Public Act 93-0352

HB3618 Enrolled                      LRB093 10431 JAM 10685 b

    AN ACT concerning public health.

    Be it enacted by the People of  the  State  of  Illinois,
represented in the General Assembly:

    Section  5.  The Ambulatory Surgical Treatment Center Act
is amended by changing Section 6.5 as follows:

    (210 ILCS 5/6.5)
    Sec. 6.5.  Clinical privileges; advanced practice nurses.
All ambulatory surgical  treatment  centers  (ASTC)  licensed
under this Act shall comply with the following requirements:
    (1)  No  ASTC policy, rule, regulation, or practice shall
be inconsistent with the provision of adequate collaboration,
including medical direction  of  licensed  advanced  practice
nurses,  in  accordance  with  Section  54.5  of  the Medical
Practice Act of 1987.
    (2)  Operative surgical  procedures  shall  be  performed
only  by a physician licensed to practice medicine in all its
branches under the Medical Practice Act of  1987,  a  dentist
licensed  under  the  Illinois  Dental  Practice  Act,  or  a
podiatrist  licensed under the Podiatric Medical Practice Act
of 1987, with medical staff membership and surgical  clinical
privileges granted by the consulting committee of the ASTC. A
licensed physician, dentist, or podiatrist may be assisted by
a   physician  licensed  to  practice  medicine  in  all  its
branches, dentist,  dental  assistant,  podiatrist,  licensed
advanced   practice   nurse,  licensed  physician  assistant,
licensed registered nurse, licensed practical nurse, surgical
assistant, surgical technician, or other individuals  granted
clinical  privileges  to  assist in surgery by the consulting
committee of the ASTC. Payment for services  rendered  by  an
assistant  in  surgery  who  is  not  an  ambulatory surgical
treatment center employee shall be paid  at  the  appropriate
non-physician  modifier  rate  if  the  payor would have made
payment had the same services been provided by a physician.
    (3)   The anesthesia service shall be under the direction
of a physician licensed  to  practice  medicine  in  all  its
branches who has had specialized preparation or experience in
the  area or who has completed a residency in anesthesiology.
An anesthesiologist, Board certified or  Board  eligible,  is
recommended.  Anesthesia  services  may  only be administered
pursuant to the order of a  physician  licensed  to  practice
medicine  in  all its branches, licensed dentist, or licensed
podiatrist.
         (A)  The individuals who, with  clinical  privileges
    granted  by  the  medical  staff and ASTC, may administer
    anesthesia services are limited to the following:
              (i)  an anesthesiologist; or
              (ii)  a physician licensed to practice medicine
         in all its branches; or
              (iii)  a dentist with authority  to  administer
         anesthesia  under Section 8.1 of the Illinois Dental
         Practice Act; or
              (iv)  a  licensed  certified  registered  nurse
         anesthetist.
         (B)  For anesthesia  services,  an  anesthesiologist
    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. In the absence  of  24-hour  availability  of
    anesthesiologists  with clinical privileges, an alternate
    policy   (requiring    participation,    presence,    and
    availability of a physician licensed to practice medicine
    in  all  its  branches) shall be developed by the medical
    staff  consulting  committee  in  consultation  with  the
    anesthesia service and  included  in  the  medical  staff
    consulting committee policies.
         (C)  A certified registered nurse anesthetist is not
    required  to  possess prescriptive authority or a written
    collaborative  agreement  meeting  the  requirements   of
    Section  15-15  of  the  Nursing  and  Advanced  Practice
    Nursing  Act  to provide anesthesia services ordered by a
    licensed physician,  dentist,  or  podiatrist.   Licensed
    certified registered nurse anesthetists are authorized to
    select,   order,  and  administer  drugs  and  apply  the
    appropriate  medical  devices   in   the   provision   of
    anesthesia services under the anesthesia plan agreed with
    by   the  anesthesiologist  or,  in  the  absence  of  an
    available  anesthesiologist  with  clinical   privileges,
    agreed   with   by  the  operating  physician,  operating
    dentist, or operating podiatrist in accordance  with  the
    medical staff consulting committee policies of a licensed
    ambulatory surgical treatment center.
(Source: P.A. 90-742, eff. 8-13-98; 91-414, eff. 8-6-99.)

    Section  10.  The  Hospital  Licensing  Act is amended by
changing Section 10.7 as follows:

    (210 ILCS 85/10.7)
    Sec.  10.7.  Clinical   privileges;   advanced   practice
nurses.    All hospitals licensed under this Act shall comply
with the following requirements:
    (1)  No hospital policy, rule,  regulation,  or  practice
shall   be   inconsistent  with  the  provision  of  adequate
collaboration,  including  medical  direction   of   licensed
advanced  practice nurses, in accordance with Section 54.5 of
the Medical Practice Act of 1987.
    (2)  Operative surgical  procedures  shall  be  performed
only  by a physician licensed to practice medicine in all its

branches under the Medical Practice Act of  1987,  a  dentist
licensed  under  the  Illinois  Dental  Practice  Act,  or  a
podiatrist  licensed under the Podiatric Medical Practice Act
of 1987, with medical staff membership and surgical  clinical
privileges  granted  at  the hospital.  A licensed physician,
dentist,  or  podiatrist  may  be  assisted  by  a  physician
licensed to practice medicine in all its  branches,  dentist,
dental  assistant,  podiatrist,  licensed  advanced  practice
nurse,  licensed  physician  assistant,  licensed  registered
nurse, licensed practical nurse, surgical assistant, surgical
technician,  or other individuals granted clinical privileges
to assist in surgery at the hospital.  Payment  for  services
rendered  by  an  assistant  in surgery who is not a hospital
employee shall  be  paid  at  the  appropriate  non-physician
modifier  rate  if  the payor would have made payment had the
same services been provided by a physician.
    (3)  The anesthesia service shall be under the  direction
of  a  physician  licensed  to  practice  medicine in all its
branches who has had specialized preparation or experience in
the area or who has completed a residency in  anesthesiology.
An  anesthesiologist,  Board  certified or Board eligible, is
recommended. Anesthesia services  may  only  be  administered
pursuant  to  the  order  of a physician licensed to practice
medicine in all its branches, licensed dentist,  or  licensed
podiatrist.
         (A)  The  individuals  who, with clinical privileges
    granted  at  the  hospital,  may  administer   anesthesia
    services are limited to the following:
              (i)  an anesthesiologist; or
              (ii)  a physician licensed to practice medicine
         in all its branches; or
              (iii)  a  dentist  with authority to administer
         anesthesia under Section 8.1 of the Illinois  Dental
         Practice Act; or
              (iv)  a  licensed  certified  registered  nurse
         anesthetist.
         (B)  For  anesthesia  services,  an anesthesiologist
    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.  In  the  absence  of 24-hour availability of
    anesthesiologists  with  medical  staff  privileges,   an
    alternate  policy (requiring participation, presence, and
    availability of a physician licensed to practice medicine
    in all its branches) shall be developed  by  the  medical
    staff  and  licensed  hospital  in  consultation with the
    anesthesia service.
         (C)  A certified registered nurse anesthetist is not
    required to possess prescriptive authority or  a  written
    collaborative   agreement  meeting  the  requirements  of
    Section  15-15  of  the  Nursing  and  Advanced  Practice
    Nursing Act to provide anesthesia services ordered  by  a
    licensed  physician,  dentist,  or  podiatrist.  Licensed
    certified registered nurse anesthetists are authorized to
    select,  order,  and  administer  drugs  and  apply   the
    appropriate   medical   devices   in   the  provision  of
    anesthesia services under the anesthesia plan agreed with
    by  the  anesthesiologist  or,  in  the  absence  of   an
    available   anesthesiologist  with  clinical  privileges,
    agreed  with  by  the  operating   physician,   operating
    dentist,  or  operating podiatrist in accordance with the
    hospital's alternative policy.
(Source: P.A. 90-742, eff. 8-13-98; 91-414, eff. 8-6-99.)