Full Text of HB2895 103rd General Assembly
HB2895ham001 103RD GENERAL ASSEMBLY | Rep. Anna Moeller Filed: 2/28/2023
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| 1 | | AMENDMENT TO HOUSE BILL 2895
| 2 | | AMENDMENT NO. ______. Amend House Bill 2895 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Department of Professional Regulation Law | 5 | | of the
Civil Administrative Code of Illinois is amended by | 6 | | adding Section 2105-367 as follows: | 7 | | (20 ILCS 2105/2105-367 new) | 8 | | Sec. 2105-367. Rules; various medical and dental Acts. The | 9 | | Department shall adopt rules to implement this amendatory Act | 10 | | of the 103rd General Assembly. | 11 | | Section 10. The Ambulatory Surgical Treatment Center Act | 12 | | is amended by changing Section 6.5 as follows:
| 13 | | (210 ILCS 5/6.5)
| 14 | | Sec. 6.5. Clinical privileges; advanced practice |
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| 1 | | registered nurses. All ambulatory surgical treatment centers | 2 | | (ASTC) licensed under this Act
shall
comply with the following | 3 | | requirements:
| 4 | | (1) No ASTC policy, rule, regulation, or practice | 5 | | shall be inconsistent
with the provision of adequate | 6 | | collaboration and consultation in accordance with Section | 7 | | 54.5 of the Medical
Practice Act of 1987.
| 8 | | (2) Operative surgical procedures shall be performed | 9 | | only by a physician
licensed to
practice medicine in
all | 10 | | its branches under the Medical Practice Act of 1987, a | 11 | | dentist
licensed under the
Illinois Dental Practice Act, | 12 | | or a podiatric physician licensed under the Podiatric
| 13 | | Medical Practice Act of 1987,
with medical staff | 14 | | membership and surgical clinical privileges granted by the
| 15 | | consulting
committee of the ASTC. A licensed physician, | 16 | | dentist, or podiatric physician may
be assisted by
a | 17 | | physician licensed to practice medicine in all its | 18 | | branches, dentist, dental
assistant, podiatric physician, | 19 | | licensed
advanced practice registered nurse, licensed | 20 | | physician assistant, licensed
registered nurse, licensed | 21 | | practical nurse,
surgical
assistant, surgical technician, | 22 | | or other individuals granted clinical
privileges to assist | 23 | | in surgery
by the consulting committee of the ASTC.
| 24 | | Payment for services rendered by an assistant in surgery | 25 | | who is not an
ambulatory surgical treatment center | 26 | | employee shall be paid
at the appropriate non-physician |
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| 1 | | modifier
rate if the payor would have made payment had the | 2 | | same services been provided
by a physician.
| 3 | | (2.5) A registered nurse licensed under the Nurse | 4 | | Practice Act and qualified by training and experience in | 5 | | operating room nursing shall be present in the operating | 6 | | room and function as the circulating nurse during all | 7 | | invasive or operative procedures. For purposes of this | 8 | | paragraph (2.5), "circulating nurse" means a registered | 9 | | nurse who is responsible for coordinating all nursing | 10 | | care, patient safety needs, and the needs of the surgical | 11 | | team in the operating room during an invasive or operative | 12 | | procedure.
| 13 | | (3) An advanced practice registered nurse is not | 14 | | required to possess prescriptive authority or a written | 15 | | collaborative agreement meeting the requirements of the | 16 | | Nurse Practice Act to provide advanced practice registered | 17 | | nursing services in an ambulatory surgical treatment | 18 | | center. An advanced practice registered nurse must possess | 19 | | clinical privileges granted by the consulting medical | 20 | | staff committee and ambulatory surgical treatment center | 21 | | in order to provide services. Individual advanced practice | 22 | | registered nurses may also be granted clinical privileges | 23 | | to order, select, and administer medications, including | 24 | | controlled substances, to provide delineated care. The | 25 | | attending physician must determine the advanced practice | 26 | | registered nurse's role in providing care for his or her |
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| 1 | | patients, except as otherwise provided in the consulting | 2 | | staff policies. The consulting medical staff committee | 3 | | shall periodically review the services of advanced | 4 | | practice registered nurses granted privileges.
| 5 | | (4) The anesthesia service shall be under the | 6 | | direction of a physician
licensed to practice
medicine in | 7 | | all its branches who has had specialized preparation or | 8 | | experience
in the area
or who has completed a residency in | 9 | | anesthesiology. An anesthesiologist, Board
certified or
| 10 | | Board eligible, is recommended. Anesthesia services may
| 11 | | only be
administered pursuant to the order of a physician | 12 | | licensed to practice medicine
in all its
branches, | 13 | | licensed dentist, or licensed podiatric physician. (A) The | 14 | | individuals who, with clinical privileges granted by the | 15 | | medical
staff and ASTC, may
administer anesthesia services | 16 | | are limited to the
following:
| 17 | | (i) an anesthesiologist; or
| 18 | | (ii) a physician licensed to practice medicine in | 19 | | all its branches; or
| 20 | | (iii) a dentist with authority to administer | 21 | | anesthesia under Section
8.1 of the
Illinois Dental | 22 | | Practice Act; or
| 23 | | (iv) a licensed certified registered nurse | 24 | | anesthetist; or | 25 | | (v) a podiatric physician licensed under the | 26 | | Podiatric Medical Practice Act of 1987.
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| 1 | | (B) (Blank). For anesthesia services, an | 2 | | anesthesiologist
shall
participate through discussion of | 3 | | and agreement with the anesthesia plan and
shall remain | 4 | | physically present and be
available on
the premises during | 5 | | the delivery of anesthesia services for
diagnosis, | 6 | | consultation, and treatment of emergency medical
| 7 | | conditions.
In the absence of 24-hour availability of | 8 | | anesthesiologists with clinical
privileges, an alternate | 9 | | policy (requiring
participation, presence,
and | 10 | | availability of a
physician licensed to practice medicine | 11 | | in all its
branches) shall be
developed by the medical | 12 | | staff consulting committee in consultation with the
| 13 | | anesthesia service and included in the medical
staff
| 14 | | consulting committee policies.
| 15 | | (C) A certified registered nurse anesthetist is not | 16 | | required to possess
prescriptive authority or a written | 17 | | collaborative agreement meeting the
requirements of | 18 | | Section 65-35 of the Nurse Practice Act
to provide | 19 | | anesthesia services
ordered by a licensed physician, | 20 | | dentist, or podiatric physician . Licensed certified
| 21 | | registered nurse anesthetists are authorized to
select, | 22 | | order, and
administer drugs and apply the appropriate | 23 | | medical devices in the provision of
anesthesia
services | 24 | | under the anesthesia plan agreed with by the
| 25 | | anesthesiologist or, in the absence of an available | 26 | | anesthesiologist with
clinical privileges,
agreed with by |
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| 1 | | the
operating physician, operating dentist, or operating | 2 | | podiatric physician in accordance
with the medical
staff | 3 | | consulting committee policies of a licensed ambulatory | 4 | | surgical treatment
center. | 5 | | (D) In accordance with the medical staff consulting | 6 | | committee policies of a licensed ambulatory surgical | 7 | | treatment center, a certified registered nurse anesthetist | 8 | | with clinical privileges may perform acts of advanced | 9 | | assessment and diagnosis and may provide such functions | 10 | | for which the certified registered nurse anesthetist is | 11 | | educationally and experientially prepared and which are | 12 | | consistent with the standards established by the national | 13 | | credentialing or certification for the specialty | 14 | | recognized by the Department.
| 15 | | (Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18 .)
| 16 | | Section 15. The Hospital Licensing Act is amended by | 17 | | changing Section 10.7 as follows:
| 18 | | (210 ILCS 85/10.7)
| 19 | | Sec. 10.7. Clinical privileges; advanced practice | 20 | | registered nurses.
All hospitals licensed under this Act | 21 | | shall comply with the following
requirements:
| 22 | | (1) No hospital policy, rule, regulation, or practice
| 23 | | shall be inconsistent
with the provision of adequate | 24 | | collaboration and consultation in accordance with Section |
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| 1 | | 54.5 of the
Medical Practice Act of 1987.
| 2 | | (2) Operative surgical procedures shall be performed | 3 | | only by a physician
licensed to practice medicine in all | 4 | | its branches under the Medical Practice
Act of 1987, a | 5 | | dentist licensed under the Illinois Dental Practice Act, | 6 | | or a podiatric physician
licensed under the Podiatric | 7 | | Medical Practice Act of 1987,
with medical staff | 8 | | membership and surgical clinical privileges granted at the
| 9 | | hospital. A licensed physician, dentist, or podiatric | 10 | | physician may be assisted by a
physician licensed to | 11 | | practice medicine in all its branches, dentist, dental
| 12 | | assistant, podiatric physician, licensed advanced practice | 13 | | registered nurse, licensed physician
assistant, licensed | 14 | | registered
nurse, licensed practical nurse, surgical
| 15 | | assistant, surgical technician, or other individuals | 16 | | granted clinical
privileges to assist in surgery
at the | 17 | | hospital.
Payment for services rendered by an assistant in | 18 | | surgery who is not a
hospital employee shall be paid
at the | 19 | | appropriate non-physician modifier rate if the payor would | 20 | | have
made payment had the same services been provided by a | 21 | | physician.
| 22 | | (2.5) A registered nurse licensed under the Nurse | 23 | | Practice Act and qualified by training and experience in | 24 | | operating room nursing shall be present in the operating | 25 | | room and function as the circulating nurse during all | 26 | | invasive or operative procedures. For purposes of this |
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| 1 | | paragraph (2.5), "circulating nurse" means a registered | 2 | | nurse who is responsible for coordinating all nursing | 3 | | care, patient safety needs, and the needs of the surgical | 4 | | team in the operating room during an invasive or operative | 5 | | procedure.
| 6 | | (3) An advanced practice registered nurse is not | 7 | | required to possess prescriptive authority or a written | 8 | | collaborative agreement meeting the requirements of the | 9 | | Nurse Practice Act to provide advanced practice registered | 10 | | nursing services in a hospital. An advanced practice | 11 | | registered nurse must possess clinical privileges | 12 | | recommended by the medical staff and granted by the | 13 | | hospital in order to provide services. Individual advanced | 14 | | practice registered nurses may also be granted clinical | 15 | | privileges to order, select, and administer medications, | 16 | | including controlled substances, to provide delineated | 17 | | care. The attending physician must determine the advanced | 18 | | practice registered nurse's role in providing care for his | 19 | | or her patients, except as otherwise provided in medical | 20 | | staff bylaws. The medical staff shall periodically review | 21 | | the services of advanced practice registered nurses | 22 | | granted privileges. This review shall be conducted in | 23 | | accordance with item (2) of subsection (a) of Section 10.8 | 24 | | of this Act for advanced practice registered nurses | 25 | | employed by the hospital.
| 26 | | (4) The anesthesia service shall be under the |
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| 1 | | direction of a physician
licensed to practice
medicine in | 2 | | all its branches who has had specialized preparation or
| 3 | | experience in the area
or who has completed a residency in | 4 | | anesthesiology. An anesthesiologist, Board
certified or | 5 | | Board eligible, is recommended. Anesthesia services may
| 6 | | only be administered pursuant to the order of a physician | 7 | | licensed to practice
medicine in all its branches, | 8 | | licensed dentist, or licensed podiatric physician. (A) The | 9 | | individuals who, with clinical privileges granted at the | 10 | | hospital,
may administer anesthesia services are limited
| 11 | | to the following:
| 12 | | (i) an anesthesiologist; or
| 13 | | (ii) a physician licensed to practice medicine in | 14 | | all its branches; or
| 15 | | (iii) a dentist with authority to administer | 16 | | anesthesia under Section
8.1 of
the Illinois Dental | 17 | | Practice Act; or
| 18 | | (iv) a licensed certified registered nurse | 19 | | anesthetist; or | 20 | | (v) a podiatric physician licensed under the | 21 | | Podiatric Medical Practice Act of 1987.
| 22 | | (B) (Blank). For anesthesia services, an | 23 | | anesthesiologist
shall
participate through discussion of | 24 | | and agreement with the anesthesia plan and
shall remain | 25 | | physically present and be
available on
the premises during | 26 | | the delivery of anesthesia services for
diagnosis, |
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| 1 | | consultation, and treatment of emergency medical | 2 | | conditions.
In the absence
of 24-hour availability of
| 3 | | anesthesiologists with medical staff privileges,
an | 4 | | alternate
policy (requiring participation, presence, and | 5 | | availability of a physician
licensed to practice
medicine | 6 | | in all its branches) shall be developed by the medical | 7 | | staff and
licensed
hospital in consultation with the | 8 | | anesthesia service.
| 9 | | (C) A certified registered nurse anesthetist is not | 10 | | required to possess
prescriptive authority or a written | 11 | | collaborative agreement meeting
the requirements of | 12 | | Section 65-35 of the Nurse Practice Act
to provide | 13 | | anesthesia services
ordered by a licensed physician, | 14 | | dentist, or podiatric physician . Licensed certified
| 15 | | registered nurse anesthetists are authorized to
select, | 16 | | order, and
administer drugs and apply the appropriate | 17 | | medical devices in the provision of
anesthesia
services | 18 | | under the anesthesia plan agreed with by the
| 19 | | anesthesiologist or, in the absence of an available | 20 | | anesthesiologist with
clinical privileges,
agreed with by | 21 | | the
operating physician, operating dentist, or operating | 22 | | podiatric physician in accordance
with the hospital's | 23 | | alternative policy. | 24 | | (D) In accordance with the hospital's policies, a | 25 | | certified registered nurse anesthetist with clinical | 26 | | privileges may perform acts of advanced assessment and |
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| 1 | | diagnosis and may provide such functions for which the | 2 | | certified registered nurse anesthetist is educationally | 3 | | and experientially prepared and which are consistent with | 4 | | the standards established by the national credentialing or | 5 | | certification for the specialty recognized by the | 6 | | Department.
| 7 | | (Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18 .)
| 8 | | Section 20. The Illinois Dental Practice Act is amended by | 9 | | changing Section 8.1 as follows:
| 10 | | (225 ILCS 25/8.1) (from Ch. 111, par. 2308.1)
| 11 | | (Section scheduled to be repealed on January 1, 2026)
| 12 | | Sec. 8.1. Permit for the administration of anesthesia and | 13 | | sedation.
| 14 | | (a) No licensed dentist shall administer general | 15 | | anesthesia, deep sedation, or
conscious sedation without first | 16 | | applying for and obtaining a
permit for such purpose from the | 17 | | Department. The Department shall issue
such permit only after | 18 | | ascertaining that the applicant possesses the
minimum | 19 | | qualifications necessary to protect public safety. A person | 20 | | with a
dental degree who administers anesthesia, deep | 21 | | sedation,
or conscious sedation
in an
approved
hospital | 22 | | training program under the supervision of either a licensed
| 23 | | dentist holding such permit or a physician licensed to | 24 | | practice medicine in
all its branches shall not be required to |
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| 1 | | obtain such permit.
| 2 | | (b) In determining the minimum permit qualifications that | 3 | | are necessary to protect public safety, the Department, by | 4 | | rule, shall: | 5 | | (1) establish the minimum educational and training | 6 | | requirements necessary for a dentist to be issued an | 7 | | appropriate permit; | 8 | | (2) establish the standards for properly equipped | 9 | | dental facilities (other than licensed hospitals and | 10 | | ambulatory surgical treatment centers) in which general | 11 | | anesthesia, deep sedation, or conscious sedation is | 12 | | administered, as necessary to protect public safety; | 13 | | (3) establish minimum requirements for all persons who | 14 | | assist the dentist in the administration of general | 15 | | anesthesia, deep sedation, or conscious sedation, | 16 | | including minimum training requirements for each member of | 17 | | the dental team, monitoring requirements, recordkeeping | 18 | | requirements, and emergency procedures; | 19 | | (4) ensure that the dentist has completed and | 20 | | maintains current certification in advanced cardiac life | 21 | | support or pediatric advanced life support and all persons | 22 | | assisting the dentist or monitoring the administration of | 23 | | general anesthesia, deep sedation, or conscious sedation | 24 | | maintain current certification in Basic Life Support | 25 | | (BLS); and | 26 | | (5) establish continuing education requirements in |
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| 1 | | sedation techniques and airway management for dentists who | 2 | | possess a permit under this Section. | 3 | | When establishing requirements under this Section, the | 4 | | Department shall consider the current American Dental | 5 | | Association guidelines on sedation and general anesthesia, the | 6 | | current "Guidelines for Monitoring and Management of Pediatric | 7 | | Patients During and After Sedation for Diagnostic and | 8 | | Therapeutic Procedures" established by the American Academy of | 9 | | Pediatrics and the American Academy of Pediatric Dentistry, | 10 | | and the current parameters of care and Office Anesthesia | 11 | | Evaluation (OAE) Manual established by the American | 12 | | Association of Oral and Maxillofacial Surgeons. | 13 | | (c) (Blank). A licensed dentist must hold an appropriate | 14 | | permit issued under this Section in order to perform dentistry | 15 | | while a nurse anesthetist administers conscious sedation, and | 16 | | a valid written collaborative agreement must exist between the | 17 | | dentist and the nurse anesthetist, in accordance with the | 18 | | Nurse
Practice Act. | 19 | | A licensed dentist must hold an appropriate permit issued | 20 | | under this Section in order to perform dentistry while a nurse | 21 | | anesthetist administers deep sedation or general anesthesia, | 22 | | and a valid written collaborative agreement must exist between | 23 | | the dentist and the nurse anesthetist, in accordance with the | 24 | | Nurse
Practice Act. | 25 | | For the purposes of this subsection (c), "nurse | 26 | | anesthetist" means a licensed certified registered nurse |
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| 1 | | anesthetist who holds a license as an advanced practice | 2 | | registered nurse. | 3 | | (Source: P.A. 100-201, eff. 8-18-17; 100-513, eff. 1-1-18; | 4 | | 101-162, eff. 7-26-19.)
| 5 | | Section 25. The Medical Practice Act of 1987 is amended by | 6 | | changing Section 54.5 as follows:
| 7 | | (225 ILCS 60/54.5)
| 8 | | (Section scheduled to be repealed on January 1, 2027)
| 9 | | Sec. 54.5. Physician delegation of authority to physician | 10 | | assistants, advanced practice registered nurses without full | 11 | | practice authority, and prescribing psychologists.
| 12 | | (a) Physicians licensed to practice medicine in all its
| 13 | | branches may delegate care and treatment responsibilities to a
| 14 | | physician assistant under guidelines in accordance with the
| 15 | | requirements of the Physician Assistant Practice Act of
1987. | 16 | | A physician licensed to practice medicine in all its
branches | 17 | | may enter into collaborative agreements with
no more than 7 | 18 | | full-time equivalent physician assistants, except in a | 19 | | hospital, hospital affiliate, or ambulatory surgical treatment | 20 | | center as set forth by Section 7.7 of the Physician Assistant | 21 | | Practice Act of 1987 and as provided in subsection (a-5).
| 22 | | (a-5) A physician licensed to practice medicine in all its | 23 | | branches may collaborate with more than 7 physician assistants | 24 | | when the services are provided in a federal primary care |
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| 1 | | health professional shortage area with a Health Professional | 2 | | Shortage Area score greater than or equal to 12, as determined | 3 | | by the United States Department of Health and Human Services. | 4 | | The collaborating physician must keep appropriate | 5 | | documentation of meeting this exemption and make it available | 6 | | to the Department upon request. | 7 | | (b) A physician licensed to practice medicine in all its
| 8 | | branches in active clinical practice may collaborate with an | 9 | | advanced practice
registered nurse in accordance with the | 10 | | requirements of the Nurse Practice Act. Collaboration
is for | 11 | | the purpose of providing medical consultation,
and no | 12 | | employment relationship is required. A
written collaborative | 13 | | agreement shall
conform to the requirements of Section 65-35 | 14 | | of the Nurse Practice Act. The written collaborative agreement | 15 | | shall
be for
services in the same area of practice or specialty | 16 | | as the collaborating physician in
his or her clinical medical | 17 | | practice.
A written collaborative agreement shall be adequate | 18 | | with respect to collaboration
with advanced practice | 19 | | registered nurses if all of the following apply:
| 20 | | (1) The agreement is written to promote the exercise | 21 | | of professional judgment by the advanced practice | 22 | | registered nurse commensurate with his or her education | 23 | | and experience.
| 24 | | (2) The advanced practice registered nurse provides | 25 | | services based upon a written collaborative agreement with | 26 | | the collaborating physician , except as set forth in |
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| 1 | | subsection (b-5) of this Section . With respect to labor | 2 | | and delivery, the collaborating physician must provide | 3 | | delivery services in order to participate with a certified | 4 | | nurse midwife. | 5 | | (3) 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 | | (b-5) An anesthesiologist or physician licensed to | 10 | | practice medicine in
all its branches may collaborate with a | 11 | | certified registered nurse anesthetist
in accordance with | 12 | | Section 65-35 of the Nurse Practice Act for the provision of | 13 | | anesthesia services. Collaboration with respect to anesthesia | 14 | | With respect to the provision of anesthesia services, the | 15 | | collaborating anesthesiologist or physician shall have | 16 | | training and experience in the delivery of anesthesia services | 17 | | consistent with Department rules. Collaboration shall be
| 18 | | adequate if: (1) an anesthesiologist or a physician
| 19 | | participates in the joint formulation and joint approval of | 20 | | orders or
guidelines and periodically reviews such orders and | 21 | | the services provided
patients under such orders; and (2) for | 22 | | anesthesia services, the anesthesiologist
or physician | 23 | | participates through discussion of and agreement with the
| 24 | | anesthesia plan and is physically present and available on the | 25 | | premises during
the delivery of anesthesia services for
| 26 | | diagnosis, consultation, and treatment of emergency medical |
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| 1 | | conditions.
Anesthesia services in a hospital shall be | 2 | | conducted in accordance with
Section 10.7 of the Hospital | 3 | | Licensing Act and in an ambulatory surgical
treatment center | 4 | | in accordance with Section 6.5 of the Ambulatory Surgical
| 5 | | Treatment Center Act.
| 6 | | (b-10) (Blank). The anesthesiologist or operating | 7 | | physician must agree with the
anesthesia plan prior to the | 8 | | delivery of services.
| 9 | | (c) The collaborating physician shall have access to the
| 10 | | medical records of all patients attended by a physician
| 11 | | assistant. The collaborating physician shall have access to
| 12 | | the medical records of all patients attended to by an
advanced | 13 | | practice registered nurse.
| 14 | | (d) (Blank).
| 15 | | (e) A physician shall not be liable for the acts or
| 16 | | omissions of a prescribing psychologist, physician assistant, | 17 | | or advanced practice
registered nurse solely on the basis of | 18 | | having signed a
supervision agreement or guidelines or a | 19 | | collaborative
agreement, an order, a standing medical order, a
| 20 | | standing delegation order, or other order or guideline
| 21 | | authorizing a prescribing psychologist, physician assistant, | 22 | | or advanced practice
registered nurse to perform acts, unless | 23 | | the physician has
reason to believe the prescribing | 24 | | psychologist, physician assistant, or advanced
practice | 25 | | registered nurse lacked the competency to perform
the act or | 26 | | acts or commits willful and wanton misconduct.
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| 1 | | (f) A collaborating physician may, but is not required to, | 2 | | delegate prescriptive authority to an advanced practice | 3 | | registered nurse as part of a written collaborative agreement, | 4 | | and the delegation of prescriptive authority shall conform to | 5 | | the requirements of Section 65-40 of the Nurse Practice Act. | 6 | | (g) A collaborating physician may, but is not required to, | 7 | | delegate prescriptive authority to a physician assistant as | 8 | | part of a written collaborative agreement, and the delegation | 9 | | of prescriptive authority shall conform to the requirements of | 10 | | Section 7.5 of the Physician Assistant Practice Act of 1987. | 11 | | (h) (Blank). | 12 | | (i) A collaborating physician shall delegate prescriptive | 13 | | authority to a prescribing psychologist as part of a written | 14 | | collaborative agreement, and the delegation of prescriptive | 15 | | authority shall conform to the requirements of Section 4.3 of | 16 | | the Clinical Psychologist Licensing Act. | 17 | | (j) As set forth in Section 22.2 of this Act, a licensee | 18 | | under this Act may not directly or indirectly divide, share, | 19 | | or split any professional fee or other form of compensation | 20 | | for professional services with anyone in exchange for a | 21 | | referral or otherwise, other than as provided in Section 22.2. | 22 | | (Source: P.A. 99-173, eff. 7-29-15; 100-453, eff. 8-25-17; | 23 | | 100-513, eff. 1-1-18; 100-605, eff. 1-1-19; 100-863, eff. | 24 | | 8-14-18 .)
| 25 | | Section 30. The Nurse Practice Act is amended by changing |
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| 1 | | Sections 65-35 and 65-45 and by adding Section 65-37 as | 2 | | follows:
| 3 | | (225 ILCS 65/65-35)
(was 225 ILCS 65/15-15)
| 4 | | (Section scheduled to be repealed on January 1, 2028)
| 5 | | Sec. 65-35. Written collaborative
agreements. | 6 | | (a) A written collaborative agreement is required for all | 7 | | advanced practice registered nurses engaged in clinical | 8 | | practice prior to meeting the requirements of Section 65-43 or | 9 | | 65-37 , except for advanced practice registered nurses who are | 10 | | privileged to practice in a hospital, hospital affiliate, or | 11 | | ambulatory surgical treatment center. | 12 | | (a-5) If an advanced practice registered nurse engages in | 13 | | clinical practice outside of a hospital, hospital affiliate, | 14 | | or ambulatory surgical treatment center in which he or she is | 15 | | privileged to practice, the advanced practice registered nurse | 16 | | must have a written collaborative agreement, except as set | 17 | | forth in Section 65-43 or 65-37 .
| 18 | | (b) A written collaborative
agreement shall describe the | 19 | | relationship of the
advanced practice registered nurse with | 20 | | the collaborating
physician and shall describe the categories | 21 | | of
care, treatment, or procedures to be provided by the | 22 | | advanced
practice registered nurse. A collaborative agreement | 23 | | with a podiatric physician must be in accordance with | 24 | | subsection (c-5) or (c-15) of this Section. A collaborative | 25 | | agreement with a dentist must be in accordance with subsection |
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| 1 | | (c-10) of this Section. A collaborative agreement with a | 2 | | podiatric physician must be in accordance with subsection | 3 | | (c-5) of this Section. Collaboration does not require an
| 4 | | employment relationship between the collaborating physician
| 5 | | and the advanced practice registered nurse.
| 6 | | The collaborative
relationship under an agreement shall | 7 | | not be
construed to require the personal presence of a | 8 | | collaborating physician at the place where services are | 9 | | rendered.
Methods of communication shall
be available for | 10 | | consultation with the collaborating
physician in person or by | 11 | | telecommunications or electronic communications as set forth | 12 | | in 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 registered nurse within the | 16 | | scope of the advanced practice registered nurses training and | 17 | | experience, (2) limit third party payors or government health | 18 | | programs, such as the medical assistance program or Medicare | 19 | | with which the advanced practice registered nurse contracts, | 20 | | or (3) limit the geographic area or practice location of the | 21 | | advanced practice registered nurse in this State. | 22 | | (c)
(Blank). In the case of anesthesia services provided | 23 | | by a certified registered nurse anesthetist, an | 24 | | anesthesiologist, a physician, a dentist, or a podiatric | 25 | | physician must participate through discussion of and agreement | 26 | | with the anesthesia plan and remain physically present and |
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| 1 | | available on the premises during the delivery of anesthesia | 2 | | services for diagnosis, consultation, and treatment of | 3 | | emergency medical conditions.
| 4 | | (c-5) A certified registered nurse anesthetist, who | 5 | | provides anesthesia services outside of a hospital or | 6 | | ambulatory surgical treatment center , shall enter into a | 7 | | written collaborative agreement with an anesthesiologist or | 8 | | the physician licensed to practice medicine in all its | 9 | | branches or the podiatric physician performing the procedure. | 10 | | The collaborative agreement may, but is not required to, | 11 | | include the following terms: (i) that the certified registered | 12 | | nurse anesthetist and the anesthesiologist, physician, or | 13 | | podiatric physician participate through discussion of and | 14 | | reach agreement on the anesthesia plan; or (ii) that | 15 | | anesthesia services shall only be delivered when the | 16 | | anesthesiologist, physician, or podiatric physician is present | 17 | | and available on the premises for diagnosis, consultation, and | 18 | | treatment of emergency medical conditions. Outside of a | 19 | | hospital or ambulatory surgical treatment center, the | 20 | | certified registered nurse anesthetist may provide only those | 21 | | services that the collaborating podiatric physician is | 22 | | authorized to provide pursuant to the Podiatric Medical | 23 | | Practice Act of 1987 and rules adopted thereunder. A certified | 24 | | registered nurse anesthetist may select, order, and administer | 25 | | medication, including controlled substances, and apply | 26 | | appropriate medical devices for delivery of anesthesia |
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| 1 | | services under the anesthesia plan agreed with by the | 2 | | anesthesiologist or the operating physician or operating | 3 | | podiatric physician . | 4 | | (c-10) A certified registered nurse anesthetist who | 5 | | provides anesthesia services in a dental office shall enter | 6 | | into a written collaborative agreement with an | 7 | | anesthesiologist or the physician licensed to practice | 8 | | medicine in all its branches or the operating dentist | 9 | | performing the procedure. The agreement shall describe the | 10 | | working relationship of the certified registered nurse | 11 | | anesthetist and dentist and shall authorize the categories of | 12 | | care, treatment, or procedures to be performed by the | 13 | | certified registered nurse anesthetist. The collaborative | 14 | | agreement may, but is not required to, include the following | 15 | | terms: (i) that the certified registered nurse anesthetist and | 16 | | the anesthesiologist, physician, or dentist participate | 17 | | through discussion of and reach agreement on the anesthesia | 18 | | plan; or (ii) that anesthesia services shall only be delivered | 19 | | when the anesthesiologist, physician, or dentist is present | 20 | | and available on the premises for diagnosis, consultation, and | 21 | | treatment of emergency medical conditions. In a collaborating | 22 | | dentist's office, the certified registered nurse anesthetist | 23 | | may only provide those services that the operating dentist | 24 | | with the appropriate permit is authorized to provide pursuant | 25 | | to the Illinois Dental Practice Act and rules adopted | 26 | | thereunder. For anesthesia services, an anesthesiologist, |
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| 1 | | physician, or operating dentist shall participate through | 2 | | discussion of and agreement with the anesthesia plan and shall | 3 | | remain physically present and be available on the premises | 4 | | during the delivery of anesthesia services for diagnosis, | 5 | | consultation, and treatment of emergency medical conditions. A | 6 | | certified registered nurse anesthetist may select, order, and | 7 | | administer medication, including controlled substances, and | 8 | | apply appropriate medical devices for delivery of anesthesia | 9 | | services under the anesthesia plan agreed with by the | 10 | | operating dentist . | 11 | | (c-15) An advanced practice registered nurse who had a | 12 | | written collaborative agreement with a podiatric physician | 13 | | immediately before the effective date of Public Act 100-513 | 14 | | may continue in that collaborative relationship or enter into | 15 | | a new written collaborative relationship with a podiatric | 16 | | physician under the requirements of this Section and Section | 17 | | 65-40, as those Sections existed immediately before the | 18 | | amendment of those Sections by Public Act 100-513 with regard | 19 | | to a written collaborative agreement between an advanced | 20 | | practice registered nurse and a podiatric physician. | 21 | | (d) A copy of the signed, written collaborative agreement | 22 | | must be available
to the Department upon request from both the | 23 | | advanced practice registered nurse
and the collaborating | 24 | | physician, dentist, or podiatric physician. | 25 | | (e) Nothing in this Act shall be construed to limit the | 26 | | delegation of tasks or duties by a physician to a licensed |
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| 1 | | practical nurse, a registered professional nurse, or other | 2 | | persons in accordance with Section 54.2 of the Medical | 3 | | Practice Act of 1987. Nothing in this Act shall be construed to | 4 | | limit the method of delegation that may be authorized by any | 5 | | means, including, but not limited to, oral, written, | 6 | | electronic, standing orders, protocols, guidelines, or verbal | 7 | | orders. | 8 | | (e-5) Nothing in this Act shall be construed to authorize | 9 | | an advanced practice registered nurse to provide health care | 10 | | services required by law or rule to be performed by a | 11 | | physician. The scope of practice of an advanced practice | 12 | | registered nurse does not include operative surgery. Nothing | 13 | | in this Section shall be construed to preclude an advanced | 14 | | practice registered nurse from assisting in surgery. | 15 | | (f) An advanced
practice registered nurse shall inform | 16 | | each collaborating physician, dentist, or podiatric physician | 17 | | of all collaborative
agreements he or she
has signed and | 18 | | provide a copy of these to any collaborating physician, | 19 | | dentist, or podiatric physician upon
request.
| 20 | | (g) (Blank). | 21 | | (Source: P.A. 100-513, eff. 1-1-18; 100-577, eff. 1-26-18; | 22 | | 100-1096, eff. 8-26-18; 101-13, eff. 6-12-19.)
| 23 | | (225 ILCS 65/65-37 new) | 24 | | Sec. 65-37. Full practice authority; certified registered | 25 | | nurse anesthetist. |
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| 1 | | (a) An Illinois-licensed advanced practice registered | 2 | | nurse certified as a certified registered nurse anesthetist | 3 | | may practice without a written collaborative agreement as set | 4 | | forth in this Section. | 5 | | (b) An advanced practice registered nurse certified as a | 6 | | certified registered nurse anesthetist who (i) has attained | 7 | | national certification and completed a professional practice | 8 | | doctorate or (ii) files with the Department a notarized | 9 | | attestation of completion of at least 250 hours of continuing | 10 | | education or training and at least 4,000 hours of clinical | 11 | | experience after first attaining national certification shall | 12 | | not require a written collaborative agreement. Documentation | 13 | | of successful completion shall be provided to the Department | 14 | | upon request. | 15 | | Continuing education or training hours required by this | 16 | | subsection shall be in the certified registered nurse | 17 | | anesthetist's area of certification as set forth by Department | 18 | | rule. | 19 | | The clinical experience must be in the certified | 20 | | registered nurse anesthetist's area of certification. The | 21 | | clinical experience shall be in collaboration with a physician | 22 | | or physicians or a certified registered nurse anesthetist with | 23 | | full practice authority. Completion of the clinical experience | 24 | | must be attested to by the collaborating physician or | 25 | | physicians or employer, collaborating certified registered | 26 | | nurse anesthetist and the certified registered nurse |
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| 1 | | anesthetist. If the collaborating physician or physicians | 2 | | collaborating certified nurse anesthetist, or employer is | 3 | | unable to attest to the completion of the clinical experience, | 4 | | the Department may accept other evidence of clinical | 5 | | experience as established by rule. | 6 | | (c) The scope of practice of a certified registered nurse | 7 | | anesthetist with full practice authority includes: | 8 | | (1) all matters included in subsection (c) of Section
| 9 | | 65-30; | 10 | | (2) practicing without a written collaborative | 11 | | agreement in all practice settings consistent with | 12 | | national certification; | 13 | | (3) authority to prescribe both legend drugs and | 14 | | Schedule II through V controlled substances; this | 15 | | authority includes prescription of, selection of, orders | 16 | | for, administration of, storage of, acceptance of samples | 17 | | of, and dispensing over-the-counter medications, legend | 18 | | drugs, and controlled substances categorized as any | 19 | | Schedule II through V controlled substances, as defined in | 20 | | Article II of the Illinois Controlled Substances Act, and | 21 | | other preparations, including, but not limited to, | 22 | | botanical and herbal remedies; | 23 | | (4) prescribing benzodiazepines or Schedule II | 24 | | narcotic drugs, such as opioids; | 25 | | (5) authority to obtain an Illinois controlled | 26 | | substance license and a federal Drug Enforcement |
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| 1 | | Administration number; | 2 | | (6) providing comprehensive pain management services, | 3 | | including acute, chronic, and interventional pain | 4 | | management; and | 5 | | (7) delivery of the full range of anesthesia and | 6 | | related services. | 7 | | (d) The Department shall adopt rules necessary to | 8 | | administer this Section, including, but not limited to, | 9 | | requiring the completion of forms and the payment of fees. | 10 | | (e) Nothing in this Act shall be construed to authorize a | 11 | | certified registered nurse anesthetist with full practice | 12 | | authority to provide health care services required by law or | 13 | | rule to be performed by a physician.
| 14 | | (225 ILCS 65/65-45)
(was 225 ILCS 65/15-25)
| 15 | | (Section scheduled to be repealed on January 1, 2028)
| 16 | | Sec. 65-45. Advanced practice registered nursing in | 17 | | hospitals, hospital affiliates, or ambulatory surgical | 18 | | treatment centers.
| 19 | | (a) An advanced practice registered nurse may provide
| 20 | | services in a hospital or a hospital affiliate as those terms | 21 | | are defined in the Hospital Licensing Act or the University of | 22 | | Illinois Hospital Act or a licensed ambulatory surgical
| 23 | | treatment center without a written collaborative agreement | 24 | | pursuant to Section 65-35 of this Act. An advanced practice | 25 | | registered nurse must possess clinical privileges recommended |
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| 1 | | by the hospital medical staff and granted by the hospital or | 2 | | the consulting medical staff committee and ambulatory surgical | 3 | | treatment center in order to provide services. The medical | 4 | | staff or consulting medical staff committee shall periodically | 5 | | review the services of all advanced practice registered nurses | 6 | | granted clinical privileges, including any care provided in a | 7 | | hospital affiliate. Authority may also be granted when | 8 | | recommended by the hospital medical staff and granted by the | 9 | | hospital or recommended by the consulting medical staff | 10 | | committee and ambulatory surgical treatment center to | 11 | | individual advanced practice registered nurses to select, | 12 | | order, and administer medications, including controlled | 13 | | substances, to provide delineated care. In a hospital, | 14 | | hospital affiliate, or ambulatory surgical treatment center, | 15 | | the attending physician shall determine an advanced practice | 16 | | registered nurse's role in providing care for his or her | 17 | | patients, except as otherwise provided in the medical staff | 18 | | bylaws or consulting committee policies.
| 19 | | (a-2) An advanced practice registered nurse privileged to | 20 | | order medications, including controlled substances, may | 21 | | complete discharge prescriptions provided the prescription is | 22 | | in the name of the advanced practice registered nurse and the | 23 | | attending or discharging physician. | 24 | | (a-3) Advanced practice registered nurses practicing in a | 25 | | hospital or an ambulatory surgical treatment center are not | 26 | | required to obtain a mid-level controlled substance license to |
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| 1 | | order controlled substances under Section 303.05 of the | 2 | | Illinois Controlled Substances Act. | 3 | | (a-4) An advanced practice registered nurse meeting the | 4 | | requirements of Section 65-43 may be privileged to complete | 5 | | discharge orders and prescriptions under the advanced practice | 6 | | registered nurse's name. | 7 | | (a-5) For
anesthesia services provided by a certified | 8 | | registered nurse anesthetist, an anesthesiologist,
physician, | 9 | | dentist,
or podiatric physician shall participate through | 10 | | discussion of and agreement with the
anesthesia plan and shall
| 11 | | remain
physically present
and be available on the premises | 12 | | during the delivery of anesthesia services for
diagnosis, | 13 | | consultation, and treatment of
emergency medical conditions, | 14 | | unless hospital policy adopted pursuant to
clause (B) of | 15 | | subdivision (3) of Section 10.7 of the Hospital Licensing Act
| 16 | | or ambulatory surgical treatment center policy adopted | 17 | | pursuant to
clause (B) of subdivision (3) of Section 6.5 of the | 18 | | Ambulatory Surgical
Treatment Center Act
provides otherwise. A | 19 | | certified registered nurse anesthetist may select, order, and | 20 | | administer medication for anesthesia services under the | 21 | | anesthesia plan agreed to by the anesthesiologist or the | 22 | | physician, in accordance with hospital alternative policy or | 23 | | the medical staff consulting committee policies of a licensed | 24 | | ambulatory surgical treatment center.
| 25 | | (b) An advanced practice registered nurse who provides
| 26 | | services in a hospital shall do so in accordance with Section |
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| 1 | | 10.7 of the
Hospital
Licensing Act and, in an
ambulatory | 2 | | surgical treatment center, in accordance with Section 6.5 of | 3 | | the
Ambulatory
Surgical Treatment Center Act. Nothing in this | 4 | | Act shall be construed to require an advanced practice | 5 | | registered nurse to have a collaborative agreement to practice | 6 | | in a hospital, hospital affiliate, or ambulatory surgical | 7 | | treatment center.
| 8 | | (c) Advanced practice registered nurses certified as nurse | 9 | | practitioners, certified registered nurse anesthetists, nurse | 10 | | midwives, or clinical nurse specialists practicing in a | 11 | | hospital affiliate may be, but are not required to be, | 12 | | privileged to prescribe Schedule II through V controlled | 13 | | substances when such authority is recommended by the | 14 | | appropriate physician committee of the hospital affiliate and | 15 | | granted by the hospital affiliate. This authority may, but is | 16 | | not required to, include prescription of, selection of, orders | 17 | | for, administration of, storage of, acceptance of samples of, | 18 | | and dispensing over-the-counter medications, legend drugs, | 19 | | medical gases, and controlled substances categorized as | 20 | | Schedule II through V controlled substances, as defined in | 21 | | Article II of the Illinois Controlled Substances Act, and | 22 | | other preparations, including, but not limited to, botanical | 23 | | and herbal remedies. | 24 | | To prescribe controlled substances under this subsection | 25 | | (c), an advanced practice registered nurse certified as a | 26 | | nurse practitioner, nurse midwife, or clinical nurse |
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| 1 | | specialist must obtain a controlled substance license. | 2 | | Medication orders shall be reviewed periodically by the | 3 | | appropriate hospital affiliate physicians committee or its | 4 | | physician designee. | 5 | | The hospital affiliate shall file with the Department | 6 | | notice of a grant of prescriptive authority consistent with | 7 | | this subsection (c) and termination of such a grant of | 8 | | authority, in accordance with rules of the Department. Upon | 9 | | receipt of this notice of grant of authority to prescribe any | 10 | | Schedule II through V controlled substances, the licensed | 11 | | advanced practice registered nurse certified as a nurse | 12 | | practitioner, nurse midwife, or clinical nurse specialist may | 13 | | register for a mid-level practitioner controlled substance | 14 | | license under Section 303.05 of the Illinois Controlled | 15 | | Substances Act. | 16 | | In addition, a hospital affiliate may, but is not required | 17 | | to, privilege an advanced practice registered nurse certified | 18 | | as a nurse practitioner, certified registered nurse | 19 | | anesthetist, nurse midwife, or clinical nurse specialist to | 20 | | prescribe any Schedule II controlled substances, if all of the | 21 | | following conditions apply: | 22 | | (1) specific Schedule II controlled substances by oral | 23 | | dosage or topical or transdermal application may be | 24 | | designated, provided that the designated Schedule II | 25 | | controlled substances are routinely prescribed by advanced | 26 | | practice registered nurses in their area of certification; |
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| 1 | | the privileging documents must identify the specific | 2 | | Schedule II controlled substances by either brand name or | 3 | | generic name; privileges to prescribe or dispense Schedule | 4 | | II controlled substances to be delivered by injection or | 5 | | other route of administration may not be granted; | 6 | | (2) any privileges must be controlled substances | 7 | | limited to the practice of the advanced practice | 8 | | registered nurse; | 9 | | (3) any prescription must be limited to no more than a | 10 | | 30-day supply; | 11 | | (4) the advanced practice registered nurse must | 12 | | discuss the condition of any patients for whom a | 13 | | controlled substance is prescribed monthly with the | 14 | | appropriate physician committee of the hospital affiliate | 15 | | or its physician designee; and | 16 | | (5) the advanced practice registered nurse must meet | 17 | | the education requirements of Section 303.05 of the | 18 | | Illinois Controlled Substances Act. | 19 | | (d) An advanced practice registered nurse meeting the | 20 | | requirements of Section 65-43 or 65-37 may be privileged to | 21 | | prescribe controlled substances categorized as Schedule II | 22 | | through V in accordance with Section 65-43. | 23 | | (Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18 .)
| 24 | | Section 35. The Podiatric Medical Practice Act of 1987 is | 25 | | amended by changing Section 20.5 as follows: |
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| 1 | | (225 ILCS 100/20.5) | 2 | | (Section scheduled to be repealed on January 1, 2028)
| 3 | | Sec. 20.5. Delegation of authority to advanced practice | 4 | | registered nurses.
| 5 | | (a) A podiatric physician in active clinical practice may | 6 | | collaborate with an advanced practice registered nurse in | 7 | | accordance with the requirements of the Nurse Practice Act. | 8 | | Collaboration shall be for the purpose of providing podiatric | 9 | | care and no employment relationship shall be required. A | 10 | | written collaborative agreement shall conform to the | 11 | | requirements of Section 65-35 of the Nurse Practice Act. A | 12 | | written collaborative agreement and podiatric physician | 13 | | collaboration and consultation shall be adequate with respect | 14 | | to advanced practice registered nurses if all of the following | 15 | | apply: | 16 | | (1) With respect to the provision of anesthesia | 17 | | services by a certified registered nurse anesthetist, the | 18 | | collaborating podiatric physician must have training and | 19 | | experience in the delivery of anesthesia consistent with | 20 | | Department rules unless the certified registered nurse | 21 | | anesthetist has full practice authority under the | 22 | | requirements of Section 65-37 . | 23 | | (2) Methods of communication are available with the | 24 | | collaborating podiatric physician in person or through | 25 | | telecommunications or electronic communications for |
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| 1 | | consultation, collaboration, and referral as needed to | 2 | | address patient care needs. | 3 | | (3) (Blank). With respect to the provision of | 4 | | anesthesia services by a certified registered nurse | 5 | | anesthetist, an anesthesiologist, physician, or podiatric | 6 | | physician shall participate through discussion of and | 7 | | agreement with the anesthesia plan and shall remain | 8 | | physically present and be available on the premises during | 9 | | the delivery of anesthesia services for diagnosis, | 10 | | consultation, and treatment of emergency medical | 11 | | conditions. The anesthesiologist or operating podiatric | 12 | | physician must agree with the anesthesia plan prior to the | 13 | | delivery of services. | 14 | | (b) The collaborating podiatric physician shall have | 15 | | access to the records of all patients attended to by an | 16 | | advanced practice registered nurse. | 17 | | (c) Nothing in this Section shall be construed to limit | 18 | | the delegation of tasks or duties by a podiatric physician to a | 19 | | licensed practical nurse, a registered professional nurse, or | 20 | | other appropriately trained persons. | 21 | | (d) A podiatric physician shall not be liable for the acts | 22 | | or omissions of an advanced practice registered nurse solely | 23 | | on the basis of having signed guidelines or a collaborative | 24 | | agreement, an order, a standing order, a standing delegation | 25 | | order, or other order or guideline authorizing an advanced | 26 | | practice registered nurse to perform acts, unless the |
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| 1 | | podiatric physician has reason to believe the advanced | 2 | | practice registered nurse lacked the competency to perform the | 3 | | act or acts or commits willful or wanton misconduct.
| 4 | | (e) A podiatric physician, may, but is not required to | 5 | | delegate prescriptive authority to an advanced practice | 6 | | registered nurse as part of a written collaborative agreement | 7 | | and the delegation of prescriptive authority shall conform to | 8 | | the requirements of Section 65-40 of the Nurse Practice Act. | 9 | | (Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18 .)
| 10 | | Section 99. Effective date. This Act takes effect upon | 11 | | becoming law.".
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