SB1954 101ST GENERAL ASSEMBLY

LRB101 10906 RAB 56053 b

101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB1954

Introduced 2/15/2019, by Sen. Don Harmon

SYNOPSIS AS INTRODUCED:

225 ILCS 80/3	from Ch. 111, par. 3903
225 ILCS 80/24.6 new

Amends the Illinois Optometric Practice Act of 1987. Provides that nothing in the Act prohibits an optometrist who is certified by the Department of Financial and Professional Regulation from performing advanced optometric procedures pursuant to a cooperative practice agreement if the optometrist has completed specified training requirements. Provides that an optometrist may not perform advanced optometric procedures on a patient under 18 years of age. Defines "surgery" and "advanced optometric procedures". Sets forth requirements for the cooperative practice agreement, conditions for cooperative practice, and training requirements for advanced optometric procedures. Requires the Department to develop a 12-month educational course that incorporates sufficient didactic and clinical training to develop the technical skills needed to properly perform the advanced optometric procedures. Makes other changes.

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 changing Section 3 and by adding Section 24.6 as follows:

(225 ILCS 80/3) (from Ch. 111, par. 3903)

(Section scheduled to be repealed on January 1, 2027)

Sec. 3. Practice of optometry defined; referrals; manufacture of lenses and prisms.

(a) The practice of optometry is defined as the employment of any and all means for the examination, diagnosis, and treatment of the human visual system, the human eye, and its appendages without the use of surgery, including, but not limited to: the appropriate use of ocular pharmaceutical agents; refraction and other determinants of visual function; prescribing corrective lenses or prisms; prescribing, dispensing, or management of contact lenses; vision therapy; visual rehabilitation; or any other procedures taught in schools and colleges of optometry approved by the Department, and not specifically restricted in this Act, subject to demonstrated competency and training as required by the Board, and pursuant to rule or regulation approved by the Board and adopted by the Department.

A person shall be deemed to be practicing optometry within the meaning of this Act who:

(1) In any way presents himself or herself to be qualified to practice optometry.

(2) Performs refractions or employs any other determinants of visual function.

(3) Employs any means for the adaptation of lenses or prisms.

(4) Prescribes corrective lenses, prisms, vision therapy, visual rehabilitation, or ocular pharmaceutical agents.

(5) Prescribes or manages contact lenses for refractive, cosmetic, or therapeutic purposes.

(6) Evaluates the need for, or prescribes, low vision aids to partially sighted persons.

(7) Diagnoses or treats any ocular abnormality, disease, or visual or muscular anomaly of the human eye or visual system.

(8) Practices, or offers or attempts to practice, optometry as defined in this Act either on his or her own behalf or as an employee of a person, firm, or corporation, whether under the supervision of his or her employer or not.

Nothing in this Section shall be interpreted (A) to prevent a person from functioning as an assistant under the direct supervision of a person licensed by the State of Illinois to practice optometry or medicine in all of its branches or (B) to prohibit visual screening programs that are conducted without a fee (other than voluntary donations), by charitable organizations acting in the public welfare under the supervision of a committee composed of persons licensed by the State of Illinois to practice optometry or persons licensed by the State of Illinois to practice medicine in all of its branches.

(b) When, in the course of providing optometric services to any person, an optometrist licensed under this Act finds an indication of a disease or condition of the eye which in his or her professional judgment requires professional service outside the scope of practice as defined in this Act, he or she shall refer such person to a physician licensed to practice medicine in all of its branches, or other appropriate health care practitioner. Nothing in this Act shall preclude an optometrist from rendering appropriate nonsurgical emergency care.

(c) Nothing contained in this Section shall prohibit a person from manufacturing ophthalmic lenses and prisms or the fabrication of contact lenses according to the specifications prescribed by an optometrist or a physician licensed to practice medicine in all of its branches, but shall specifically prohibit (1) the sale or delivery of ophthalmic lenses, prisms, and contact lenses without a prescription signed by an optometrist or a physician licensed to practice medicine in all of its branches and (2) the dispensing of contact lenses by anyone other than a licensed optometrist, licensed pharmacist, or a physician licensed to practice medicine in all of its branches. For the purposes of this Act, "contact lenses" include, but are not limited to, contact lenses with prescriptive power and decorative and plano power contact lenses. Nothing in this Section shall prohibit the sale of contact lenses by an optical firm or corporation primarily engaged in manufacturing or dealing in eyeglasses or contact lenses with an affiliated optometrist who practices and is licensed or has an ancillary registration for the location where the sale occurs.

(d) Nothing in this Act shall restrict the filling of a prescription by a pharmacist licensed under the Pharmacy Practice Act.

(e) Nothing in this Act shall be construed to restrict the dispensing and sale by an optometrist of ocular devices, such as contact lenses, that contain and deliver ocular pharmaceutical agents permitted for use or prescription under this Act.

(f) Nothing On and after January 1, 2018, nothing in this Act shall prohibit an optometrist who is certified by a school of optometry approved by the Department from performing advanced optometric procedures pursuant to a cooperative practice agreement if the optometrist has completed the training requirements under Section 24.6 , pursuant to educational requirements established by rule, that are consistent with the recommendations of the Collaborative Optometric/Ophthalmological Task Force created in Section 15.3 of this Act and that are taught (1) at an accredited, private 4-year school of optometry that is located in a city in Illinois with a population in excess of 1,500,000, or (2) at a school of optometry with a curriculum that is substantially similar to the curriculum taught at the school of optometry described in item (1) of this subsection. Advanced optometric procedures do not include the use of lasers.

(g) As used in this Act, "surgery" means any procedure employed to treat diseases or conditions of the human eye and adjoining tissues or structures, to correct refractive error, or to alter or enhance structures of the eye or adnexa for cosmetic purposes in which human tissue is cut, ablated, vaporized, punctured, burned, frozen, or otherwise permanently altered or penetrated by instruments, laser, ultrasound, ultraviolet light, cryotherapy, electrocautery, chemicals, ionizing radiation, or by other means, including placement and removal of sutures, transplanting or applying human or other tissue, and inserting an instrument into or placement of a device into a natural opening of the body. "Surgery" does not include advanced optometric procedures as defined in this Act, the use of a scanning laser for purely diagnostic purposes to create an image, irrigation of the lacrimal duct, insertion and removal of plugs in the tear duct to treat dry eye, removal of eye lashes with the use of forceps, scraping of the cornea to remove dead tissue including incidental live tissue, scraping external tissues including the cornea with a dull device such as a swab or a spatula for the purpose of collecting a specimen for culture, and shaping the cornea with an external device such as a contact lens.

(h) Notwithstanding the provisions of subsection (g), "advanced optometric procedures" includes:

(1) Category A: Removal of non-perforating foreign bodies from the cornea no deeper than the midstroma, the conjunctiva, or the eyelid; radio frequency ablation of eyelashes; application of self-retaining amniotic membrane on the cornea without the use of sutures; and removal of a suture with approval of the surgeon who placed the suture or according to a protocol established as part of a co-management agreement for post-operative care. Category A advanced optometric procedures may be performed by a licensed optometrist with a topical anesthetic upon satisfactory completion of a course of not less than 32 hours of instruction, and demonstration of competence, as defined by rule.

(2) Category B: Removal of acrochordon (skin tags) in the area around the eye, but not on the eyelid; debridement of live corneal epithelium, excluding corneal cross linking; excision, removal or destruction of chalazion; excision, removal or destruction of benign, superficial lesions; incision and drainage of cysts; and biopsy, excluding corneal biopsy. Category B advanced optometric procedures are subject to educational and collaboration requirements as defined in Section 24.6.

"Advanced optometric procedures" does not include any procedure: (1) requiring the use of general or injectable anesthesia; (2) in which the globe or orbit of the eye is penetrated by any means; (3) involving use of a scalpel; (4) involving the use of a laser, except as provided for in subsection (g); (5) involving the removal of or disturbing any cancerous or neoplastic tissue, or removal of pterygium and pinguecula; (6) involving injections, except as provided for in Section 15.1; and (7) requiring placement or removal of sutures, except as provided for in this subsection.

An optometrist may not perform advanced optometric procedures on a patient under 18 years of age.

(Source: P.A. 98-186, eff. 8-5-13; 99-909, eff. 1-1-17.)

(225 ILCS 80/24.6 new)

Sec. 24.6. Cooperative practice and training requirements for advanced optometric procedures.

(a) In this Section, "cooperating physician" means a physician licensed to practice medicine in all of its branches in Illinois who is certified by the American Board of Ophthalmology and who practices ophthalmology in Illinois and prescribes medications and performs those items listed as advanced optometric procedures in the normal course of his or her clinical practice.

(b) A written cooperative practice agreement is required for any optometrist licensed to practice under this Act to complete advanced optometric procedures as defined under this Act.

When working together to provide care, an optometrist and cooperating physician shall enter into a cooperative practice agreement. The cooperative practice agreement shall describe the working relationship of the cooperating physician and the optometrist. Cooperation does not require an employment relationship between the cooperating physician and optometrist. Absent an employment relationship, an agreement may not restrict third-party payment sources accepted by the optometrist. In this subsection, "cooperative practice agreement" means the relationship between a cooperating physician and the optometrist with respect to the delivery of advanced optometric procedures in accordance with (1) the optometrist's training, education, and experience and (2) cooperation and consultation as documented in a jointly developed written cooperative practice agreement.

The cooperative practice agreement shall not be construed to require the personal presence of a cooperating physician at the place where services are rendered. Methods of communication shall be available for cooperation and consultation with the cooperating physician in person or by telecommunications in accordance with established written guidelines as set forth in the written agreement.

The cooperating physician must:

(1) be available to provide an appropriate level of contact, communication, collaboration, and consultation with the optometrist and must meet in-person or by telecommunication with the optometrist at least quarterly for review and consultation;

(2) have specific standing orders or policy guidelines for procedures that are to be carried out for each location or program, although the cooperating physician need not be present when the procedures are being performed;

(3) provide for the patient's additional necessary care in consultation with the optometrist;

(4) file agreements and notifications as required; and

(5) include procedures for creating and maintaining patient records, including protocols for transmission of all records between the optometrist and the cooperating physician following each treatment, which shall include a notation regarding communication between the cooperating physician and the optometrist prior to performing an advanced optometric procedure and the location where those records are to be kept.

Each cooperating physician and optometrist who enters into a cooperative practice agreement must document and maintain a copy of any change or termination of that agreement.

Patient records shall be owned and maintained by both the optometrist and the cooperating physician for all patients treated under a cooperative practice agreement.

A cooperating physician entering into an agreement under this subsection may enter into agreements for cooperative practice with no more than 5 optometrists. Nothing shall prohibit an optometrist from entering into one or more written cooperative practice agreements under this Section.

An optometrist providing services under a written cooperative practice agreement may perform only those duties as defined as advanced optometric procedures under this Act under a cooperative practice agreement.

An optometrist providing services under a cooperative practice agreement must:

(1) provide to the patient or guardian a written plan for referral or an agreement for follow-up that records all conditions observed that should be called to the attention of a cooperating physician for further diagnosis;

(2) inform each patient who may require further care by a cooperating physician of that need;

(3) maintain an appropriate level of contact and communication with the cooperating physician providing supervision; and

(4) complete an additional training and education as required under subsection (c) and receive a certification from the Department that such required training has been completed.

(c) An optometrist must complete clinical training consisting of at least 10 cases with actual patients who are diagnosed with the condition needing treatment for each advanced optometric procedure supervised by a licensed physician who meets the qualifications of a cooperating physician under subsection (a).

In addition to the 10 supervised cases for each advanced optometric procedure, the Department shall develop a 12-month educational course that incorporates sufficient didactic and clinical training to develop the technical skills needed to properly perform the advanced optometric procedures, including any complications that may arise, the knowledge to properly diagnose the condition requiring use of an advanced optometric procedure, and the judgment necessary to determine when an advanced optometric procedure should and should not be used. The education course that is developed by the Department shall be provided by an accredited medical school. Instructors must be physicians licensed to practice medicine in all its branches in Illinois.

The Department shall create a certification by rule to recognize the completion of the training required under this Section.