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Public Act 098-0192 Public Act 0192 98TH GENERAL ASSEMBLY |
Public Act 098-0192 | HB1052 Enrolled | LRB098 05035 MGM 35066 b |
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| 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| (Section scheduled to be repealed on December 31, 2013)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
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| (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.)
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Effective Date: 1/1/2014
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