Full Text of HB1052 98th General Assembly
HB1052ham001 98TH GENERAL ASSEMBLY | Rep. John E. Bradley Filed: 3/19/2013
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| 1 | | AMENDMENT TO HOUSE BILL 1052
| 2 | | AMENDMENT NO. ______. Amend House Bill 1052 by replacing | 3 | | everything after the enacting clause with the following:
| 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| 7 | | (Section scheduled to be repealed on December 31, 2013)
| 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 5 | 16 | | physician assistants as set forth in subsection (a) of Section |
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| 1 | | 7 of the Physician Assistant Practice Act of 1987.
| 2 | | (b) A physician licensed to practice medicine in all its
| 3 | | branches in active clinical practice may collaborate with an | 4 | | advanced practice
nurse in accordance with the requirements of | 5 | | the Nurse Practice Act. Collaboration
is for the purpose of | 6 | | providing medical consultation,
and no employment relationship | 7 | | is required. A
written collaborative agreement shall
conform to | 8 | | the requirements of Section 65-35 of the Nurse Practice Act. | 9 | | The written collaborative agreement shall
be for
services the | 10 | | collaborating physician generally provides or may provide in to
| 11 | | his or her patients in the normal course of clinical medical | 12 | | practice.
A written collaborative agreement shall be adequate | 13 | | with respect to collaboration
with advanced practice nurses if | 14 | | all of the following apply:
| 15 | | (1) The agreement is written to promote the exercise of | 16 | | professional judgment by the advanced practice nurse | 17 | | commensurate with his or her education and experience. The | 18 | | agreement need not describe the exact steps that an | 19 | | advanced practice nurse must take with respect to each | 20 | | specific condition, disease, or symptom, but must specify | 21 | | those procedures that require a physician's presence as the | 22 | | procedures are being performed.
| 23 | | (2) Practice guidelines and orders are developed and | 24 | | approved jointly by the advanced practice nurse and | 25 | | collaborating physician, as needed, based on the practice | 26 | | of the practitioners. Such guidelines and orders and the |
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| 1 | | patient services provided thereunder are periodically | 2 | | reviewed by the collaborating physician.
| 3 | | (3) The advance practice nurse provides services the | 4 | | collaborating physician generally provides or may provide | 5 | | in to his or her patients in the normal course of clinical | 6 | | medical practice, except as set forth in subsection (b-5) | 7 | | of this Section. With respect to labor and delivery, the | 8 | | collaborating physician must provide delivery services in | 9 | | order to participate with a certified nurse midwife. | 10 | | (4) The collaborating physician and advanced practice | 11 | | nurse consult at least once a month to provide | 12 | | collaboration and consultation. | 13 | | (5) Methods of communication are available with the | 14 | | collaborating physician in person or through | 15 | | telecommunications for consultation, collaboration, and | 16 | | referral as needed to address patient care needs. | 17 | | (6) 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-5) An anesthesiologist or physician licensed to | 22 | | practice medicine in
all its branches may collaborate with a | 23 | | certified registered nurse anesthetist
in accordance with | 24 | | Section 65-35 of the Nurse Practice Act for the provision of | 25 | | anesthesia services. With respect to the provision of | 26 | | anesthesia services, the collaborating anesthesiologist or |
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| 1 | | physician shall have training and experience in the delivery of | 2 | | anesthesia services consistent with Department rules. | 3 | | Collaboration shall be
adequate if:
| 4 | | (1) an anesthesiologist or a physician
participates in | 5 | | the joint formulation and joint approval of orders or
| 6 | | guidelines and periodically reviews such orders and the | 7 | | services provided
patients under such orders; and
| 8 | | (2) for anesthesia services, the anesthesiologist
or | 9 | | physician participates through discussion of and agreement | 10 | | with the
anesthesia plan and is physically present and | 11 | | available on the premises during
the delivery of anesthesia | 12 | | services for
diagnosis, consultation, and treatment of | 13 | | emergency medical conditions.
Anesthesia services in a | 14 | | hospital shall be conducted in accordance with
Section 10.7 | 15 | | of the Hospital Licensing Act and in an ambulatory surgical
| 16 | | treatment center in accordance with Section 6.5 of the | 17 | | Ambulatory Surgical
Treatment Center Act.
| 18 | | (b-10) The anesthesiologist or operating physician must | 19 | | agree with the
anesthesia plan prior to the delivery of | 20 | | services.
| 21 | | (c) The supervising physician shall have access to the
| 22 | | medical records of all patients attended by a physician
| 23 | | assistant. The collaborating physician shall have access to
the | 24 | | medical records of all patients attended to by an
advanced | 25 | | practice nurse.
| 26 | | (d) (Blank).
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| 1 | | (e) A physician shall not be liable for the acts or
| 2 | | omissions of a physician assistant or advanced practice
nurse | 3 | | solely on the basis of having signed a
supervision agreement or | 4 | | guidelines or a collaborative
agreement, an order, a standing | 5 | | medical order, a
standing delegation order, or other order or | 6 | | guideline
authorizing a physician assistant or advanced | 7 | | practice
nurse to perform acts, unless the physician has
reason | 8 | | to believe the physician assistant or advanced
practice nurse | 9 | | lacked the competency to perform
the act or acts or commits | 10 | | willful and wanton misconduct.
| 11 | | (f) A collaborating physician may, but is not required to, | 12 | | delegate prescriptive authority to an advanced practice nurse | 13 | | as part of a written collaborative agreement, and the | 14 | | delegation of prescriptive authority shall conform to the | 15 | | requirements of Section 65-40 of the Nurse Practice Act. | 16 | | (g) A supervising physician may, but is not required to, | 17 | | delegate prescriptive authority to a physician assistant as | 18 | | part of a written supervision agreement, and the delegation of | 19 | | prescriptive authority shall conform to the requirements of | 20 | | Section 7.5 of the Physician Assistant Practice Act of 1987. | 21 | | (h) For the purposes of this Section, "generally provides | 22 | | or may provide in his or her clinical medical practice" means | 23 | | categories of care or treatment, not specific tasks or duties, | 24 | | that the physician provides individually or through delegation | 25 | | to other persons so that the physician has the experience and | 26 | | ability to provide collaboration and consultation. This |
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| 1 | | definition shall not be construed to prohibit an advanced | 2 | | practice nurse from providing primary health treatment or care | 3 | | within the scope of his or her training and experience, | 4 | | including, but not limited to, health screenings, patient | 5 | | histories, physical examinations, women's health examinations, | 6 | | or school physicals that may be provided as part of the routine | 7 | | practice of an advanced practice nurse or on a volunteer basis. | 8 | | (Source: P.A. 96-618, eff. 1-1-10; 97-358, eff. 8-12-11; | 9 | | 97-1071, eff. 8-24-12 .)
| 10 | | Section 10. The Nurse Practice Act is amended by changing | 11 | | Section 65-35 as follows:
| 12 | | (225 ILCS 65/65-35)
(was 225 ILCS 65/15-15)
| 13 | | (Section scheduled to be repealed on January 1, 2018)
| 14 | | Sec. 65-35. Written collaborative
agreements. | 15 | | (a) A written collaborative agreement is required for all | 16 | | advanced practice nurses engaged in clinical practice, except | 17 | | for advanced practice nurses who are authorized to practice in | 18 | | a hospital or ambulatory surgical treatment center. | 19 | | (a-5) If an advanced practice nurse engages in clinical | 20 | | practice outside of a hospital or ambulatory surgical treatment | 21 | | center in which he or she is authorized to practice, the | 22 | | advanced practice nurse must have a written collaborative | 23 | | agreement.
| 24 | | (b) A written collaborative
agreement shall describe the |
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| 1 | | working relationship of the
advanced practice nurse with the | 2 | | collaborating
physician or podiatrist and shall authorize the | 3 | | categories of
care, treatment, or procedures to be performed by | 4 | | the advanced
practice nurse. A collaborative agreement with a | 5 | | dentist must be in accordance with subsection (c-10) of this | 6 | | Section. Collaboration does not require an
employment | 7 | | relationship between the collaborating physician
and advanced | 8 | | practice nurse. Absent an employment relationship, an | 9 | | agreement may not restrict the categories of patients or | 10 | | third-party payment sources accepted by the advanced practice | 11 | | nurse. Collaboration means
the relationship under
which an | 12 | | advanced practice nurse works with a collaborating
physician or | 13 | | podiatrist in an active clinical practice to deliver health | 14 | | care services in
accordance with
(i) the advanced practice | 15 | | nurse's training, education,
and experience and (ii) | 16 | | collaboration and consultation as documented in a
jointly | 17 | | developed written collaborative
agreement.
| 18 | | The agreement shall promote the
exercise of professional | 19 | | judgment by the advanced practice
nurse commensurate with his | 20 | | or her education and
experience. The services to be provided by | 21 | | the advanced
practice nurse shall be services that the
| 22 | | collaborating physician or podiatrist is authorized to and | 23 | | generally provides or may provide to his or her
patients in the | 24 | | normal course of his or her clinical medical or podiatric | 25 | | practice, except as set forth in subsections (b-5) or | 26 | | subsection (c-5) of this Section.
The agreement need not |
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| 1 | | describe the exact steps that an advanced practice
nurse must | 2 | | take with respect to each specific condition, disease, or | 3 | | symptom
but must specify
which authorized procedures require | 4 | | the presence of the collaborating physician or podiatrist as
| 5 | | the procedures are being performed. The collaborative
| 6 | | relationship under an agreement shall not be
construed to | 7 | | require the personal presence of a physician or podiatrist at | 8 | | the place where services are rendered.
Methods of communication | 9 | | shall
be available for consultation with the collaborating
| 10 | | physician or podiatrist in person or by telecommunications in | 11 | | accordance with
established written guidelines as set forth in | 12 | | the written
agreement.
| 13 | | (b-5) Absent an employment relationship, a written | 14 | | collaborative agreement may not (1) restrict the categories of | 15 | | patients of an advanced practice nurse within the scope of the | 16 | | advanced practice nurses training and experience, (2) limit | 17 | | third party payors or government health programs, such as the | 18 | | medical assistance program or Medicare with which the advanced | 19 | | practice nurse contracts, or (3) limit the geographic area or | 20 | | practice location of the advanced practice nurse in this State. | 21 | | (c) Collaboration and consultation under all collaboration | 22 | | agreements
shall be adequate if a
collaborating physician or | 23 | | podiatrist does each of the following:
| 24 | | (1) Participates in the joint formulation and joint | 25 | | approval of orders or
guidelines with the advanced practice | 26 | | nurse and he or she periodically reviews such orders and |
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| 1 | | the
services provided patients under such orders in | 2 | | accordance with accepted
standards of medical practice or | 3 | | podiatric practice and advanced practice nursing practice.
| 4 | | (2) Provides collaboration and consultation with the | 5 | | advanced practice nurse at least once a month. In the case | 6 | | of anesthesia services provided by a certified registered | 7 | | nurse anesthetist, an anesthesiologist, physician, | 8 | | dentist, or podiatrist must participate through discussion | 9 | | of and agreement with the anesthesia plan and remain | 10 | | physically present and available on the premises during the | 11 | | delivery of anesthesia services for diagnosis, | 12 | | consultation, and treatment of emergency medical | 13 | | conditions.
| 14 | | (3) Is available through telecommunications for | 15 | | consultation on medical
problems, complications, or | 16 | | emergencies or patient referral. In the case of anesthesia | 17 | | services provided by a certified registered nurse | 18 | | anesthetist, an anesthesiologist, physician, dentist, or | 19 | | podiatrist must participate through discussion of and | 20 | | agreement with the anesthesia plan and remain physically | 21 | | present and available on the premises during the delivery | 22 | | of anesthesia services for diagnosis, consultation, and | 23 | | treatment of emergency medical conditions.
| 24 | | The agreement must contain provisions detailing notice for | 25 | | termination or change of status involving a written | 26 | | collaborative agreement, except when such notice is given for |
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| 1 | | just cause. | 2 | | (c-5) A certified registered nurse anesthetist, who | 3 | | provides anesthesia services outside of a hospital or | 4 | | ambulatory surgical treatment center shall enter into a written | 5 | | collaborative agreement with an anesthesiologist or the | 6 | | physician licensed to practice medicine in all its branches or | 7 | | the podiatrist performing the procedure. Outside of a hospital | 8 | | or ambulatory surgical treatment center, the certified | 9 | | registered nurse anesthetist may provide only those services | 10 | | that the collaborating podiatrist is authorized to provide | 11 | | pursuant to the Podiatric Medical Practice Act of 1987 and | 12 | | rules adopted thereunder. A certified registered nurse | 13 | | anesthetist may select, order, and administer medication, | 14 | | including controlled substances, and apply appropriate medical | 15 | | devices for delivery of anesthesia services under the | 16 | | anesthesia plan agreed with by the anesthesiologist or the | 17 | | operating physician or operating podiatrist. | 18 | | (c-10) A certified registered nurse anesthetist who | 19 | | provides anesthesia services in a dental office shall enter | 20 | | into a written collaborative agreement with an | 21 | | anesthesiologist or the physician licensed to practice | 22 | | medicine in all its branches or the operating dentist | 23 | | performing the procedure. The agreement shall describe the | 24 | | working relationship of the certified registered nurse | 25 | | anesthetist and dentist and shall authorize the categories of | 26 | | care, treatment, or procedures to be performed by the certified |
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| 1 | | registered nurse anesthetist. In a collaborating dentist's | 2 | | office, the certified registered nurse anesthetist may only | 3 | | provide those services that the operating dentist with the | 4 | | appropriate permit is authorized to provide pursuant to the | 5 | | Illinois Dental Practice Act and rules adopted thereunder. For | 6 | | anesthesia services, an anesthesiologist, physician, or | 7 | | operating dentist shall participate through discussion of and | 8 | | agreement with the anesthesia plan and shall remain physically | 9 | | present and be available on the premises during the delivery of | 10 | | anesthesia services for diagnosis, consultation, and treatment | 11 | | of emergency medical conditions. A certified registered nurse | 12 | | anesthetist may select, order, and administer medication, | 13 | | including controlled substances, and apply appropriate medical | 14 | | devices for delivery of anesthesia services under the | 15 | | anesthesia plan agreed with by the operating dentist. | 16 | | (d) A copy of the signed, written collaborative agreement | 17 | | must be available
to the Department upon request from both the | 18 | | advanced practice nurse
and the collaborating physician or | 19 | | podiatrist. | 20 | | (e) Nothing in this Act shall be construed to limit the | 21 | | delegation of tasks or duties by a physician to a licensed | 22 | | practical nurse, a registered professional nurse, or other | 23 | | persons in accordance with Section 54.2 of the Medical Practice | 24 | | Act of 1987. Nothing in this Act shall be construed to limit | 25 | | the method of delegation that may be authorized by any means, | 26 | | including, but not limited to, oral, written, electronic, |
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| 1 | | standing orders, protocols, guidelines, or verbal orders. | 2 | | (f) An advanced
practice nurse shall inform each | 3 | | collaborating physician, dentist, or podiatrist of all | 4 | | collaborative
agreements he or she
has signed and provide a | 5 | | copy of these to any collaborating physician, dentist, or | 6 | | podiatrist upon
request.
| 7 | | (g) For the purposes of this Act, "generally provides or | 8 | | may provide in to his or her patients in the normal course of | 9 | | his or her clinical medical practice" means categories of care | 10 | | or treatment services , not specific tasks or duties, the | 11 | | physician or podiatrist routinely provides individually or | 12 | | through delegation to other persons so that the physician or | 13 | | podiatrist has the experience and ability to provide | 14 | | collaboration and consultation. This definition shall not be | 15 | | construed to prohibit an advanced practice nurse from providing | 16 | | primary health treatment or care within the scope of his or her | 17 | | training and experience, including, but not limited to, health | 18 | | screenings, patient histories, physical examinations, women's | 19 | | health examinations, or school physicals that may be provided | 20 | | as part of the routine practice of an advanced practice nurse | 21 | | or on a volunteer basis. | 22 | | For the purposes of this Act, "generally provides to his or | 23 | | her patients in the normal course of his or her clinical | 24 | | podiatric practice" means services, not specific tasks or | 25 | | duties, that the podiatrist routinely provides individually or | 26 | | through delegation to other persons so that the podiatrist has |
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| 1 | | the experience and ability to provide collaboration and | 2 | | consultation. | 3 | | (Source: P.A. 96-618, eff. 1-1-10; 97-358, eff. 8-12-11.)".
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