Bill Amendment: IL HB2895 | 2023-2024 | 103rd General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: RN ANESTHETIST-COLLAB AGREE

Status: 2025-01-07 - Session Sine Die [HB2895 Detail]

Download: Illinois-2023-HB2895-House_Amendment_001.html

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Rep. Anna Moeller

Filed: 2/28/2023

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AMENDMENT TO HOUSE BILL 2895
AMENDMENT NO. ______. Amend House Bill 2895 by replacing
everything after the enacting clause with the following:
"Section 5. The Department of Professional Regulation Law
of the Civil Administrative Code of Illinois is amended by
adding Section 2105-367 as follows:
(20 ILCS 2105/2105-367 new)
Sec. 2105-367. Rules; various medical and dental Acts. The
Department shall adopt rules to implement this amendatory Act
of the 103rd General Assembly.
Section 10. The Ambulatory Surgical Treatment Center Act
is amended by changing Section 6.5 as follows:
(210 ILCS 5/6.5)
Sec. 6.5. Clinical privileges; advanced practice

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registered nurses. All ambulatory surgical treatment centers
(ASTC) licensed under this Act shall comply with the following
requirements:
(1) No ASTC policy, rule, regulation, or practice
shall be inconsistent with the provision of adequate
collaboration and consultation in accordance with Section
54.5 of the Medical Practice Act of 1987.
(2) Operative surgical procedures shall be performed
only by a physician licensed to practice medicine in all
its branches under the Medical Practice Act of 1987, a
dentist licensed under the Illinois Dental Practice Act,
or a podiatric physician licensed under the Podiatric
Medical Practice Act of 1987, with medical staff
membership and surgical clinical privileges granted by the
consulting committee of the ASTC. A licensed physician,
dentist, or podiatric physician may be assisted by a
physician licensed to practice medicine in all its
branches, dentist, dental assistant, podiatric physician,
licensed advanced practice registered nurse, licensed
physician assistant, licensed registered nurse, licensed
practical nurse, surgical assistant, surgical technician,
or other individuals granted clinical privileges to assist
in surgery by the consulting committee of the ASTC.
Payment for services rendered by an assistant in surgery
who is not an ambulatory surgical treatment center
employee shall be paid at the appropriate non-physician

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modifier rate if the payor would have made payment had the
same services been provided by a physician.
(2.5) A registered nurse licensed under the Nurse
Practice Act and qualified by training and experience in
operating room nursing shall be present in the operating
room and function as the circulating nurse during all
invasive or operative procedures. For purposes of this
paragraph (2.5), "circulating nurse" means a registered
nurse who is responsible for coordinating all nursing
care, patient safety needs, and the needs of the surgical
team in the operating room during an invasive or operative
procedure.
(3) An advanced practice registered nurse is not
required to possess prescriptive authority or a written
collaborative agreement meeting the requirements of the
Nurse Practice Act to provide advanced practice registered
nursing services in an ambulatory surgical treatment
center. An advanced practice registered nurse must possess
clinical privileges granted by the consulting medical
staff committee and ambulatory surgical treatment center
in order to provide services. Individual advanced practice
registered nurses may also be granted clinical privileges
to order, select, and administer medications, including
controlled substances, to provide delineated care. The
attending physician must determine the advanced practice
registered nurse's role in providing care for his or her

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patients, except as otherwise provided in the consulting
staff policies. The consulting medical staff committee
shall periodically review the services of advanced
practice registered nurses granted privileges.
(4) The anesthesia service shall be under the
direction of a physician licensed to practice medicine in
all its branches who has had specialized preparation or
experience in the area or who has completed a residency in
anesthesiology. An anesthesiologist, Board certified or
Board eligible, is recommended. Anesthesia services may
only be administered pursuant to the order of a physician
licensed to practice medicine in all its branches,
licensed dentist, or licensed podiatric physician. (A) The
individuals who, with clinical privileges granted by the
medical staff and ASTC, may administer anesthesia services
are limited to the following:
(i) an anesthesiologist; or
(ii) a physician licensed to practice medicine in
all its branches; or
(iii) a dentist with authority to administer
anesthesia under Section 8.1 of the Illinois Dental
Practice Act; or
(iv) a licensed certified registered nurse
anesthetist; or
(v) a podiatric physician licensed under the
Podiatric Medical Practice Act of 1987.

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(B) (Blank). For anesthesia services, an
anesthesiologist shall participate through discussion of
and agreement with the anesthesia plan and shall remain
physically present and be available on the premises during
the delivery of anesthesia services for diagnosis,
consultation, and treatment of emergency medical
conditions. In the absence of 24-hour availability of
anesthesiologists with clinical privileges, an alternate
policy (requiring participation, presence, and
availability of a physician licensed to practice medicine
in all its branches) shall be developed by the medical
staff consulting committee in consultation with the
anesthesia service and included in the medical staff
consulting committee policies.
(C) A certified registered nurse anesthetist is not
required to possess prescriptive authority or a written
collaborative agreement meeting the requirements of
Section 65-35 of the Nurse Practice Act to provide
anesthesia services ordered by a licensed physician,
dentist, or podiatric physician. Licensed certified
registered nurse anesthetists are authorized to select,
order, and administer drugs and apply the appropriate
medical devices in the provision of anesthesia services
under the anesthesia plan agreed with by the
anesthesiologist or, in the absence of an available
anesthesiologist with clinical privileges, agreed with by

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the operating physician, operating dentist, or operating
podiatric physician in accordance with the medical staff
consulting committee policies of a licensed ambulatory
surgical treatment center.
(D) In accordance with the medical staff consulting
committee policies of a licensed ambulatory surgical
treatment center, a certified registered nurse anesthetist
with clinical privileges may perform acts of advanced
assessment and diagnosis and may provide such functions
for which the certified registered nurse anesthetist is
educationally and experientially prepared and which are
consistent with the standards established by the national
credentialing or certification for the specialty
recognized by the Department.
(Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18.)
Section 15. The Hospital Licensing Act is amended by
changing Section 10.7 as follows:
(210 ILCS 85/10.7)
Sec. 10.7. Clinical privileges; advanced practice
registered nurses. All hospitals licensed under this Act
shall comply with the following requirements:
(1) No hospital policy, rule, regulation, or practice
shall be inconsistent with the provision of adequate
collaboration and consultation in accordance with Section

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54.5 of the Medical Practice Act of 1987.
(2) Operative surgical procedures shall be performed
only by a physician licensed to practice medicine in all
its branches under the Medical Practice Act of 1987, a
dentist licensed under the Illinois Dental Practice Act,
or a podiatric physician licensed under the Podiatric
Medical Practice Act of 1987, with medical staff
membership and surgical clinical privileges granted at the
hospital. A licensed physician, dentist, or podiatric
physician may be assisted by a physician licensed to
practice medicine in all its branches, dentist, dental
assistant, podiatric physician, licensed advanced practice
registered nurse, licensed physician assistant, licensed
registered nurse, licensed practical nurse, surgical
assistant, surgical technician, or other individuals
granted clinical privileges to assist in surgery at the
hospital. Payment for services rendered by an assistant in
surgery who is not a hospital employee shall be paid at the
appropriate non-physician modifier rate if the payor would
have made payment had the same services been provided by a
physician.
(2.5) A registered nurse licensed under the Nurse
Practice Act and qualified by training and experience in
operating room nursing shall be present in the operating
room and function as the circulating nurse during all
invasive or operative procedures. For purposes of this

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paragraph (2.5), "circulating nurse" means a registered
nurse who is responsible for coordinating all nursing
care, patient safety needs, and the needs of the surgical
team in the operating room during an invasive or operative
procedure.
(3) An advanced practice registered nurse is not
required to possess prescriptive authority or a written
collaborative agreement meeting the requirements of the
Nurse Practice Act to provide advanced practice registered
nursing services in a hospital. An advanced practice
registered nurse must possess clinical privileges
recommended by the medical staff and granted by the
hospital in order to provide services. Individual advanced
practice registered nurses may also be granted clinical
privileges to order, select, and administer medications,
including controlled substances, to provide delineated
care. The attending physician must determine the advanced
practice registered nurse's role in providing care for his
or her patients, except as otherwise provided in medical
staff bylaws. The medical staff shall periodically review
the services of advanced practice registered nurses
granted privileges. This review shall be conducted in
accordance with item (2) of subsection (a) of Section 10.8
of this Act for advanced practice registered nurses
employed by the hospital.
(4) The anesthesia service shall be under the

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direction of a physician licensed to practice medicine in
all its branches who has had specialized preparation or
experience in the area or who has completed a residency in
anesthesiology. An anesthesiologist, Board certified or
Board eligible, is recommended. Anesthesia services may
only be administered pursuant to the order of a physician
licensed to practice medicine in all its branches,
licensed dentist, or licensed podiatric physician. (A) The
individuals who, with clinical privileges granted at the
hospital, may administer anesthesia services are limited
to the following:
(i) an anesthesiologist; or
(ii) a physician licensed to practice medicine in
all its branches; or
(iii) a dentist with authority to administer
anesthesia under Section 8.1 of the Illinois Dental
Practice Act; or
(iv) a licensed certified registered nurse
anesthetist; or
(v) a podiatric physician licensed under the
Podiatric Medical Practice Act of 1987.
(B) (Blank). For anesthesia services, an
anesthesiologist shall participate through discussion of
and agreement with the anesthesia plan and shall remain
physically present and be available on the premises during
the delivery of anesthesia services for diagnosis,

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consultation, and treatment of emergency medical
conditions. In the absence of 24-hour availability of
anesthesiologists with medical staff privileges, an
alternate policy (requiring participation, presence, and
availability of a physician licensed to practice medicine
in all its branches) shall be developed by the medical
staff and licensed hospital in consultation with the
anesthesia service.
(C) A certified registered nurse anesthetist is not
required to possess prescriptive authority or a written
collaborative agreement meeting the requirements of
Section 65-35 of the Nurse Practice Act to provide
anesthesia services ordered by a licensed physician,
dentist, or podiatric physician. Licensed certified
registered nurse anesthetists are authorized to select,
order, and administer drugs and apply the appropriate
medical devices in the provision of anesthesia services
under the anesthesia plan agreed with by the
anesthesiologist or, in the absence of an available
anesthesiologist with clinical privileges, agreed with by
the operating physician, operating dentist, or operating
podiatric physician in accordance with the hospital's
alternative policy.
(D) In accordance with the hospital's policies, a
certified registered nurse anesthetist with clinical
privileges may perform acts of advanced assessment and

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diagnosis and may provide such functions for which the
certified registered nurse anesthetist is educationally
and experientially prepared and which are consistent with
the standards established by the national credentialing or
certification for the specialty recognized by the
Department.
(Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18.)
Section 20. The Illinois Dental Practice Act is amended by
changing Section 8.1 as follows:
(225 ILCS 25/8.1) (from Ch. 111, par. 2308.1)
(Section scheduled to be repealed on January 1, 2026)
Sec. 8.1. Permit for the administration of anesthesia and
sedation.
(a) No licensed dentist shall administer general
anesthesia, deep sedation, or conscious sedation without first
applying for and obtaining a permit for such purpose from the
Department. The Department shall issue such permit only after
ascertaining that the applicant possesses the minimum
qualifications necessary to protect public safety. A person
with a dental degree who administers anesthesia, deep
sedation, or conscious sedation in an approved hospital
training program under the supervision of either a licensed
dentist holding such permit or a physician licensed to
practice medicine in all its branches shall not be required to

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obtain such permit.
(b) In determining the minimum permit qualifications that
are necessary to protect public safety, the Department, by
rule, shall:
(1) establish the minimum educational and training
requirements necessary for a dentist to be issued an
appropriate permit;
(2) establish the standards for properly equipped
dental facilities (other than licensed hospitals and
ambulatory surgical treatment centers) in which general
anesthesia, deep sedation, or conscious sedation is
administered, as necessary to protect public safety;
(3) establish minimum requirements for all persons who
assist the dentist in the administration of general
anesthesia, deep sedation, or conscious sedation,
including minimum training requirements for each member of
the dental team, monitoring requirements, recordkeeping
requirements, and emergency procedures;
(4) ensure that the dentist has completed and
maintains current certification in advanced cardiac life
support or pediatric advanced life support and all persons
assisting the dentist or monitoring the administration of
general anesthesia, deep sedation, or conscious sedation
maintain current certification in Basic Life Support
(BLS); and
(5) establish continuing education requirements in

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sedation techniques and airway management for dentists who
possess a permit under this Section.
When establishing requirements under this Section, the
Department shall consider the current American Dental
Association guidelines on sedation and general anesthesia, the
current "Guidelines for Monitoring and Management of Pediatric
Patients During and After Sedation for Diagnostic and
Therapeutic Procedures" established by the American Academy of
Pediatrics and the American Academy of Pediatric Dentistry,
and the current parameters of care and Office Anesthesia
Evaluation (OAE) Manual established by the American
Association of Oral and Maxillofacial Surgeons.
(c) (Blank). A licensed dentist must hold an appropriate
permit issued under this Section in order to perform dentistry
while a nurse anesthetist administers conscious sedation, and
a valid written collaborative agreement must exist between the
dentist and the nurse anesthetist, in accordance with the
Nurse Practice Act.
A licensed dentist must hold an appropriate permit issued
under this Section in order to perform dentistry while a nurse
anesthetist administers deep sedation or general anesthesia,
and a valid written collaborative agreement must exist between
the dentist and the nurse anesthetist, in accordance with the
Nurse Practice Act.
For the purposes of this subsection (c), "nurse
anesthetist" means a licensed certified registered nurse

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anesthetist who holds a license as an advanced practice
registered nurse.
(Source: P.A. 100-201, eff. 8-18-17; 100-513, eff. 1-1-18;
101-162, eff. 7-26-19.)
Section 25. The Medical Practice Act of 1987 is amended by
changing Section 54.5 as follows:
(225 ILCS 60/54.5)
(Section scheduled to be repealed on January 1, 2027)
Sec. 54.5. Physician delegation of authority to physician
assistants, advanced practice registered nurses without full
practice authority, and prescribing psychologists.
(a) Physicians licensed to practice medicine in all its
branches may delegate care and treatment responsibilities to a
physician assistant under guidelines in accordance with the
requirements of the Physician Assistant Practice Act of 1987.
A physician licensed to practice medicine in all its branches
may enter into collaborative agreements with no more than 7
full-time equivalent physician assistants, except in a
hospital, hospital affiliate, or ambulatory surgical treatment
center as set forth by Section 7.7 of the Physician Assistant
Practice Act of 1987 and as provided in subsection (a-5).
(a-5) A physician licensed to practice medicine in all its
branches may collaborate with more than 7 physician assistants
when the services are provided in a federal primary care

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health professional shortage area with a Health Professional
Shortage Area score greater than or equal to 12, as determined
by the United States Department of Health and Human Services.
The collaborating physician must keep appropriate
documentation of meeting this exemption and make it available
to the Department upon request.
(b) A physician licensed to practice medicine in all its
branches in active clinical practice may collaborate with an
advanced practice registered nurse in accordance with the
requirements of the Nurse Practice Act. Collaboration is for
the purpose of providing medical consultation, and no
employment relationship is required. A written collaborative
agreement shall conform to the requirements of Section 65-35
of the Nurse Practice Act. The written collaborative agreement
shall be for services in the same area of practice or specialty
as the collaborating physician in his or her clinical medical
practice. A written collaborative agreement shall be adequate
with respect to collaboration with advanced practice
registered nurses if all of the following apply:
(1) The agreement is written to promote the exercise
of professional judgment by the advanced practice
registered nurse commensurate with his or her education
and experience.
(2) The advanced practice registered nurse provides
services based upon a written collaborative agreement with
the collaborating physician, except as set forth in

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subsection (b-5) of this Section. With respect to labor
and delivery, the collaborating physician must provide
delivery services in order to participate with a certified
nurse midwife.
(3) Methods of communication are available with the
collaborating physician in person or through
telecommunications for consultation, collaboration, and
referral as needed to address patient care needs.
(b-5) An anesthesiologist or physician licensed to
practice medicine in all its branches may collaborate with a
certified registered nurse anesthetist in accordance with
Section 65-35 of the Nurse Practice Act for the provision of
anesthesia services. Collaboration with respect to anesthesia
With respect to the provision of anesthesia services, the
collaborating anesthesiologist or physician shall have
training and experience in the delivery of anesthesia services
consistent with Department rules. Collaboration shall be
adequate if: (1) an anesthesiologist or a physician
participates in the joint formulation and joint approval of
orders or guidelines and periodically reviews such orders and
the services provided patients under such orders; and (2) for
anesthesia services, the anesthesiologist or physician
participates through discussion of and agreement with the
anesthesia plan and is physically present and available on the
premises during the delivery of anesthesia services for
diagnosis, consultation, and treatment of emergency medical

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conditions. Anesthesia services in a hospital shall be
conducted in accordance with Section 10.7 of the Hospital
Licensing Act and in an ambulatory surgical treatment center
in accordance with Section 6.5 of the Ambulatory Surgical
Treatment Center Act.
(b-10) (Blank). The anesthesiologist or operating
physician must agree with the anesthesia plan prior to the
delivery of services.
(c) The collaborating physician shall have access to the
medical records of all patients attended by a physician
assistant. The collaborating physician shall have access to
the medical records of all patients attended to by an advanced
practice registered nurse.
(d) (Blank).
(e) A physician shall not be liable for the acts or
omissions of a prescribing psychologist, physician assistant,
or advanced practice registered nurse solely on the basis of
having signed a supervision agreement or guidelines or a
collaborative agreement, an order, a standing medical order, a
standing delegation order, or other order or guideline
authorizing a prescribing psychologist, physician assistant,
or advanced practice registered nurse to perform acts, unless
the physician has reason to believe the prescribing
psychologist, physician assistant, or advanced practice
registered nurse lacked the competency to perform the act or
acts or commits willful and wanton misconduct.

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(f) A collaborating physician may, but is not required to,
delegate prescriptive authority to an advanced practice
registered nurse as part of a written collaborative agreement,
and the delegation of prescriptive authority shall conform to
the requirements of Section 65-40 of the Nurse Practice Act.
(g) A collaborating physician may, but is not required to,
delegate prescriptive authority to a physician assistant as
part of a written collaborative agreement, and the delegation
of prescriptive authority shall conform to the requirements of
Section 7.5 of the Physician Assistant Practice Act of 1987.
(h) (Blank).
(i) A collaborating physician shall delegate prescriptive
authority to a prescribing psychologist as part of a written
collaborative agreement, and the delegation of prescriptive
authority shall conform to the requirements of Section 4.3 of
the Clinical Psychologist Licensing Act.
(j) As set forth in Section 22.2 of this Act, a licensee
under this Act may not directly or indirectly divide, share,
or split any professional fee or other form of compensation
for professional services with anyone in exchange for a
referral or otherwise, other than as provided in Section 22.2.
(Source: P.A. 99-173, eff. 7-29-15; 100-453, eff. 8-25-17;
100-513, eff. 1-1-18; 100-605, eff. 1-1-19; 100-863, eff.
8-14-18.)
Section 30. The Nurse Practice Act is amended by changing

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Sections 65-35 and 65-45 and by adding Section 65-37 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 or
65-37, 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 or 65-37.
(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 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

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(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
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. 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 (3) limit the geographic area or practice location of the
advanced practice registered nurse in this State.
(c) (Blank). 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

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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 performing the procedure.
The collaborative agreement may, but is not required to,
include the following terms: (i) that the certified registered
nurse anesthetist and the anesthesiologist, physician, or
podiatric physician participate through discussion of and
reach agreement on the anesthesia plan; or (ii) that
anesthesia services shall only be delivered when the
anesthesiologist, physician, or podiatric physician is present
and available on the premises for diagnosis, consultation, and
treatment of emergency medical conditions. Outside of a
hospital or ambulatory surgical treatment center, the
certified registered nurse anesthetist may provide only those
services that the collaborating podiatric physician is
authorized to provide pursuant to the Podiatric Medical
Practice Act of 1987 and rules adopted thereunder. A certified
registered nurse anesthetist may select, order, and administer
medication, including controlled substances, and apply
appropriate medical devices for delivery of anesthesia

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services under the anesthesia plan agreed with by the
anesthesiologist or the operating physician or operating
podiatric physician.
(c-10) 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. The collaborative
agreement may, but is not required to, include the following
terms: (i) that the certified registered nurse anesthetist and
the anesthesiologist, physician, or dentist participate
through discussion of and reach agreement on the anesthesia
plan; or (ii) that anesthesia services shall only be delivered
when the anesthesiologist, physician, or dentist is present
and available on the premises for diagnosis, consultation, and
treatment of emergency medical conditions. 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,

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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.
(c-15) An advanced practice registered nurse 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

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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
services required by law or rule to be performed by a
physician. The scope of practice of an advanced practice
registered nurse does not include operative surgery. Nothing
in this Section shall be construed to preclude an advanced
practice registered nurse from assisting in surgery.
(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. 100-513, eff. 1-1-18; 100-577, eff. 1-26-18;
100-1096, eff. 8-26-18; 101-13, eff. 6-12-19.)
(225 ILCS 65/65-37 new)
Sec. 65-37. Full practice authority; certified registered
nurse anesthetist.

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(a) An Illinois-licensed advanced practice registered
nurse certified as a certified registered nurse anesthetist
may practice without a written collaborative agreement as set
forth in this Section.
(b) An advanced practice registered nurse certified as a
certified registered nurse anesthetist who (i) has attained
national certification and completed a professional practice
doctorate or (ii) 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
not require a written collaborative agreement. Documentation
of successful completion shall be provided to the Department
upon request.
Continuing education or training hours required by this
subsection shall be in the certified registered nurse
anesthetist's area of certification as set forth by Department
rule.
The clinical experience must be in the certified
registered nurse anesthetist's area of certification. The
clinical experience shall be in collaboration with a physician
or physicians or a certified registered nurse anesthetist with
full practice authority. Completion of the clinical experience
must be attested to by the collaborating physician or
physicians or employer, collaborating certified registered
nurse anesthetist and the certified registered nurse

10300HB2895ham001 - 26 - LRB103 30134 AWJ 57604 a
anesthetist. If the collaborating physician or physicians
collaborating certified nurse anesthetist, or employer is
unable to attest to the completion of the clinical experience,
the Department may accept other evidence of clinical
experience as established by rule.
(c) The scope of practice of a certified registered nurse
anesthetist with full practice authority includes:
(1) all matters included in subsection (c) of Section
65-30;
(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
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;
(5) authority to obtain an Illinois controlled
substance license and a federal Drug Enforcement

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Administration number;
(6) providing comprehensive pain management services,
including acute, chronic, and interventional pain
management; and
(7) delivery of the full range of anesthesia and
related services.
(d) The Department shall 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 a
certified registered nurse anesthetist with full practice
authority to provide health care services required by law or
rule to be performed by a physician.
(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.
(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

10300HB2895ham001 - 28 - LRB103 30134 AWJ 57604 a
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
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

10300HB2895ham001 - 29 - LRB103 30134 AWJ 57604 a
order controlled substances under Section 303.05 of the
Illinois Controlled Substances Act.
(a-4) An advanced practice registered nurse 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
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
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

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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, certified registered nurse anesthetists, 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
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

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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, certified registered nurse
anesthetist, nurse midwife, or clinical nurse specialist to
prescribe any Schedule II controlled substances, if all of the
following conditions apply:
(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;

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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 or 65-37 may be privileged to
prescribe controlled substances categorized as Schedule II
through V in accordance with Section 65-43.
(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18.)
Section 35. The Podiatric Medical Practice Act of 1987 is
amended by changing Section 20.5 as follows:

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(225 ILCS 100/20.5)
(Section scheduled to be repealed on January 1, 2028)
Sec. 20.5. Delegation of authority to advanced practice
registered nurses.
(a) A podiatric physician in active clinical practice may
collaborate with an advanced practice registered nurse in
accordance with the requirements of the Nurse Practice Act.
Collaboration shall be for the purpose of providing podiatric
care and no employment relationship shall be required. A
written collaborative agreement shall conform to the
requirements of Section 65-35 of the Nurse Practice Act. A
written collaborative agreement and podiatric physician
collaboration and consultation shall be adequate with respect
to advanced practice registered nurses if all of the following
apply:
(1) With respect to the provision of anesthesia
services by a certified registered nurse anesthetist, the
collaborating podiatric physician must have training and
experience in the delivery of anesthesia consistent with
Department rules unless the certified registered nurse
anesthetist has full practice authority under the
requirements of Section 65-37.
(2) Methods of communication are available with the
collaborating podiatric physician in person or through
telecommunications or electronic communications for

10300HB2895ham001 - 34 - LRB103 30134 AWJ 57604 a
consultation, collaboration, and referral as needed to
address patient care needs.
(3) (Blank). With respect to the provision of
anesthesia services by a certified registered nurse
anesthetist, an anesthesiologist, physician, 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. The anesthesiologist or operating podiatric
physician must agree with the anesthesia plan prior to the
delivery of services.
(b) The collaborating podiatric physician shall have
access to the records of all patients attended to by an
advanced practice registered nurse.
(c) Nothing in this Section shall be construed to limit
the delegation of tasks or duties by a podiatric physician to a
licensed practical nurse, a registered professional nurse, or
other appropriately trained persons.
(d) A podiatric physician shall not be liable for the acts
or omissions of an advanced practice registered nurse solely
on the basis of having signed guidelines or a collaborative
agreement, an order, a standing order, a standing delegation
order, or other order or guideline authorizing an advanced
practice registered nurse to perform acts, unless the

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podiatric physician has reason to believe the advanced
practice registered nurse lacked the competency to perform the
act or acts or commits willful or wanton misconduct.
(e) A podiatric physician, may, but is not required to
delegate prescriptive authority to an advanced practice
registered nurse as part of a written collaborative agreement
and the delegation of prescriptive authority shall conform to
the requirements of Section 65-40 of the Nurse Practice Act.
(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.".