Bill Amendment: IL SB1322 | 2017-2018 | 100th General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: SMHRF-PROVISIONAL LICENSES

Status: 2018-01-26 - Public Act . . . . . . . . . 100-0577 [SB1322 Detail]

Download: Illinois-2017-SB1322-House_Amendment_002.html

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Rep. Sara Feigenholtz

Filed: 10/23/2017

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AMENDMENT TO SENATE BILL 1322
AMENDMENT NO. ______. Amend Senate Bill 1322 by replacing
everything after the enacting clause with the following:
"Section 5. The Nurse Practice Act is amended by changing
Section 65-35 as follows:
(225 ILCS 65/65-35) (was 225 ILCS 65/15-15)
(Text of Section before amendment by P.A. 100-513)
(Section scheduled to be repealed on January 1, 2028)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 nurses engaged in clinical practice, except
for advanced practice nurses who are authorized to practice in
a hospital, hospital affiliate, or ambulatory surgical
treatment center.
(a-5) If an advanced practice nurse engages in clinical
practice outside of a hospital, hospital affiliate, or

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ambulatory surgical treatment center in which he or she is
authorized to practice, the advanced practice nurse must have a
written collaborative agreement.
(b) A written collaborative agreement shall describe the
relationship of the advanced practice nurse with the
collaborating physician or podiatric physician and shall
describe the categories of care, treatment, or procedures to be
provided by the advanced practice nurse. A collaborative
agreement with a dentist must be in accordance with subsection
(c-10) of this Section. Collaboration does not require an
employment relationship between the collaborating physician or
podiatric physician and advanced practice nurse.
The collaborative relationship under an agreement shall
not be construed to require the personal presence of a
physician or podiatric physician at the place where services
are rendered. Methods of communication shall be available for
consultation with the collaborating physician or podiatric
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 nurse within the scope of the
advanced practice 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 nurse contracts, or (3) limit the geographic area or

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practice location of the advanced practice 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 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 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
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

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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.
(d) A copy of the signed, written collaborative agreement
must be available to the Department upon request from both the
advanced practice nurse and the collaborating physician,

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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.
Nothing in this Act shall be construed to authorize an advanced
practice nurse to provide health care services required by law
or rule to be performed by a physician.
(f) An advanced practice 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. 98-192, eff. 1-1-14; 98-214, eff. 8-9-13; 98-756,
eff. 7-16-14; 99-173, eff. 7-29-15.)
(Text of Section after amendment by P.A. 100-513)
(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

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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
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-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

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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) 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 performing the procedure. Outside of a

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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
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. 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

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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 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, until the
collaborative relationship between the advanced practice
registered nurse and podiatric physician terminates.
(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, 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.)
Section 95. No acceleration or delay. Where this Act makes
changes in a statute that is represented in this Act by text
that is not yet or no longer in effect (for example, a Section
represented by multiple versions), the use of that text does
not accelerate or delay the taking effect of (i) the changes
made by this Act or (ii) provisions derived from any other
Public Act.

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Section 99. Effective date. This Act takes effect January
1, 2018.".