Full Text of HB2895 103rd General Assembly
HB2895ham002 103RD GENERAL ASSEMBLY | Rep. Anna Moeller Filed: 2/28/2024 | | 10300HB2895ham002 | | LRB103 30134 CES 69920 a |
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| 1 | | AMENDMENT TO HOUSE BILL 2895
| 2 | | AMENDMENT NO. ______. Amend House Bill 2895 by replacing | 3 | | everything after the enacting clause with the following: | 4 | | "Section 5. The Ambulatory Surgical Treatment Center Act | 5 | | is amended by changing Section 6.5 as follows: | 6 | | (210 ILCS 5/6.5) | 7 | | Sec. 6.5. Clinical privileges; advanced practice | 8 | | registered nurses. All ambulatory surgical treatment centers | 9 | | (ASTC) licensed under this Act shall comply with the following | 10 | | requirements: | 11 | | (1) No ASTC policy, rule, regulation, or practice | 12 | | shall be inconsistent with the provision of adequate | 13 | | collaboration and consultation in accordance with Section | 14 | | 54.5 of the Medical Practice Act of 1987. | 15 | | (2) Operative surgical procedures shall be performed | 16 | | only by a physician licensed to practice medicine in all |
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| 1 | | its branches under the Medical Practice Act of 1987, a | 2 | | dentist licensed under the Illinois Dental Practice Act, | 3 | | or a podiatric physician licensed under the Podiatric | 4 | | Medical Practice Act of 1987, with medical staff | 5 | | membership and surgical clinical privileges granted by the | 6 | | consulting committee of the ASTC. A licensed physician, | 7 | | dentist, or podiatric physician may be assisted by a | 8 | | physician licensed to practice medicine in all its | 9 | | branches, dentist, dental assistant, podiatric physician, | 10 | | licensed advanced practice registered nurse, licensed | 11 | | physician assistant, licensed registered nurse, licensed | 12 | | practical nurse, surgical assistant, surgical technician, | 13 | | or other individuals granted clinical privileges to assist | 14 | | in surgery by the consulting committee of the ASTC. | 15 | | Payment for services rendered by an assistant in surgery | 16 | | who is not an ambulatory surgical treatment center | 17 | | employee shall be paid at the appropriate non-physician | 18 | | modifier rate if the payor would have made payment had the | 19 | | same services been provided by a physician. | 20 | | (2.5) A registered nurse licensed under the Nurse | 21 | | Practice Act and qualified by training and experience in | 22 | | operating room nursing shall be present in the operating | 23 | | room and function as the circulating nurse during all | 24 | | invasive or operative procedures. For purposes of this | 25 | | paragraph (2.5), "circulating nurse" means a registered | 26 | | nurse who is responsible for coordinating all nursing |
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| 1 | | care, patient safety needs, and the needs of the surgical | 2 | | team in the operating room during an invasive or operative | 3 | | procedure. | 4 | | (3) An advanced practice registered nurse is not | 5 | | required to possess prescriptive authority or a written | 6 | | collaborative agreement meeting the requirements of the | 7 | | Nurse Practice Act to provide advanced practice registered | 8 | | nursing services in an ambulatory surgical treatment | 9 | | center. An advanced practice registered nurse must possess | 10 | | clinical privileges granted by the consulting medical | 11 | | staff committee and ambulatory surgical treatment center | 12 | | in order to provide services. Individual advanced practice | 13 | | registered nurses may also be granted clinical privileges | 14 | | to order, select, and administer medications, including | 15 | | controlled substances, to provide delineated care. The | 16 | | attending physician must determine the advanced practice | 17 | | registered nurse's role in providing care for his or her | 18 | | patients, except as otherwise provided in the consulting | 19 | | staff policies. The consulting medical staff committee | 20 | | shall periodically review the services of advanced | 21 | | practice registered nurses granted privileges. | 22 | | (4) (Blank). The anesthesia service shall be under the | 23 | | direction of a physician licensed to practice medicine in | 24 | | all its branches who has had specialized preparation or | 25 | | experience in the area or who has completed a residency in | 26 | | anesthesiology. An anesthesiologist, Board certified or |
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| 1 | | Board eligible, is recommended. Anesthesia services may | 2 | | only be administered pursuant to the order of a physician | 3 | | licensed to practice medicine in all its branches, | 4 | | licensed dentist, or licensed podiatric physician. | 5 | | (A) The individuals who, with clinical privileges | 6 | | granted by the medical staff and ASTC, may administer | 7 | | anesthesia services are limited to the following: | 8 | | (i) an anesthesiologist; or | 9 | | (ii) a physician licensed to practice medicine | 10 | | in all its branches; or | 11 | | (iii) a dentist with authority to administer | 12 | | anesthesia under Section 8.1 of the Illinois | 13 | | Dental Practice Act; or | 14 | | (iv) a licensed certified registered nurse | 15 | | anesthetist; or | 16 | | (v) a podiatric physician licensed under the | 17 | | Podiatric Medical Practice Act of 1987. | 18 | | (B) For anesthesia services, a certified | 19 | | registered nurse anesthetist shall seek consultation | 20 | | regarding development of an anesthesia plan and | 21 | | treatment of patients as is appropriate to the | 22 | | certified registered nurse anesthetist's level of | 23 | | expertise and scope of practice and as is warranted by | 24 | | the needs of the patient an anesthesiologist shall | 25 | | participate through discussion of and agreement with | 26 | | the anesthesia plan and shall remain physically |
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| 1 | | present and be available on the premises during the | 2 | | delivery of anesthesia services for diagnosis, | 3 | | consultation, and treatment of emergency medical | 4 | | conditions. In the absence of 24-hour availability of | 5 | | anesthesiologists with clinical privileges, an | 6 | | alternate policy (requiring participation, presence, | 7 | | and availability of a physician licensed to practice | 8 | | medicine in all its branches) shall be developed by | 9 | | the medical staff consulting committee in consultation | 10 | | with the anesthesia service and included in the | 11 | | medical staff consulting committee policies . | 12 | | (C) A certified registered nurse anesthetist is | 13 | | not required to possess prescriptive authority or a | 14 | | written collaborative agreement meeting the | 15 | | requirements of Section 65-35 of the Nurse Practice | 16 | | Act to provide anesthesia and related services ordered | 17 | | by a licensed physician, dentist, or podiatric | 18 | | physician . Licensed certified registered nurse | 19 | | anesthetists are authorized to select, order, and | 20 | | administer drugs and apply the appropriate medical | 21 | | devices in the provision of anesthesia and related | 22 | | services under the anesthesia plan agreed with by the | 23 | | anesthesiologist or, in the absence of an available | 24 | | anesthesiologist with clinical privileges, agreed with | 25 | | by the operating physician, operating dentist, or | 26 | | operating podiatric physician in accordance with the |
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| 1 | | medical staff consulting committee policies of a | 2 | | licensed ambulatory surgical treatment center. | 3 | | (D) In accordance with the medical staff | 4 | | consulting committee policies of a licensed ambulatory | 5 | | surgical treatment center, a certified registered | 6 | | nurse anesthetist with clinical privileges may perform | 7 | | acts of advanced assessment and diagnosis and may | 8 | | provide such functions for which the certified | 9 | | registered nurse anesthetist is educationally and | 10 | | experientially prepared. A certified registered nurse | 11 | | anesthetist shall practice in accordance with the | 12 | | scope and all standards of the appropriate national | 13 | | professional nursing association. | 14 | | (Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18 .) | 15 | | Section 10. The Hospital Licensing Act is amended by | 16 | | changing Section 10.7 as follows: | 17 | | (210 ILCS 85/10.7) | 18 | | Sec. 10.7. Clinical privileges; advanced practice | 19 | | registered nurses. All hospitals licensed under this Act | 20 | | shall comply with the following requirements: | 21 | | (1) No hospital policy, rule, regulation, or practice | 22 | | shall be inconsistent with the provision of adequate | 23 | | collaboration and consultation in accordance with Section | 24 | | 54.5 of the Medical Practice Act of 1987. |
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| 1 | | (2) Operative surgical procedures shall be performed | 2 | | only by a physician licensed to practice medicine in all | 3 | | its branches under the Medical Practice Act of 1987, a | 4 | | dentist licensed under the Illinois Dental Practice Act, | 5 | | or a podiatric physician licensed under the Podiatric | 6 | | Medical Practice Act of 1987, with medical staff | 7 | | membership and surgical clinical privileges granted at the | 8 | | hospital. A licensed physician, dentist, or podiatric | 9 | | physician may be assisted by a physician licensed to | 10 | | practice medicine in all its branches, dentist, dental | 11 | | assistant, podiatric physician, licensed advanced practice | 12 | | registered nurse, licensed physician assistant, licensed | 13 | | registered nurse, licensed practical nurse, surgical | 14 | | assistant, surgical technician, or other individuals | 15 | | granted clinical privileges to assist in surgery at the | 16 | | hospital. Payment for services rendered by an assistant in | 17 | | surgery who is not a hospital employee shall be paid at the | 18 | | appropriate non-physician modifier rate if the payor would | 19 | | have made payment had the same services been provided by a | 20 | | physician. | 21 | | (2.5) A registered nurse licensed under the Nurse | 22 | | Practice Act and qualified by training and experience in | 23 | | operating room nursing shall be present in the operating | 24 | | room and function as the circulating nurse during all | 25 | | invasive or operative procedures. For purposes of this | 26 | | paragraph (2.5), "circulating nurse" means a registered |
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| 1 | | nurse who is responsible for coordinating all nursing | 2 | | care, patient safety needs, and the needs of the surgical | 3 | | team in the operating room during an invasive or operative | 4 | | procedure. | 5 | | (3) An advanced practice registered nurse is not | 6 | | required to possess prescriptive authority or a written | 7 | | collaborative agreement meeting the requirements of the | 8 | | Nurse Practice Act to provide advanced practice registered | 9 | | nursing services in a hospital. An advanced practice | 10 | | registered nurse must possess clinical privileges | 11 | | recommended by the medical staff and granted by the | 12 | | hospital in order to provide services. Individual advanced | 13 | | practice registered nurses may also be granted clinical | 14 | | privileges to order, select, and administer medications, | 15 | | including controlled substances, to provide delineated | 16 | | care. The attending physician must determine the advanced | 17 | | practice registered nurse's role in providing care for his | 18 | | or her patients, except as otherwise provided in medical | 19 | | staff bylaws. The medical staff shall periodically review | 20 | | the services of advanced practice registered nurses | 21 | | granted privileges. This review shall be conducted in | 22 | | accordance with item (2) of subsection (a) of Section 10.8 | 23 | | of this Act for advanced practice registered nurses | 24 | | employed by the hospital. | 25 | | (4) (Blank). The anesthesia service shall be under the | 26 | | direction of a physician licensed to practice medicine in |
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| 1 | | all its branches who has had specialized preparation or | 2 | | experience in the area or who has completed a residency in | 3 | | anesthesiology. An anesthesiologist, Board certified or | 4 | | Board eligible, is recommended. Anesthesia services may | 5 | | only be administered pursuant to the order of a physician | 6 | | licensed to practice medicine in all its branches, | 7 | | licensed dentist, or licensed podiatric physician. | 8 | | (A) The individuals who, with clinical privileges | 9 | | granted at the hospital, may administer anesthesia | 10 | | services are limited to the following: | 11 | | (i) an anesthesiologist; or | 12 | | (ii) a physician licensed to practice medicine | 13 | | in all its branches; or | 14 | | (iii) a dentist with authority to administer | 15 | | anesthesia under Section 8.1 of the Illinois | 16 | | Dental Practice Act; or | 17 | | (iv) a licensed certified registered nurse | 18 | | anesthetist; or | 19 | | (v) a podiatric physician licensed under the | 20 | | Podiatric Medical Practice Act of 1987. | 21 | | (B) For anesthesia services, a certified | 22 | | registered nurse anesthetist shall seek consultation | 23 | | regarding development of an anesthesia plan and | 24 | | treatment of patients as is appropriate to the | 25 | | certified registered nurse anesthetist's level of | 26 | | expertise and scope of practice and as is warranted by |
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| 1 | | the needs of the patient an anesthesiologist shall | 2 | | participate through discussion of and agreement with | 3 | | the anesthesia plan and shall remain physically | 4 | | present and be available on the premises during the | 5 | | delivery of anesthesia services for diagnosis, | 6 | | consultation, and treatment of emergency medical | 7 | | conditions. In the absence of 24-hour availability of | 8 | | anesthesiologists with medical staff privileges, an | 9 | | alternate policy (requiring participation, presence, | 10 | | and availability of a physician licensed to practice | 11 | | medicine in all its branches) shall be developed by | 12 | | the medical staff and licensed hospital in | 13 | | consultation with the anesthesia service . | 14 | | (C) A certified registered nurse anesthetist is | 15 | | not required to possess prescriptive authority or a | 16 | | written collaborative agreement meeting the | 17 | | requirements of Section 65-35 of the Nurse Practice | 18 | | Act to provide anesthesia and related services ordered | 19 | | by a licensed physician, dentist, or podiatric | 20 | | physician . Licensed certified registered nurse | 21 | | anesthetists are authorized to select, order, and | 22 | | administer drugs and apply the appropriate medical | 23 | | devices in the provision of anesthesia and related | 24 | | services under the anesthesia plan agreed with by the | 25 | | anesthesiologist or, in the absence of an available | 26 | | anesthesiologist with clinical privileges, agreed with |
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| 1 | | by the operating physician, operating dentist, or | 2 | | operating podiatric physician in accordance with the | 3 | | hospital's alternative policy. | 4 | | (D) In accordance with the hospital's policies, a | 5 | | certified registered nurse anesthetist with clinical | 6 | | privileges may perform acts of advanced assessment and | 7 | | diagnosis and may provide such functions for which the | 8 | | CRNA is educationally and experientially prepared. A | 9 | | certified registered nurse anesthetist shall practice | 10 | | in accordance with the scope and all standards of the | 11 | | appropriate national professional nursing association. | 12 | | (Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18 .) | 13 | | Section 15. The Medical Practice Act of 1987 is amended by | 14 | | changing Section 54.5 as follows: | 15 | | (225 ILCS 60/54.5) | 16 | | (Section scheduled to be repealed on January 1, 2027) | 17 | | Sec. 54.5. Physician delegation of authority to physician | 18 | | assistants, advanced practice registered nurses without full | 19 | | practice authority, and prescribing psychologists. | 20 | | (a) Physicians licensed to practice medicine in all its | 21 | | branches may delegate care and treatment responsibilities to a | 22 | | physician assistant under guidelines in accordance with the | 23 | | requirements of the Physician Assistant Practice Act of 1987. | 24 | | A physician licensed to practice medicine in all its branches |
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| 1 | | may enter into collaborative agreements with no more than 7 | 2 | | full-time equivalent physician assistants, except in a | 3 | | hospital, hospital affiliate, or ambulatory surgical treatment | 4 | | center as set forth by Section 7.7 of the Physician Assistant | 5 | | Practice Act of 1987 and as provided in subsection (a-5). | 6 | | (a-5) A physician licensed to practice medicine in all its | 7 | | branches may collaborate with more than 7 physician assistants | 8 | | when the services are provided in a federal primary care | 9 | | health professional shortage area with a Health Professional | 10 | | Shortage Area score greater than or equal to 12, as determined | 11 | | by the United States Department of Health and Human Services. | 12 | | The collaborating physician must keep appropriate | 13 | | documentation of meeting this exemption and make it available | 14 | | to the Department upon request. | 15 | | (b) A physician licensed to practice medicine in all its | 16 | | branches in active clinical practice may collaborate with an | 17 | | advanced practice registered nurse in accordance with the | 18 | | requirements of the Nurse Practice Act. Collaboration is for | 19 | | the purpose of providing medical consultation, and no | 20 | | employment relationship is required. A written collaborative | 21 | | agreement shall conform to the requirements of Section 65-35 | 22 | | of the Nurse Practice Act. The written collaborative agreement | 23 | | shall be for services for which the collaborating physician | 24 | | can provide adequate collaboration. A written collaborative | 25 | | agreement shall be adequate with respect to collaboration with | 26 | | advanced practice registered nurses if all of the following |
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| 1 | | apply: | 2 | | (1) The agreement is written to promote the exercise | 3 | | of professional judgment by the advanced practice | 4 | | registered nurse commensurate with his or her education | 5 | | and experience. | 6 | | (2) The advanced practice registered nurse provides | 7 | | services based upon a written collaborative agreement with | 8 | | the collaborating physician , except as set forth in | 9 | | subsection (b-5) of this Section . With respect to labor | 10 | | and delivery, the collaborating physician must provide | 11 | | delivery services in order to participate with a certified | 12 | | nurse midwife. | 13 | | (3) Methods of communication are available with the | 14 | | collaborating physician in person or through | 15 | | telecommunications for consultation, collaboration, and | 16 | | referral as needed to address patient care needs. | 17 | | (b-5) An anesthesiologist or physician licensed to | 18 | | practice medicine in all its branches may collaborate with a | 19 | | certified registered nurse anesthetist in accordance with | 20 | | Section 65-35 of the Nurse Practice Act for the provision of | 21 | | anesthesia and related services. A written collaborative | 22 | | agreement shall be adequate with respect to collaboration with | 23 | | certified registered nurse anesthetists if all of the | 24 | | following apply: | 25 | | (1) The agreement is written to promote exercise of | 26 | | professional judgment by the certified registered nurse |
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| 1 | | anesthetist commensurate with his or her education and | 2 | | experience. | 3 | | (2) The certified registered nurse anesthetist | 4 | | provides service based on a written collaborative | 5 | | agreement with the collaborating physician. | 6 | | (3) Methods of communication are available with the | 7 | | collaborating physician in person or through | 8 | | telecommunications for consultation, collaboration, and | 9 | | referral as needed to address patient care needs. With | 10 | | respect to the provision of anesthesia services, the | 11 | | collaborating anesthesiologist or physician shall have | 12 | | training and experience in the delivery of anesthesia | 13 | | services consistent with Department rules. Collaboration | 14 | | shall be adequate if: | 15 | | (1) an anesthesiologist or a physician participates in | 16 | | the joint formulation and joint approval of orders or | 17 | | guidelines and periodically reviews such orders and the | 18 | | services provided patients under such orders; and | 19 | | (2) for anesthesia services, the anesthesiologist or | 20 | | physician participates through discussion of and agreement | 21 | | with the anesthesia plan and is physically present and | 22 | | available on the premises during the delivery of | 23 | | anesthesia services for diagnosis, consultation, and | 24 | | treatment of emergency medical conditions. Collaboration | 25 | | with respect to an anesthesia and related Anesthesia | 26 | | services in a hospital shall be conducted in accordance |
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| 1 | | with Section 10.7 of the Hospital Licensing Act and in an | 2 | | ambulatory surgical treatment center in accordance with | 3 | | Section 6.5 of the Ambulatory Surgical Treatment Center | 4 | | Act. | 5 | | (b-10) For anesthesia services, a certified registered | 6 | | nurse anesthetist shall consult with the collaborating | 7 | | physician or other appropriate health care professionals | 8 | | regarding development of an anesthesia plan and treatment of a | 9 | | patient as is appropriate to the certified registered nurse | 10 | | anesthetist's level of expertise and scope of practice and as | 11 | | is warranted by the needs of the patient The anesthesiologist | 12 | | or operating physician must agree with the anesthesia plan | 13 | | prior to the delivery of services . | 14 | | (c) The collaborating physician shall have access to the | 15 | | medical records of all patients attended by a physician | 16 | | assistant. The collaborating physician shall have access to | 17 | | the medical records of all patients attended to by an advanced | 18 | | practice registered nurse. | 19 | | (d) (Blank). | 20 | | (e) A physician shall not be liable for the acts or | 21 | | omissions of a prescribing psychologist, physician assistant, | 22 | | or advanced practice registered nurse solely on the basis of | 23 | | having signed a supervision agreement or guidelines or a | 24 | | collaborative agreement, an order, a standing medical order, a | 25 | | standing delegation order, or other order or guideline | 26 | | authorizing a prescribing psychologist, physician assistant, |
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| 1 | | or advanced practice registered nurse to perform acts, unless | 2 | | the physician has reason to believe the prescribing | 3 | | psychologist, physician assistant, or advanced practice | 4 | | registered nurse lacked the competency to perform the act or | 5 | | acts or commits willful and wanton misconduct. | 6 | | (f) A collaborating physician may, but is not required to, | 7 | | delegate prescriptive authority to an advanced practice | 8 | | registered nurse as part of a written collaborative agreement, | 9 | | and the delegation of prescriptive authority shall conform to | 10 | | the requirements of Section 65-40 of the Nurse Practice Act. | 11 | | (g) A collaborating physician may, but is not required to, | 12 | | delegate prescriptive authority to a physician assistant as | 13 | | part of a written collaborative agreement, and the delegation | 14 | | of prescriptive authority shall conform to the requirements of | 15 | | Section 7.5 of the Physician Assistant Practice Act of 1987. | 16 | | (h) (Blank). | 17 | | (i) A collaborating physician shall delegate prescriptive | 18 | | authority to a prescribing psychologist as part of a written | 19 | | collaborative agreement, and the delegation of prescriptive | 20 | | authority shall conform to the requirements of Section 4.3 of | 21 | | the Clinical Psychologist Licensing Act. | 22 | | (j) As set forth in Section 22.2 of this Act, a licensee | 23 | | under this Act may not directly or indirectly divide, share, | 24 | | or split any professional fee or other form of compensation | 25 | | for professional services with anyone in exchange for a | 26 | | referral or otherwise, other than as provided in Section 22.2. |
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| 1 | | (Source: P.A. 103-228, eff. 1-1-24 .) | 2 | | Section 20. The Nurse Practice Act is amended by changing | 3 | | Sections 65-35 and 65-45 and by adding Section 65-70 as | 4 | | follows: | 5 | | (225 ILCS 65/65-35) (was 225 ILCS 65/15-15) | 6 | | (Section scheduled to be repealed on January 1, 2028) | 7 | | Sec. 65-35. Written collaborative agreements. | 8 | | (a) A written collaborative agreement is required for all | 9 | | advanced practice registered nurses engaged in clinical | 10 | | practice prior to meeting the requirements of Section 65-43, | 11 | | except for advanced practice registered nurses who are | 12 | | privileged to practice in a hospital, hospital affiliate, or | 13 | | ambulatory surgical treatment center. | 14 | | (a-5) If an advanced practice registered nurse engages in | 15 | | clinical practice outside of a hospital, hospital affiliate, | 16 | | or ambulatory surgical treatment center in which he or she is | 17 | | privileged to practice, the advanced practice registered nurse | 18 | | must have a written collaborative agreement, except as set | 19 | | forth in Section 65-43 and 65-70 . | 20 | | (b) A written collaborative agreement shall describe the | 21 | | relationship of the advanced practice registered nurse with | 22 | | the collaborating physician and shall describe the categories | 23 | | of care, treatment, or procedures to be provided by the | 24 | | advanced practice registered nurse. A collaborative agreement |
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| 1 | | with a podiatric physician must be in accordance with | 2 | | subsection (c-5) or (c-15) of this Section. A collaborative | 3 | | agreement with a dentist must be in accordance with subsection | 4 | | (c-10) of this Section. A collaborative agreement with a | 5 | | podiatric physician must be in accordance with subsection | 6 | | (c-5) of this Section. Collaboration does not require an | 7 | | employment relationship between the collaborating physician | 8 | | and the advanced practice registered nurse. | 9 | | The collaborative relationship under an agreement shall | 10 | | not be construed to require the personal presence of a | 11 | | collaborating physician at the place where services are | 12 | | rendered. Methods of communication shall be available for | 13 | | consultation with the collaborating physician in person or by | 14 | | telecommunications or electronic communications as set forth | 15 | | in the written agreement. | 16 | | (b-5) Absent an employment relationship, a written | 17 | | collaborative agreement may not (1) restrict the categories of | 18 | | patients of an advanced practice registered nurse within the | 19 | | scope of the advanced practice registered nurses training and | 20 | | experience, (2) limit third party payors or government health | 21 | | programs, such as the medical assistance program or Medicare | 22 | | with which the advanced practice registered nurse contracts, | 23 | | or (3) limit the geographic area or practice location of the | 24 | | advanced practice registered nurse in this State. | 25 | | (c) In the case of anesthesia services provided by a | 26 | | certified registered nurse anesthetist, a certified registered |
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| 1 | | nurse anesthetist shall seek consultation regarding | 2 | | development of an anesthesia plan and treatment of patients as | 3 | | is appropriate to the certified registered nurse anesthetist's | 4 | | level of expertise and scope of practice and as is warranted by | 5 | | the needs of the patient an anesthesiologist, a physician, a | 6 | | dentist, or a podiatric physician must participate through | 7 | | discussion of and agreement with the anesthesia plan and | 8 | | remain physically present and available on the premises during | 9 | | the delivery of anesthesia services for diagnosis, | 10 | | consultation, and treatment of emergency medical conditions . | 11 | | (c-5) A certified registered nurse anesthetist, who | 12 | | provides anesthesia and related services outside of a hospital | 13 | | or ambulatory surgical treatment center shall enter into a | 14 | | written collaborative agreement with an anesthesiologist or | 15 | | the physician licensed to practice medicine in all its | 16 | | branches or the podiatric physician performing the procedure. | 17 | | The collaborative agreement may, but is not required to, | 18 | | include the following terms: (i) that the certified registered | 19 | | nurse anesthetist providing anesthesia services and the | 20 | | anesthesiologist, physician, or podiatric physician | 21 | | participate through discussion of and reach agreement on the | 22 | | anesthesia plan or (ii) that anesthesia services shall only be | 23 | | delivered when the anesthesiologist, physician, or podiatric | 24 | | physician is present and available on the premises for | 25 | | diagnosis, consultation, and treatment of emergency medical | 26 | | conditions. Outside of a hospital or ambulatory surgical |
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| 1 | | treatment center, the certified registered nurse anesthetist | 2 | | may provide only those services that the collaborating | 3 | | podiatric physician is authorized to provide pursuant to the | 4 | | Podiatric Medical Practice Act of 1987 and rules adopted | 5 | | thereunder. A certified registered nurse anesthetist may | 6 | | select, order, and administer medication, including controlled | 7 | | substances, and apply appropriate medical devices for delivery | 8 | | of anesthesia and related services under the anesthesia plan | 9 | | agreed with by the anesthesiologist or the operating physician | 10 | | or operating podiatric physician . | 11 | | (c-10) A certified registered nurse anesthetist who | 12 | | provides anesthesia services in a dental office shall enter | 13 | | into a written collaborative agreement with an | 14 | | anesthesiologist or the physician licensed to practice | 15 | | medicine in all its branches or the operating dentist | 16 | | performing the procedure. The agreement shall describe the | 17 | | working relationship of the certified registered nurse | 18 | | anesthetist and dentist and shall authorize the categories of | 19 | | care, treatment, or procedures to be performed by the | 20 | | certified registered nurse anesthetist. The collaborative | 21 | | agreement may, but is not required to, include the following | 22 | | terms: (i) that the certified registered nurse anesthetist | 23 | | providing anesthesia services and the anesthesiologist, | 24 | | physician, or podiatric physician participate through | 25 | | discussion of and reach agreement on the anesthesia plan or | 26 | | (ii) that anesthesia services shall only be delivered when the |
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| 1 | | anesthesiologist, physician, or podiatric physician is present | 2 | | and available on the premises for diagnosis, consultation, and | 3 | | treatment of emergency medical conditions. In a collaborating | 4 | | dentist's office, the certified registered nurse anesthetist | 5 | | may only provide those services that the operating dentist | 6 | | with the appropriate permit is authorized to provide pursuant | 7 | | to the Illinois Dental Practice Act and rules adopted | 8 | | thereunder. For anesthesia services, a certified registered | 9 | | nurse anesthetist shall seek consultation regarding | 10 | | development of an anesthesia plan and treatment of patients as | 11 | | is appropriate to the certified registered nurse anesthetist's | 12 | | level of expertise and scope of practice and as is warranted by | 13 | | the needs of the patient an anesthesiologist, physician, or | 14 | | operating dentist shall participate through discussion of and | 15 | | agreement with the anesthesia plan and shall remain physically | 16 | | present and be available on the premises during the delivery | 17 | | of anesthesia services for diagnosis, consultation, and | 18 | | treatment of emergency medical conditions . A certified | 19 | | registered nurse anesthetist may select, order, and administer | 20 | | medication, including controlled substances, and apply | 21 | | appropriate medical devices for delivery of anesthesia and | 22 | | related services under the anesthesia plan agreed with by the | 23 | | operating dentist . | 24 | | (c-15) An advanced practice registered nurse who had a | 25 | | written collaborative agreement with a podiatric physician | 26 | | immediately before the effective date of Public Act 100-513 |
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| 1 | | may continue in that collaborative relationship or enter into | 2 | | a new written collaborative relationship with a podiatric | 3 | | physician under the requirements of this Section and Section | 4 | | 65-40, as those Sections existed immediately before the | 5 | | amendment of those Sections by Public Act 100-513 with regard | 6 | | to a written collaborative agreement between an advanced | 7 | | practice registered nurse and a podiatric physician. | 8 | | (d) A copy of the signed, written collaborative agreement | 9 | | must be available to the Department upon request from both the | 10 | | advanced practice registered nurse and the collaborating | 11 | | physician, dentist, or podiatric physician. | 12 | | (e) Nothing in this Act shall be construed to limit the | 13 | | delegation of tasks or duties by a physician to a licensed | 14 | | practical nurse, a registered professional nurse, or other | 15 | | persons in accordance with Section 54.2 of the Medical | 16 | | Practice Act of 1987. Nothing in this Act shall be construed to | 17 | | limit the method of delegation that may be authorized by any | 18 | | means, including, but not limited to, oral, written, | 19 | | electronic, standing orders, protocols, guidelines, or verbal | 20 | | orders. | 21 | | (e-5) Nothing in this Act shall be construed to authorize | 22 | | an advanced practice registered nurse to provide health care | 23 | | services required by law or rule to be performed by a | 24 | | physician. The scope of practice of an advanced practice | 25 | | registered nurse does not include operative surgery. Nothing | 26 | | in this Section shall be construed to preclude an advanced |
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| 1 | | practice registered nurse from assisting in surgery. | 2 | | (f) An advanced practice registered nurse shall inform | 3 | | each collaborating physician, dentist, or podiatric physician | 4 | | of all collaborative agreements he or she has signed and | 5 | | provide a copy of these to any collaborating physician, | 6 | | dentist, or podiatric physician upon request. | 7 | | (g) (Blank). | 8 | | (Source: P.A. 100-513, eff. 1-1-18; 100-577, eff. 1-26-18; | 9 | | 100-1096, eff. 8-26-18; 101-13, eff. 6-12-19.) | 10 | | (225 ILCS 65/65-45) (was 225 ILCS 65/15-25) | 11 | | (Section scheduled to be repealed on January 1, 2028) | 12 | | Sec. 65-45. Advanced practice registered nursing in | 13 | | hospitals, hospital affiliates, or ambulatory surgical | 14 | | treatment centers. | 15 | | (a) An advanced practice registered nurse may provide | 16 | | services in a hospital or a hospital affiliate as those terms | 17 | | are defined in the Hospital Licensing Act or the University of | 18 | | Illinois Hospital Act or a licensed ambulatory surgical | 19 | | treatment center without a written collaborative agreement | 20 | | pursuant to Section 65-35 of this Act. An advanced practice | 21 | | registered nurse must possess clinical privileges recommended | 22 | | by the hospital medical staff and granted by the hospital or | 23 | | the consulting medical staff committee and ambulatory surgical | 24 | | treatment center in order to provide services. The medical | 25 | | staff or consulting medical staff committee shall periodically |
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| 1 | | review the services of all advanced practice registered nurses | 2 | | granted clinical privileges, including any care provided in a | 3 | | hospital affiliate. Authority may also be granted when | 4 | | recommended by the hospital medical staff and granted by the | 5 | | hospital or recommended by the consulting medical staff | 6 | | committee and ambulatory surgical treatment center to | 7 | | individual advanced practice registered nurses to select, | 8 | | order, and administer medications, including controlled | 9 | | substances, to provide delineated care. In a hospital, | 10 | | hospital affiliate, or ambulatory surgical treatment center, | 11 | | the attending physician shall determine an advanced practice | 12 | | registered nurse's role in providing care for his or her | 13 | | patients, except as otherwise provided in the medical staff | 14 | | bylaws or consulting committee policies. | 15 | | (a-2) An advanced practice registered nurse privileged to | 16 | | order medications, including controlled substances, may | 17 | | complete discharge prescriptions provided the prescription is | 18 | | in the name of the advanced practice registered nurse and the | 19 | | attending or discharging physician. | 20 | | (a-3) Advanced practice registered nurses practicing in a | 21 | | hospital or an ambulatory surgical treatment center are not | 22 | | required to obtain a mid-level controlled substance license to | 23 | | order controlled substances under Section 303.05 of the | 24 | | Illinois Controlled Substances Act. | 25 | | (a-4) An advanced practice registered nurse meeting the | 26 | | requirements of Section 65-43 or 65-70 may be privileged to |
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| 1 | | complete discharge orders and prescriptions under the advanced | 2 | | practice registered nurse's name. | 3 | | (a-5) For anesthesia services provided by a certified | 4 | | registered nurse anesthetist, certified registered nurse | 5 | | anesthetist shall seek consultation regarding development of | 6 | | an anesthesia plan and treatment of patients as is appropriate | 7 | | to the certified registered nurse anesthetist's level of | 8 | | expertise and scope of practice and as is warranted by the | 9 | | needs of the patient an anesthesiologist, physician, dentist, | 10 | | or podiatric physician shall participate through discussion of | 11 | | and agreement with the anesthesia plan and shall remain | 12 | | physically present and be available on the premises during the | 13 | | delivery of anesthesia services for diagnosis, consultation, | 14 | | and treatment of emergency medical conditions, unless hospital | 15 | | policy adopted pursuant to clause (B) of subdivision (3) of | 16 | | Section 10.7 of the Hospital Licensing Act or ambulatory | 17 | | surgical treatment center policy adopted pursuant to clause | 18 | | (B) of subdivision (3) of Section 6.5 of the Ambulatory | 19 | | Surgical Treatment Center Act provides otherwise . A certified | 20 | | registered nurse anesthetist may select, order, and administer | 21 | | medication for anesthesia and related services under the | 22 | | anesthesia plan agreed to by the anesthesiologist or the | 23 | | physician, in accordance with hospital alternative policy or | 24 | | the medical staff consulting committee policies of a licensed | 25 | | ambulatory surgical treatment center. | 26 | | (b) An advanced practice registered nurse who provides |
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| 1 | | services in a hospital shall do so in accordance with Section | 2 | | 10.7 of the Hospital Licensing Act and, in an ambulatory | 3 | | surgical treatment center, in accordance with Section 6.5 of | 4 | | the Ambulatory Surgical Treatment Center Act. Nothing in this | 5 | | Act shall be construed to require an advanced practice | 6 | | registered nurse to have a collaborative agreement to practice | 7 | | in a hospital, hospital affiliate, or ambulatory surgical | 8 | | treatment center. | 9 | | (c) Advanced practice registered nurses certified as nurse | 10 | | practitioners, nurse midwives, or clinical nurse specialists | 11 | | practicing in a hospital affiliate may be, but are not | 12 | | required to be, privileged to prescribe Schedule II through V | 13 | | controlled substances when such authority is recommended by | 14 | | the appropriate physician committee of the hospital affiliate | 15 | | and granted by the hospital affiliate. This authority may, but | 16 | | is not required to, include prescription of, selection of, | 17 | | orders for, administration of, storage of, acceptance of | 18 | | samples of, and dispensing over-the-counter medications, | 19 | | legend drugs, medical gases, and controlled substances | 20 | | categorized as Schedule II through V controlled substances, as | 21 | | defined in Article II of the Illinois Controlled Substances | 22 | | Act, and other preparations, including, but not limited to, | 23 | | botanical and herbal remedies. | 24 | | To prescribe controlled substances under this subsection | 25 | | (c), an advanced practice registered nurse certified as a | 26 | | nurse practitioner, nurse midwife, or clinical nurse |
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| 1 | | specialist must obtain a controlled substance license. | 2 | | Medication orders shall be reviewed periodically by the | 3 | | appropriate hospital affiliate physicians committee or its | 4 | | physician designee. | 5 | | The hospital affiliate shall file with the Department | 6 | | notice of a grant of prescriptive authority consistent with | 7 | | this subsection (c) and termination of such a grant of | 8 | | authority, in accordance with rules of the Department. Upon | 9 | | receipt of this notice of grant of authority to prescribe any | 10 | | Schedule II through V controlled substances, the licensed | 11 | | advanced practice registered nurse certified as a nurse | 12 | | practitioner, nurse midwife, or clinical nurse specialist may | 13 | | register for a mid-level practitioner controlled substance | 14 | | license under Section 303.05 of the Illinois Controlled | 15 | | Substances Act. | 16 | | In addition, a hospital affiliate may, but is not required | 17 | | to, privilege an advanced practice registered nurse certified | 18 | | as a nurse practitioner, nurse midwife, or clinical nurse | 19 | | specialist to prescribe any Schedule II controlled substances, | 20 | | if all of the following conditions apply: | 21 | | (1) specific Schedule II controlled substances by oral | 22 | | dosage or topical or transdermal application may be | 23 | | designated, provided that the designated Schedule II | 24 | | controlled substances are routinely prescribed by advanced | 25 | | practice registered nurses in their area of certification; | 26 | | the privileging documents must identify the specific |
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| 1 | | Schedule II controlled substances by either brand name or | 2 | | generic name; privileges to prescribe or dispense Schedule | 3 | | II controlled substances to be delivered by injection or | 4 | | other route of administration may not be granted; | 5 | | (2) any privileges must be controlled substances | 6 | | limited to the practice of the advanced practice | 7 | | registered nurse; | 8 | | (3) any prescription must be limited to no more than a | 9 | | 30-day supply; | 10 | | (4) the advanced practice registered nurse must | 11 | | discuss the condition of any patients for whom a | 12 | | controlled substance is prescribed monthly with the | 13 | | appropriate physician committee of the hospital affiliate | 14 | | or its physician designee; and | 15 | | (5) the advanced practice registered nurse must meet | 16 | | the education requirements of Section 303.05 of the | 17 | | Illinois Controlled Substances Act. | 18 | | (d) An advanced practice registered nurse meeting the | 19 | | requirements of Section 65-43 may be privileged to prescribe | 20 | | controlled substances categorized as Schedule II through V in | 21 | | accordance with Section 65-43. | 22 | | (Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18 .) | 23 | | (225 ILCS 65/65-70 new) | 24 | | Sec. 65-70. Conditions under which a written collaborative | 25 | | agreement not required. |
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| 1 | | (a) An Illinois-licensed advanced practice registered | 2 | | nurse certified as a certified registered nurse anesthetist | 3 | | shall be deemed by law to possess the ability to practice | 4 | | without a written collaborative agreement as set forth in this | 5 | | Act. | 6 | | (b) An advanced practice registered nurse certified as a | 7 | | certified registered nurse anesthetist who (i) has attained | 8 | | national certification and completed a professional practice | 9 | | doctorate or (ii) files with the Department a notarized | 10 | | attestation of completion of at least 250 hours of continuing | 11 | | education or training and at least 4,000 hours of clinical | 12 | | experience after first attaining national certification, shall | 13 | | not require a written collaborative agreement. Documentation | 14 | | of successful completion shall be provided to the Department | 15 | | upon request. Continuing education or training hours required | 16 | | by this subsection shall be in the certified registered nurse | 17 | | anesthetist's area of certification as set forth by Department | 18 | | rule. | 19 | | The clinical experience must be in the certified | 20 | | registered nurse anesthetist's area of certification. The | 21 | | clinical experience shall be in collaboration with a physician | 22 | | or physicians or a certified registered nurse anesthetist with | 23 | | full practice authority. Completion of the clinical experience | 24 | | must be attested to by the collaborating physician or | 25 | | physicians or employer, collaborating certified registered | 26 | | nurse anesthetist and the certified registered nurse |
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| 1 | | anesthetist. If the collaborating physician or physicians | 2 | | collaborating certified nurse anesthetist, or employer is | 3 | | unable to attest to the completion of the clinical experience, | 4 | | the Department may accept other evidence of clinical | 5 | | experience as established by rule. | 6 | | (c) The scope of practice of a certified registered nurse | 7 | | anesthetist with full practice authority includes: | 8 | | (1) all matters included in subsection (c) of Section | 9 | | 65-30 of this Act; | 10 | | (2) practicing without a written collaborative | 11 | | agreement in all practice settings consistent with | 12 | | national certification; | 13 | | (3) authority to prescribe both legend drugs and | 14 | | Schedule II through V controlled substances; this | 15 | | authority includes prescription of, selection of, orders | 16 | | for, administration of, storage of, acceptance of samples | 17 | | of, and dispensing over the counter medications, legend | 18 | | drugs, and controlled substances categorized as any | 19 | | Schedule II through V controlled substances, as defined in | 20 | | Article II of the Illinois Controlled Substances Act, and | 21 | | other preparations, including, but not limited to, | 22 | | botanical and herbal remedies; | 23 | | (4) prescribing benzodiazepines or Schedule II | 24 | | narcotic drugs, such as opioids; and | 25 | | (5) authority to obtain an Illinois controlled | 26 | | substance license and a federal Drug Enforcement |
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| 1 | | Administration number. | 2 | | (d) The Department may adopt rules necessary to administer | 3 | | this Section, including, but not limited to, requiring the | 4 | | completion of forms and the payment of fees. | 5 | | (e) Nothing in this Act shall be construed to authorize a | 6 | | certified registered nurse anesthetist with full practice | 7 | | authority to provide health care services required by law or | 8 | | rule to be performed by a physician. | 9 | | Section 25. The Illinois Dental Practice Act is amended by | 10 | | changing Section 8.1 as follows: | 11 | | (225 ILCS 25/8.1) (from Ch. 111, par. 2308.1) | 12 | | (Section scheduled to be repealed on January 1, 2026) | 13 | | Sec. 8.1. Permit for the administration of anesthesia and | 14 | | sedation. | 15 | | (a) No licensed dentist shall administer general | 16 | | anesthesia, deep sedation, or conscious sedation without first | 17 | | applying for and obtaining a permit for such purpose from the | 18 | | Department. The Department shall issue such permit only after | 19 | | ascertaining that the applicant possesses the minimum | 20 | | qualifications necessary to protect public safety. A person | 21 | | with a dental degree who administers anesthesia, deep | 22 | | sedation, or conscious sedation in an approved hospital | 23 | | training program under the supervision of either a licensed | 24 | | dentist holding such permit or a physician licensed to |
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| 1 | | practice medicine in all its branches shall not be required to | 2 | | obtain such permit. | 3 | | (b) In determining the minimum permit qualifications that | 4 | | are necessary to protect public safety, the Department, by | 5 | | rule, shall: | 6 | | (1) establish the minimum educational and training | 7 | | requirements necessary for a dentist to be issued an | 8 | | appropriate permit; | 9 | | (2) establish the standards for properly equipped | 10 | | dental facilities (other than licensed hospitals and | 11 | | ambulatory surgical treatment centers) in which general | 12 | | anesthesia, deep sedation, or conscious sedation is | 13 | | administered, as necessary to protect public safety; | 14 | | (3) establish minimum requirements for all persons who | 15 | | assist the dentist in the administration of general | 16 | | anesthesia, deep sedation, or conscious sedation, | 17 | | including minimum training requirements for each member of | 18 | | the dental team, monitoring requirements, recordkeeping | 19 | | requirements, and emergency procedures; | 20 | | (4) ensure that the dentist has completed and | 21 | | maintains current certification in advanced cardiac life | 22 | | support or pediatric advanced life support and all persons | 23 | | assisting the dentist or monitoring the administration of | 24 | | general anesthesia, deep sedation, or conscious sedation | 25 | | maintain current certification in Basic Life Support | 26 | | (BLS); and |
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| 1 | | (5) establish continuing education requirements in | 2 | | sedation techniques and airway management for dentists who | 3 | | possess a permit under this Section. | 4 | | When establishing requirements under this Section, the | 5 | | Department shall consider the current American Dental | 6 | | Association guidelines on sedation and general anesthesia, the | 7 | | current "Guidelines for Monitoring and Management of Pediatric | 8 | | Patients During and After Sedation for Diagnostic and | 9 | | Therapeutic Procedures" established by the American Academy of | 10 | | Pediatrics and the American Academy of Pediatric Dentistry, | 11 | | and the current parameters of care and Office Anesthesia | 12 | | Evaluation (OAE) Manual established by the American | 13 | | Association of Oral and Maxillofacial Surgeons. | 14 | | (c) A licensed dentist must hold an appropriate permit | 15 | | issued under this Section in order to perform dentistry while | 16 | | a nurse anesthetist administers conscious sedation, and a | 17 | | valid written collaborative agreement must exist between the | 18 | | dentist and the nurse anesthetist, in accordance with the | 19 | | Nurse Practice Act , unless the nurse anesthetist has full | 20 | | practice authority under the requirements of Section 65-70 . | 21 | | A licensed dentist must hold an appropriate permit issued | 22 | | under this Section in order to perform dentistry while a nurse | 23 | | anesthetist administers deep sedation or general anesthesia, | 24 | | and a valid written collaborative agreement must exist between | 25 | | the dentist and the nurse anesthetist, in accordance with the | 26 | | Nurse Practice Act , unless the nurse anesthetist has full |
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| 1 | | practice authority under the requirements of Section 65-70 . | 2 | | For the purposes of this subsection (c), "nurse | 3 | | anesthetist" means a licensed certified registered nurse | 4 | | anesthetist who holds a license as an advanced practice | 5 | | registered nurse. | 6 | | (Source: P.A. 100-201, eff. 8-18-17; 100-513, eff. 1-1-18; | 7 | | 101-162, eff. 7-26-19.) | 8 | | Section 30. The Podiatric Medical Practice Act of 1987 is | 9 | | amended by changing Section 20.5 as follows: | 10 | | (225 ILCS 100/20.5) | 11 | | (Section scheduled to be repealed on January 1, 2028) | 12 | | Sec. 20.5. Delegation of authority to advanced practice | 13 | | registered nurses. | 14 | | (a) A podiatric physician in active clinical practice may | 15 | | collaborate with an advanced practice registered nurse in | 16 | | accordance with the requirements of the Nurse Practice Act. | 17 | | Collaboration shall be for the purpose of providing podiatric | 18 | | care and no employment relationship shall be required. A | 19 | | written collaborative agreement shall conform to the | 20 | | requirements of Section 65-35 of the Nurse Practice Act. A | 21 | | written collaborative agreement and podiatric physician | 22 | | collaboration and consultation shall be adequate with respect | 23 | | to advanced practice registered nurses if all of the following | 24 | | apply: |
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| 1 | | (1) With respect to the provision of anesthesia | 2 | | services by a certified registered nurse anesthetist, the | 3 | | collaborating podiatric physician must have training and | 4 | | experience in the delivery of anesthesia consistent with | 5 | | Department rules unless the certified registered nurse | 6 | | anesthetist has full practice authority under the | 7 | | requirements of Section 65-70 . | 8 | | (2) Methods of communication are available with the | 9 | | collaborating podiatric physician in person or through | 10 | | telecommunications or electronic communications for | 11 | | consultation, collaboration, and referral as needed to | 12 | | address patient care needs. | 13 | | (3) With respect to the provision of anesthesia | 14 | | services by a certified registered nurse anesthetist, | 15 | | certified registered nurse anesthetist shall seek | 16 | | consultation regarding development of an anesthesia plan | 17 | | and treatment of patients as is appropriate to the | 18 | | certified registered nurse anesthetist's level of | 19 | | expertise and scope of practice and as is warranted by the | 20 | | needs of the patient an anesthesiologist, physician, or | 21 | | podiatric physician shall participate through discussion | 22 | | of and agreement with the anesthesia plan and shall remain | 23 | | physically present and be available on the premises during | 24 | | the delivery of anesthesia services for diagnosis, | 25 | | consultation, and treatment of emergency medical | 26 | | conditions. The anesthesiologist or operating podiatric |
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| 1 | | physician must agree with the anesthesia plan prior to the | 2 | | delivery of services . | 3 | | (b) The collaborating podiatric physician shall have | 4 | | access to the records of all patients attended to by an | 5 | | advanced practice registered nurse. | 6 | | (c) Nothing in this Section shall be construed to limit | 7 | | the delegation of tasks or duties by a podiatric physician to a | 8 | | licensed practical nurse, a registered professional nurse, or | 9 | | other appropriately trained persons. | 10 | | (d) A podiatric physician shall not be liable for the acts | 11 | | or omissions of an advanced practice registered nurse solely | 12 | | on the basis of having signed guidelines or a collaborative | 13 | | agreement, an order, a standing order, a standing delegation | 14 | | order, or other order or guideline authorizing an advanced | 15 | | practice registered nurse to perform acts, unless the | 16 | | podiatric physician has reason to believe the advanced | 17 | | practice registered nurse lacked the competency to perform the | 18 | | act or acts or commits willful or wanton misconduct. | 19 | | (e) A podiatric physician, may, but is not required to | 20 | | delegate prescriptive authority to an advanced practice | 21 | | registered nurse as part of a written collaborative agreement | 22 | | and the delegation of prescriptive authority shall conform to | 23 | | the requirements of Section 65-40 of the Nurse Practice Act. | 24 | | (Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18 .) | 25 | | Section 99. Effective date. This Act takes effect upon |
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| 1 | | becoming law.". |
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