SB2214 103RD GENERAL ASSEMBLY

LRB103 06052 AMQ 51082 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB2214

Introduced 2/10/2023, by Sen. Cristina Castro

SYNOPSIS AS INTRODUCED:

New Act
5 ILCS 80/4.43 new
210 ILCS 5/6.5
210 ILCS 85/10.7
225 ILCS 60/54.5
225 ILCS 60/54.7 new

Creates the Certified Anesthesiologist Assistant Practice Act. Provides for the licensure of certified anesthesiologist assistants by the Department of Financial and Professional Regulation. Sets forth provisions concerning: administrative procedures; the applicability of the Act; using titles, advertising, and billing; supervision requirements; application for licensure; unlicensed practice, violations, and civil penalties; the Certified Anesthesiologist Assistant Advisory Committee; qualifications for licensure; the expiration and renewal of a license; the inactive status of a license; and grounds for disciplinary action. Amends the Medical Practice Act of 1987. Provides that, under delegation from a supervising anesthesiologist, a licensed certified anesthesiologist assistant is authorized to select, order, and administer drugs and apply the appropriate medical devices in the provision of anesthesia services under the anesthesia plan agreed to by the supervising anesthesiologist. Amends the Ambulatory Surgical Treatment Center Act and the Hospital Licensing Act. Provides that a licensed certified anesthesiologist assistant under the supervision of an anesthesiologist with clinical privileges granted by the medical staff and ambulatory surgical center or at the hospital may administer anesthesia services. Amends the Regulatory Sunset Act to provide for the repeal of the Certified Anesthesiologist Assistant Practice Act on January 1, 2033.

A BILL FOR

AN ACT concerning regulation.

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

Section 1. Short title. This Act may be cited as the Certified Anesthesiologist Assistant Practice Act.

Section 5. Findings. The practice of anesthesiology is the practice of medicine. The practice as a certified anesthesiologist assistant in this State is declared to affect the public health, safety, and welfare and to be subject to regulation and control in the public interest. The purpose and legislative intent of this Act is to encourage and promote the more effective utilization of the skills of anesthesiologists by enabling them to delegate certain medical care to certified anesthesiologist assistants where such delegation is consistent with the health and welfare of the patient and is conducted at the direction of and under the responsible supervision of an anesthesiologist.

It is further declared to be a matter of public health and concern that the practice as a certified anesthesiologist assistant, as defined in this Act, merit and receive the confidence of the public and that only qualified persons be authorized to practice as a certified anesthesiologist assistant in this State. This Act shall be liberally construed to best carry out these subjects and purposes.

Section 10. Administrative Procedure Act. The Illinois Administrative Procedure Act is hereby expressly adopted and incorporated herein as if all of the provisions of that Act were included in this Act. The Secretary may adopt rules for the administration and enforcement of this Act and may prescribe forms to be issued in connection with this Act.

Section 15. Definitions. As used in this Act:

"Anesthesiologist" means a physician licensed to practice medicine in all its branches by the Department who has completed a residency in anesthesiology approved by the American Board of Anesthesiology or the American Osteopathic Board of Anesthesiology, is board eligible or board certified, holds an unrestricted license, and is actively engaged in clinical practice.

"Board" means the Illinois State Medical Board constituted under the Medical Practice Act of 1987.

"Certified anesthesiologist assistant" means an individual licensed by the Department to provide anesthesia services under the supervision of an anesthesiologist.

"Department" means the Department of Financial and Professional Regulation.

"Secretary" means the Secretary of Financial and Professional Regulation.

"Supervision" means overseeing the activities of, and accepting responsibility for, the medical services rendered by the certified anesthesiologist assistant and maintaining physical proximity that allows the anesthesiologist to return to reestablish direct contact with the patient to meet medical needs and address any urgent or emergent clinical problems at all times that medical services are rendered by the certified anesthesiologist assistant.

Section 20. Applicability. This Act does not prohibit:

(1) Any person licensed in this State under any other Act from engaging in the practice for which the person is licensed.

(2) The practice as an certified anesthesiologist assistant by a person who is employed by the United States government or any bureau, division, or agency thereof while in the discharge of the employee's official duties.

(3) The practice as a certified anesthesiologist assistant that is included in the certified anesthesiologist assistant's program of study by students enrolled in schools.

Section 25. Title; advertising; billing.

(a) No certified anesthesiologist assistant shall use the title of doctor or associate with the licensee's name or any other term in the clinical setting or while in contact with patients under the licensee's care that would indicate to other persons that the licensee is qualified to engage in the general independent practice of anesthesiology or interventional pain management.

(b) A licensee shall include in every advertisement for services regulated under this Act the licensee's title as it appears on the license or the initials authorized under this Act.

(c) A certified anesthesiologist assistant shall not be allowed to bill patients or in any way charge for services. Nothing in this Act, however, shall be so construed as to prevent the employer of a certified anesthesiologist assistant from charging for services rendered by the certified anesthesiologist assistant. Payment for services rendered by a certified anesthesiologist assistant shall be made to the certified anesthesiologist assistant's employer if the payor would have made payment had the services been provided by an anesthesiologist.

Section 30. Supervision requirements.

(a) As used in this Section, "supervision" means the use of the powers of direction and decision to coordinate, direct, and inspect the accomplishment of another, and to oversee the implementation of the anesthesiologist's intentions.

(b) A certified anesthesiologist assistant may deliver medical care only under the supervision of an anesthesiologist and only as described in a supervision agreement between the certified anesthesiologist assistant and an anesthesiologist who represents the certified anesthesiologist assistant's employer. The supervising anesthesiologist shall be immediately available at all times while supervising a certified anesthesiologist assistant.

For the purposes of this Section, "immediately available" means the medically directing anesthesiologist being in such physical proximity to allow the anesthesiologist to return to reestablish direct contact with the patient to meet the patient's medical needs and address any urgent or emergent problems. These responsibilities may also be met through careful coordination among anesthesiologists of the same group or department. It is recognized that the design and size of various facilities, the severity of patient illnesses, and the complexity and demands of the particular surgical procedures make it impossible to define a specific time or distance for physical proximity.

(c) A certified anesthesiologist assistant's practice may not exceed the licensee's education and training, the scope of practice of the supervising anesthesiologist, and the practice outlined in the certified anesthesiologist assistant supervision agreement. A medical care task assigned by the supervising anesthesiologist to the certified anesthesiologist assistant may not be delegated by the certified anesthesiologist assistant to another person, except for the preceptorship of a student in an anesthesiologist assistant training program.

(d) A certified anesthesiologist assistant may assist only the supervising anesthesiologist in the delivery of medical care and may perform medical care tasks as well as any other tasks within the scope of training and education of the certified anesthesiologist assistant as assigned by the supervising anesthesiologist.

(e) An anesthesiologist who represents a certified anesthesiologist assistant's employer shall review the supervision agreement with the certified anesthesiologist assistant at least annually. The supervision agreement shall be available for inspection at the location where the certified anesthesiologist assistant practices. The supervision agreement may limit the practice of a certified anesthesiologist assistant to less than the full scope of practice authorized under this Act.

(f) A certified anesthesiologist assistant shall be employed by a health care provider that is licensed in this State for the primary purpose of providing the medical services of physicians or that is an entity. If a certified anesthesiologist assistant's employer is not an anesthesiologist, the employer shall provide for, and not interfere with, an anesthesiologist's supervision of the certified anesthesiologist assistant.

(g) A student in an anesthesiologist assistant training program may assist only an anesthesiologist in the delivery of medical care and may perform only medical care tasks assigned by the anesthesiologist. An anesthesiologist may delegate the preceptorship of a student in an anesthesiologist assistant training program to a qualified anesthesia provider. This Section shall not be interpreted to limit the number of other qualified anesthesia providers an anesthesiologist may supervise.

(h) A student in an anesthesiologist assistant training program shall be identified as a student anesthesiologist assistant or an anesthesiologist assistant student and may not be identified as an "intern", "resident", or "fellow".

Section 35. Application for licensure. An application for an original license shall be made to the Department in writing on forms or electronically as prescribed by the Department and shall be accompanied by the required fee, which shall not be refundable. An application shall require information that, in the judgment of the Department, will enable the Department to pass on the qualifications of the applicant for a license. An application shall include evidence of passage of the examination of the National Commission for the Certification of Anesthesiologist Assistants, or its successor agency, and proof that the applicant holds a valid certificate issued by that Commission.

An applicant has 3 years from the date of application to complete the application process. If the process has not been completed in 3 years, the application shall be denied, the fee shall be forfeited, and the applicant must reapply and meet the requirements in effect at the time of reapplication.

Section 40. Social security number on license application. In addition to any other information required to be contained in the application, every application for an original license under this Act shall include the applicant's social security number, which shall be retained in the agency's records pertaining to the license.

As soon as practical, the Department shall assign a customer's identification number to each applicant for a license. Every application for a renewal or restored license shall require the applicant's customer identification number.

Section 45. Identification. No person may designate oneself as a certified anesthesiologist assistant, use or assume the title "certified anesthesiologist assistant", or append to the person's name the words or letters "certified anesthesiologist assistant" or "C.A.A." or any other titles, letters, or designation that represents or may tend to represent the person as a certified anesthesiologist assistant unless the licensee is licensed as a certified anesthesiologist assistant by the Department. A certified anesthesiologist assistant shall be clearly identified as a certified anesthesiologist assistant.

Section 50. Unlicensed practice; violation; civil penalty.

(a) Any person who practices, offers to practice, attempts to practice, or holds oneself out to practice as a certified anesthesiologist assistant without being licensed under this Act shall, in addition to any other penalty provided by law, pay a civil penalty to the Department in an amount not to exceed $10,000 for each offense as determined by the Department. The civil penalty shall be assessed by the Department after a hearing is held in accordance with the provisions set forth in this Act regarding the provision of a hearing for the discipline of a licensee.

(b) The Department has the authority and power to investigate any and all unlicensed activity.

(c) No person shall use any words, abbreviations, figures, letters, title, sign, card, or device tending to imply that the person is a certified anesthesiologist assistant, including, but not limited to, using the titles or initials "Certified Anesthesiologist Assistant" or "C.A.A.", or similar titles or initials, with the intention of indicating practice as a certified anesthesiologist assistant without meeting the requirements of this Act.

(d) The civil penalty shall be paid within 60 days after the effective date of the order imposing the civil penalty. The order shall constitute a judgment and may be filed and execution had thereon in the same manner as any judgment from any court of record.

Section 55. Committee.

(a) There is established a Certified Anesthesiologist Assistant Advisory Committee to the Department and the Board. The Certified Anesthesiologist Assistant Advisory Committee may review and make recommendations to the Department and the Board regarding all matters relating to certified anesthesiologist assistants. These matters may include, but are not limited to:

(1) applications for licensure;

(2) disciplinary proceedings;

(3) renewal requirements; and

(4) any other issues pertaining to the regulation and practice of certified anesthesiologist assistants in the State.

(b) The Committee's membership shall consist of the following members appointed by the Governor and selected from a list of recommended appointees submitted by the president of a statewide academy or society representing certified anesthesiologist assistants:

(1) one member of the Board;

(2) two certified anesthesiologist assistants licensed under this Act;

(3) one anesthesiologist; and

(4) one public member.

Members shall be appointed for 3-year terms. The president of a statewide academy representing certified anesthesiologist assistants shall consider the recommendations of the president of a statewide academy or association representing anesthesiologists when recommending appointees under paragraph (2).

(c) Members of the Certified Anesthesiologist Assistant Advisory Committee shall have no liability for any action based upon a disciplinary proceeding or other activity performed in good faith as a member of the Committee.

Section 60. Qualifications for licensure. A person shall be qualified for licensure as a certified anesthesiologist assistant and the Department may issue a certified anesthesiologist assistant license to a person who:

(1) has applied in writing in form and substance satisfactory to the Department and has not violated any of the provisions of this Act or the rules adopted under this Act; the Department may take into consideration any felony conviction of the applicant, but such conviction shall not operate as an absolute bar to licensure;

(2) has submitted evidence satisfactory to the Department that the applicant has:

(A) obtained a master's degree;

(B) satisfactorily completed an anesthesiologist assistant program that is accredited by the Commission on Accreditation of Allied Health Education Programs, or its predecessor or successor entity; and

(C) passed the certifying examination administered by and obtained active certification from the National Commission for Certification of Anesthesiologist Assistants or a successor entity; and

(3) complies with all applicable rules of the Department.

Section 65. Endorsement. Upon payment of the required fee, the Department may, in its discretion, license as a certified anesthesiologist assistant an applicant who is a certified anesthesiologist assistant licensed in another jurisdiction if the requirements for licensure in that jurisdiction were at the time of licensure substantially equivalent to the requirement in force in this State on that date or equivalent to the requirements of this Act.

Section 70. Expiration and renewal of license. The expiration date and renewal period for each license issued under this Act shall be set by rule. Renewal shall be conditioned on paying the required fee and by meeting such other requirements as may be established by rule.

Any certified anesthesiologist assistant who has permitted the license to expire or who has had the license on inactive status may have the license restored by making application to the Department and filing proof acceptable to the Department of the individual's fitness to have the license restored, and by paying the required fees. Proof of fitness may include sworn evidence certifying to active lawful practice in another jurisdiction.

If the certified anesthesiologist assistant has not maintained an active practice in another jurisdiction satisfactory to the Department, the Department shall determine, by an evaluation program established by rule, the individual's fitness for restoration of the license and shall establish procedures and requirements for such restoration.

However, any certified anesthesiologist assistant whose license expired while the individual was (i) in federal service on active duty with the Armed Forces of the United States, or the State Militia called into service or training, or (ii) in training or education under the supervision of the United States preliminary to induction into the military service, may have the individual's license restored without paying any lapsed renewal fees if within 2 years after honorable termination of such service, training, or education the individual furnishes the Department with satisfactory evidence to the effect that the individual has been so engaged and that the individual's service, training, or education has been so terminated.

Section 75. Inactive status. Any certified anesthesiologist assistant who notifies the Department in writing on forms prescribed by the Department, may elect to place the license on an inactive status and shall, subject to rules of the Department, be excused from payment of renewal fees until the individual notifies the Department in writing of the individual's intention to restore the license.

Any certified anesthesiologist assistant requesting restoration from inactive status shall be required to pay the current renewal fee and shall be required to restore the license, as provided in Section 70.

Any certified anesthesiologist assistant whose license is in an inactive status shall not practice in this State.

Any certified anesthesiologist assistant who engages in practice while the license is lapsed or on inactive status shall be considered to be practicing without a license, which shall be grounds for discipline under Section 80.

Section 80. Grounds for disciplinary action.

(a) The Department may refuse to issue or renew, or may revoke, suspend, place on probation, reprimand, or take other disciplinary or non-disciplinary action with regard to any license issued under this Act as the Department may deem proper, including the issuance of fines not to exceed $10,000 for each violation, for any one or a combination of the following causes:

(1) Material misstatement in furnishing information to the Department.

(2) Violations of this Act or the rules adopted under this Act.

(3) Conviction by plea of guilty or nolo contendere, finding of guilt, jury verdict, or entry of judgment or sentencing, including, but not limited to, convictions, preceding sentences of supervision, conditional discharge, or first offender probation, under the laws of any jurisdiction of the United States that is: (i) a felony; or (ii) a misdemeanor an essential element of which is dishonesty or that is directly related to the practice of the profession.

(4) Making any misrepresentation for the purpose of obtaining licenses.

(5) Professional incompetence.

(6) Aiding or assisting another person in violating any provision of this Act or its rules.

(7) Failing, within 60 days, to provide information in response to a written request made by the Department.

(8) Engaging in dishonorable, unethical, or unprofessional conduct, as defined by rule, of a character likely to deceive, defraud, or harm the public.

(9) Habitual or excessive use or addiction to alcohol, narcotics, stimulants, or any other chemical agent or drug that results in a certified anesthesiologist assistant's inability to practice with reasonable judgment, skill, or safety.

(10) Discipline by another U.S. jurisdiction or foreign nation, if at least one of the grounds for discipline is the same or substantially equivalent to those set forth in this Section.

(11) Directly or indirectly giving to or receiving from any person, firm, corporation, partnership, or association any fee, commission, rebate, or other form of compensation for any professional services not actually or personally rendered. Nothing in this paragraph affects any bona fide independent contractor or employment arrangements, which may include provisions for compensation, health insurance, pension, or other employment benefits, with persons or entities authorized under this Act for the provision of services within the scope of the licensee's practice under this Act.

(12) A finding by the Board that the licensee, after having the licensee's license placed on probationary status has violated the terms of probation.

(13) Abandonment of a patient.

(14) Willfully making or filing false records or reports in the certified anesthesiologist assistant's practice, including, but not limited to, false records filed with State agencies or departments.

(15) Willfully failing to report an instance of suspected child abuse or neglect as required by the Abused and Neglected Child Reporting Act.

(16) Physical illness or mental illness or impairment that results in the inability to practice the profession with reasonable judgment, skill, or safety, including, but not limited to, deterioration through the aging process or loss of motor skill.

(17) Being named as a perpetrator in an indicated report by the Department of Children and Family Services under the Abused and Neglected Child Reporting Act, and upon proof by clear and convincing evidence that the licensee has caused a child to be an abused child or neglected child as defined in the Abused and Neglected Child Reporting Act.

(18) Gross negligence resulting in the permanent injury or death of a patient.

(19) Employment of fraud, deception, or any unlawful means in applying for or securing a license as a certified anesthesiologist assistant.

(20) Exceeding the authority delegated to the certified anesthesiologist assistant by the certified anesthesiologist assistant's supervising anesthesiologist.

(21) Immoral conduct in the commission of any act, such as sexual abuse, sexual misconduct, or sexual exploitation related to the licensee's practice.

(22) Violation of the Health Care Worker Self-Referral Act.

(23) Practicing under a false or assumed name, except as provided by law.

(24) Making a false or misleading statement regarding the certified anesthesiologist assistant's skill or the efficacy or value of the medicine, treatment, or remedy prescribed by the certified anesthesiologist assistant in the course of treatment.

(25) Allowing another person to use the certified anesthesiologist assistant's license to practice.

(26) Prescribing, selling, administering, distributing, giving, or self-administering a drug classified as a controlled substance for other than medically accepted therapeutic purposes.

(27) Promotion of the sale of drugs, devices, appliances, or goods provided for a patient in a manner to exploit the patient for financial gain.

(28) A pattern of practice or other behavior that demonstrates incapacity or incompetence to practice under this Act.

(29) Violating State or federal laws, rules, or regulations relating to controlled substances or other legend drugs or ephedra as defined in the Ephedra Prohibition Act.

(30) Failure to establish and maintain records of patient care and treatment as required by law.

(31) Attempting to subvert or cheat on the examination of the National Commission for Certification of Anesthesiologist Assistants or its successor agency.

(32) Willfully or negligently violating the confidentiality between the certified anesthesiologist assistant and patient, except as required by law.

(33) Willfully failing to report an instance of suspected abuse, neglect, financial exploitation, or self-neglect of an eligible adult as defined in and required by the Adult Protective Services Act.

(34) Being named as an abuser in a verified report by the Department on Aging under the Adult Protective Services Act and upon proof by clear and convincing evidence that the licensee abused, neglected, or financially exploited an eligible adult as defined in the Adult Protective Services Act.

(35) Failure to report to the Department an adverse final action taken against the certified anesthesiologist assistant by another licensing jurisdiction of the United States or a foreign state or country, a peer review body, a health care institution, a professional society or association, a governmental agency, a law enforcement agency, or a court for acts or conduct similar to acts or conduct that would constitute grounds for action under this Section.

(36) Failure to provide copies of records of patient care or treatment, except as required by law.

(37) Violating the Compassionate Use of Medical Cannabis Program Act.

(b) The Department may, without a hearing, refuse to issue or renew or may suspend the license of any person who fails to file a return, or to pay the tax, penalty, or interest shown in a filed return, or to pay any final assessment of the tax, penalty, or interest as required by any tax Act administered by the Department of Revenue, until the requirements of any such tax Act are satisfied.

(c) The determination by a circuit court that a licensee is subject to involuntary admission or judicial admission as provided in the Mental Health and Developmental Disabilities Code operates as an automatic suspension. The suspension will end only upon a finding by a court that the patient is no longer subject to involuntary admission or judicial admission and issues an order so finding and discharging the patient, and upon the recommendation of the Board to the Secretary that the licensee be allowed to resume the licensee's practice.

(d) In enforcing this Section, the Department upon a showing of a possible violation may compel an individual licensed to practice under this Act, or who has applied for licensure under this Act, to submit to a mental or physical examination, or both, which may include a substance abuse or sexual offender evaluation, as required by and at the expense of the Department.

The Department shall specifically designate the examining physician licensed to practice medicine in all of its branches or, if applicable, the multidisciplinary team involved in providing the mental or physical examination or both. The multidisciplinary team shall be led by a physician licensed to practice medicine in all of its branches and may consist of one or more or a combination of physicians licensed to practice medicine in all of its branches, licensed clinical psychologists, licensed clinical social workers, licensed clinical professional counselors, and other professional and administrative staff. Any examining physician or member of the multidisciplinary team may require any person ordered to submit to an examination pursuant to this Section to submit to any additional supplemental testing deemed necessary to complete any examination or evaluation process, including, but not limited to, blood testing, urinalysis, psychological testing, or neuropsychological testing.

The Department may order the examining physician or any member of the multidisciplinary team to provide to the Department any and all records, including business records, that relate to the examination and evaluation, including any supplemental testing performed.

The Department may order the examining physician or any member of the multidisciplinary team to present testimony concerning the mental or physical examination of the licensee or applicant. No information, report, record, or other documents in any way related to the examination shall be excluded by reason of any common law or statutory privilege relating to communications between the licensee or applicant and the examining physician or any member of the multidisciplinary team. No authorization is necessary from the licensee or applicant ordered to undergo an examination for the examining physician or any member of the multidisciplinary team to provide information, reports, records, or other documents or to provide any testimony regarding the examination and evaluation.

The individual to be examined may have, at the individual's own expense, another physician of the individual's choice present during all aspects of this examination. However, that physician shall be present only to observe and may not interfere in any way with the examination.

Failure of an individual to submit to a mental or physical examination, when ordered, shall result in an automatic suspension of the individual's license until the individual submits to the examination.

If the Department finds an individual unable to practice because of the reasons set forth in this Section, the Department may require that individual to submit to care, counseling, or treatment by physicians approved or designated by the Department, as a condition, term, or restriction for continued, reinstated, or renewed licensure to practice; or, in lieu of care, counseling, or treatment, the Department may file a complaint to immediately suspend, revoke, or otherwise discipline the license of the individual. An individual whose license was granted, continued, reinstated, renewed, disciplined, or supervised subject to such terms, conditions, or restrictions, and who fails to comply with such terms, conditions, or restrictions, shall be referred to the Secretary for a determination as to whether the individual shall have the individual's license suspended immediately, pending a hearing by the Department.

In instances in which the Secretary immediately suspends an individual's license under this Section, a hearing on that individual's license must be convened by the Department within 30 days after the suspension and completed without appreciable delay. The Department shall have the authority to review the subject individual's record of treatment and counseling regarding the impairment to the extent permitted by applicable federal statutes and regulations safeguarding the confidentiality of medical records.

An individual licensed under this Act and affected under this Section shall be afforded an opportunity to demonstrate to the Department that the individual can resume practice in compliance with acceptable and prevailing standards under the provisions of the individual's license.

(e) An individual or organization acting in good faith, and not in a willful and wanton manner, in complying with this Section by providing a report or other information to the Board, by assisting in the investigation or preparation of a report or information, by participating in proceedings of the Board, or by serving as a member of the Board, shall not be subject to criminal prosecution or civil damages as a result of such actions.

(f) Members of the Board shall be indemnified by the State for any actions occurring within the scope of services of the Board, done in good faith and not willful and wanton in nature. The Attorney General shall defend all such actions unless the Attorney General determines either that there would be a conflict of interest in such representation or that the actions complained of were not in good faith or were willful and wanton.

If the Attorney General declines representation, the member has the right to employ counsel of the member's choice, whose fees shall be provided by the State, after approval by the Attorney General, unless there is a determination by a court that the member's actions were not in good faith or were willful and wanton.

The member must notify the Attorney General within 7 days after receipt of notice of the initiation of any action involving services of the Board. Failure to so notify the Attorney General constitutes an absolute waiver of the right to a defense and indemnification.

The Attorney General shall determine, within 7 days after receiving such notice, whether the Attorney General will undertake to represent the member.

Section 900. The Regulatory Sunset Act is amended by adding Section 4.43 as follows:

(5 ILCS 80/4.43 new)

Sec. 4.43. Act repealed on January 1, 2033. The following Act is repealed on January 1, 2033:

The Certified Anesthesiologist Assistant Practice Act.

Section 905. 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 registered 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 and consultation 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 podiatric physician 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 podiatric physician may be assisted by a physician licensed to practice medicine in all its branches, dentist, dental assistant, podiatric physician, licensed advanced practice registered nurse, licensed physician assistant, licensed registered nurse, licensed practical nurse, surgical assistant, surgical technician, licensed certified anesthesiologist assistant, 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.

(2.5) A registered nurse licensed under the Nurse Practice Act and qualified by training and experience in operating room nursing shall be present in the operating room and function as the circulating nurse during all invasive or operative procedures. For purposes of this paragraph (2.5), "circulating nurse" means a registered nurse who is responsible for coordinating all nursing care, patient safety needs, and the needs of the surgical team in the operating room during an invasive or operative procedure.

(3) An advanced practice registered nurse is not required to possess prescriptive authority or a written collaborative agreement meeting the requirements of the Nurse Practice Act to provide advanced practice registered nursing services in an ambulatory surgical treatment center. An advanced practice registered nurse must possess clinical privileges granted by the consulting medical staff committee and ambulatory surgical treatment center in order to provide services. Individual advanced practice registered nurses may also be granted clinical privileges to order, select, and administer medications, including controlled substances, to provide delineated care. The attending physician must determine the advanced practice registered nurse's role in providing care for his or her patients, except as otherwise provided in the consulting staff policies. The consulting medical staff committee shall periodically review the services of advanced practice registered nurses granted privileges.

(4) 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 podiatric physician.

(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 podiatric physician licensed under the Podiatric Medical Practice Act of 1987; or .

(vi) a licensed certified anesthesiologist assistant under the supervision of an anesthesiologist.

(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 65-35 of the Nurse Practice Act to provide anesthesia services ordered by a licensed physician, dentist, or podiatric physician. 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 podiatric physician in accordance with the medical staff consulting committee policies of a licensed ambulatory surgical treatment center.

(Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18.)

Section 910. The Hospital Licensing Act is amended by changing Section 10.7 as follows:

(210 ILCS 85/10.7)

Sec. 10.7. Clinical privileges; advanced practice registered nurses. All hospitals licensed under this Act shall comply with the following requirements:

(1) No hospital policy, rule, regulation, or practice shall be inconsistent with the provision of adequate collaboration and consultation 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 podiatric physician licensed under the Podiatric Medical Practice Act of 1987, with medical staff membership and surgical clinical privileges granted at the hospital. A licensed physician, dentist, or podiatric physician may be assisted by a physician licensed to practice medicine in all its branches, dentist, dental assistant, podiatric physician, licensed advanced practice registered nurse, licensed physician assistant, licensed registered nurse, licensed practical nurse, surgical assistant, surgical technician, licensed certified anesthesiologist assistant, or other individuals granted clinical privileges to assist in surgery at the hospital. Payment for services rendered by an assistant in surgery who is not a hospital 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.

(2.5) A registered nurse licensed under the Nurse Practice Act and qualified by training and experience in operating room nursing shall be present in the operating room and function as the circulating nurse during all invasive or operative procedures. For purposes of this paragraph (2.5), "circulating nurse" means a registered nurse who is responsible for coordinating all nursing care, patient safety needs, and the needs of the surgical team in the operating room during an invasive or operative procedure.

(3) An advanced practice registered nurse is not required to possess prescriptive authority or a written collaborative agreement meeting the requirements of the Nurse Practice Act to provide advanced practice registered nursing services in a hospital. An advanced practice registered nurse must possess clinical privileges recommended by the medical staff and granted by the hospital in order to provide services. Individual advanced practice registered nurses may also be granted clinical privileges to order, select, and administer medications, including controlled substances, to provide delineated care. The attending physician must determine the advanced practice registered nurse's role in providing care for his or her patients, except as otherwise provided in medical staff bylaws. The medical staff shall periodically review the services of advanced practice registered nurses granted privileges. This review shall be conducted in accordance with item (2) of subsection (a) of Section 10.8 of this Act for advanced practice registered nurses employed by the hospital.

(4) 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 podiatric physician.

(A) The individuals who, with clinical privileges granted at the hospital, 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 podiatric physician licensed under the Podiatric Medical Practice Act of 1987; or .

(vi) a licensed certified anesthesiologist assistant under the supervision of an anesthesiologist.

(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 medical staff 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 and licensed hospital in consultation with the anesthesia service.

(C) A certified registered nurse anesthetist is not required to possess prescriptive authority or a written collaborative agreement meeting the requirements of Section 65-35 of the Nurse Practice Act to provide anesthesia services ordered by a licensed physician, dentist, or podiatric physician. 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 podiatric physician in accordance with the hospital's alternative policy.

(Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18.)

Section 915. The Medical Practice Act of 1987 is amended by changing Section 54.5 and by adding Section 54.7 as follows:

(225 ILCS 60/54.5)

(Section scheduled to be repealed on January 1, 2027)

Sec. 54.5. Physician delegation of authority to physician assistants, certified anesthesiologist assistants, advanced practice registered nurses without full practice authority, and prescribing psychologists.

(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 collaborative agreements with no more than 7 full-time equivalent physician assistants, except in a hospital, hospital affiliate, or ambulatory surgical treatment center as set forth by Section 7.7 of the Physician Assistant Practice Act of 1987 and as provided in subsection (a-5).

(a-5) A physician licensed to practice medicine in all its branches may collaborate with more than 7 physician assistants when the services are provided in a federal primary care health professional shortage area with a Health Professional Shortage Area score greater than or equal to 12, as determined by the United States Department of Health and Human Services.

The collaborating physician must keep appropriate documentation of meeting this exemption and make it available to the Department upon request.

(b) A physician licensed to practice medicine in all its branches in active clinical practice may collaborate with an advanced practice registered 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 in the same area of practice or specialty as the collaborating physician in his or her clinical medical practice. A written collaborative agreement shall be adequate with respect to collaboration with advanced practice registered nurses if all of the following apply:

(1) The agreement is written to promote the exercise of professional judgment by the advanced practice registered nurse commensurate with his or her education and experience.

(2) The advanced practice registered nurse provides services based upon a written collaborative agreement with the collaborating physician, 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.

(3) 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.

(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.

(b-15) Under delegation from a supervising anesthesiologist, a certified anesthesiologist assistant licensed under the Certified Anesthesiologist Assistant Practice Act is authorized to select, order, and administer drugs, performing skill sets within the scope of the certified anesthesiologist assistant's education and training, and apply the appropriate medical devices in the provision of anesthesia services under the anesthesia plan agreed to by the supervising anesthesiologist.

(c) The collaborating 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 registered nurse.

(d) (Blank).

(e) A physician shall not be liable for the acts or omissions of a prescribing psychologist, physician assistant, or advanced practice registered 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 prescribing psychologist, physician assistant, or advanced practice registered nurse to perform acts, unless the physician has reason to believe the prescribing psychologist, physician assistant, or advanced practice registered nurse lacked the competency to perform the act or acts or commits willful and wanton misconduct.

(f) A collaborating physician may, but is not required to, delegate prescriptive authority to an advanced practice registered nurse as part of a written collaborative agreement, and the delegation of prescriptive authority shall conform to the requirements of Section 65-40 of the Nurse Practice Act.

(g) A collaborating physician may, but is not required to, delegate prescriptive authority to a physician assistant as part of a written collaborative agreement, and the delegation of prescriptive authority shall conform to the requirements of Section 7.5 of the Physician Assistant Practice Act of 1987.

(h) (Blank).

(i) A collaborating physician shall delegate prescriptive authority to a prescribing psychologist as part of a written collaborative agreement, and the delegation of prescriptive authority shall conform to the requirements of Section 4.3 of the Clinical Psychologist Licensing Act.

(j) As set forth in Section 22.2 of this Act, a licensee under this Act may not directly or indirectly divide, share, or split any professional fee or other form of compensation for professional services with anyone in exchange for a referral or otherwise, other than as provided in Section 22.2.

(Source: P.A. 99-173, eff. 7-29-15; 100-453, eff. 8-25-17; 100-513, eff. 1-1-18; 100-605, eff. 1-1-19; 100-863, eff. 8-14-18.)

(225 ILCS 60/54.7 new)

Sec. 54.7. Certified anesthesiologist assistants; administration of anesthesia. Nothing in this Act precludes a certified anesthesiologist assistant licensed under the Certified Anesthesiologist Assistant Practice Act from selecting, ordering, and administering drugs, perform skill sets within the scope of the certified anesthesiologist assistant's education and training, and applying the appropriate medical devices in the provision of anesthesia services under the anesthesia plan agreed to by the supervising anesthesiologist licensed to practice medicine in this State.