Illinois General Assembly - Full Text of SB0218
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Full Text of SB0218  103rd General Assembly


Sen. Ann Gillespie

Filed: 3/28/2023





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2    AMENDMENT NO. ______. Amend Senate Bill 218 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Physician Assistant Practice Act of 1987
5is amended by changing Sections 4, 7, 7.5, and 7.7 and by
6adding Section 7.6 as follows:
7    (225 ILCS 95/4)  (from Ch. 111, par. 4604)
8    (Section scheduled to be repealed on January 1, 2028)
9    Sec. 4. Definitions. In this Act:
10    1. "Department" means the Department of Financial and
11Professional Regulation.
12    2. "Secretary" means the Secretary of Financial and
13Professional Regulation.
14    3. "Physician assistant" means any person not holding an
15active license or permit issued by the Department pursuant to
16the Medical Practice Act of 1987 who has been certified as a



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1physician assistant by the National Commission on the
2Certification of Physician Assistants or equivalent successor
3agency and performs procedures in collaboration with a
4physician as defined in this Act. A physician assistant may
5perform such procedures within the specialty of the
6collaborating physician, except that such physician shall
7exercise such direction, collaboration, and control over such
8physician assistants as will assure that patients shall
9receive quality medical care. Physician assistants shall be
10capable of performing a variety of tasks within the specialty
11of medical care in collaboration with a physician.
12Collaboration with the physician assistant shall not be
13construed to necessarily require the personal presence of the
14collaborating physician at all times at the place where
15services are rendered, as long as there is communication
16available for consultation by radio, telephone or
17telecommunications within established guidelines as determined
18by the physician/physician assistant team. The collaborating
19physician may delegate tasks and duties to the physician
20assistant. Delegated tasks or duties shall be consistent with
21physician assistant education, training, and experience. The
22delegated tasks or duties shall be specific to the practice
23setting and shall be implemented and reviewed under a written
24collaborative agreement established by the physician or
25physician/physician assistant team. A physician assistant,
26acting as an agent of the physician, shall be permitted to



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1transmit the collaborating physician's orders as determined by
2the institution's by-laws, policies, procedures, or job
3description within which the physician/physician assistant
4team practices. Physician assistants shall practice only in
5accordance with a written collaborative agreement.
6    Any person who holds an active license or permit issued
7pursuant to the Medical Practice Act of 1987 shall have that
8license automatically placed into inactive status upon
9issuance of a physician assistant license. Any person who
10holds an active license as a physician assistant who is issued
11a license or permit pursuant to the Medical Practice Act of
121987 shall have his or her physician assistant license
13automatically placed into inactive status.
14    3.5. "Physician assistant practice" means the performance
15of procedures within the specialty of the collaborating
16physician. Physician assistants shall be capable of performing
17a variety of tasks within the specialty of medical care of the
18collaborating physician. Collaboration with the physician
19assistant shall not be construed to necessarily require the
20personal presence of the collaborating physician at all times
21at the place where services are rendered, as long as there is
22communication available for consultation by radio, telephone,
23telecommunications, or electronic communications. The
24collaborating physician may delegate tasks and duties to the
25physician assistant. Delegated tasks or duties shall be
26consistent with physician assistant education, training, and



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1experience. The delegated tasks or duties shall be specific to
2the practice setting and shall be implemented and reviewed
3under a written collaborative agreement established by the
4physician or physician/physician assistant team. A physician
5assistant shall be permitted to transmit the collaborating
6physician's orders as determined by the institution's bylaws,
7policies, or procedures or the job description within which
8the physician/physician assistant team practices. Physician
9assistants shall practice only in accordance with a written
10collaborative agreement, except as provided in Section 7.5 of
11this Act.
12    4. "Board" means the Medical Licensing Board constituted
13under the Medical Practice Act of 1987.
14    5. (Blank).
15    6. "Physician" means a person licensed to practice
16medicine in all of its branches under the Medical Practice Act
17of 1987.
18    7. "Collaborating physician" means the physician who,
19within his or her specialty and expertise, may delegate a
20variety of tasks and procedures to the physician assistant.
21Such tasks and procedures shall be delegated in accordance
22with a written collaborative agreement.
23    8. (Blank).
24    9. "Address of record" means the designated address
25recorded by the Department in the applicant's or licensee's
26application file or license file maintained by the



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1Department's licensure maintenance unit.
2    10. "Hospital affiliate" means a corporation, partnership,
3joint venture, limited liability company, or similar
4organization, other than a hospital, that is devoted primarily
5to the provision, management, or support of health care
6services and that directly or indirectly controls, is
7controlled by, or is under common control of the hospital. For
8the purposes of this definition, "control" means having at
9least an equal or a majority ownership or membership interest.
10A hospital affiliate shall be 100% owned or controlled by any
11combination of hospitals, their parent corporations, or
12physicians licensed to practice medicine in all its branches
13in Illinois. "Hospital affiliate" does not include a health
14maintenance organization regulated under the Health
15Maintenance Organization Act.
16    11. "Email address of record" means the designated email
17address recorded by the Department in the applicant's
18application file or the licensee's license file, as maintained
19by the Department's licensure maintenance unit.
20    12. "Federally qualified health center" means a health
21center funded under Section 330 of the federal Public Health
22Service Act.
23(Source: P.A. 102-1117, eff. 1-13-23.)
24    (225 ILCS 95/7)  (from Ch. 111, par. 4607)
25    (Section scheduled to be repealed on January 1, 2028)



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1    Sec. 7. Collaboration requirements.
2    (a) A collaborating physician shall determine the number
3of physician assistants to collaborate with, provided the
4physician is able to provide adequate collaboration as
5outlined in the written collaborative agreement required under
6Section 7.5 of this Act and consideration is given to the
7nature of the physician's practice, complexity of the patient
8population, and the experience of each physician assistant. A
9collaborating physician may collaborate with a maximum of 7
10full-time equivalent physician assistants as described in
11Section 54.5 of the Medical Practice Act of 1987. As used in
12this Section, "full-time equivalent" means the equivalent of
1340 hours per week per individual. Physicians and physician
14assistants who work in a hospital, hospital affiliate,
15federally qualified health center, or ambulatory surgical
16treatment center as defined by Section 7.7 of this Act are
17exempt from the collaborative ratio restriction requirements
18of this Section. A physician assistant shall be able to hold
19more than one professional position. A collaborating physician
20shall file a notice of collaboration of each physician
21assistant according to the rules of the Department.
22    Physician assistants shall collaborate only with
23physicians as defined in this Act who are engaged in clinical
24practice, or in clinical practice in public health or other
25community health facilities.
26    Nothing in this Act shall be construed to limit the



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1delegation of tasks or duties by a physician to a nurse or
2other appropriately trained personnel.
3    Nothing in this Act shall be construed to prohibit the
4employment of physician assistants by a hospital, nursing home
5or other health care facility where such physician assistants
6function under a collaborating physician.
7    A physician assistant may be employed by a practice group
8or other entity employing multiple physicians at one or more
9locations. In that case, one of the physicians practicing at a
10location shall be designated the collaborating physician. The
11other physicians with that practice group or other entity who
12practice in the same general type of practice or specialty as
13the collaborating physician may collaborate with the physician
14assistant with respect to their patients.
15    (b) A physician assistant licensed in this State, or
16licensed or authorized to practice in any other U.S.
17jurisdiction or credentialed by his or her federal employer as
18a physician assistant, who is responding to a need for medical
19care created by an emergency or by a state or local disaster
20may render such care that the physician assistant is able to
21provide without collaboration as it is defined in this Section
22or with such collaboration as is available.
23    Any physician who collaborates with a physician assistant
24providing medical care in response to such an emergency or
25state or local disaster shall not be required to meet the
26requirements set forth in this Section for a collaborating



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2(Source: P.A. 100-453, eff. 8-25-17; 100-605, eff. 1-1-19.)
3    (225 ILCS 95/7.5)
4    (Section scheduled to be repealed on January 1, 2028)
5    Sec. 7.5. Written collaborative agreements; prescriptive
7    (a) A written collaborative agreement is required for all
8physician assistants to practice in the State, except as
9provided in Section 7.7 of this Act.
10        (1) A written collaborative agreement shall describe
11    the working relationship of the physician assistant with
12    the collaborating physician and shall describe the
13    categories of care, treatment, or procedures to be
14    provided by the physician assistant. The written
15    collaborative agreement shall promote the exercise of
16    professional judgment by the physician assistant
17    commensurate with his or her education and experience. The
18    services to be provided by the physician assistant shall
19    be services that the collaborating physician is authorized
20    to and generally provides to his or her patients in the
21    normal course of his or her clinical medical practice. The
22    written collaborative agreement need not describe the
23    exact steps that a physician assistant must take with
24    respect to each specific condition, disease, or symptom
25    but must specify which authorized procedures require the



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



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



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1    physician.
2        (2) The collaborating physician shall file with the
3    Department notice of delegation of prescriptive authority
4    to a physician assistant and termination of delegation,
5    specifying the authority delegated or terminated. Upon
6    receipt of this notice delegating authority to prescribe
7    controlled substances, the physician assistant shall be
8    eligible to register for a mid-level practitioner
9    controlled substances license under Section 303.05 of the
10    Illinois Controlled Substances Act. Nothing in this Act
11    shall be construed to limit the delegation of tasks or
12    duties by the collaborating physician to a nurse or other
13    appropriately trained persons in accordance with Section
14    54.2 of the Medical Practice Act of 1987.
15        (3) In addition to the requirements of this subsection
16    (b), a collaborating physician may, but is not required
17    to, delegate authority to a physician assistant to
18    prescribe Schedule II controlled substances, if all of the
19    following conditions apply:
20            (A) Specific Schedule II controlled substances by
21        oral dosage or topical or transdermal application may
22        be delegated, provided that the delegated Schedule II
23        controlled substances are routinely prescribed by the
24        collaborating physician. This delegation must identify
25        the specific Schedule II controlled substances by
26        either brand name or generic name. Schedule II



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



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1shall be construed to preclude a physician assistant from
2assisting in surgery.
3    (c-5) Nothing in this Section shall be construed to apply
4to any medication authority, including Schedule II controlled
5substances of a licensed physician assistant for care provided
6in a hospital, hospital affiliate, federally qualified health
7center, or ambulatory surgical treatment center pursuant to
8Section 7.7 of this Act.
9    (d) (Blank).
10    (e) Nothing in this Section shall be construed to prohibit
11generic substitution.
12(Source: P.A. 101-13, eff. 6-12-19; 102-558, eff. 8-20-21.)
13    (225 ILCS 95/7.6 new)
14    Sec. 7.6. Written collaborative agreement; temporary
15practice. Any physician assistant required to enter into a
16written collaborative agreement with a collaborating physician
17is authorized to continue to practice for up to 90 days after
18the termination of a written collaborative agreement, provided
19the physician assistant seeks any necessary collaboration at a
20local hospital and refers patients who require services beyond
21the training and experience of the physician assistant to a
22physician or other health care provider.
23    (225 ILCS 95/7.7)
24    (Section scheduled to be repealed on January 1, 2028)



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1    Sec. 7.7. Physician assistants in hospitals, hospital
2affiliates, federally qualified health centers, or ambulatory
3surgical treatment centers.
4    (a) A physician assistant may provide services in a
5hospital as defined in the Hospital Licensing Act, a hospital
6affiliate as defined in the University of Illinois Hospital
7Act, a federally qualified health center, or a licensed
8ambulatory surgical treatment center as defined in the
9Ambulatory Surgical Treatment Center Act without a written
10collaborative agreement pursuant to Section 7.5 of this Act
11only in accordance with this Section. A physician assistant
12must possess clinical privileges recommended by (i) the
13hospital medical staff and granted by the hospital, (ii) the
14physician committee and federally qualified health center, or
15(iii) the consulting medical staff committee and ambulatory
16surgical treatment center in order to provide services. The
17medical staff, physician committee, or consulting medical
18staff committee shall periodically review the services of
19physician assistants granted clinical privileges, including
20any care provided in a hospital affiliate or federally
21qualified health center. Authority may also be granted when
22recommended by the hospital medical staff and granted by the
23hospital, recommended by the physician committee and granted
24by the federally qualified health center, or recommended by
25the consulting medical staff committee and ambulatory surgical
26treatment center to individual physician assistants to select,



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1order, and administer medications, including controlled
2substances, to provide delineated care. In a hospital,
3hospital affiliate, federally qualified health center, or
4ambulatory surgical treatment center, the attending physician
5shall determine a physician assistant's role in providing care
6for his or her patients, except as otherwise provided in the
7medical staff bylaws or consulting committee policies.
8    (a-5) Physician assistants practicing in a hospital
9affiliate or a federally qualified health center may be, but
10are not required to be, granted authority to prescribe
11Schedule II through V controlled substances when such
12authority is recommended by the appropriate physician
13committee of the hospital affiliate and granted by the
14hospital affiliate or recommended by the physician committee
15of the federally qualified health center and granted by the
16federally qualified health center. This authority may, but is
17not required to, include prescription of, selection of, orders
18for, administration of, storage of, acceptance of samples of,
19and dispensing over-the-counter medications, legend drugs,
20medical gases, and controlled substances categorized as
21Schedule II through V controlled substances, as defined in
22Article II of the Illinois Controlled Substances Act, and
23other preparations, including, but not limited to, botanical
24and herbal remedies.
25    To prescribe controlled substances under this subsection
26(a-5), a physician assistant must obtain a mid-level



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1practitioner controlled substance license. Medication orders
2shall be reviewed periodically by the appropriate hospital
3affiliate physicians committee or its physician designee or by
4the physician committee of a federally qualified health
6    The hospital affiliate or federally qualified health
7center shall file with the Department notice of a grant of
8prescriptive authority consistent with this subsection (a-5)
9and termination of such a grant of authority in accordance
10with rules of the Department. Upon receipt of this notice of
11grant of authority to prescribe any Schedule II through V
12controlled substances, the licensed physician assistant may
13register for a mid-level practitioner controlled substance
14license under Section 303.05 of the Illinois Controlled
15Substances Act.
16    In addition, a hospital affiliate or a federally qualified
17health center may, but is not required to, grant authority to a
18physician assistant to prescribe any Schedule II controlled
19substances if all of the following conditions apply:
20        (1) specific Schedule II controlled substances by oral
21    dosage or topical or transdermal application may be
22    designated, provided that the designated Schedule II
23    controlled substances are routinely prescribed by
24    physician assistants in their area of certification; this
25    grant of authority must identify the specific Schedule II
26    controlled substances by either brand name or generic



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1    name; authority to prescribe or dispense Schedule II
2    controlled substances to be delivered by injection or
3    other route of administration may not be granted;
4        (2) any grant of authority must be controlled
5    substances limited to the practice of the physician
6    assistant;
7        (3) any prescription must be limited to no more than a
8    30-day supply;
9        (4) the physician assistant must discuss the condition
10    of any patients for whom a controlled substance is
11    prescribed monthly with the appropriate physician
12    committee of the hospital affiliate or its physician
13    designee, or the physician committee of a federally
14    qualified health center; and
15        (5) the physician assistant must meet the education
16    requirements of Section 303.05 of the Illinois Controlled
17    Substances Act.
18    (b) A physician assistant granted authority to order
19medications including controlled substances may complete
20discharge prescriptions provided the prescription is in the
21name of the physician assistant and the attending or
22discharging physician.
23    (c) Physician assistants practicing in a hospital,
24hospital affiliate, federally qualified health center, or an
25ambulatory surgical treatment center are not required to
26obtain a mid-level controlled substance license to order



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1controlled substances under Section 303.05 of the Illinois
2Controlled Substances Act.
3(Source: P.A. 100-453, eff. 8-25-17.)".