Public Act 096-0618
 		





SB0318 Enrolled
LRB096 08980 ASK 19119 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 and  by adding Section 54.2 as follows:
 
    (225 ILCS 60/54.2  new)
    (Section scheduled to be repealed on December 31, 2010)
    Sec. 54.2. Physician delegation of authority. 
    (a)  Nothing in this Act shall be construed to limit the 
delegation of patient care tasks or duties by a physician, to a 
licensed practical nurse, a registered professional nurse, or 
other licensed person practicing within the scope of his or her 
individual licensing Act.  Delegation by a  physician licensed to 
practice medicine in all its branches to physician assistants 
or advanced practice nurses is also addressed in Section 54.5 
of this Act.  No physician may delegate any patient care task or 
duty that is statutorily or by rule mandated to be performed by 
a physician.
    (b)  In an office or practice setting and within a 
physician-patient relationship, a physician may delegate 
patient care tasks or duties to an unlicensed person who 
possesses appropriate training and experience provided a 
health care professional, who is practicing within the scope of 
such licensed professional's individual licensing Act, is on 
site to provide assistance.
    (c)  Any such patient care task or duty delegated to a 
licensed or unlicensed person must be within the scope of 
practice, education, training, or experience of the delegating 
physician and within the context of a physician-patient 
relationship.
    (d)  Nothing in this Section shall be construed to affect 
referrals for professional services required by law.
    (e)  The Department shall have the authority to promulgate 
rules concerning a physician's delegation, including but not 
limited to, the use of light emitting devices for patient care 
or treatment.
 



    (225 ILCS 60/54.5)


    (Section scheduled to be repealed on December 31, 2010)

    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 2 
physician assistants.

    (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 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 to his or her 
    patients in the normal course of clinical 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 meet in person 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). Nothing in this Act
shall be construed to 
limit the delegation of
tasks or duties by a physician licensed 
to practice medicine
in all its branches to a licensed 
practical nurse, a registered professional
nurse, or other 
persons.

    (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.

(Source: P.A. 95-639, eff. 10-5-07.)

 
    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.  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 be defined to 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 to his or her
patients in 
the normal course of his or her clinical medical practice, 
except as set forth in 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
all times 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.

    (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 and 
    advanced practice nursing practice.


        (2) Meets in person with the advanced practice nurse at 
    least once a month to provide collaboration and

    consultation. 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.
    (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.

(Source: P.A. 95-639, eff. 10-5-07.)

 
    Section 15. The Physician Assistant Practice Act of 1987 is 
amended  by changing Section 7.5 as follows:
 



    (225 ILCS 95/7.5)



    (Section scheduled to be repealed on January 1, 2018)

    Sec. 7.5. Prescriptions. A supervising physician may 
delegate
limited prescriptive authority to a physician 
assistant.
This authority may, but is not required to, include 
prescription and
dispensing of legend
drugs and legend 
controlled substances categorized as Schedule III, IV, or V

controlled substances, as defined in Article II of the Illinois 
Controlled
Substances Act, as delegated in the written 
guidelines required by this
Act. To prescribe Schedule III, IV, 
or V controlled substances under this
Section, a physician 
assistant must obtain a mid-level practitioner
controlled 
substances license. Medication orders issued by a
physician

assistant shall be reviewed
periodically by the supervising 
physician. The supervising physician shall file
with the 
Department notice of delegation of prescriptive authority to a

physician assistant and
termination of delegation, specifying 
the authority delegated or terminated.
Upon receipt of this 
notice delegating authority to prescribe Schedule III,
IV, or V 
controlled substances, the physician assistant shall be 
eligible to
register for a mid-level practitioner controlled 
substances license under
Section 303.05 of the Illinois 
Controlled Substances Act.
Nothing in this Act shall be 
construed to limit the delegation of tasks or
duties by the 
supervising physician to a nurse or other appropriately trained 
persons in accordance with Section 54.2 of the Medical Practice 
Act of 1987
personnel.

    The Department shall establish by rule the minimum 
requirements for
written guidelines to be followed under this 
Section.

(Source: P.A. 90-116, eff. 7-14-97; 90-818, eff. 3-23-99.)

 
    Section 20. The Podiatric Medical Practice Act of 1987 is 
amended  by changing Section 20.5 as follows:
 
    (225 ILCS 100/20.5)
    (Section scheduled to be repealed on January 1, 2018)

    Sec. 20.5. Delegation of authority to advanced practice 
nurses.

    (a)  A podiatrist in active clinical practice may 
collaborate with an advanced practice nurse in accordance with 
the requirements of the Nurse Practice Act.  Collaboration shall 
be for the purpose of providing podiatric  consultation and no 
employment relationship shall be 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 podiatrist generally provides to his or her 
patients in the normal course of clinical podiatric practice, 
except as set forth in item (3) of this subsection (a).  A 
written collaborative agreement and podiatric collaboration 
and consultation shall be adequate with respect to 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 
    which procedures require a podiatrist'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 podiatrist, 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 podiatrist.
        (3)  The advance practice nurse provides services that 
    the collaborating podiatrist generally provides to  his or 
    her patients in the normal course of clinical practice.  
    With respect to the provision of anesthesia services by a 
    certified registered nurse anesthetist, the collaborating 
    podiatrist must have training and experience in the 
    delivery of anesthesia consistent with Department rules.
        (4)  The collaborating podiatrist and the advanced 
    practice nurse meet in person  at least once a month to 
    provide collaboration and consultation.
        (5)  Methods of communication are available with the 
    collaborating podiatrist in person or through 
    telecommunications for consultation, collaboration, and 
    referral as needed to address patient care needs.
        (6)  With respect to the provision of anesthesia 
    services by a certified registered nurse anesthetist, an 
    anesthesiologist, physician, or podiatrist 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. The anesthesiologist or 
    operating podiatrist must agree with the anesthesia plan 
    prior to the delivery of services.
        (7)  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)  The collaborating podiatrist shall have access to the 
records of all patients attended to by an advanced practice 
nurse.
    (c)  Nothing in this Section shall be construed to limit the 
delegation of tasks or duties by a podiatrist to a licensed 
practical nurse, a registered professional nurse, or other 
appropriately trained persons.
    (d)  A podiatrist shall not be liable for the acts or 
omissions of an advanced practice nurse solely on the basis of 
having signed guidelines or a collaborative agreement, an 
order, a standing order, a standing delegation order, or other 
order or guideline authorizing an advanced practice nurse to 
perform acts, unless the podiatrist has reason to believe the 
advanced practice nurse lacked the competency to perform the 
act or acts or commits willful or  wanton misconduct.

(Source: P.A. 95-639, eff. 10-5-07.)
 
    Section 99. Effective date. This Act takes effect January 
1, 2010.