Full Text of SB0218 103rd General Assembly
SB0218sam002 103RD GENERAL ASSEMBLY | Sen. Ann Gillespie Filed: 3/28/2023
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| 1 | | AMENDMENT TO SENATE BILL 218
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 218 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Physician Assistant Practice Act of 1987 | 5 | | is amended by changing Sections 4, 7, 7.5, and 7.7 and by | 6 | | adding Section 7.6 as follows:
| 7 | | (225 ILCS 95/4) (from Ch. 111, par. 4604)
| 8 | | (Section scheduled to be repealed on January 1, 2028)
| 9 | | Sec. 4. Definitions. In this Act:
| 10 | | 1. "Department" means the Department of Financial and
| 11 | | Professional Regulation.
| 12 | | 2. "Secretary" means the Secretary
of Financial and | 13 | | Professional Regulation.
| 14 | | 3. "Physician assistant" means any person not holding an | 15 | | active license or permit issued by the Department pursuant to | 16 | | the Medical Practice Act of 1987 who has been
certified as a |
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| 1 | | physician assistant by the National Commission on the
| 2 | | Certification of Physician Assistants or equivalent successor | 3 | | agency and
performs procedures in collaboration with a | 4 | | physician as defined in this
Act. A physician assistant may | 5 | | perform such procedures within the
specialty of the | 6 | | collaborating physician, except that such physician shall
| 7 | | exercise such direction, collaboration, and control over such | 8 | | physician
assistants as will assure that patients shall | 9 | | receive quality medical
care. Physician assistants shall be | 10 | | capable of performing a variety of tasks
within the specialty | 11 | | of medical care in collaboration with a physician.
| 12 | | Collaboration with the physician assistant shall not be | 13 | | construed to
necessarily require the personal presence of the | 14 | | collaborating physician at
all times at the place where | 15 | | services are rendered, as long as there is
communication | 16 | | available for consultation by radio, telephone or
| 17 | | telecommunications within established guidelines as determined | 18 | | by the
physician/physician assistant team. The collaborating | 19 | | physician may delegate
tasks and duties to the physician | 20 | | assistant. Delegated tasks or duties
shall be consistent with | 21 | | physician assistant education, training, and
experience. The | 22 | | delegated tasks or duties shall be specific to the
practice | 23 | | setting and shall be implemented and reviewed under a written | 24 | | collaborative agreement
established by the physician or | 25 | | physician/physician assistant team. A
physician assistant, | 26 | | acting as an agent of the physician, shall be
permitted to |
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| 1 | | transmit the collaborating physician's orders as determined by
| 2 | | the institution's by-laws, policies, procedures, or job | 3 | | description within
which the physician/physician assistant | 4 | | team practices. Physician
assistants shall practice only in | 5 | | accordance with a written collaborative agreement.
| 6 | | Any person who holds an active license or permit issued | 7 | | pursuant to the Medical Practice Act of 1987 shall have that | 8 | | license automatically placed into inactive status upon | 9 | | issuance of a physician assistant license. Any person who | 10 | | holds an active license as a physician assistant who is issued | 11 | | a license or permit pursuant to the Medical Practice Act of | 12 | | 1987 shall have his or her physician assistant license | 13 | | automatically placed into inactive status. | 14 | | 3.5. "Physician assistant practice" means the performance | 15 | | of procedures within the specialty of the collaborating | 16 | | physician. Physician assistants shall be capable of performing | 17 | | a variety of tasks within the specialty of medical care of the | 18 | | collaborating physician. Collaboration with the physician | 19 | | assistant shall not be construed to necessarily require the | 20 | | personal presence of the collaborating physician at all times | 21 | | at the place where services are rendered, as long as there is | 22 | | communication available for consultation by radio, telephone, | 23 | | telecommunications, or electronic communications. The | 24 | | collaborating physician may delegate tasks and duties to the | 25 | | physician assistant. Delegated tasks or duties shall be | 26 | | consistent with physician assistant education, training, and |
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| 1 | | experience. The delegated tasks or duties shall be specific to | 2 | | the practice setting and shall be implemented and reviewed | 3 | | under a written collaborative agreement established by the | 4 | | physician or physician/physician assistant team. A physician | 5 | | assistant shall be permitted to transmit the collaborating | 6 | | physician's orders as determined by the institution's bylaws, | 7 | | policies, or procedures or the job description within which | 8 | | the physician/physician assistant team practices. Physician | 9 | | assistants shall practice only in accordance with a written | 10 | | collaborative agreement, except as provided in Section 7.5 of | 11 | | this Act. | 12 | | 4. "Board" means the Medical Licensing Board
constituted | 13 | | under the Medical Practice Act of 1987.
| 14 | | 5. (Blank).
| 15 | | 6. "Physician" means a person licensed to
practice | 16 | | medicine in all of its branches under the Medical Practice Act | 17 | | of 1987.
| 18 | | 7. "Collaborating physician" means the physician who, | 19 | | within
his or her specialty and expertise, may delegate a | 20 | | variety of
tasks and procedures to the physician assistant. | 21 | | Such tasks and
procedures shall be delegated in accordance | 22 | | with a written
collaborative agreement.
| 23 | | 8. (Blank).
| 24 | | 9. "Address of record" means the designated address | 25 | | recorded by the Department in the applicant's or licensee's | 26 | | application file or license file maintained by the |
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| 1 | | Department's licensure maintenance unit.
| 2 | | 10. "Hospital affiliate" means a corporation, partnership, | 3 | | joint venture, limited liability company, or similar | 4 | | organization, other than a hospital, that is devoted primarily | 5 | | to the provision, management, or support of health care | 6 | | services and that directly or indirectly controls, is | 7 | | controlled by, or is under common control of the hospital. For | 8 | | the purposes of this definition, "control" means having at | 9 | | least an equal or a majority ownership or membership interest. | 10 | | A hospital affiliate shall be 100% owned or controlled by any | 11 | | combination of hospitals, their parent corporations, or | 12 | | physicians licensed to practice medicine in all its branches | 13 | | in Illinois. "Hospital affiliate" does not include a health | 14 | | maintenance organization regulated under the Health | 15 | | Maintenance Organization Act. | 16 | | 11. "Email address of record" means the designated email | 17 | | address recorded by the Department in the applicant's | 18 | | application file or the licensee's license file, as maintained | 19 | | by the Department's licensure maintenance unit. | 20 | | 12. "Federally qualified health center" means a health | 21 | | center funded under Section 330 of the federal Public Health | 22 | | Service Act. | 23 | | (Source: P.A. 102-1117, eff. 1-13-23.)
| 24 | | (225 ILCS 95/7) (from Ch. 111, par. 4607)
| 25 | | (Section scheduled to be repealed on January 1, 2028)
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| 1 | | Sec. 7. Collaboration requirements. | 2 | | (a) A collaborating physician shall determine the number | 3 | | of physician assistants to collaborate with, provided the | 4 | | physician is able to provide adequate collaboration as | 5 | | outlined in the written collaborative agreement required under | 6 | | Section 7.5 of this Act and consideration is given to the | 7 | | nature of the physician's practice, complexity of the patient | 8 | | population, and the experience of each physician assistant. A | 9 | | collaborating physician may collaborate with a maximum of 7 | 10 | | full-time equivalent physician assistants as described in | 11 | | Section 54.5 of the Medical Practice Act of 1987. As used in | 12 | | this Section, "full-time equivalent" means the equivalent of | 13 | | 40 hours per week per individual. Physicians and physician | 14 | | assistants who work in a hospital, hospital affiliate, | 15 | | federally qualified health center, or ambulatory surgical | 16 | | treatment center as defined by Section 7.7 of this Act are | 17 | | exempt from the collaborative ratio restriction requirements | 18 | | of this Section. A physician assistant shall be able to
hold | 19 | | more than one professional position. A collaborating physician | 20 | | shall
file a notice of collaboration of each physician | 21 | | assistant according to the
rules of the Department.
| 22 | | Physician assistants shall collaborate only with | 23 | | physicians as defined in
this Act
who are engaged in clinical | 24 | | practice, or in clinical practice in
public health or other | 25 | | community health facilities.
| 26 | | Nothing in this Act shall be construed to limit the |
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| 1 | | delegation of tasks or
duties by a physician to a nurse or | 2 | | other appropriately trained personnel.
| 3 | | Nothing in this Act
shall be construed to prohibit the | 4 | | employment of physician assistants by
a hospital, nursing home | 5 | | or other health care facility where such physician
assistants | 6 | | function under a collaborating physician.
| 7 | | A physician assistant may be employed by a practice group | 8 | | or other entity
employing multiple physicians at one or more | 9 | | locations. In that case, one of
the
physicians practicing at a | 10 | | location shall be designated the collaborating
physician. The | 11 | | other physicians with that practice group or other entity who
| 12 | | practice in the same general type of practice or specialty
as | 13 | | the collaborating physician may collaborate with the physician | 14 | | assistant with respect
to their patients.
| 15 | | (b) A physician assistant licensed in this State, or | 16 | | licensed or authorized to practice in any other U.S. | 17 | | jurisdiction or credentialed by his or her federal employer as | 18 | | a physician assistant, who is responding to a need for medical | 19 | | care created by an emergency or by a state or local disaster | 20 | | may render such care that the physician assistant is able to | 21 | | provide without collaboration as it is defined in this Section | 22 | | or with such collaboration as is available.
| 23 | | Any physician who collaborates with a physician assistant | 24 | | providing medical care in response to such an emergency or | 25 | | state or local disaster shall not be required to meet the | 26 | | requirements set forth in this Section for a collaborating |
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| 1 | | physician. | 2 | | (Source: P.A. 100-453, eff. 8-25-17; 100-605, eff. 1-1-19 .)
| 3 | | (225 ILCS 95/7.5)
| 4 | | (Section scheduled to be repealed on January 1, 2028)
| 5 | | Sec. 7.5. Written collaborative agreements; prescriptive | 6 | | authority. | 7 | | (a) A written collaborative agreement is required for all | 8 | | physician assistants to practice in the State, except as | 9 | | provided in Section 7.7 of this Act. | 10 | | (1) A written collaborative agreement shall describe | 11 | | the working relationship of the physician assistant with | 12 | | the collaborating physician and shall describe the | 13 | | categories of care, treatment, or procedures to be | 14 | | provided by the physician assistant.
The written | 15 | | collaborative agreement shall promote the exercise of | 16 | | professional judgment by the physician assistant | 17 | | commensurate with his or her education and experience. The | 18 | | services to be provided by the physician assistant shall | 19 | | be services that the collaborating physician is authorized | 20 | | to and generally provides to his or her patients in the | 21 | | normal course of his or her clinical medical practice. The | 22 | | written collaborative agreement need not describe the | 23 | | exact steps that a physician assistant must take with | 24 | | respect to each specific condition, disease, or symptom | 25 | | but must specify which authorized procedures require the |
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| 1 | | presence of the collaborating physician as the procedures | 2 | | are being performed. The relationship under a written | 3 | | collaborative agreement shall not be construed to require | 4 | | the personal presence of a physician at the place where | 5 | | services are rendered. Methods of communication shall be | 6 | | available for consultation with the collaborating | 7 | | physician in person or by telecommunications or electronic | 8 | | communications as set forth in the written collaborative | 9 | | agreement. For the purposes of this Act, "generally | 10 | | provides to his or her patients in the normal course of his | 11 | | or her clinical medical practice" means services, not | 12 | | specific tasks or duties, the collaborating physician | 13 | | routinely provides individually or through delegation to | 14 | | other persons so that the physician has the experience and | 15 | | ability to collaborate and provide consultation. | 16 | | (2) The written collaborative agreement shall be | 17 | | adequate if a physician does each of the following: | 18 | | (A) Participates in the joint formulation and | 19 | | joint approval of orders or guidelines with the | 20 | | physician assistant and he or she periodically reviews | 21 | | such orders and the services provided patients under | 22 | | such orders in accordance with accepted standards of | 23 | | medical practice and physician assistant practice. | 24 | | (B) Provides consultation at least once a month. | 25 | | (3) A copy of the signed, written collaborative | 26 | | agreement must be available to the Department upon request |
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| 1 | | from both the physician assistant and the collaborating | 2 | | physician. | 3 | | (4) A physician assistant shall inform each | 4 | | collaborating physician of all written collaborative | 5 | | agreements he or she has signed and provide a copy of these | 6 | | to any collaborating physician upon request. | 7 | | (b) A collaborating physician may, but is not required to, | 8 | | delegate prescriptive authority to a physician assistant as | 9 | | part of a written collaborative agreement. This authority may, | 10 | | but is not required to, include prescription of, selection of, | 11 | | orders for, administration of, storage of, acceptance of | 12 | | samples of, and dispensing medical devices, over the counter | 13 | | medications, legend drugs, medical gases, and controlled | 14 | | substances categorized as Schedule II through V controlled | 15 | | substances, as defined in Article II of the Illinois | 16 | | Controlled Substances Act, and other preparations, including, | 17 | | but not limited to, botanical and herbal remedies. The | 18 | | collaborating physician must have a valid, current Illinois | 19 | | controlled substance license and federal registration with the | 20 | | Drug Enforcement Administration to delegate the authority to | 21 | | prescribe controlled substances. | 22 | | (1) To prescribe Schedule II, III, IV, or V controlled | 23 | | substances under this
Section, a physician assistant must | 24 | | obtain a mid-level practitioner
controlled substances | 25 | | license. Medication orders issued by a
physician
assistant | 26 | | shall be reviewed
periodically by the collaborating |
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| 1 | | physician. | 2 | | (2) The collaborating physician shall file
with the | 3 | | Department notice of delegation of prescriptive authority | 4 | | to a
physician assistant and
termination of delegation, | 5 | | specifying the authority delegated or terminated.
Upon | 6 | | receipt of this notice delegating authority to prescribe | 7 | | controlled substances, the physician assistant shall be | 8 | | eligible to
register for a mid-level practitioner | 9 | | controlled substances license under
Section 303.05 of the | 10 | | Illinois Controlled Substances Act.
Nothing in this Act | 11 | | shall be construed to limit the delegation of tasks or
| 12 | | duties by the collaborating physician to a nurse or other | 13 | | appropriately trained
persons in accordance with Section | 14 | | 54.2 of the Medical Practice Act of 1987.
| 15 | | (3) In addition to the requirements of this subsection | 16 | | (b), a collaborating physician may, but is not required | 17 | | to, delegate authority to a physician assistant to | 18 | | prescribe Schedule II controlled substances, if all of the | 19 | | following conditions apply: | 20 | | (A) Specific Schedule II controlled substances by | 21 | | oral dosage or topical or transdermal application may | 22 | | be delegated, provided that the delegated Schedule II | 23 | | controlled substances are routinely prescribed by the | 24 | | collaborating physician. This delegation must identify | 25 | | the specific Schedule II controlled substances by | 26 | | either brand name or generic name. Schedule II |
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| 1 | | controlled substances to be delivered by injection or | 2 | | other route of administration may not be delegated. | 3 | | (B) (Blank). | 4 | | (C) Any prescription must be limited to no more | 5 | | than a 30-day supply, with any continuation authorized | 6 | | only after prior approval of the collaborating | 7 | | physician. | 8 | | (D) The physician assistant must discuss the | 9 | | condition of any patients for whom a controlled | 10 | | substance is prescribed monthly with the collaborating | 11 | | physician. | 12 | | (E) The physician assistant meets the education | 13 | | requirements of Section 303.05 of the Illinois | 14 | | Controlled Substances Act. | 15 | | (c) Nothing in this Act shall be construed to limit the | 16 | | delegation of tasks or duties by a physician to a licensed | 17 | | practical nurse, a registered professional nurse, or other | 18 | | persons. Nothing in this Act shall be construed to limit the | 19 | | method of delegation that may be authorized by any means, | 20 | | including, but not limited to, oral, written, electronic, | 21 | | standing orders, protocols, guidelines, or verbal orders. | 22 | | Nothing in this Act shall be construed to authorize a | 23 | | physician assistant to provide health care services required | 24 | | by law or rule to be performed by a physician. Nothing in this | 25 | | Act shall be construed to authorize the delegation or | 26 | | performance of operative surgery. Nothing in this Section |
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| 1 | | shall be construed to preclude a physician assistant from | 2 | | assisting in surgery. | 3 | | (c-5) Nothing in this Section shall be construed to apply
| 4 | | to any medication authority, including Schedule II controlled
| 5 | | substances of a licensed physician assistant for care provided
| 6 | | in a hospital, hospital affiliate, federally qualified health | 7 | | center, or ambulatory surgical
treatment center pursuant to | 8 | | Section 7.7 of this Act.
| 9 | | (d) (Blank). | 10 | | (e) Nothing in this Section shall be construed to prohibit | 11 | | generic substitution. | 12 | | (Source: P.A. 101-13, eff. 6-12-19; 102-558, eff. 8-20-21.)
| 13 | | (225 ILCS 95/7.6 new) | 14 | | Sec. 7.6. Written collaborative agreement; temporary | 15 | | practice. Any physician assistant required to enter into a | 16 | | written collaborative agreement with a collaborating physician | 17 | | is authorized to continue to practice for up to 90 days after | 18 | | the termination of a written collaborative agreement, provided | 19 | | the physician assistant seeks any necessary collaboration at a | 20 | | local hospital and refers patients who require services beyond | 21 | | the training and experience of the physician assistant to a | 22 | | physician or other health care provider. | 23 | | (225 ILCS 95/7.7) | 24 | | (Section scheduled to be repealed on January 1, 2028) |
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| 1 | | Sec. 7.7. Physician assistants in hospitals, hospital | 2 | | affiliates, federally qualified health centers, or ambulatory | 3 | | surgical treatment centers. | 4 | | (a) A physician assistant may provide services in a | 5 | | hospital as defined in the Hospital Licensing Act, a hospital | 6 | | affiliate as defined in the University of Illinois Hospital | 7 | | Act, a federally qualified health center, or a licensed | 8 | | ambulatory surgical treatment center as defined in the | 9 | | Ambulatory Surgical Treatment Center Act without a written | 10 | | collaborative agreement pursuant to Section 7.5 of this Act | 11 | | only in accordance with this Section . A physician assistant | 12 | | must possess clinical privileges recommended by (i) the | 13 | | hospital medical staff and granted by the hospital , (ii) the | 14 | | physician committee and federally qualified health center, or | 15 | | (iii) the consulting medical staff committee and ambulatory | 16 | | surgical treatment center in order to provide services. The | 17 | | medical staff , physician committee, or consulting medical | 18 | | staff committee shall periodically review the services of | 19 | | physician assistants granted clinical privileges, including | 20 | | any care provided in a hospital affiliate or federally | 21 | | qualified health center . Authority may also be granted when | 22 | | recommended by the hospital medical staff and granted by the | 23 | | hospital , recommended by the physician committee and granted | 24 | | by the federally qualified health center, or recommended by | 25 | | the consulting medical staff committee and ambulatory surgical | 26 | | treatment center to individual physician assistants to select, |
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| 1 | | order, and administer medications, including controlled | 2 | | substances, to provide delineated care. In a hospital, | 3 | | hospital affiliate, federally qualified health center, or | 4 | | ambulatory surgical treatment center, the attending physician | 5 | | shall determine a physician assistant's role in providing care | 6 | | for his or her patients, except as otherwise provided in the | 7 | | medical staff bylaws or consulting committee policies. | 8 | | (a-5) Physician assistants practicing in a hospital | 9 | | affiliate or a federally qualified health center may be, but | 10 | | are not required to be, granted authority to prescribe | 11 | | Schedule II through V controlled substances when such | 12 | | authority is recommended by the appropriate physician | 13 | | committee of the hospital affiliate and granted by the | 14 | | hospital affiliate or recommended by the physician committee | 15 | | of the federally qualified health center and granted by the | 16 | | federally qualified health center . This authority may, but is | 17 | | not required to, include prescription of, selection of, orders | 18 | | for, administration of,
storage of, acceptance of samples of, | 19 | | and dispensing over-the-counter medications, legend drugs, | 20 | | medical gases, and controlled substances categorized as | 21 | | Schedule II through V controlled substances, as defined in | 22 | | Article II of the Illinois Controlled Substances Act, and | 23 | | other preparations, including, but not limited to, botanical | 24 | | and herbal remedies. | 25 | | To prescribe controlled substances under this subsection | 26 | | (a-5), a physician assistant must obtain a mid-level |
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| 1 | | practitioner controlled substance license. Medication orders | 2 | | shall be reviewed periodically by the appropriate hospital | 3 | | affiliate physicians committee or its physician designee or by | 4 | | the physician committee of a federally qualified health | 5 | | center . | 6 | | The hospital affiliate or federally qualified health | 7 | | center shall file with the Department notice of a grant of | 8 | | prescriptive authority consistent with this subsection (a-5) | 9 | | and termination of such a grant of authority in accordance | 10 | | with rules of the Department. Upon receipt of this notice of | 11 | | grant of authority to prescribe any Schedule II through V | 12 | | controlled substances, the licensed physician assistant 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 or a federally qualified | 17 | | health center may, but is not required to, grant authority to a | 18 | | physician assistant to prescribe any Schedule II controlled | 19 | | substances if all of the following conditions apply: | 20 | | (1) specific Schedule II controlled substances by oral | 21 | | dosage or topical or transdermal application may be | 22 | | designated, provided that the designated Schedule II | 23 | | controlled substances are routinely prescribed by | 24 | | physician assistants in their area of certification; this | 25 | | grant of authority must identify the specific Schedule II | 26 | | controlled substances by either brand name or generic |
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| 1 | | name; authority to prescribe or dispense Schedule II | 2 | | controlled substances to be delivered by injection or | 3 | | other route of administration may not be granted; | 4 | | (2) any grant of authority must be controlled | 5 | | substances limited to the practice of the physician | 6 | | assistant; | 7 | | (3) any prescription must be limited to no more than a | 8 | | 30-day supply; | 9 | | (4) the physician assistant must discuss the condition | 10 | | of any patients for whom a controlled substance is | 11 | | prescribed monthly with the appropriate physician | 12 | | committee of the hospital affiliate or its physician | 13 | | designee , or the physician committee of a federally | 14 | | qualified health center ; and | 15 | | (5) the physician assistant must meet the education | 16 | | requirements of Section 303.05 of the Illinois Controlled | 17 | | Substances Act. | 18 | | (b) A physician assistant granted authority to order | 19 | | medications including controlled substances may complete | 20 | | discharge prescriptions provided the prescription is in the | 21 | | name of the physician assistant and the attending or | 22 | | discharging physician. | 23 | | (c) Physician assistants practicing in a hospital, | 24 | | hospital affiliate, federally qualified health center, or an | 25 | | ambulatory surgical treatment center are not required to | 26 | | obtain a mid-level controlled substance license to order |
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| 1 | | controlled substances under Section 303.05 of the Illinois | 2 | | Controlled Substances Act.
| 3 | | (Source: P.A. 100-453, eff. 8-25-17.)".
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