101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB1683

 

Introduced 2/15/2019, by Sen. Emil Jones, III

 

SYNOPSIS AS INTRODUCED:
 
225 ILCS 65/65-35  was 225 ILCS 65/15-15
225 ILCS 65/65-43
225 ILCS 65/65-45  was 225 ILCS 65/15-25

    Amends the Nurse Practice Act. Provides that collaboration does not require an employment relationship between the collaborating physician, podiatric physician, or dentist and the advanced practice registered nurse. Provides that, 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 available (rather than remain physically present and available on the premises during the delivery of anesthesia services) for diagnosis, consultation, and treatment of emergency medical conditions. Makes changes concerning the written collaborative agreements between a certified registered nurse anesthetist and a dentist. Changes provisions concerning full practice authority to apply them to certified registered nurse anesthetists. Requires that during the delivery of anesthesia by a certified registered nurse anesthetists, the attestation for completion of clinical experience must be attested to by the collaborating physician or physicians, podiatrists, or dentists, and the certified registered nurse anesthetist. Makes other changes. Effective immediately.


LRB101 07977 RAB 53033 b

 

 

A BILL FOR

 

SB1683LRB101 07977 RAB 53033 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Nurse Practice Act is amended by changing
5Sections 65-35, 65-43, and 65-45 as follows:
 
6    (225 ILCS 65/65-35)   (was 225 ILCS 65/15-15)
7    (Section scheduled to be repealed on January 1, 2028)
8    Sec. 65-35. Written collaborative agreements.
9    (a) A written collaborative agreement is required for all
10advanced practice registered nurses engaged in clinical
11practice prior to meeting the requirements of Section 65-43,
12except for advanced practice registered nurses who are
13privileged to practice in a hospital, hospital affiliate, or
14ambulatory surgical treatment center.
15    (a-5) If an advanced practice registered nurse engages in
16clinical practice outside of a hospital, hospital affiliate, or
17ambulatory surgical treatment center in which he or she is
18privileged to practice, the advanced practice registered nurse
19must have a written collaborative agreement, except as set
20forth in Section 65-43.
21    (b) A written collaborative agreement shall describe the
22relationship of the advanced practice registered nurse with the
23collaborating physician and shall describe the categories of

 

 

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1care, treatment, or procedures to be provided by the advanced
2practice registered nurse. A collaborative agreement with a
3podiatric physician must be in accordance with subsection (c-5)
4or (c-15) of this Section. A collaborative agreement with a
5dentist must be in accordance with subsection (c-5) (c-10) of
6this Section. A collaborative agreement with a podiatric
7physician must be in accordance with subsection (c-5) of this
8Section. Collaboration does not require an employment
9relationship between the collaborating physician, podiatric
10physician, or dentist and the advanced practice registered
11nurse.
12    The collaborative relationship under an agreement shall
13not be construed to require the personal presence of a
14collaborating physician at the place where services are
15rendered, except for the delivery of anesthesia in accordance
16with subsection (c-5) of this Section. Methods of communication
17shall be available for consultation with the collaborating
18physician in person or by telecommunications or electronic
19communications as set forth in the written agreement.
20    (b-5) Absent an employment relationship, a written
21collaborative agreement may not (1) restrict the categories of
22patients of an advanced practice registered nurse within the
23scope of the advanced practice registered nurses training and
24experience, (2) limit third party payors or government health
25programs, such as the medical assistance program or Medicare
26with which the advanced practice registered nurse contracts, or

 

 

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1(3) limit the geographic area or practice location of the
2advanced practice registered nurse in this State.
3    (c) In the case of anesthesia services provided by a
4certified registered nurse anesthetist, an anesthesiologist, a
5physician, a dentist, or a podiatric physician must participate
6through discussion of and agreement with the anesthesia plan
7and remain physically present and available on the premises
8during the delivery of anesthesia services for diagnosis,
9consultation, and treatment of emergency medical conditions.
10    (c-5) A certified registered nurse anesthetist, who
11provides anesthesia services outside of a hospital or
12ambulatory surgical treatment center shall enter into a written
13collaborative agreement with an anesthesiologist or the
14physician licensed to practice medicine in all its branches, or
15the podiatric physician, or the dentist who has the appropriate
16permit under the Illinois Dental Practice Act performing the
17procedure. Outside of a hospital or ambulatory surgical
18treatment center, the certified registered nurse anesthetist
19may provide only those services that the collaborating
20podiatric physician or dentist is authorized to provide
21pursuant to the Podiatric Medical Practice Act of 1987 or the
22Illinois Dental Practice Act and rules adopted under those Acts
23thereunder. A certified registered nurse anesthetist may
24select, order, and administer medication, including controlled
25substances, and apply appropriate medical devices for delivery
26of anesthesia services under the anesthesia plan agreed with by

 

 

SB1683- 4 -LRB101 07977 RAB 53033 b

1the anesthesiologist or the operating physician or operating
2podiatric physician.
3    (c-10) (Blank). A certified registered nurse anesthetist
4who provides anesthesia services in a dental office shall enter
5into a written collaborative agreement with an
6anesthesiologist or the physician licensed to practice
7medicine in all its branches or the operating dentist
8performing the procedure. The agreement shall describe the
9working relationship of the certified registered nurse
10anesthetist and dentist and shall authorize the categories of
11care, treatment, or procedures to be performed by the certified
12registered nurse anesthetist. In a collaborating dentist's
13office, the certified registered nurse anesthetist may only
14provide those services that the operating dentist with the
15appropriate permit is authorized to provide pursuant to the
16Illinois Dental Practice Act and rules adopted thereunder. For
17anesthesia services, an anesthesiologist, physician, or
18operating dentist shall participate through discussion of and
19agreement with the anesthesia plan and shall remain physically
20present and be available on the premises during the delivery of
21anesthesia services for diagnosis, consultation, and treatment
22of emergency medical conditions. A certified registered nurse
23anesthetist may select, order, and administer medication,
24including controlled substances, and apply appropriate medical
25devices for delivery of anesthesia services under the
26anesthesia plan agreed with by the operating dentist.

 

 

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1    (c-15) An advanced practice registered nurse certified as a
2nurse practitioner, clinical nurse specialist, or certified
3nurse midwife who had a written collaborative agreement with a
4podiatric physician immediately before the effective date of
5Public Act 100-513 may continue in that collaborative
6relationship or enter into a new written collaborative
7relationship with a podiatric physician under the requirements
8of this Section and Section 65-40, as those Sections existed
9immediately before the amendment of those Sections by Public
10Act 100-513 with regard to a written collaborative agreement
11between an advanced practice registered nurse and a podiatric
12physician.
13    (d) A copy of the signed, written collaborative agreement
14must be available to the Department upon request from both the
15advanced practice registered nurse and the collaborating
16physician, dentist, or podiatric physician.
17    (e) Nothing in this Act shall be construed to limit the
18delegation of tasks or duties by a physician to a licensed
19practical nurse, a registered professional nurse, or other
20persons in accordance with Section 54.2 of the Medical Practice
21Act of 1987. Nothing in this Act shall be construed to limit
22the method of delegation that may be authorized by any means,
23including, but not limited to, oral, written, electronic,
24standing orders, protocols, guidelines, or verbal orders.
25    (e-5) Nothing in this Act shall be construed to authorize
26an advanced practice registered nurse to provide health care

 

 

SB1683- 6 -LRB101 07977 RAB 53033 b

1services required by law or rule to be performed by a
2physician, including those acts to be performed by a physician
3in Section 3.1 of the Illinois Abortion Law of 1975.
4    (f) An advanced practice registered nurse shall inform each
5collaborating physician, dentist, or podiatric physician of
6all collaborative agreements he or she has signed and provide a
7copy of these to any collaborating physician, dentist, or
8podiatric physician upon request.
9    (g) (Blank).
10(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18;
11100-577, eff. 1-26-18; 100-1096, eff. 8-26-18.)
 
12    (225 ILCS 65/65-43)
13    (Section scheduled to be repealed on January 1, 2028)
14    Sec. 65-43. Full practice authority.
15    (a) An Illinois-licensed advanced practice registered
16nurse certified as a nurse practitioner, nurse midwife, or
17clinical nurse specialist shall be deemed by law to possess the
18ability to practice without a written collaborative agreement
19as set forth in this Section.
20    (b) An advanced practice registered nurse certified as a
21nurse midwife, clinical nurse specialist, or nurse
22practitioner who files with the Department a notarized
23attestation of completion of at least 250 hours of continuing
24education or training and at least 4,000 hours of clinical
25experience after first attaining national certification shall

 

 

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1not require a written collaborative agreement, except as
2specified in subsection (c). Documentation of successful
3completion shall be provided to the Department upon request.
4    Continuing education or training hours required by
5subsection (b) shall be in the advanced practice registered
6nurse's area of certification as set forth by Department rule.
7    The clinical experience must be in the advanced practice
8registered nurse's area of certification. The clinical
9experience shall be in collaboration with a physician or
10physicians. Completion of the clinical experience must be
11attested to by the collaborating physician or physicians and
12the advanced practice registered nurse. For the delivery of
13anesthesia provided by a certified registered nurse
14anesthetist, the attestation for completion of clinical
15experience must be attested to by the collaborating physician
16or physicians, podiatrists, or dentists and the certified
17registered nurse anesthetist.
18    (c) The scope of practice of an advanced practice
19registered nurse with full practice authority includes:
20        (1) all matters included in subsection (c) of Section
21    65-30 of this Act;
22        (2) practicing without a written collaborative
23    agreement in all practice settings consistent with
24    national certification;
25        (3) authority to prescribe both legend drugs and
26    Schedule II through V controlled substances; this

 

 

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1    authority includes prescription of, selection of, orders
2    for, administration of, storage of, acceptance of samples
3    of, and dispensing over the counter medications, legend
4    drugs, and controlled substances categorized as any
5    Schedule II through V controlled substances, as defined in
6    Article II of the Illinois Controlled Substances Act, and
7    other preparations, including, but not limited to,
8    botanical and herbal remedies;
9        (4) prescribing benzodiazepines or Schedule II
10    narcotic drugs, such as opioids, only in a consultation
11    relationship with a physician; this consultation
12    relationship shall be recorded in the Prescription
13    Monitoring Program website, pursuant to Section 316 of the
14    Illinois Controlled Substances Act, by the physician and
15    advanced practice registered nurse with full practice
16    authority and is not required to be filed with the
17    Department; the specific Schedule II narcotic drug must be
18    identified by either brand name or generic name; the
19    specific Schedule II narcotic drug, such as an opioid, may
20    be administered by oral dosage or topical or transdermal
21    application; delivery by injection or other route of
22    administration is not permitted; at least monthly, the
23    advanced practice registered nurse and the physician must
24    discuss the condition of any patients for whom a
25    benzodiazepine or opioid is prescribed; nothing in this
26    subsection shall be construed to require a prescription by

 

 

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1    an advanced practice registered nurse with full practice
2    authority to require a physician name;
3        (5) authority to obtain an Illinois controlled
4    substance license and a federal Drug Enforcement
5    Administration number; and
6        (6) use of only local anesthetic, except for the
7    delivery of anesthesia services by a certified registered
8    nurse anesthetist.
9    The scope of practice of an advanced practice registered
10nurse does not include operative surgery.
11    (d) The Department may adopt rules necessary to administer
12this Section, including, but not limited to, requiring the
13completion of forms and the payment of fees.
14    (e) Nothing in this Act shall be construed to authorize an
15advanced practice registered nurse with full practice
16authority to provide health care services required by law or
17rule to be performed by a physician, including, but not limited
18to, those acts to be performed by a physician in Section 3.1 of
19the Illinois Abortion Law of 1975.
20(Source: P.A. 100-513, eff. 1-1-18.)
 
21    (225 ILCS 65/65-45)   (was 225 ILCS 65/15-25)
22    (Section scheduled to be repealed on January 1, 2028)
23    Sec. 65-45. Advanced practice registered nursing in
24hospitals, hospital affiliates, or ambulatory surgical
25treatment centers.

 

 

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1    (a) An advanced practice registered nurse may provide
2services in a hospital or a hospital affiliate as those terms
3are defined in the Hospital Licensing Act or the University of
4Illinois Hospital Act or a licensed ambulatory surgical
5treatment center without a written collaborative agreement
6pursuant to Section 65-35 of this Act. An advanced practice
7registered nurse must possess clinical privileges recommended
8by the hospital medical staff and granted by the hospital or
9the consulting medical staff committee and ambulatory surgical
10treatment center in order to provide services. The medical
11staff or consulting medical staff committee shall periodically
12review the services of all advanced practice registered nurses
13granted clinical privileges, including any care provided in a
14hospital affiliate. Authority may also be granted when
15recommended by the hospital medical staff and granted by the
16hospital or recommended by the consulting medical staff
17committee and ambulatory surgical treatment center to
18individual advanced practice registered nurses to select,
19order, and administer medications, including controlled
20substances, to provide delineated care. In a hospital, hospital
21affiliate, or ambulatory surgical treatment center, the
22attending physician shall determine an advanced practice
23registered nurse's role in providing care for his or her
24patients, except as otherwise provided in the medical staff
25bylaws or consulting committee policies.
26    (a-2) An advanced practice registered nurse privileged to

 

 

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1order medications, including controlled substances, may
2complete discharge prescriptions provided the prescription is
3in the name of the advanced practice registered nurse and the
4attending or discharging physician.
5    (a-3) Advanced practice registered nurses practicing in a
6hospital or an ambulatory surgical treatment center are not
7required to obtain a mid-level controlled substance license to
8order controlled substances under Section 303.05 of the
9Illinois Controlled Substances Act.
10    (a-4) An advanced practice registered nurse certified as a
11nurse practitioner, clinical nurse specialist, or certified
12nurse midwife meeting the requirements of Section 65-43 may be
13privileged to complete discharge orders and prescriptions
14under the advanced practice registered nurse's name.
15    (a-5) For anesthesia services provided by a certified
16registered nurse anesthetist, an anesthesiologist, physician,
17dentist, or podiatric physician shall participate through
18discussion of and agreement with the anesthesia plan and shall
19remain physically present and be available on the premises
20during the delivery of anesthesia services for diagnosis,
21consultation, and treatment of emergency medical conditions,
22unless hospital policy adopted pursuant to clause (B) of
23subdivision (3) of Section 10.7 of the Hospital Licensing Act
24or ambulatory surgical treatment center policy adopted
25pursuant to clause (B) of subdivision (3) of Section 6.5 of the
26Ambulatory Surgical Treatment Center Act provides otherwise. A

 

 

SB1683- 12 -LRB101 07977 RAB 53033 b

1certified registered nurse anesthetist may select, order, and
2administer medication for anesthesia services under the
3anesthesia plan agreed to by the anesthesiologist or the
4physician, in accordance with hospital alternative policy or in
5accordance with the medical staff consulting committee
6policies of a licensed ambulatory surgical treatment center.
7    (b) An advanced practice registered nurse who provides
8services in a hospital shall do so in accordance with Section
910.7 of the Hospital Licensing Act and, in an ambulatory
10surgical treatment center, in accordance with Section 6.5 of
11the Ambulatory Surgical Treatment Center Act. Nothing in this
12Act shall be construed to require an advanced practice
13registered nurse to have a collaborative agreement to practice
14in a hospital, hospital affiliate, or ambulatory surgical
15treatment center.
16    (c) Advanced practice registered nurses certified as nurse
17practitioners, nurse midwives, or clinical nurse specialists
18practicing in a hospital affiliate may be, but are not required
19to be, privileged to prescribe Schedule II through V controlled
20substances when such authority is recommended by the
21appropriate physician committee of the hospital affiliate and
22granted by the hospital affiliate. This authority may, but is
23not required to, include prescription of, selection of, orders
24for, administration of, storage of, acceptance of samples of,
25and dispensing over-the-counter medications, legend drugs,
26medical gases, and controlled substances categorized as

 

 

SB1683- 13 -LRB101 07977 RAB 53033 b

1Schedule II through V controlled substances, as defined in
2Article II of the Illinois Controlled Substances Act, and other
3preparations, including, but not limited to, botanical and
4herbal remedies.
5    To prescribe controlled substances under this subsection
6(c), an advanced practice registered nurse certified as a nurse
7practitioner, nurse midwife, or clinical nurse specialist must
8obtain a controlled substance license. Medication orders shall
9be reviewed periodically by the appropriate hospital affiliate
10physicians committee or its physician designee.
11    The hospital affiliate shall file with the Department
12notice of a grant of prescriptive authority consistent with
13this subsection (c) and termination of such a grant of
14authority, in accordance with rules of the Department. Upon
15receipt of this notice of grant of authority to prescribe any
16Schedule II through V controlled substances, the licensed
17advanced practice registered nurse certified as a nurse
18practitioner, nurse midwife, or clinical nurse specialist may
19register for a mid-level practitioner controlled substance
20license under Section 303.05 of the Illinois Controlled
21Substances Act.
22    In addition, a hospital affiliate may, but is not required
23to, privilege an advanced practice registered nurse certified
24as a nurse practitioner, nurse midwife, or clinical nurse
25specialist to prescribe any Schedule II controlled substances,
26if all of the following conditions apply:

 

 

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1        (1) specific Schedule II controlled substances by oral
2    dosage or topical or transdermal application may be
3    designated, provided that the designated Schedule II
4    controlled substances are routinely prescribed by advanced
5    practice registered nurses in their area of certification;
6    the privileging documents must identify the specific
7    Schedule II controlled substances by either brand name or
8    generic name; privileges to prescribe or dispense Schedule
9    II controlled substances to be delivered by injection or
10    other route of administration may not be granted;
11        (2) any privileges must be controlled substances
12    limited to the practice of the advanced practice registered
13    nurse;
14        (3) any prescription must be limited to no more than a
15    30-day supply;
16        (4) the advanced practice registered nurse must
17    discuss the condition of any patients for whom a controlled
18    substance is prescribed monthly with the appropriate
19    physician committee of the hospital affiliate or its
20    physician designee; and
21        (5) the advanced practice registered nurse must meet
22    the education requirements of Section 303.05 of the
23    Illinois Controlled Substances Act.
24    (d) An advanced practice registered nurse meeting the
25requirements of Section 65-43 may be privileged to prescribe
26controlled substances categorized as Schedule II through V in

 

 

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1accordance with Section 65-43.
2(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18.)
 
3    Section 99. Effective date. This Act takes effect upon
4becoming law.