Legislative Update!!

Recall from a previous legislative report, in an effort to 'break down the barriers', ISAPN spearheaded 5 bills introduced with various proposals.  These proposals were for negotiating purposes to remove the onerous language pertaining to APN practice from both comprehensive and incremental approaches. 

Original Bills

HB 1682 (Gabel) and SB 1616 (Steans): eliminates the written collaborative agreement (WCA) language for all APNs in all practice settings.

HB 2978 (Bradley) and SB 2255 (Haine/Forby): full prescribing authority under a WCA.

HB 3133 (Feigenholtz): Provides that an advanced practice nurse may, but is not required to, submit a request to the Department to eliminate the requirement of the written collaborative agreement, allowing the advanced practice nurse autonomous practice with full prescribing authority if the advance practice nurse (i) shows proof of successfully practicing under a delegated written collaborative agreement for a minimum of 2 years, (ii) shows proof of an unencumbered license, (iii) shows proof of individual malpractice insurance, (iv) agrees in writing that 20 hours of the 50-hour requirement for continuing education be in pharmacology, and (v) signs a memorandum of understanding to the Department affirming that the advance practice nurse will collaborate, consult, and refer to a physician and other colleagues in adherence to the Act and all rules governing the scope of practice for certification.

Please thank each of the above legislators for their advocacy on behalf of APNs in Illinois.

SB 2255 became the viable bill (and the only one that passed both chambers) after negotiations and agreement with ISMS and IHA.  The bill will now be sent to the Governor for signature, which probably won't happen until mid to late August.  Until then:  NONE OF THE FOLLOWING CHANGES CAN BE IMPLEMENTED UNTIL THE GOVERNOR SIGNS THE BILL.

SCHEDULE II PRESCRIBING AUTHORITY: ISAPN WILL LET YOU KNOW WHEN IT HAS BEEN AUTHORIZED BY IDFPR.  UNTIL THEN, PLEASE DO NOT PRESCRIBE MORE THAN 5 ORAL SCHEDULE II MEDICATIONS PER THE WCA!  TO DO SO IS ILLEGAL AND YOUR LICENSE AT RISK. 

SB 2255 Synopsis and Analysis of the Nurse Practice Act Changes:

Section 65/35: Written Collaborative Agreements: changes include:

• A physician who is a collaborating physician, but does not employ the APN may not limit the APN from accepting whatever third party payment the APN desires.  In other word, if an APN desires to accept Medicaid patients she/he may do so.  If employed, it is considered a business decision solved by the individual APN with the collaborating physician.
• Monthly meetings: no longer need be in person.  It can be done via phone, email, Skype or whatever means determined.  This change eliminates the geographic restriction on collaboration: an APN can have a WCA with a physician in the northern part of the state and live in the southern part....and vice versa.
• Delegation methods are not limited: it may be oral, written, electronic, standing orders, etc.  This is clarification and legal protection for both the APN and physician.
• Authorized services the APN may provide under the WCA need only be what the physician generally provides, not specific tasks or duties.  This language gives APN's who have specialty expertise (i.e. joint injections) the ability to provide the service (if it is identified in the WCA) even if the physician does not choose to provide that specific service. This is intended to provide clarity and flexibility.

Section 65/40: Prescriptive Authority with a WCA

Schedule II:

• All oral, topical or transdermal controlled substances may be prescribed as delegated. 
• The physician must also routinely prescribe these medications.
• The WCA must identify the delegated medications by either brand or generic name.
• NO injections or other routes of administration may be prescribed at this time.
• New criteria: referenced in the NPA, but described in the Illinois Controlled Substances Act-for any new license issued with Schedule II authority after the effective date, the APN must provide evidence of completion of 45 graduate contact hours in pharmacology.
• APNs who currently hold a mid-level or DEA number for prescribing Schedule II medications are 'grandmothered', and do not have to provide such proof.  However, if you are licensed currently as an APN and do not have a mid-level or DEA number for Schedule II and decide later to get one, you will need to provide such proof.
• New graduates will need to provide this proof.  However, 45 contact hours is typical of Illinois APN programs.
• All APNs who prescribe Schedule II medications must annually complete 5 hours of CE in pharmacology to maintain the privilege to prescribe Schedule II medications.
• Any APN who writes a prescription for a controlled substance without authority to do so may be fined $50.00 per prescription, and DPR may take other disciplinary action.

Section 65/45: Advanced Practice Nursing in Hospitals, ASTCs, and Hospital Affiliates.

• An APN may provide services in a hospital or a hospital affiliate (new) as defined in the Hospital Licensing Act or the University of Illinois Hospital Act or an ASTC. This broadens the practice sites that do not require a WCA.
• If privileged to do so in the above practice sites, an individual APN may select, order, and administer medications, including controlled substances.
• APNs practicing in a hospital or ASTC are not required to obtain a mid-level controlled substances license to select, order or administer controlled substances.
• An APN privileged to do so may complete discharge orders, including prescribing controlled substances, provided the prescriptions are in the name of the APN and the attending or discharging physician.

Congratulations!  This is a stepping stone for autonomous practice!!!