | 9 | | being performed. The collaborative
relationship under an | 10 | | agreement shall not be
construed to require the personal | 11 | | presence of a physician or podiatrist at
all times at the place | 12 | | where services are rendered.
Methods of communication shall
be | 13 | | available for consultation with the collaborating
physician or | 14 | | podiatrist in person or by telecommunications in accordance | 15 | | with
established written guidelines as set forth in the written
| 16 | | agreement.
| 17 | | (c) Collaboration and consultation under all collaboration | 18 | | agreements
shall be adequate if a
collaborating physician or | 19 | | podiatrist 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 | 22 | | termination or change of status involving a written | 23 | | collaborative agreement, except when such notice is given for | 24 | | just cause. | 25 | | (c-5) A certified registered nurse anesthetist, who | 26 | | provides anesthesia services outside of a hospital or |
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| 1 | | ambulatory surgical treatment center shall enter into a written | 2 | | collaborative agreement with an anesthesiologist or the | 3 | | physician licensed to practice medicine in all its branches or | 4 | | the podiatrist performing the procedure. Outside of a hospital | 5 | | or ambulatory surgical treatment center, the certified | 6 | | registered nurse anesthetist may provide only those services | 7 | | that the collaborating podiatrist is authorized to provide | 8 | | pursuant to the Podiatric Medical Practice Act of 1987 and | 9 | | rules adopted thereunder. A certified registered nurse | 10 | | anesthetist may select, order, and administer medication, | 11 | | including controlled substances, and apply appropriate medical | 12 | | devices for delivery of anesthesia services under the | 13 | | anesthesia plan agreed with by the anesthesiologist or the | 14 | | operating physician or operating podiatrist. | 15 | | (c-10) A certified registered nurse anesthetist who | 16 | | provides anesthesia services in a dental office shall enter | 17 | | into a written collaborative agreement with an | 18 | | anesthesiologist or the physician licensed to practice | 19 | | medicine in all its branches or the operating dentist | 20 | | performing the procedure. The agreement shall describe the | 21 | | working relationship of the certified registered nurse | 22 | | anesthetist and dentist and shall authorize the categories of | 23 | | care, treatment, or procedures to be performed by the certified | 24 | | registered nurse anesthetist. In a collaborating dentist's | 25 | | office, the certified registered nurse anesthetist may only | 26 | | provide those services that the operating dentist with the |
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| 1 | | appropriate permit is authorized to provide pursuant to the | 2 | | Illinois Dental Practice Act and rules adopted thereunder. For | 3 | | anesthesia services, an anesthesiologist, physician, or | 4 | | operating dentist shall participate through discussion of and | 5 | | agreement with the anesthesia plan and shall remain physically | 6 | | present and be available on the premises during the delivery of | 7 | | anesthesia services for diagnosis, consultation, and treatment | 8 | | of emergency medical conditions. A certified registered nurse | 9 | | anesthetist may select, order, and administer medication, | 10 | | including controlled substances, and apply appropriate medical | 11 | | devices for delivery of anesthesia services under the | 12 | | anesthesia plan agreed with by the operating dentist. | 13 | | (d) A copy of the signed, written collaborative agreement | 14 | | must be available
to the Department upon request from both the | 15 | | advanced practice nurse
and the collaborating physician or | 16 | | podiatrist. | 17 | | (e) Nothing in this Act shall be construed to limit the | 18 | | delegation of tasks or duties by a physician to a licensed | 19 | | practical nurse, a registered professional nurse, or other | 20 | | persons in accordance with Section 54.2 of the Medical Practice | 21 | | Act of 1987. Nothing in this Act shall be construed to limit | 22 | | the method of delegation that may be authorized by any means, | 23 | | including, but not limited to, oral, written, electronic, | 24 | | standing orders, protocols, guidelines, or verbal orders. | 25 | | (f) An advanced
practice nurse shall inform each | 26 | | collaborating physician, dentist, or podiatrist of all |
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| 1 | | collaborative
agreements he or she
has signed and provide a | 2 | | copy of these to any collaborating physician, dentist, or | 3 | | podiatrist upon
request.
| 4 | | (g) For the purposes of this Act, "generally provides to | 5 | | his or her patients in the normal course of his or her clinical | 6 | | medical practice" means services, not specific tasks or duties, | 7 | | the physician or podiatrist routinely provides individually or | 8 | | through delegation to other persons so that the physician or | 9 | | podiatrist has the experience and ability to provide | 10 | | collaboration 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 | 15 | | Prescriptive authority.
| 16 | | (a) A collaborating
physician or podiatrist may, but is not | 17 | | required to, delegate
prescriptive authority to an advanced | 18 | | practice
nurse as part of a written collaborative agreement. | 19 | | This authority may, but is
not required to, include
| 20 | | prescription of, selection of, orders for, administration of, | 21 | | storage of, acceptance of samples of, and dispensing over the | 22 | | counter medications, legend drugs, medical gases, and | 23 | | controlled
substances categorized as
any Schedule III through V | 24 | | controlled substances, as defined in Article II of the
Illinois | 25 | | Controlled Substances Act, and other preparations, including, |
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| 1 | | but not limited to, botanical and herbal remedies. The | 2 | | collaborating physician or podiatrist must have a valid current | 3 | | Illinois controlled substance license and federal registration | 4 | | to delegate authority to prescribe delegated controlled | 5 | | substances.
| 6 | | (b) To prescribe controlled
substances under this Section, | 7 | | an advanced practice
nurse must obtain a mid-level practitioner | 8 | | controlled substance license.
Medication orders shall be
| 9 | | reviewed
periodically by the collaborating physician or | 10 | | podiatrist.
| 11 | | (c) The collaborating physician or podiatrist shall file | 12 | | with the
Department notice of delegation of prescriptive | 13 | | authority
and
termination of such delegation, in accordance | 14 | | with rules of the Department.
Upon receipt of this notice | 15 | | delegating authority to prescribe any Schedule III through V | 16 | | controlled substances, the licensed advanced practice nurse | 17 | | shall be
eligible to register for a mid-level practitioner | 18 | | controlled substance license
under Section 303.05 of the | 19 | | Illinois Controlled Substances Act.
| 20 | | (d) In addition to the requirements of subsections (a), | 21 | | (b), and (c) of this Section, a collaborating physician or | 22 | | podiatrist may, but is not required to, delegate authority to | 23 | | an advanced practice nurse to prescribe any Schedule II | 24 | | controlled substances, if all of the following conditions | 25 | | apply: | 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 | 23 | | delegation of tasks
or duties by a physician to a licensed | 24 | | practical nurse, a registered
professional nurse, or other | 25 | | persons. Nothing in this Act shall be construed to limit the | 26 | | method of delegation that may be authorized by any means, |
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| 1 | | including, but not limited to, oral, written, electronic, | 2 | | standing orders, protocols, guidelines, or verbal orders.
| 3 | | (f) Nothing in this Section shall be construed to apply to | 4 | | any medication authority including Schedule II controlled | 5 | | substances of an advanced practice nurse for care provided in a | 6 | | hospital, hospital affiliate, or ambulatory surgical treatment | 7 | | center pursuant to Section 65-45. | 8 | | (g) Any advanced practice nurse who writes a prescription | 9 | | for a controlled substance without having a valid appropriate | 10 | | authority may be fined by the Department not more than $50 per | 11 | | prescription, and the Department may take any other | 12 | | disciplinary action provided for in this Act. | 13 | | (h) Nothing in this Section shall be construed to prohibit | 14 | | generic 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 , | 19 | | hospital affiliates, or ambulatory surgical treatment centers.
| 20 | | (a) An advanced practice nurse may provide
services in a | 21 | | licensed hospital or a hospital affiliate as those terms are | 22 | | defined in the Hospital Licensing Act or the University of | 23 | | Illinois Hospital Act or a licensed ambulatory surgical
| 24 | | treatment center without prescriptive authority or a written | 25 | | collaborative agreement pursuant to Section 65-35 of this Act. |
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| 1 | | An advanced practice nurse must possess clinical privileges | 2 | | recommended by the hospital medical staff and granted by the | 3 | | hospital or the consulting medical staff committee and | 4 | | ambulatory surgical treatment center in order to provide | 5 | | services. The medical staff or consulting medical staff | 6 | | committee shall periodically review the services of advanced | 7 | | practice nurses granted clinical privileges , including any | 8 | | care provided in a hospital affiliate . Authority may also be | 9 | | granted when recommended by the hospital medical staff and | 10 | | granted by the hospital or recommended by the consulting | 11 | | medical staff committee and ambulatory surgical treatment | 12 | | center to individual advanced practice nurses to select, order, | 13 | | and administer medications, including controlled substances, | 14 | | to provide delineated care. In a hospital, hospital affiliate, | 15 | | or ambulatory surgical treatment center, the The attending | 16 | | physician shall determine an advanced practice nurse's role in | 17 | | providing care for his or her patients, except as otherwise | 18 | | provided in the medical staff bylaws or consulting committee | 19 | | policies.
| 20 | | (a-2) An advanced practice nurse granted authority to order | 21 | | medications including controlled substances may complete | 22 | | discharge prescriptions provided the prescription is in the | 23 | | name of the advanced practice nurse and the attending or | 24 | | discharging physician. | 25 | | (a-3) Advanced practice nurses practicing in a hospital or | 26 | | an ambulatory surgical treatment center are not required to |
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| 1 | | obtain a mid-level controlled substance license to order | 2 | | controlled substances under Section 303.05 of the Illinois | 3 | | Controlled Substances Act. | 4 | | (a-5) For
anesthesia services provided by a certified | 5 | | registered nurse anesthetist, an anesthesiologist,
physician, | 6 | | dentist,
or podiatrist shall participate through discussion of | 7 | | and agreement with the
anesthesia plan and shall
remain
| 8 | | physically present
and be available on the premises during the | 9 | | delivery of anesthesia services for
diagnosis, consultation, | 10 | | and treatment of
emergency medical conditions, unless hospital | 11 | | policy adopted pursuant to
clause (B) of subdivision (3) of | 12 | | Section 10.7 of the Hospital Licensing Act
or ambulatory | 13 | | surgical treatment center policy adopted pursuant to
clause (B) | 14 | | of subdivision (3) of Section 6.5 of the Ambulatory Surgical
| 15 | | Treatment Center Act
provides otherwise. A certified | 16 | | registered nurse anesthetist may select, order, and administer | 17 | | medication for anesthesia services under the anesthesia plan | 18 | | agreed to by the anesthesiologist or the physician, in | 19 | | accordance with hospital alternative policy or the medical | 20 | | staff consulting committee policies of a licensed ambulatory | 21 | | surgical treatment center.
| 22 | | (b) An advanced practice nurse who provides
services in a | 23 | | hospital shall do so in accordance with Section 10.7 of the
| 24 | | Hospital
Licensing Act and, in an
ambulatory surgical treatment | 25 | | center, in accordance with Section 6.5 of the
Ambulatory
| 26 | | Surgical 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 | 3 | | amended 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; | 7 | | prescriptive authority. | 8 | | (a) A written supervision agreement is required for all | 9 | | physician 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, | 11 | | delegate prescriptive authority to a physician assistant as | 12 | | part of a written supervision agreement. This authority may, | 13 | | but is not required to, include prescription of, selection of, | 14 | | orders for, administration of, storage of, acceptance of | 15 | | samples of, and dispensing over the counter medications, legend | 16 | | drugs, medical gases, and controlled substances categorized as | 17 | | Schedule III through V controlled substances, as defined in | 18 | | Article II of the Illinois Controlled Substances Act, and other | 19 | | preparations, including, but not limited to, botanical and | 20 | | herbal remedies. The supervising physician must have a valid, | 21 | | current Illinois controlled substance license and federal | 22 | | registration with the Drug Enforcement Agency to delegate the | 23 | | authority 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 | 20 | | delegation of tasks or duties by a physician to a licensed | 21 | | practical nurse, a registered professional nurse, or other | 22 | | persons. Nothing in this Act shall be construed to limit the | 23 | | method of delegation that may be authorized by any means, | 24 | | including, but not limited to, oral, written, electronic, | 25 | | standing orders, protocols, guidelines, or verbal orders.
| 26 | | (d) Any physician assistant who writes a prescription for a |
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| 1 | | controlled substance without having a valid appropriate | 2 | | authority may be fined by the Department not more than $50 per | 3 | | prescription, and the Department may take any other | 4 | | disciplinary action provided for in this Act. | 5 | | (e) Nothing in this Section shall be construed to prohibit | 6 | | generic substitution. | 7 | | (Source: P.A. 96-268, eff. 8-11-09; 96-618, eff. 1-1-10; | 8 | | 96-1000, eff. 7-2-10.)
| 9 | | Section 20. The Podiatric Medical Practice Act of 1987 is | 10 | | amended 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 | 14 | | nurses.
| 15 | | (a) A podiatrist in active clinical practice may | 16 | | collaborate with an advanced practice nurse in accordance with | 17 | | the requirements of the Nurse Practice Act. Collaboration shall | 18 | | be for the purpose of providing podiatric consultation and no | 19 | | employment relationship shall be required. A written | 20 | | collaborative agreement shall conform to the requirements of | 21 | | Section 65-35 of the Nurse Practice Act. The written | 22 | | collaborative agreement shall be for services the | 23 | | collaborating podiatrist generally provides to his or her | 24 | | patients in the normal course of clinical podiatric practice, |
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| 1 | | except as set forth in item (3) of this subsection (a). A | 2 | | written collaborative agreement and podiatric collaboration | 3 | | and consultation shall be adequate with respect to advanced | 4 | | practice 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 | 22 | | records of all patients attended to by an advanced practice | 23 | | nurse. | 24 | | (c) Nothing in this Section shall be construed to limit the | 25 | | delegation of tasks or duties by a podiatrist to a licensed | 26 | | practical nurse, a registered professional nurse, or other |
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| 1 | | appropriately trained persons. | 2 | | (d) A podiatrist shall not be liable for the acts or | 3 | | omissions of an advanced practice nurse solely on the basis of | 4 | | having signed guidelines or a collaborative agreement, an | 5 | | order, a standing order, a standing delegation order, or other | 6 | | order or guideline authorizing an advanced practice nurse to | 7 | | perform acts, unless the podiatrist has reason to believe the | 8 | | advanced practice nurse lacked the competency to perform the | 9 | | act or acts or commits willful or wanton misconduct.
| 10 | | (f) A podiatrist, may, but is not required to delegate | 11 | | prescriptive authority to an advanced practice nurse as part of | 12 | | a written collaborative agreement and the delegation of | 13 | | prescriptive authority shall conform to the requirements of | 14 | | Section 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 | 17 | | amended 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 | 21 | | Regulation shall register licensed
physician assistants and | 22 | | licensed advanced practice nurses to prescribe and
dispense | 23 | | controlled substances under Section 303 and euthanasia
| 24 | | agencies to purchase, store, or administer animal euthanasia |
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| 1 | | drugs 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 | 4 | | prescribe those
schedules of controlled substances for which a | 5 | | licensed physician or licensed podiatrist has delegated
| 6 | | prescriptive authority, except that an animal euthanasia | 7 | | agency does not have any
prescriptive authority.
A physician | 8 | | assistant and an advanced practice nurse are prohibited from | 9 | | prescribing medications and controlled substances not set | 10 | | forth in the required written delegation of authority.
| 11 | | (c) Upon completion of all registration requirements, | 12 | | physician
assistants, advanced practice nurses, and animal | 13 | | euthanasia agencies shall be issued a
mid-level practitioner
| 14 | | controlled substances license for Illinois.
| 15 | | (d) A collaborating physician or podiatrist may, but is not | 16 | | required to, delegate prescriptive authority to an advanced | 17 | | practice nurse as part of a written collaborative agreement, | 18 | | and the delegation of prescriptive authority shall conform to | 19 | | the requirements of Section 65-40 of the Nurse Practice Act. | 20 | | (e) A supervising physician may, but is not required to, | 21 | | delegate prescriptive authority to a physician assistant as | 22 | | part of a written supervision agreement, and the delegation of | 23 | | prescriptive authority shall conform to the requirements of | 24 | | Section 7.5 of the Physician Assistant Practice Act of 1987. | 25 | | (f) Nothing in this Section shall be construed to prohibit | 26 | | generic substitution. |
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| 1 | | (Source: P.A. 95-639, eff. 10-5-07; 96-189, eff. 8-10-09; | 2 | | 96-268, eff. 8-11-09; 96-1000, eff. 7-2-10.)
| 3 | | Section 99. Effective date. This Act takes effect July 1, | 4 | | 2011.
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