Bill Text: IL SB1683 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: Amends the Nurse Practice Act. Provides that, in the case of anesthesia services provided by a certified registered nurse anesthetist, a physician, a dentist, or a podiatric physician must participate through discussion of and agreement with the anesthesia plan and remain available during the delivery of surgical anesthesia services for diagnosis, consultation, and treatment of emergency medical conditions (rather than an anesthesiologist, a physician, a dentist, or a podiatric physician must participate through discussion of and agreement with the anesthesia plan and remain physically present and available on the premises during the delivery of anesthesia services for diagnosis, consultation, and treatment of emergency medical conditions). Effective immediately.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2021-01-13 - Session Sine Die [SB1683 Detail]

Download: Illinois-2019-SB1683-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 SB1683 Introduced 2/15/2019, by Sen. Emil Jones, III SYNOPSIS AS INTRODUCED:
225 ILCS 65/65-35 was 225 ILCS 65/15-15
225 ILCS 65/65-43
225 ILCS 65/65-45 was 225 ILCS 65/15-25
Amends the Nurse Practice Act. Provides that collaboration does not require an employment relationship between the collaborating physician, podiatric physician, or dentist and the advanced practice registered nurse. Provides that, in the case of anesthesia services provided by a certified registered nurse anesthetist, an anesthesiologist, a physician, a dentist, or a podiatric physician must participate through discussion of and agreement with the anesthesia plan and remain available (rather than remain physically present and available on the premises during the delivery of anesthesia services) for diagnosis, consultation, and treatment of emergency medical conditions. Makes changes concerning the written collaborative agreements between a certified registered nurse anesthetist and a dentist. Changes provisions concerning full practice authority to apply them to certified registered nurse anesthetists. Requires that during the delivery of anesthesia by a certified registered nurse anesthetists, the attestation for completion of clinical experience must be attested to by the collaborating physician or physicians, podiatrists, or dentists, and the certified registered nurse anesthetist. Makes other changes. Effective immediately.
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A BILL FOR
SB1683 LRB101 07977 RAB 53033 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Nurse Practice Act is amended by changing
Sections 65-35, 65-43, and 65-45 as follows:
(225 ILCS 65/65-35) (was 225 ILCS 65/15-15)
(Section scheduled to be repealed on January 1, 2028)
Sec. 65-35. Written collaborative agreements.
(a) A written collaborative agreement is required for all
advanced practice registered nurses engaged in clinical
practice prior to meeting the requirements of Section 65-43,
except for advanced practice registered nurses who are
privileged to practice in a hospital, hospital affiliate, or
ambulatory surgical treatment center.
(a-5) If an advanced practice registered nurse engages in
clinical practice outside of a hospital, hospital affiliate, or
ambulatory surgical treatment center in which he or she is
privileged to practice, the advanced practice registered nurse
must have a written collaborative agreement, except as set
forth in Section 65-43.
(b) A written collaborative agreement shall describe the
relationship of the advanced practice registered nurse with the
collaborating physician and shall describe the categories of

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care, treatment, or procedures to be provided by the advanced
practice registered nurse. A collaborative agreement with a
podiatric physician must be in accordance with subsection (c-5)
or (c-15) of this Section. A collaborative agreement with a
dentist must be in accordance with subsection (c-5) (c-10) of
this Section. A collaborative agreement with a podiatric
physician must be in accordance with subsection (c-5) of this
Section. Collaboration does not require an employment
relationship between the collaborating physician, podiatric
physician, or dentist and the advanced practice registered
nurse.
The collaborative relationship under an agreement shall
not be construed to require the personal presence of a
collaborating physician at the place where services are
rendered, except for the delivery of anesthesia in accordance
with subsection (c-5) of this Section. Methods of communication
shall be available for consultation with the collaborating
physician in person or by telecommunications or electronic
communications as set forth in the written agreement.
(b-5) Absent an employment relationship, a written
collaborative agreement may not (1) restrict the categories of
patients of an advanced practice registered nurse within the
scope of the advanced practice registered nurses training and
experience, (2) limit third party payors or government health
programs, such as the medical assistance program or Medicare
with which the advanced practice registered nurse contracts, or

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(3) limit the geographic area or practice location of the
advanced practice registered nurse in this State.
(c) In the case of anesthesia services provided by a
certified registered nurse anesthetist, an anesthesiologist, a
physician, a dentist, or a podiatric physician must participate
through discussion of and agreement with the anesthesia plan
and remain physically present and available on the premises
during the delivery of anesthesia services for diagnosis,
consultation, and treatment of emergency medical conditions.
(c-5) A certified registered nurse anesthetist, who
provides anesthesia services outside of a hospital or
ambulatory surgical treatment center shall enter into a written
collaborative agreement with an anesthesiologist or the
physician licensed to practice medicine in all its branches, or
the podiatric physician, or the dentist who has the appropriate
permit under the Illinois Dental Practice Act performing the
procedure. Outside of a hospital or ambulatory surgical
treatment center, the certified registered nurse anesthetist
may provide only those services that the collaborating
podiatric physician or dentist is authorized to provide
pursuant to the Podiatric Medical Practice Act of 1987 or the
Illinois Dental Practice Act and rules adopted under those Acts
thereunder. A certified registered nurse anesthetist may
select, order, and administer medication, including controlled
substances, and apply appropriate medical devices for delivery
of anesthesia services under the anesthesia plan agreed with by

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the anesthesiologist or the operating physician or operating
podiatric physician.
(c-10) (Blank). A certified registered nurse anesthetist
who provides anesthesia services in a dental office shall enter
into a written collaborative agreement with an
anesthesiologist or the physician licensed to practice
medicine in all its branches or the operating dentist
performing the procedure. The agreement shall describe the
working relationship of the certified registered nurse
anesthetist and dentist and shall authorize the categories of
care, treatment, or procedures to be performed by the certified
registered nurse anesthetist. In a collaborating dentist's
office, the certified registered nurse anesthetist may only
provide those services that the operating dentist with the
appropriate permit is authorized to provide pursuant to the
Illinois Dental Practice Act and rules adopted thereunder. For
anesthesia services, an anesthesiologist, physician, or
operating dentist shall participate through discussion of and
agreement with the anesthesia plan and shall remain physically
present and be available on the premises during the delivery of
anesthesia services for diagnosis, consultation, and treatment
of emergency medical conditions. A certified registered nurse
anesthetist may select, order, and administer medication,
including controlled substances, and apply appropriate medical
devices for delivery of anesthesia services under the
anesthesia plan agreed with by the operating dentist.

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(c-15) An advanced practice registered nurse certified as a
nurse practitioner, clinical nurse specialist, or certified
nurse midwife who had a written collaborative agreement with a
podiatric physician immediately before the effective date of
Public Act 100-513 may continue in that collaborative
relationship or enter into a new written collaborative
relationship with a podiatric physician under the requirements
of this Section and Section 65-40, as those Sections existed
immediately before the amendment of those Sections by Public
Act 100-513 with regard to a written collaborative agreement
between an advanced practice registered nurse and a podiatric
physician.
(d) A copy of the signed, written collaborative agreement
must be available to the Department upon request from both the
advanced practice registered nurse and the collaborating
physician, dentist, or podiatric physician.
(e) Nothing in this Act shall be construed to limit the
delegation of tasks or duties by a physician to a licensed
practical nurse, a registered professional nurse, or other
persons in accordance with Section 54.2 of the Medical Practice
Act of 1987. Nothing in this Act shall be construed to limit
the method of delegation that may be authorized by any means,
including, but not limited to, oral, written, electronic,
standing orders, protocols, guidelines, or verbal orders.
(e-5) Nothing in this Act shall be construed to authorize
an advanced practice registered nurse to provide health care

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services required by law or rule to be performed by a
physician, including those acts to be performed by a physician
in Section 3.1 of the Illinois Abortion Law of 1975.
(f) An advanced practice registered nurse shall inform each
collaborating physician, dentist, or podiatric physician of
all collaborative agreements he or she has signed and provide a
copy of these to any collaborating physician, dentist, or
podiatric physician upon request.
(g) (Blank).
(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18;
100-577, eff. 1-26-18; 100-1096, eff. 8-26-18.)
(225 ILCS 65/65-43)
(Section scheduled to be repealed on January 1, 2028)
Sec. 65-43. Full practice authority.
(a) An Illinois-licensed advanced practice registered
nurse certified as a nurse practitioner, nurse midwife, or
clinical nurse specialist shall be deemed by law to possess the
ability to practice without a written collaborative agreement
as set forth in this Section.
(b) An advanced practice registered nurse certified as a
nurse midwife, clinical nurse specialist, or nurse
practitioner who files with the Department a notarized
attestation of completion of at least 250 hours of continuing
education or training and at least 4,000 hours of clinical
experience after first attaining national certification shall

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not require a written collaborative agreement, except as
specified in subsection (c). Documentation of successful
completion shall be provided to the Department upon request.
Continuing education or training hours required by
subsection (b) shall be in the advanced practice registered
nurse's area of certification as set forth by Department rule.
The clinical experience must be in the advanced practice
registered nurse's area of certification. The clinical
experience shall be in collaboration with a physician or
physicians. Completion of the clinical experience must be
attested to by the collaborating physician or physicians and
the advanced practice registered nurse. For the delivery of
anesthesia provided by a certified registered nurse
anesthetist, the attestation for completion of clinical
experience must be attested to by the collaborating physician
or physicians, podiatrists, or dentists and the certified
registered nurse anesthetist.
(c) The scope of practice of an advanced practice
registered nurse with full practice authority includes:
(1) all matters included in subsection (c) of Section
65-30 of this Act;
(2) practicing without a written collaborative
agreement in all practice settings consistent with
national certification;
(3) authority to prescribe both legend drugs and
Schedule II through V controlled substances; this

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authority includes prescription of, selection of, orders
for, administration of, storage of, acceptance of samples
of, and dispensing over the counter medications, legend
drugs, and controlled substances categorized as any
Schedule II through V controlled substances, as defined in
Article II of the Illinois Controlled Substances Act, and
other preparations, including, but not limited to,
botanical and herbal remedies;
(4) prescribing benzodiazepines or Schedule II
narcotic drugs, such as opioids, only in a consultation
relationship with a physician; this consultation
relationship shall be recorded in the Prescription
Monitoring Program website, pursuant to Section 316 of the
Illinois Controlled Substances Act, by the physician and
advanced practice registered nurse with full practice
authority and is not required to be filed with the
Department; the specific Schedule II narcotic drug must be
identified by either brand name or generic name; the
specific Schedule II narcotic drug, such as an opioid, may
be administered by oral dosage or topical or transdermal
application; delivery by injection or other route of
administration is not permitted; at least monthly, the
advanced practice registered nurse and the physician must
discuss the condition of any patients for whom a
benzodiazepine or opioid is prescribed; nothing in this
subsection shall be construed to require a prescription by

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an advanced practice registered nurse with full practice
authority to require a physician name;
(5) authority to obtain an Illinois controlled
substance license and a federal Drug Enforcement
Administration number; and
(6) use of only local anesthetic, except for the
delivery of anesthesia services by a certified registered
nurse anesthetist.
The scope of practice of an advanced practice registered
nurse does not include operative surgery.
(d) The Department may adopt rules necessary to administer
this Section, including, but not limited to, requiring the
completion of forms and the payment of fees.
(e) Nothing in this Act shall be construed to authorize an
advanced practice registered nurse with full practice
authority to provide health care services required by law or
rule to be performed by a physician, including, but not limited
to, those acts to be performed by a physician in Section 3.1 of
the Illinois Abortion Law of 1975.
(Source: P.A. 100-513, eff. 1-1-18.)
(225 ILCS 65/65-45) (was 225 ILCS 65/15-25)
(Section scheduled to be repealed on January 1, 2028)
Sec. 65-45. Advanced practice registered nursing in
hospitals, hospital affiliates, or ambulatory surgical
treatment centers.

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(a) An advanced practice registered nurse may provide
services in a hospital or a hospital affiliate as those terms
are defined in the Hospital Licensing Act or the University of
Illinois Hospital Act or a licensed ambulatory surgical
treatment center without a written collaborative agreement
pursuant to Section 65-35 of this Act. An advanced practice
registered nurse must possess clinical privileges recommended
by the hospital medical staff and granted by the hospital or
the consulting medical staff committee and ambulatory surgical
treatment center in order to provide services. The medical
staff or consulting medical staff committee shall periodically
review the services of all advanced practice registered nurses
granted clinical privileges, including any care provided in a
hospital affiliate. Authority may also be granted when
recommended by the hospital medical staff and granted by the
hospital or recommended by the consulting medical staff
committee and ambulatory surgical treatment center to
individual advanced practice registered nurses to select,
order, and administer medications, including controlled
substances, to provide delineated care. In a hospital, hospital
affiliate, or ambulatory surgical treatment center, the
attending physician shall determine an advanced practice
registered nurse's role in providing care for his or her
patients, except as otherwise provided in the medical staff
bylaws or consulting committee policies.
(a-2) An advanced practice registered nurse privileged to

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order medications, including controlled substances, may
complete discharge prescriptions provided the prescription is
in the name of the advanced practice registered nurse and the
attending or discharging physician.
(a-3) Advanced practice registered nurses practicing in a
hospital or an ambulatory surgical treatment center are not
required to obtain a mid-level controlled substance license to
order controlled substances under Section 303.05 of the
Illinois Controlled Substances Act.
(a-4) An advanced practice registered nurse certified as a
nurse practitioner, clinical nurse specialist, or certified
nurse midwife meeting the requirements of Section 65-43 may be
privileged to complete discharge orders and prescriptions
under the advanced practice registered nurse's name.
(a-5) For anesthesia services provided by a certified
registered nurse anesthetist, an anesthesiologist, physician,
dentist, or podiatric physician shall participate through
discussion of and agreement with the anesthesia plan and shall
remain physically present and be available on the premises
during the delivery of anesthesia services for diagnosis,
consultation, and treatment of emergency medical conditions,
unless hospital policy adopted pursuant to clause (B) of
subdivision (3) of Section 10.7 of the Hospital Licensing Act
or ambulatory surgical treatment center policy adopted
pursuant to clause (B) of subdivision (3) of Section 6.5 of the
Ambulatory Surgical Treatment Center Act provides otherwise. A

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certified registered nurse anesthetist may select, order, and
administer medication for anesthesia services under the
anesthesia plan agreed to by the anesthesiologist or the
physician, in accordance with hospital alternative policy or in
accordance with the medical staff consulting committee
policies of a licensed ambulatory surgical treatment center.
(b) An advanced practice registered nurse who provides
services in a hospital shall do so in accordance with Section
10.7 of the Hospital Licensing Act and, in an ambulatory
surgical treatment center, in accordance with Section 6.5 of
the Ambulatory Surgical Treatment Center Act. Nothing in this
Act shall be construed to require an advanced practice
registered nurse to have a collaborative agreement to practice
in a hospital, hospital affiliate, or ambulatory surgical
treatment center.
(c) Advanced practice registered nurses certified as nurse
practitioners, nurse midwives, or clinical nurse specialists
practicing in a hospital affiliate may be, but are not required
to be, privileged to prescribe Schedule II through V controlled
substances when such authority is recommended by the
appropriate physician committee of the hospital affiliate and
granted by the hospital affiliate. This authority may, but is
not required to, include prescription of, selection of, orders
for, administration of, storage of, acceptance of samples of,
and dispensing over-the-counter medications, legend drugs,
medical gases, and controlled substances categorized as

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Schedule II through V controlled substances, as defined in
Article II of the Illinois Controlled Substances Act, and other
preparations, including, but not limited to, botanical and
herbal remedies.
To prescribe controlled substances under this subsection
(c), an advanced practice registered nurse certified as a nurse
practitioner, nurse midwife, or clinical nurse specialist must
obtain a controlled substance license. Medication orders shall
be reviewed periodically by the appropriate hospital affiliate
physicians committee or its physician designee.
The hospital affiliate shall file with the Department
notice of a grant of prescriptive authority consistent with
this subsection (c) and termination of such a grant of
authority, in accordance with rules of the Department. Upon
receipt of this notice of grant of authority to prescribe any
Schedule II through V controlled substances, the licensed
advanced practice registered nurse certified as a nurse
practitioner, nurse midwife, or clinical nurse specialist may
register for a mid-level practitioner controlled substance
license under Section 303.05 of the Illinois Controlled
Substances Act.
In addition, a hospital affiliate may, but is not required
to, privilege an advanced practice registered nurse certified
as a nurse practitioner, nurse midwife, or clinical nurse
specialist to prescribe any Schedule II controlled substances,
if all of the following conditions apply:

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(1) specific Schedule II controlled substances by oral
dosage or topical or transdermal application may be
designated, provided that the designated Schedule II
controlled substances are routinely prescribed by advanced
practice registered nurses in their area of certification;
the privileging documents must identify the specific
Schedule II controlled substances by either brand name or
generic name; privileges to prescribe or dispense Schedule
II controlled substances to be delivered by injection or
other route of administration may not be granted;
(2) any privileges must be controlled substances
limited to the practice of the advanced practice registered
nurse;
(3) any prescription must be limited to no more than a
30-day supply;
(4) the advanced practice registered nurse must
discuss the condition of any patients for whom a controlled
substance is prescribed monthly with the appropriate
physician committee of the hospital affiliate or its
physician designee; and
(5) the advanced practice registered nurse must meet
the education requirements of Section 303.05 of the
Illinois Controlled Substances Act.
(d) An advanced practice registered nurse meeting the
requirements of Section 65-43 may be privileged to prescribe
controlled substances categorized as Schedule II through V in

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accordance with Section 65-43.
(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18.)
Section 99. Effective date. This Act takes effect upon
becoming law.