SB1694 94TH GENERAL ASSEMBLY

LRB094 10821 LJB 41311 b

94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
SB1694

Introduced 2/24/2005, by Sen. Terry Link

SYNOPSIS AS INTRODUCED:

225 ILCS 80/26.17 new

Amends the Illinois Optometric Practice Act of 1987. Provides that surgical comanagement of patients by eye care providers is permitted in certain circumstances. Provides that no comanaging eye care provider may receive a percentage of the global surgical fee that exceeds the relative value of services provided to the comanaged patient. Requires each eye care provider to be licensed or certified and qualified for the services provided to the patient. Requires the patient or legal guardian to be fully informed in writing about the surgical comanagement arrangement and to sign a statement acknowledging that certain details of the arrangement have been fully explained. Requires comanaging eye care providers to establish written protocols governing the manner in which care will be provided to comanaged patients. Requires comanaging eye care providers to communicate regularly and in a timely manner regarding patients' care. Prohibits certain acts by comanaging eye care providers. Provides that the Department of Financial and Professional Regulation is responsible for enforcing the provisions. Allows the Department to adopt rules to implement the provisions. Provides that the provisions do not limit the tort liability of a licensee and that compliance with the provisions may not be construed as malpractice. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Optometric Practice Act of 1987 is amended by adding Section 26.17 as follows:

(225 ILCS 80/26.17 new)

Sec. 26.17. Surgical comanagement arrangements.

(a) As used in this Section, the following terms shall have the meaning ascribed to them:

"Ancillary personnel" means a person who is not an ophthalmologist or an optometrist working under the direction of an ophthalmologist or an optometrist.

"Eye care provider" means a person licensed pursuant to this Act.

"Ophthalmologist" means a physician who has graduated from an accredited ophthalmology residency program.

"Optometrist" means a doctor of optometry who has graduated from an accredited school of optometry.

"Surgical comanagement" means the collaboration and sharing of responsibilities among eye care providers with respect to the preoperative or postoperative care of an eye surgery patient. Surgical comanagement does not include delegating tasks relating to the care of a surgical patient to ancillary personnel working under the direct supervision of an eye care provider.

(b) Surgical comanagement is permitted when the following conditions are met:

(1) the patient has indicated a preference to have preoperative or postoperative care provided by an eye care provider other than the operating surgeon; the distance from the patient's home to the operating surgeon's office would result in an unreasonable hardship for the patient; extenuating circumstances exist that prevent the patient from visiting the surgeon's office for routine preoperative or postoperative care and such care can be provided by another qualified eye care provider; the surgeon chosen by the patient is not available to perform the operation and associated care within a reasonable proximity to the patient's home; or the operating surgeon will not be available to provide postoperative care after the surgery, provided that the absence of the operating surgeon does not constitute patient abandonment or improper itinerant surgery; and

(2) the patient chooses to have preoperative or postoperative care finished by an eye care provider other than the operating surgeon after being fully informed about the proposed comanagement as described in subsection (e).

(c) None of the comanaging eye care providers shall receive a percentage of the global surgical fee that exceeds the relative value of services provided to the patient that are reasonable and necessary for the patient's care.

(d) Each comanaging eye care provider shall be licensed or certified and qualified for the services the eye care provider provides to the patient. If surgical intervention is required during the postoperative period for medically necessary reasons, the patient shall be referred back to the original operating surgeon or to another surgeon with comparable skills.

(e) A patient or legal guardian shall be fully informed in writing about the surgical comanagement arrangement and shall sign and receive a statement acknowledging that the details of the surgical comanagement arrangement have been fully explained to the patient, including, but not limited to, all of the following:

(1) the licensure and qualifications of the eye care providers who will be managing the patient's care preoperatively, during the operation, and postoperatively;

(2) the financial arrangement between the comanaging eye care providers, including the division of the global surgical fee among the providers participating in the surgical comanagement arrangement;

(3) the patient's right to receive care from any of the comanaging eye care providers that the providers are licensed and qualified to provide; and

(4) the patient's right to accept or decline to participate in the surgical comanagement arrangement.

The comanagement informed consent shall be documented in the patient's medical records maintained by each of the comanaging eye care providers, including the patient's acknowledgment of and agreement to the surgical comanagement arrangement.

(f) The comanaging eye care providers shall establish written protocols governing the manner in which care will be provided to the patient, including, but not limited to:

(1) the nature of routine care expected;

(2) who will deliver each aspect of care;

(3) how complications will be handled;

(4) the parameters that will determine when a patient is fully healed and may be released from further care, and how the release will be accomplished; and

(5) the manner in which communication between the eye care providers will occur.

To comply with the provisions of this subsection (f), it is not necessary to establish a separate or unique protocol for each patient.

(g) Comanaging eye care providers shall communicate regularly and in a timely manner consistent with the comanagement protocol procedures established pursuant to subsection (f) regarding the patient's care and progress for the duration of the surgical care period until the patient is released from further care.

(h) Nothing in this Section shall authorize a comanaging eye care provider to do any of the following:

(1) enter into a surgical comanagement arrangement for the purpose of splitting a fee without providing a commensurate medically necessary service to the patient;

(2) demand to manage postoperative care in return for making a surgical referral;

(3) threaten to withhold referrals to a surgeon who does not agree to comanage a patient;

(4) offer to comanage a patient in return for receiving a surgical referral;

(5) intentionally refer a patient for surgery in a manner that has no other legitimate purpose than to justify a surgical comanagement arrangement;

(6) initiate a surgical comanagement arrangement when the patient otherwise would have been released from further care following surgery;

(7) fail to fully inform the patient about the surgical comanagement arrangement or failing to obtain a signed informed consent statement as defined in subsection (e);

(8) mislead a patient as to the appropriateness of surgical comanagement for his or her particular circumstances, or leading a patient to believe that he or she does not have the right to receive postoperative care from the operating surgeon or other comanaging providers;

(9) fail to engage in regular and timely communication among the comanaging eye care providers;

(10) fail to establish a written protocol for comanaged patients; or

(11) any other action that is not in the best interest of the patient as determined by the eye care provider's respective licensing board.

Nothing in this subsection (h) shall be construed to infringe upon an eye care provider's prerogative to recommend a surgeon or refer a patient to a surgeon based on that provider's opinion or assessment of the surgeon's ability or fitness to provide appropriate surgical care to a patient.

(i) The Department shall be responsible for enforcement of the provisions of this Section.

(j) The Department may adopt rules to implement the provisions of this Section as it affects licensees under this Act.

(k) Nothing in this Section shall be construed to infringe upon the right of any eye care provider to decide whether or not to participate in comanagement arrangements either as a matter of policy or in a particular instance.

(l) Nothing in this Section shall be construed to limit tort liability of a physician or an optometrist with respect to any aspect of patient care. Compliance with this Section shall not be construed as malpractice.

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