Public Act 098-0192
 
HB1052 EnrolledLRB098 05035 MGM 35066 b

    AN ACT concerning regulation.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Medical Practice Act of 1987 is amended by
changing Section 54.5 as follows:
 
    (225 ILCS 60/54.5)
    (Section scheduled to be repealed on December 31, 2013)
    Sec. 54.5. Physician delegation of authority to physician
assistants and advanced practice nurses.
    (a) Physicians licensed to practice medicine in all its
branches may delegate care and treatment responsibilities to a
physician assistant under guidelines in accordance with the
requirements of the Physician Assistant Practice Act of 1987. A
physician licensed to practice medicine in all its branches may
enter into supervising physician agreements with no more than 5
physician assistants as set forth in subsection (a) of Section
7 of the Physician Assistant Practice Act of 1987.
    (b) A physician licensed to practice medicine in all its
branches in active clinical practice may collaborate with an
advanced practice nurse in accordance with the requirements of
the Nurse Practice Act. Collaboration is for the purpose of
providing medical consultation, and no employment relationship
is required. A written collaborative agreement shall conform to
the requirements of Section 65-35 of the Nurse Practice Act.
The written collaborative agreement shall be for services the
collaborating physician generally provides or may provide in to
his or her patients in the normal course of clinical medical
practice. A written collaborative agreement shall be adequate
with respect to collaboration with advanced practice nurses if
all of the following apply:
        (1) The agreement is written to promote the exercise of
    professional judgment by the advanced practice nurse
    commensurate with his or her education and experience. The
    agreement need not describe the exact steps that an
    advanced practice nurse must take with respect to each
    specific condition, disease, or symptom, but must specify
    those procedures that require a physician's presence as the
    procedures are being performed.
        (2) Practice guidelines and orders are developed and
    approved jointly by the advanced practice nurse and
    collaborating physician, as needed, based on the practice
    of the practitioners. Such guidelines and orders and the
    patient services provided thereunder are periodically
    reviewed by the collaborating physician.
        (3) The advance practice nurse provides services the
    collaborating physician generally provides or may provide
    in to his or her patients in the normal course of clinical
    medical practice, except as set forth in subsection (b-5)
    of this Section. With respect to labor and delivery, the
    collaborating physician must provide delivery services in
    order to participate with a certified nurse midwife.
        (4) The collaborating physician and advanced practice
    nurse consult at least once a month to provide
    collaboration and consultation.
        (5) Methods of communication are available with the
    collaborating physician in person or through
    telecommunications for consultation, collaboration, and
    referral as needed to address patient care needs.
        (6) The agreement contains provisions detailing notice
    for termination or change of status involving a written
    collaborative agreement, except when such notice is given
    for just cause.
    (b-5) An anesthesiologist or physician licensed to
practice medicine in all its branches may collaborate with a
certified registered nurse anesthetist in accordance with
Section 65-35 of the Nurse Practice Act for the provision of
anesthesia services. With respect to the provision of
anesthesia services, the collaborating anesthesiologist or
physician shall have training and experience in the delivery of
anesthesia services consistent with Department rules.
Collaboration shall be adequate if:
        (1) an anesthesiologist or a physician participates in
    the joint formulation and joint approval of orders or
    guidelines and periodically reviews such orders and the
    services provided patients under such orders; and
        (2) for anesthesia services, the anesthesiologist or
    physician participates through discussion of and agreement
    with the anesthesia plan and is physically present and
    available on the premises during the delivery of anesthesia
    services for diagnosis, consultation, and treatment of
    emergency medical conditions. Anesthesia services in a
    hospital shall be conducted in accordance with Section 10.7
    of the Hospital Licensing Act and in an ambulatory surgical
    treatment center in accordance with Section 6.5 of the
    Ambulatory Surgical Treatment Center Act.
    (b-10) The anesthesiologist or operating physician must
agree with the anesthesia plan prior to the delivery of
services.
    (c) The supervising physician shall have access to the
medical records of all patients attended by a physician
assistant. The collaborating physician shall have access to the
medical records of all patients attended to by an advanced
practice nurse.
    (d) (Blank).
    (e) A physician shall not be liable for the acts or
omissions of a physician assistant or advanced practice nurse
solely on the basis of having signed a supervision agreement or
guidelines or a collaborative agreement, an order, a standing
medical order, a standing delegation order, or other order or
guideline authorizing a physician assistant or advanced
practice nurse to perform acts, unless the physician has reason
to believe the physician assistant or advanced practice nurse
lacked the competency to perform the act or acts or commits
willful and wanton misconduct.
    (f) A collaborating physician may, but is not required to,
delegate prescriptive authority to an advanced practice nurse
as part of a written collaborative agreement, and the
delegation of prescriptive authority shall conform to the
requirements of Section 65-40 of the Nurse Practice Act.
    (g) A supervising physician may, but is not required to,
delegate prescriptive authority to a physician assistant as
part of a written supervision agreement, and the delegation of
prescriptive authority shall conform to the requirements of
Section 7.5 of the Physician Assistant Practice Act of 1987.
    (h) For the purposes of this Section, "generally provides
or may provide in his or her clinical medical practice" means
categories of care or treatment, not specific tasks or duties,
that the physician provides individually or through delegation
to other persons so that the physician has the experience and
ability to provide collaboration and consultation. This
definition shall not be construed to prohibit an advanced
practice nurse from providing primary health treatment or care
within the scope of his or her training and experience,
including, but not limited to, health screenings, patient
histories, physical examinations, women's health examinations,
or school physicals that may be provided as part of the routine
practice of an advanced practice nurse or on a volunteer basis.
(Source: P.A. 96-618, eff. 1-1-10; 97-358, eff. 8-12-11;
97-1071, eff. 8-24-12.)
 
    Section 10. The Nurse Practice Act is amended by changing
Section 65-35 as follows:
 
    (225 ILCS 65/65-35)   (was 225 ILCS 65/15-15)
    (Section scheduled to be repealed on January 1, 2018)
    Sec. 65-35. Written collaborative agreements.
    (a) A written collaborative agreement is required for all
advanced practice nurses engaged in clinical practice, except
for advanced practice nurses who are authorized to practice in
a hospital or ambulatory surgical treatment center.
    (a-5) If an advanced practice nurse engages in clinical
practice outside of a hospital or ambulatory surgical treatment
center in which he or she is authorized to practice, the
advanced practice nurse must have a written collaborative
agreement.
    (b) A written collaborative agreement shall describe the
working relationship of the advanced practice nurse with the
collaborating physician or podiatrist and shall authorize the
categories of care, treatment, or procedures to be performed by
the advanced practice nurse. A collaborative agreement with a
dentist must be in accordance with subsection (c-10) of this
Section. Collaboration does not require an employment
relationship between the collaborating physician and advanced
practice nurse. Absent an employment relationship, an
agreement may not restrict the categories of patients or
third-party payment sources accepted by the advanced practice
nurse. Collaboration means the relationship under which an
advanced practice nurse works with a collaborating physician or
podiatrist in an active clinical practice to deliver health
care services in accordance with (i) the advanced practice
nurse's training, education, and experience and (ii)
collaboration and consultation as documented in a jointly
developed written collaborative agreement.
    The agreement shall promote the exercise of professional
judgment by the advanced practice nurse commensurate with his
or her education and experience. The services to be provided by
the advanced practice nurse shall be services that the
collaborating physician or podiatrist is authorized to and
generally provides or may provide to his or her patients in the
normal course of his or her clinical medical or podiatric
practice, except as set forth in subsections (b-5) or
subsection (c-5) of this Section. The agreement need not
describe the exact steps that an advanced practice nurse must
take with respect to each specific condition, disease, or
symptom but must specify which authorized procedures require
the presence of the collaborating physician or podiatrist as
the procedures are being performed. The collaborative
relationship under an agreement shall not be construed to
require the personal presence of a physician or podiatrist at
the place where services are rendered. Methods of communication
shall be available for consultation with the collaborating
physician or podiatrist in person or by telecommunications in
accordance with established written guidelines as set forth in
the written agreement.
    (b-5) Absent an employment relationship, a written
collaborative agreement may not (1) restrict the categories of
patients of an advanced practice nurse within the scope of the
advanced practice nurses training and experience, (2) limit
third party payors or government health programs, such as the
medical assistance program or Medicare with which the advanced
practice nurse contracts, or (3) limit the geographic area or
practice location of the advanced practice nurse in this State.
    (c) Collaboration and consultation under all collaboration
agreements shall be adequate if a collaborating physician or
podiatrist does each of the following:
        (1) Participates in the joint formulation and joint
    approval of orders or guidelines with the advanced practice
    nurse and he or she periodically reviews such orders and
    the services provided patients under such orders in
    accordance with accepted standards of medical practice or
    podiatric practice and advanced practice nursing practice.
        (2) Provides collaboration and consultation with the
    advanced practice nurse at least once a month. In the case
    of anesthesia services provided by a certified registered
    nurse anesthetist, an anesthesiologist, physician,
    dentist, or podiatrist must participate through discussion
    of and agreement with the anesthesia plan and remain
    physically present and available on the premises during the
    delivery of anesthesia services for diagnosis,
    consultation, and treatment of emergency medical
    conditions.
        (3) Is available through telecommunications for
    consultation on medical problems, complications, or
    emergencies or patient referral. In the case of anesthesia
    services provided by a certified registered nurse
    anesthetist, an anesthesiologist, physician, dentist, or
    podiatrist must participate through discussion of and
    agreement with the anesthesia plan and remain physically
    present and available on the premises during the delivery
    of anesthesia services for diagnosis, consultation, and
    treatment of emergency medical conditions.
    The agreement must contain provisions detailing notice for
termination or change of status involving a written
collaborative agreement, except when such notice is given for
just cause.
    (c-5) A certified registered nurse anesthetist, who
provides anesthesia services outside of a hospital or
ambulatory surgical treatment center shall enter into a written
collaborative agreement with an anesthesiologist or the
physician licensed to practice medicine in all its branches or
the podiatrist performing the procedure. Outside of a hospital
or ambulatory surgical treatment center, the certified
registered nurse anesthetist may provide only those services
that the collaborating podiatrist is authorized to provide
pursuant to the Podiatric Medical Practice Act of 1987 and
rules adopted thereunder. A certified registered nurse
anesthetist may select, order, and administer medication,
including controlled substances, and apply appropriate medical
devices for delivery of anesthesia services under the
anesthesia plan agreed with by the anesthesiologist or the
operating physician or operating podiatrist.
    (c-10) A certified registered nurse anesthetist who
provides anesthesia services in a dental office shall enter
into a written collaborative agreement with an
anesthesiologist or the physician licensed to practice
medicine in all its branches or the operating dentist
performing the procedure. The agreement shall describe the
working relationship of the certified registered nurse
anesthetist and dentist and shall authorize the categories of
care, treatment, or procedures to be performed by the certified
registered nurse anesthetist. In a collaborating dentist's
office, the certified registered nurse anesthetist may only
provide those services that the operating dentist with the
appropriate permit is authorized to provide pursuant to the
Illinois Dental Practice Act and rules adopted thereunder. For
anesthesia services, an anesthesiologist, physician, or
operating dentist shall participate through discussion of and
agreement with the anesthesia plan and shall remain physically
present and be available on the premises during the delivery of
anesthesia services for diagnosis, consultation, and treatment
of emergency medical conditions. A certified registered nurse
anesthetist may select, order, and administer medication,
including controlled substances, and apply appropriate medical
devices for delivery of anesthesia services under the
anesthesia plan agreed with by the operating dentist.
    (d) A copy of the signed, written collaborative agreement
must be available to the Department upon request from both the
advanced practice nurse and the collaborating physician or
podiatrist.
    (e) Nothing in this Act shall be construed to limit the
delegation of tasks or duties by a physician to a licensed
practical nurse, a registered professional nurse, or other
persons in accordance with Section 54.2 of the Medical Practice
Act of 1987. Nothing in this Act shall be construed to limit
the method of delegation that may be authorized by any means,
including, but not limited to, oral, written, electronic,
standing orders, protocols, guidelines, or verbal orders.
    (f) An advanced practice nurse shall inform each
collaborating physician, dentist, or podiatrist of all
collaborative agreements he or she has signed and provide a
copy of these to any collaborating physician, dentist, or
podiatrist upon request.
    (g) For the purposes of this Act, "generally provides or
may provide in to his or her patients in the normal course of
his or her clinical medical practice" means categories of care
or treatment services, not specific tasks or duties, the
physician or podiatrist routinely provides individually or
through delegation to other persons so that the physician or
podiatrist has the experience and ability to provide
collaboration and consultation. This definition shall not be
construed to prohibit an advanced practice nurse from providing
primary health treatment or care within the scope of his or her
training and experience, including, but not limited to, health
screenings, patient histories, physical examinations, women's
health examinations, or school physicals that may be provided
as part of the routine practice of an advanced practice nurse
or on a volunteer basis.
    For the purposes of this Act, "generally provides to his or
her patients in the normal course of his or her clinical
podiatric practice" means services, not specific tasks or
duties, that the podiatrist routinely provides individually or
through delegation to other persons so that the podiatrist has
the experience and ability to provide collaboration and
consultation.
(Source: P.A. 96-618, eff. 1-1-10; 97-358, eff. 8-12-11.)