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

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Bill Title: Amends the Nurse Practice Act. Provides that a certified registered nurse anesthetist providing anesthesia services outside the hospital, ambulatory surgical treatment center, or hospital affiliate shall enter into a written collaborative agreement with a physician, podiatric physician, or dentist. Removes provisions providing that a certified registered nurse anesthetist, an anesthesiologist, a physician, a dentist, or a podiatric physician must participate through discussion of an agreement with the anesthesia plan and remain physically present and available on the premises during the delivery of anesthesia services. Makes corresponding changes in the Ambulatory Surgical Treatment Center Act and the Medical Practice Act of 1987. Effective immediately.

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Introduced) 2024-04-05 - House Committee Amendment No. 2 Rule 19(c) / Re-referred to Rules Committee [HB2895 Detail]

Download: Illinois-2023-HB2895-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB2895 Introduced , by Rep. Anna Moeller SYNOPSIS AS INTRODUCED:
210 ILCS 5/6.5
225 ILCS 60/54.5
225 ILCS 65/65-35 was 225 ILCS 65/15-15
225 ILCS 65/65-45 was 225 ILCS 65/15-25
Amends the Nurse Practice Act. Provides that a certified registered nurse anesthetist providing anesthesia services outside the hospital, ambulatory surgical treatment center, or hospital affiliate shall enter into a written collaborative agreement with a physician, podiatric physician, or dentist. Removes provisions providing that a certified registered nurse anesthetist, an anesthesiologist, a physician, a dentist, or a podiatric physician must participate through discussion of an agreement with the anesthesia plan and remain physically present and available on the premises during the delivery of anesthesia services. Makes corresponding changes in the Ambulatory Surgical Treatment Center Act and the Medical Practice Act of 1987. Effective immediately.
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A BILL FOR
HB2895 LRB103 30134 AMQ 56558 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. 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
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

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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
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

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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
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 upon the request 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

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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, 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.

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(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 medical staff consulting committee
policies of a licensed ambulatory surgical treatment
center.
(Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18.)
Section 10. 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

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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
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

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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
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

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anesthesia services. 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 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.

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(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.
(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

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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 15. The Nurse Practice Act is amended by changing
Sections 65-35 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,

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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 certified
registered nurse anesthetist providing anesthesia services
outside the hospital, ambulatory surgical treatment center, or
hospital affiliate shall enter into a written collaborative
agreement with a physician, podiatric physician, or dentist. 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
rendered. Methods of communication shall be available for
consultation with the collaborating physician in person or by

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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
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,

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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 operating dentist shall participate through

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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
practical nurse, a registered professional nurse, or other

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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 65/65-45) (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

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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
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.

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(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
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

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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
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

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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
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,

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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;
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

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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 99. Effective date. This Act takes effect upon
becoming law.