Public Act 100-0577
 
SB1322 EnrolledLRB100 08882 MJP 19025 b


  
    AN ACT concerning regulation.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  


 
    Section 5. The Nurse Practice Act is amended  by changing 
Section 65-35 as follows:
 


    (225 ILCS 65/65-35)
  (was 225 ILCS 65/15-15)


    (Text of Section before amendment by P.A. 100-513)

    (Section scheduled to be repealed on January 1, 2028)

    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, hospital affiliate, or ambulatory surgical 
treatment center.
    (a-5)  If an advanced practice nurse engages in clinical 
practice outside of a hospital, hospital affiliate, 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 
relationship of the
advanced practice nurse with the 
collaborating
physician or podiatric physician and shall 
describe the categories of
care, treatment, or procedures to be 
provided 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
or 
podiatric physician and advanced practice nurse.

    The collaborative
relationship under an agreement shall 
not be
construed to require the personal presence of a  
physician or podiatric physician at the place where services 
are rendered.
 Methods of communication shall
be available for 
consultation with the collaborating
physician or podiatric 
physician in person or by telecommunications or electronic 
communications 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)
In the case of  anesthesia services provided by a 
certified registered nurse anesthetist, an anesthesiologist, a 
physician, a dentist, or a podiatric physician 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.


    (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 podiatric physician 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 podiatric physician 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 
podiatric physician.
    (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, 
dentist, or podiatric physician.  
    (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. 
Nothing in this Act shall be construed to authorize an advanced 
practice nurse to provide health care services required by law 
or rule to be performed by a physician. 
    (f) An advanced
practice nurse shall inform each 
collaborating physician, dentist, or podiatric physician of 
all collaborative
agreements he or she
has signed and provide a 
copy of these to any collaborating physician, dentist, or 
podiatric physician upon
request.

    (g) (Blank).
(Source: P.A. 98-192, eff. 1-1-14; 98-214, eff. 8-9-13; 98-756, 
eff. 7-16-14; 99-173, eff. 7-29-15.)

 
    (Text of Section after amendment by P.A. 100-513)

    (Section scheduled to be repealed on January 1, 2028)

    Sec. 65-35. Written collaborative
agreements.
    (a) A written collaborative agreement is required for all 
advanced practice registered nurses engaged in clinical 
practice prior to meeting the requirements of Section 65-43, 
except for advanced practice registered nurses who are 
privileged to practice in a hospital, hospital affiliate, or 
ambulatory surgical treatment center.
    (a-5)  If an advanced practice registered nurse engages in 
clinical practice outside of a hospital, hospital affiliate, or 
ambulatory surgical treatment center in which he or she is 
privileged to practice, the advanced practice registered nurse 
must have a written collaborative agreement, except as set 
forth in Section 65-43.

    (b) A written collaborative
agreement shall describe the 
relationship of the
advanced practice registered nurse with the 
collaborating
physician and shall describe the categories of

care, treatment, or procedures to be provided by the advanced

practice registered nurse. A collaborative agreement with a 
podiatric physician must be in accordance with subsection (c-5) 
or (c-15) of this Section. A collaborative agreement with a 
dentist must be in accordance with subsection (c-10) of this 
Section. A collaborative agreement  with a podiatric physician 
must be in accordance with subsection (c-5) of this Section.  
Collaboration does not require an
employment relationship 
between the collaborating physician
 and the advanced practice 
registered nurse.

    The collaborative
relationship under an agreement shall 
not be
construed to require the personal presence of a  
collaborating physician at the place where services are 
rendered.
 Methods of communication shall
be available for 
consultation with the collaborating
physician in person or by 
telecommunications or electronic communications 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 registered nurse within the 
scope of the advanced practice registered 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 registered nurse contracts, or 
(3) limit the geographic area or  practice location of the 
advanced practice registered nurse in this State.
    (c)
In the case of  anesthesia services provided by a 
certified registered nurse anesthetist, an anesthesiologist, a 
physician, a dentist, or a podiatric physician 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.


    (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 podiatric physician 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 podiatric physician 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 
podiatric physician.
    (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.
    (c-15) An advanced practice registered nurse who had a 
written collaborative agreement with a podiatric physician 
immediately before the effective date of Public Act 100-513 may 
continue in that collaborative relationship under the 
requirements of this Section and Section 65-40, as those 
Sections existed immediately before the amendment of those 
Sections by Public Act 100-513 with regard to a written 
collaborative agreement between an advanced practice 
registered nurse and a podiatric physician, until the 
collaborative relationship between the advanced practice 
registered nurse and podiatric physician terminates. 
    (d) A copy of the signed, written collaborative agreement 
must be available
to the Department upon request from both the 
advanced practice registered nurse
and the collaborating 
physician, dentist, or podiatric physician.  
    (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. 
    (e-5) Nothing in this Act shall be construed to authorize 
an advanced practice registered nurse to provide health care 
services required by law or rule to be performed by a 
physician, including those acts to be performed by a physician 
in Section 3.1 of the Illinois Abortion Law of 1975. 
    (f) An advanced
practice registered nurse shall inform each 
collaborating physician, dentist, or podiatric physician of 
all collaborative
agreements he or she
has signed and provide a 
copy of these to any collaborating physician, dentist, or 
podiatric physician upon
request.

    (g) (Blank).
(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18.)

 
    Section 95. No acceleration or delay. Where this Act makes 
changes in a statute that is represented in this Act by text 
that is not yet or no longer in effect (for example, a Section 
represented by multiple versions), the use of that text does 
not accelerate or delay the taking effect of (i) the changes 
made by this Act or (ii) provisions derived from any other 
Public Act.
 

    Section 99. Effective date. This Act takes effect January 
1, 2018.