Public Act 095-0911
 		





HB4673 Enrolled
LRB095 15669 RAS 41674 b






    AN ACT concerning regulation.

 
    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 and 
consultation 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.

    (2.5) A registered nurse licensed under the Nurse Practice 
Act and qualified by training and experience in operating room 
nursing shall be present in the operating room and function as 
the circulating nurse during all invasive or operative 
procedures. For purposes of this paragraph (2.5), "circulating 
nurse" means a registered nurse who is responsible for 
coordinating all nursing care, patient safety needs, and the 
needs of the surgical team in the operating room during an 
invasive or operative procedure.

    (3)  An advanced practice nurse is not required to possess 
prescriptive authority or a written collaborative agreement 
meeting the requirements of the Nurse Practice Act to provide 
advanced practice nursing services in an ambulatory surgical 
treatment center.    An advanced practice nurse must possess 
clinical privileges granted by the consulting medical staff 
committee and ambulatory surgical treatment center in order to 
provide services.  Individual advanced practice nurses may also 
be granted clinical privileges to order, select, and administer 
medications, including controlled substances,  to provide 
delineated care.  The attending physician must determine the 
advance practice nurse's role in providing care for his or her 
patients, except as otherwise provided in the consulting staff 
policies.  The consulting medical staff committee shall 
periodically review the services of advanced practice nurses 
granted privileges.

    (4)  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; or .
            (v) a podiatrist licensed under the Podiatric 
        Medical Practice Act of 1987. 


        (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 65-35 of the Nurse Practice 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. 94-915, eff. 1-1-07; 95-639, eff. 10-5-07.)

 
    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 
and consultation 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.

    (2.5) A registered nurse licensed under the Nurse Practice 
Act and qualified by training and experience in operating room 
nursing shall be present in the operating room and function as 
the circulating nurse during all invasive or operative 
procedures. For purposes of this paragraph (2.5), "circulating 
nurse" means a registered nurse who is responsible for 
coordinating all nursing care, patient safety needs, and the 
needs of the surgical team in the operating room during an 
invasive or operative procedure.

    (3)  An advanced practice nurse is not required to possess 
prescriptive authority or a written collaborative agreement 
meeting the requirements of the Nurse Practice Act to provide 
advanced practice nursing services in a hospital.    An advanced 
practice nurse must possess clinical privileges recommended by 
the  medical staff and granted by the hospital in order to 
provide services.  Individual advanced practice nurses may also 
be granted clinical privileges to order, select, and administer 
medications, including controlled substances, to provide 
delineated care.  The attending physician must determine the 
advance practice nurse's role in providing care for his or her 
patients, except as otherwise provided in medical staff bylaws.  
The medical staff shall periodically review the services of 
advanced practice nurses granted privileges. This review shall 
be conducted in accordance with item (2) of subsection (a) of 
Section 10.8 of this Act for  advanced practice nurses employed 
by the hospital.

    (4) 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; or .
            (v) a podiatrist licensed under the Podiatric 
        Medical Practice Act of 1987. 


        (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 65-35 of the Nurse Practice 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. 94-915, eff. 1-1-07; 95-639, eff. 10-5-07.)

 

    Section 99. Effective date. This Act takes effect upon 
becoming law.