100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB5495

 

Introduced , by Rep. Patricia R. Bellock

 

SYNOPSIS AS INTRODUCED:
 
225 ILCS 65/65-45  was 225 ILCS 65/15-25
225 ILCS 95/7.7

    Amends the Nurse Practice Act and the Physician Assistant Practice Act of 1987. Provides that the Secretary of Financial and Professional Regulation shall by rule provide for advanced practice registered nurses and physician assistants to admit patients to rural hospitals where they have privileges.


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A BILL FOR

 

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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
5Section 65-45 as follows:
 
6    (225 ILCS 65/65-45)   (was 225 ILCS 65/15-25)
7    (Section scheduled to be repealed on January 1, 2028)
8    Sec. 65-45. Advanced practice registered nursing in
9hospitals, hospital affiliates, or ambulatory surgical
10treatment centers.
11    (a) An advanced practice registered nurse may provide
12services in a hospital or a hospital affiliate as those terms
13are defined in the Hospital Licensing Act or the University of
14Illinois Hospital Act or a licensed ambulatory surgical
15treatment center without a written collaborative agreement
16pursuant to Section 65-35 of this Act. An advanced practice
17registered nurse must possess clinical privileges recommended
18by the hospital medical staff and granted by the hospital or
19the consulting medical staff committee and ambulatory surgical
20treatment center in order to provide services. The medical
21staff or consulting medical staff committee shall periodically
22review the services of all advanced practice registered nurses
23granted clinical privileges, including any care provided in a

 

 

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1hospital affiliate. Authority may also be granted when
2recommended by the hospital medical staff and granted by the
3hospital or recommended by the consulting medical staff
4committee and ambulatory surgical treatment center to
5individual advanced practice registered nurses to select,
6order, and administer medications, including controlled
7substances, to provide delineated care. In a hospital, hospital
8affiliate, or ambulatory surgical treatment center, the
9attending physician shall determine an advanced practice
10registered nurse's role in providing care for his or her
11patients, except as otherwise provided in the medical staff
12bylaws or consulting committee policies.
13    (a-2) An advanced practice registered nurse privileged to
14order medications, including controlled substances, may
15complete discharge prescriptions provided the prescription is
16in the name of the advanced practice registered nurse and the
17attending or discharging physician.
18    (a-3) Advanced practice registered nurses practicing in a
19hospital or an ambulatory surgical treatment center are not
20required to obtain a mid-level controlled substance license to
21order controlled substances under Section 303.05 of the
22Illinois Controlled Substances Act.
23    (a-4) An advanced practice registered nurse meeting the
24requirements of Section 65-43 may be privileged to complete
25discharge orders and prescriptions under the advanced practice
26registered nurse's name.

 

 

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1    (a-5) For anesthesia services provided by a certified
2registered nurse anesthetist, an anesthesiologist, physician,
3dentist, or podiatric physician shall participate through
4discussion of and agreement with the anesthesia plan and shall
5remain physically present and be available on the premises
6during the delivery of anesthesia services for diagnosis,
7consultation, and treatment of emergency medical conditions,
8unless hospital policy adopted pursuant to clause (B) of
9subdivision (3) of Section 10.7 of the Hospital Licensing Act
10or ambulatory surgical treatment center policy adopted
11pursuant to clause (B) of subdivision (3) of Section 6.5 of the
12Ambulatory Surgical Treatment Center Act provides otherwise. A
13certified registered nurse anesthetist may select, order, and
14administer medication for anesthesia services under the
15anesthesia plan agreed to by the anesthesiologist or the
16physician, in accordance with hospital alternative policy or
17the medical staff consulting committee policies of a licensed
18ambulatory surgical treatment center.
19    (b) An advanced practice registered nurse who provides
20services in a hospital shall do so in accordance with Section
2110.7 of the Hospital Licensing Act and, in an ambulatory
22surgical treatment center, in accordance with Section 6.5 of
23the Ambulatory Surgical Treatment Center Act. Nothing in this
24Act shall be construed to require an advanced practice
25registered nurse to have a collaborative agreement to practice
26in a hospital, hospital affiliate, or ambulatory surgical

 

 

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1treatment center.
2    (c) Advanced practice registered nurses certified as nurse
3practitioners, nurse midwives, or clinical nurse specialists
4practicing in a hospital affiliate may be, but are not required
5to be, privileged to prescribe Schedule II through V controlled
6substances when such authority is recommended by the
7appropriate physician committee of the hospital affiliate and
8granted by the hospital affiliate. This authority may, but is
9not required to, include prescription of, selection of, orders
10for, administration of, storage of, acceptance of samples of,
11and dispensing over-the-counter medications, legend drugs,
12medical gases, and controlled substances categorized as
13Schedule II through V controlled substances, as defined in
14Article II of the Illinois Controlled Substances Act, and other
15preparations, including, but not limited to, botanical and
16herbal remedies.
17    To prescribe controlled substances under this subsection
18(c), an advanced practice registered nurse certified as a nurse
19practitioner, nurse midwife, or clinical nurse specialist must
20obtain a controlled substance license. Medication orders shall
21be reviewed periodically by the appropriate hospital affiliate
22physicians committee or its physician designee.
23    The hospital affiliate shall file with the Department
24notice of a grant of prescriptive authority consistent with
25this subsection (c) and termination of such a grant of
26authority, in accordance with rules of the Department. Upon

 

 

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1receipt of this notice of grant of authority to prescribe any
2Schedule II through V controlled substances, the licensed
3advanced practice registered nurse certified as a nurse
4practitioner, nurse midwife, or clinical nurse specialist may
5register for a mid-level practitioner controlled substance
6license under Section 303.05 of the Illinois Controlled
7Substances Act.
8    In addition, a hospital affiliate may, but is not required
9to, privilege an advanced practice registered nurse certified
10as a nurse practitioner, nurse midwife, or clinical nurse
11specialist to prescribe any Schedule II controlled substances,
12if all of the following conditions apply:
13        (1) specific Schedule II controlled substances by oral
14    dosage or topical or transdermal application may be
15    designated, provided that the designated Schedule II
16    controlled substances are routinely prescribed by advanced
17    practice registered nurses in their area of certification;
18    the privileging documents must identify the specific
19    Schedule II controlled substances by either brand name or
20    generic name; privileges to prescribe or dispense Schedule
21    II controlled substances to be delivered by injection or
22    other route of administration may not be granted;
23        (2) any privileges must be controlled substances
24    limited to the practice of the advanced practice registered
25    nurse;
26        (3) any prescription must be limited to no more than a

 

 

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1    30-day supply;
2        (4) the advanced practice registered nurse must
3    discuss the condition of any patients for whom a controlled
4    substance is prescribed monthly with the appropriate
5    physician committee of the hospital affiliate or its
6    physician designee; and
7        (5) the advanced practice registered nurse must meet
8    the education requirements of Section 303.05 of the
9    Illinois Controlled Substances Act.
10    (d) An advanced practice registered nurse meeting the
11requirements of Section 65-43 may be privileged to prescribe
12controlled substances categorized as Schedule II through V in
13accordance with Section 65-43.
14    (e) In order to increase access to care in rural hospitals,
15the Secretary shall by rule provide for advanced practice
16registered nurses to admit patients to rural hospitals where
17they have privileges. For the purpose of this subsection,
18"rural hospitals" has the meaning provided in Section 8 of the
19Hospital Licensing Act.
20(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18.)
 
21    Section 10. The Physician Assistant Practice Act of 1987 is
22amended by changing Section 7.7 as follows:
 
23    (225 ILCS 95/7.7)
24    (Section scheduled to be repealed on January 1, 2028)

 

 

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1    Sec. 7.7. Physician assistants in hospitals, hospital
2affiliates, or ambulatory surgical treatment centers.
3    (a) A physician assistant may provide services in a
4hospital as defined in the Hospital Licensing Act, a hospital
5affiliate as defined in the University of Illinois Hospital
6Act, or a licensed ambulatory surgical treatment center as
7defined in the Ambulatory Surgical Treatment Center Act without
8a written collaborative agreement pursuant to Section 7.5 of
9this Act. A physician assistant must possess clinical
10privileges recommended by the hospital medical staff and
11granted by the hospital or the consulting medical staff
12committee and ambulatory surgical treatment center in order to
13provide services. The medical staff or consulting medical staff
14committee shall periodically review the services of physician
15assistants granted clinical privileges, including any care
16provided in a hospital affiliate. Authority may also be granted
17when recommended by the hospital medical staff and granted by
18the hospital or recommended by the consulting medical staff
19committee and ambulatory surgical treatment center to
20individual physician assistants to select, order, and
21administer medications, including controlled substances, to
22provide delineated care. In a hospital, hospital affiliate, or
23ambulatory surgical treatment center, the attending physician
24shall determine a physician assistant's role in providing care
25for his or her patients, except as otherwise provided in the
26medical staff bylaws or consulting committee policies.

 

 

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1    (a-5) Physician assistants practicing in a hospital
2affiliate may be, but are not required to be, granted authority
3to prescribe Schedule II through V controlled substances when
4such authority is recommended by the appropriate physician
5committee of the hospital affiliate and granted by the hospital
6affiliate. This authority may, but is not required to, include
7prescription of, selection of, orders for, administration of,
8storage of, acceptance of samples of, and dispensing
9over-the-counter medications, legend drugs, medical gases, and
10controlled substances categorized as Schedule II through V
11controlled substances, as defined in Article II of the Illinois
12Controlled Substances Act, and other preparations, including,
13but not limited to, botanical and herbal remedies.
14    To prescribe controlled substances under this subsection
15(a-5), a physician assistant must obtain a mid-level
16practitioner controlled substance license. Medication orders
17shall be reviewed periodically by the appropriate hospital
18affiliate physicians committee or its physician designee.
19    The hospital affiliate shall file with the Department
20notice of a grant of prescriptive authority consistent with
21this subsection (a-5) and termination of such a grant of
22authority in accordance with rules of the Department. Upon
23receipt of this notice of grant of authority to prescribe any
24Schedule II through V controlled substances, the licensed
25physician assistant may register for a mid-level practitioner
26controlled substance license under Section 303.05 of the

 

 

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1Illinois Controlled Substances Act.
2    In addition, a hospital affiliate may, but is not required
3to, grant authority to a physician assistant to prescribe any
4Schedule II controlled substances if all of the following
5conditions apply:
6        (1) specific Schedule II controlled substances by oral
7    dosage or topical or transdermal application may be
8    designated, provided that the designated Schedule II
9    controlled substances are routinely prescribed by
10    physician assistants in their area of certification; this
11    grant of authority must identify the specific Schedule II
12    controlled substances by either brand name or generic name;
13    authority to prescribe or dispense Schedule II controlled
14    substances to be delivered by injection or other route of
15    administration may not be granted;
16        (2) any grant of authority must be controlled
17    substances limited to the practice of the physician
18    assistant;
19        (3) any prescription must be limited to no more than a
20    30-day supply;
21        (4) the physician assistant must discuss the condition
22    of any patients for whom a controlled substance is
23    prescribed monthly with the appropriate physician
24    committee of the hospital affiliate or its physician
25    designee; and
26        (5) the physician assistant must meet the education

 

 

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1    requirements of Section 303.05 of the Illinois Controlled
2    Substances Act.
3    (b) A physician assistant granted authority to order
4medications including controlled substances may complete
5discharge prescriptions provided the prescription is in the
6name of the physician assistant and the attending or
7discharging physician.
8    (c) Physician assistants practicing in a hospital,
9hospital affiliate, or an ambulatory surgical treatment center
10are not required to obtain a mid-level controlled substance
11license to order controlled substances under Section 303.05 of
12the Illinois Controlled Substances Act.
13    (d) In order to increase access to care in rural hospitals,
14the Secretary shall by rule provide for physician assistants to
15admit patients to rural hospitals where they have privileges.
16For the purpose of this subsection, "rural hospitals" has the
17meaning provided in Section 8 of the Hospital Licensing Act.
18(Source: P.A. 100-453, eff. 8-25-17.)