HB3154ham001 94TH GENERAL ASSEMBLY

Rep. Rich Brauer

Filed: 4/12/2005

09400HB3154ham001 LRB094 07743 DRJ 44586 a

AMENDMENT TO HOUSE BILL 3154

AMENDMENT NO. ______. Amend House Bill 3154 by replacing everything after the enacting clause with the following:

"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; or

(v) a registered nurse under the conditions set forth in item (D).

(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.

(D) A registered nurse may administer conscious sedation, as defined in the Medical Practice Act of 1987, under the following conditions:

(1) The registered nurse has privileges granted by the medical staff and ASTC to administer conscious sedation.

(2) The registered nurse is under the direct supervision of the operating physician or dentist during the delivery conscious sedation.

(3) The registered nurse maintains current Advanced Cardiac Life Support certification.

(4) The operating physician has training and experience in the delivery of anesthesia services to patients by either possessing clinical privileges at the ASTC to administer anesthesia or completing a minimum of 8 hours of continuing education (CME) in the delivery of anesthesia, including the administration of conscious sedation within each 3-year license period.

In addition, the operating physician or dentist with authority to administer anesthesia under Section 8.1 of the Illinois Dental Practice Act must maintain current Advanced Cardiac Life Support certification. This training and experience must be documented in the operating physician or dentist clinical privilege file.

(Source: P.A. 93-352, eff. 1-1-04.)

Section 10. The Medical Practice Act of 1987 is amended by adding Section 54.7 as follows:

(225 ILCS 60/54.7 new)

Sec. 54.7. Anesthesia services.

(a) Any physician may order and administer anesthesia services in accordance with his or her training or experience.

(b) In a hospital setting, anesthesia services shall be administered in accordance with Section 10.7 of the Hospital Licensing Act.

(c) In an ambulatory surgical treatment center, anesthesia services shall be administered in accordance with Section 6.5 of the Ambulatory Surgical Treatment Center Act.

(d) In a physician's office, anesthesia services shall be administered in accordance with the following:

(1) In a physician's office, the operating physician shall have training and experience in the delivery of anesthesia services in order to administer anesthesia or to enter into a practice agreement with a certified registered nurse anesthetist (CRNA) to provide anesthesia services in the office pursuant to Section 54.5 of the Medical Practice Act and Section 15-25 of the Nursing and Advanced Practice Nursing Act. When an anesthesiologist is administering anesthesia in a physician's office, the operating physician is not required to have the training and experience set forth in paragraph (2). A "physician's office" is any practice location not regulated by Section 10.7 of the Hospital Licensing Act or Section 6.5 of the Ambulatory Surgical Treatment Center Act.

(2) The training and experience requirements may be met in the manner specified in either subparagraph (A) or subparagraph (B):

(A) The physician maintains clinic privileges to administer anesthesia services in a hospital licensed in accordance with the Hospital Licensing Act or an ambulatory surgical treatment center licensed in accordance with the Ambulatory Surgical Treatment Center Act; or

(B) Completion of continuing medical education:

(i) For conscious sedation only, the physician shall complete a minimum of 8 hours of continuing medical education (CME) in delivery of anesthesia, including the administration of conscious sedation within each 3-year license renewal period.

(ii) For deep sedation, regional anesthesia, or general anesthesia, or any combination of those, a physician shall complete a minimum of 34 hours of continuing medical education in the delivery of anesthesia services within each 3-year license renewal period. Fulfillment of this requirement shall satisfy the requirement of subdivision (2)(B)(i) for the administration of conscious sedation.

(iii) A continuing medical education program shall be conducted by a university, professional association, or hospital as a formal CME program.

(3) In a physician's office where anesthesia is administered, all operating physicians and anesthesiologists shall obtain Advanced Cardiac Life Support (ACLS) certification and shall thereafter maintain current ACLS certification. If the physician enters into a practice agreement with a CRNA, the CRNA shall also have a current ACLS certification.

(4) The ACLS certification and the physician training and experience required by this Section shall be documented in the written practice agreement between the physician and the CRNA.

(5) The continuing medical education required in paragraph (2) and the ACLS training required in paragraph (3) may be applied to fulfillment of the 150 hours of continuing medical education required for renewal of a license.

(6) For the provision of anesthesia services, the operating physician or 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.

(e) "Conscious sedation" means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is maintained.

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