ASTC-ANESTHESIA SERVICES

Illinois General Assembly - Full Text of SB0239

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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB0239

Introduced 1/22/2025, by Sen. Lakesia Collins

SYNOPSIS AS INTRODUCED:

See Index

Amends the Ambulatory Surgical Treatment Center Act. Removes a
provision which provides that, in ambulatory surgical treatment centers,
anesthesia service shall be under the direction of a physician who has had
specialized preparation or experience in the area or who has completed a
residency in anesthesiology. Specifies that with respect to anesthesia
service in an ambulatory surgical treatment center, a certified registered
nurse anesthetist shall seek consultation regarding development of an
anesthesia plan and treatment of patients as is appropriate to the
certified registered nurse anesthetist's level of expertise and scope of
practice and as is warranted by the needs of the patient. Removes a
requirement that an anesthesiologist participate through discussion of and
agreement with the anesthesia plan and remain physically present and be
available on the premises. Provides that 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. Makes conforming changes to the Hospital Licensing Act. Amends
the Medical Practice Act of 1987. Provides that a written collaborative
agreement shall be adequate with respect to collaboration with certified
registered nurse anesthetists if all of the following apply: (1) the
agreement is written to promote exercise of professional judgment by the
certified registered nurse anesthetist commensurate with his or her
education and experience; (2) the certified registered nurse anesthetist
provides service based on a written collaborative agreement with the
collaborating physician; and (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. Amends the Nurse Practice Act. Provides that an
Illinois-licensed advanced practice registered nurse certified as a
certified registered nurse anesthetist shall be deemed by law to possess
the ability to practice without a written collaborative agreement. Sets
forth requirements of a certified registered nurse anesthetist. Makes
conforming changes in the Illinois Dental Practice Act. Effective
immediately.
LRB104 07525 BAB 17569 b

A BILL FOR

SB0239
LRB104 07525 BAB 17569 b
1

AN ACT concerning regulation.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Ambulatory Surgical Treatment Center Act is
5
amended by changing Section 6.5 as follows:

6

(210 ILCS 5/6.5)
7

Sec. 6.5.
Clinical privileges; advanced practice
8
registered nurses.
All ambulatory surgical treatment centers
9
(ASTC) licensed under this Act shall comply with the following
10
requirements:
11

(1) No ASTC policy, rule, regulation, or practice
12

shall be inconsistent with the provision of adequate
13

collaboration and consultation in accordance with Section
14

54.5 of the Medical Practice Act of 1987.
15

(2) Operative surgical procedures shall be performed
16

only by a physician licensed to practice medicine in all
17

its branches under the Medical Practice Act of 1987, a
18

dentist licensed under the Illinois Dental Practice Act,
19

or a podiatric physician licensed under the Podiatric
20

Medical Practice Act of 1987, with medical staff
21

membership and surgical clinical privileges granted by the
22

consulting committee of the ASTC. A licensed physician,
23

dentist, or podiatric physician may be assisted by a

SB0239
- 2 -
LRB104 07525 BAB 17569 b
1

physician licensed to practice medicine in all its
2

branches, dentist, dental assistant, podiatric physician,
3

licensed advanced practice registered nurse, licensed
4

physician assistant, licensed registered nurse, licensed
5

practical nurse, surgical assistant, surgical technician,
6

or other individuals granted clinical privileges to assist
7

in surgery by the consulting committee of the ASTC.
8

Payment for services rendered by an assistant in surgery
9

who is not an ambulatory surgical treatment center
10

employee shall be paid at the appropriate non-physician
11

modifier rate if the payor would have made payment had the
12

same services been provided by a physician.
13

(2.5) A registered nurse licensed under the Nurse
14

Practice Act and qualified by training and experience in
15

operating room nursing shall be present in the operating
16

room and function as the circulating nurse during all
17

invasive or operative procedures. For purposes of this
18

paragraph (2.5), "circulating nurse" means a registered
19

nurse who is responsible for coordinating all nursing
20

care, patient safety needs, and the needs of the surgical
21

team in the operating room during an invasive or operative
22

procedure.
23

(3) An advanced practice registered nurse is not
24

required to possess prescriptive authority or a written
25

collaborative agreement meeting the requirements of the
26

Nurse Practice Act to provide advanced practice registered

SB0239
- 3 -
LRB104 07525 BAB 17569 b
1

nursing services in an ambulatory surgical treatment
2

center. An advanced practice registered nurse must possess
3

clinical privileges granted by the consulting medical
4

staff committee and ambulatory surgical treatment center
5

in order to provide services. Individual advanced practice
6

registered nurses may also be granted clinical privileges
7

to order, select, and administer medications, including
8

controlled substances, to provide delineated care. The
9

attending physician must determine the advanced practice
10

registered nurse's role in providing care for his or her
11

patients, except as otherwise provided in the consulting
12

staff policies. The consulting medical staff committee
13

shall periodically review the services of advanced
14

practice registered nurses granted privileges.
15

(4)
(Blank).

The anesthesia service shall be under the
16

direction of a physician licensed to practice medicine in
17

all its branches who has had specialized preparation or
18

experience in the area or who has completed a residency in
19

anesthesiology. An anesthesiologist, Board certified or
20

Board eligible, is recommended. Anesthesia services may
21

only be administered pursuant to the order of a physician
22

licensed to practice medicine in all its branches,
23

licensed dentist, or licensed podiatric physician.
24

(A) The individuals who, with clinical privileges
25

granted by the medical staff and ASTC, may administer
26

anesthesia services are limited to the following:

SB0239
- 4 -
LRB104 07525 BAB 17569 b
1

(i) an anesthesiologist; or
2

(ii) a physician licensed to practice medicine
3

in all its branches; or
4

(iii) a dentist with authority to administer
5

anesthesia under Section 8.1 of the Illinois
6

Dental Practice Act; or
7

(iv) a licensed certified registered nurse
8

anesthetist; or
9

(v) a podiatric physician licensed under the
10

Podiatric Medical Practice Act of 1987.
11

(B) For anesthesia services,
a certified
12

registered nurse anesthetist shall seek consultation
13

regarding development of an anesthesia plan and
14

treatment of patients as is appropriate to the
15

certified registered nurse anesthetist's level of
16

expertise and scope of practice and as is warranted by
17

the needs of the patient

an anesthesiologist shall
18

participate through discussion of and agreement with
19

the anesthesia plan and shall remain physically
20

present and be available on the premises during the
21

delivery of anesthesia services for diagnosis,
22

consultation, and treatment of emergency medical
23

conditions. In the absence of 24-hour availability of
24

anesthesiologists with clinical privileges, an
25

alternate policy (requiring participation, presence,
26

and availability of a physician licensed to practice

SB0239
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LRB104 07525 BAB 17569 b
1

medicine in all its branches) shall be developed by
2

the medical staff consulting committee in consultation
3

with the anesthesia service and included in the
4

medical staff consulting committee policies
.
5

(C) A certified registered nurse anesthetist is
6

not required to possess prescriptive authority or a
7

written collaborative agreement meeting the
8

requirements of Section 65-35 of the Nurse Practice
9

Act to provide anesthesia
and related
services
ordered
10

by a licensed physician, dentist, or podiatric
11

physician
. Licensed certified registered nurse
12

anesthetists are authorized to select, order, and
13

administer drugs and apply the appropriate medical
14

devices in the provision of anesthesia
and related

15

services
under the anesthesia plan agreed with by the
16

anesthesiologist or, in the absence of an available
17

anesthesiologist with clinical privileges, agreed with
18

by the operating physician, operating dentist, or
19

operating podiatric physician
in accordance with the
20

medical staff consulting committee policies of a
21

licensed ambulatory surgical treatment center.
22

(D) In accordance with the medical staff
23

consulting committee policies of a licensed ambulatory
24

surgical treatment center, a certified registered
25

nurse anesthetist with clinical privileges may perform
26

acts of advanced assessment and diagnosis and may

SB0239
- 6 -
LRB104 07525 BAB 17569 b
1

provide such functions for which the certified
2

registered nurse anesthetist is educationally and
3

experientially prepared. A certified registered nurse
4

anesthetist shall practice in accordance with the
5

scope and all standards of the appropriate national
6

professional nursing association.

7
(Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18
.)

8

Section 10.
The Hospital Licensing Act is amended by
9
changing Section 10.7 as follows:

10

(210 ILCS 85/10.7)
11

Sec. 10.7.
Clinical privileges; advanced practice
12
registered nurses.
All hospitals licensed under this Act
13
shall comply with the following requirements:
14

(1) No hospital policy, rule, regulation, or practice
15

shall be inconsistent with the provision of adequate
16

collaboration and consultation in accordance with Section
17

54.5 of the Medical Practice Act of 1987.
18

(2) Operative surgical procedures shall be performed
19

only by a physician licensed to practice medicine in all
20

its branches under the Medical Practice Act of 1987, a
21

dentist licensed under the Illinois Dental Practice Act,
22

or a podiatric physician licensed under the Podiatric
23

Medical Practice Act of 1987, with medical staff
24

membership and surgical clinical privileges granted at the

SB0239
- 7 -
LRB104 07525 BAB 17569 b
1

hospital. A licensed physician, dentist, or podiatric
2

physician may be assisted by a physician licensed to
3

practice medicine in all its branches, dentist, dental
4

assistant, podiatric physician, licensed advanced practice
5

registered nurse, licensed physician assistant, licensed
6

registered nurse, licensed practical nurse, surgical
7

assistant, surgical technician, or other individuals
8

granted clinical privileges to assist in surgery at the
9

hospital. Payment for services rendered by an assistant in
10

surgery who is not a hospital employee shall be paid at the
11

appropriate non-physician modifier rate if the payor would
12

have made payment had the same services been provided by a
13

physician.
14

(2.5) A registered nurse licensed under the Nurse
15

Practice Act and qualified by training and experience in
16

operating room nursing shall be present in the operating
17

room and function as the circulating nurse during all
18

invasive or operative procedures. For purposes of this
19

paragraph (2.5), "circulating nurse" means a registered
20

nurse who is responsible for coordinating all nursing
21

care, patient safety needs, and the needs of the surgical
22

team in the operating room during an invasive or operative
23

procedure.
24

(3) An advanced practice registered nurse is not
25

required to possess prescriptive authority or a written
26

collaborative agreement meeting the requirements of the

SB0239
- 8 -
LRB104 07525 BAB 17569 b
1

Nurse Practice Act to provide advanced practice registered
2

nursing services in a hospital. An advanced practice
3

registered nurse must possess clinical privileges
4

recommended by the medical staff and granted by the
5

hospital in order to provide services. Individual advanced
6

practice registered nurses may also be granted clinical
7

privileges to order, select, and administer medications,
8

including controlled substances, to provide delineated
9

care. The attending physician must determine the advanced
10

practice registered nurse's role in providing care for his
11

or her patients, except as otherwise provided in medical
12

staff bylaws. The medical staff shall periodically review
13

the services of advanced practice registered nurses
14

granted privileges. This review shall be conducted in
15

accordance with item (2) of subsection (a) of Section 10.8
16

of this Act for advanced practice registered nurses
17

employed by the hospital.
18

(4)
(Blank).

The anesthesia service shall be under the
19

direction of a physician licensed to practice medicine in
20

all its branches who has had specialized preparation or
21

experience in the area or who has completed a residency in
22

anesthesiology. An anesthesiologist, Board certified or
23

Board eligible, is recommended. Anesthesia services may
24

only be administered pursuant to the order of a physician
25

licensed to practice medicine in all its branches,
26

licensed dentist, or licensed podiatric physician.

SB0239
- 9 -
LRB104 07525 BAB 17569 b
1

(A) The individuals who, with clinical privileges
2

granted at the hospital, may administer anesthesia
3

services are limited to the following:
4

(i) an anesthesiologist; or
5

(ii) a physician licensed to practice medicine
6

in all its branches; or
7

(iii) a dentist with authority to administer
8

anesthesia under Section 8.1 of the Illinois
9

Dental Practice Act; or
10

(iv) a licensed certified registered nurse
11

anesthetist; or
12

(v) a podiatric physician licensed under the
13

Podiatric Medical Practice Act of 1987.
14

(B) For anesthesia services,
a certified
15

registered nurse anesthetist shall seek consultation
16

regarding development of an anesthesia plan and
17

treatment of patients as is appropriate to the
18

certified registered nurse anesthetist's level of
19

expertise and scope of practice and as is warranted by
20

the needs of the patient

an anesthesiologist shall
21

participate through discussion of and agreement with
22

the anesthesia plan and shall remain physically
23

present and be available on the premises during the
24

delivery of anesthesia services for diagnosis,
25

consultation, and treatment of emergency medical
26

conditions. In the absence of 24-hour availability of

SB0239
- 10 -
LRB104 07525 BAB 17569 b
1

anesthesiologists with medical staff privileges, an
2

alternate policy (requiring participation, presence,
3

and availability of a physician licensed to practice
4

medicine in all its branches) shall be developed by
5

the medical staff and licensed hospital in
6

consultation with the anesthesia service
.
7

(C) A certified registered nurse anesthetist is
8

not required to possess prescriptive authority or a
9

written collaborative agreement meeting the
10

requirements of Section 65-35 of the Nurse Practice
11

Act to provide anesthesia
and related
services
ordered
12

by a licensed physician, dentist, or podiatric
13

physician
. Licensed certified registered nurse
14

anesthetists are authorized to select, order, and
15

administer drugs and apply the appropriate medical
16

devices in the provision of anesthesia
and related

17

services
under the anesthesia plan agreed with by the
18

anesthesiologist or, in the absence of an available
19

anesthesiologist with clinical privileges, agreed with
20

by the operating physician, operating dentist, or
21

operating podiatric physician
in accordance with the
22

hospital's
alternative
policy.
23

(D) In accordance with the hospital's policies, a
24

certified registered nurse anesthetist with clinical
25

privileges may perform acts of advanced assessment and
26

diagnosis and may provide such functions for which the

SB0239
- 11 -
LRB104 07525 BAB 17569 b
1

CRNA is educationally and experientially prepared. A
2

certified registered nurse anesthetist shall practice
3

in accordance with the scope and all standards of the
4

appropriate national professional nursing association.

5
(Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18
.)

6

Section 15.
The Medical Practice Act of 1987 is amended by
7
changing Section 54.5 as follows:

8

(225 ILCS 60/54.5)
9

(Section scheduled to be repealed on January 1, 2027)
10

Sec. 54.5.
Physician delegation of authority to physician
11
assistants, advanced practice registered nurses without full
12
practice authority, and prescribing psychologists.
13

(a) Physicians licensed to practice medicine in all its
14
branches may delegate care and treatment responsibilities to a
15
physician assistant under guidelines in accordance with the
16
requirements of the Physician Assistant Practice Act of 1987.
17
A physician licensed to practice medicine in all its branches
18
may enter into collaborative agreements with no more than 7
19
full-time equivalent physician assistants, except in a
20
hospital, hospital affiliate, or ambulatory surgical treatment
21
center as set forth by Section 7.7 of the Physician Assistant
22
Practice Act of 1987 and as provided in subsection (a-5).
23

(a-5) A physician licensed to practice medicine in all its
24
branches may collaborate with more than 7 physician assistants

SB0239
- 12 -
LRB104 07525 BAB 17569 b
1
when the services are provided in a federal primary care
2
health professional shortage area with a Health Professional
3
Shortage Area score greater than or equal to 12, as determined
4
by the United States Department of Health and Human Services.
5

The collaborating physician must keep appropriate
6
documentation of meeting this exemption and make it available
7
to the Department upon request.
8

(b) A physician licensed to practice medicine in all its
9
branches in active clinical practice may collaborate with an
10
advanced practice registered nurse in accordance with the
11
requirements of the Nurse Practice Act. Collaboration is for
12
the purpose of providing medical consultation, and no
13
employment relationship is required. A written collaborative
14
agreement shall conform to the requirements of Section 65-35
15
of the Nurse Practice Act. The written collaborative agreement
16
shall be for services for which the collaborating physician
17
can provide adequate collaboration. A written collaborative
18
agreement shall be adequate with respect to collaboration with
19
advanced practice registered nurses if all of the following
20
apply:
21

(1) The agreement is written to promote the exercise
22

of professional judgment by the advanced practice
23

registered nurse commensurate with his or her education
24

and experience.
25

(2) The advanced practice registered nurse provides
26

services based upon a written collaborative agreement with

SB0239
- 13 -
LRB104 07525 BAB 17569 b
1

the collaborating physician
, except as set forth in
2

subsection (b-5) of this Section
. With respect to labor
3

and delivery, the collaborating physician must provide
4

delivery services in order to participate with a certified
5

nurse midwife.
6

(3) Methods of communication are available with the
7

collaborating physician in person or through
8

telecommunications for consultation, collaboration, and
9

referral as needed to address patient care needs.
10

(b-5) An anesthesiologist or physician licensed to
11
practice medicine in all its branches may collaborate with a
12
certified registered nurse anesthetist in accordance with
13
Section 65-35 of the Nurse Practice Act for the provision of
14
anesthesia
and related
services.
A written collaborative
15
agreement shall be adequate with respect to collaboration with
16
certified registered nurse anesthetists if all of the
17
following apply:
18

(1) The agreement is written to promote exercise of
19

professional judgment by the certified registered nurse
20

anesthetist commensurate with his or her education and
21

experience.
22

(2) The certified registered nurse anesthetist
23

provides service based on a written collaborative
24

agreement with the collaborating physician.
25

(3) Methods of communication are available with the
26

collaborating physician in person or through

SB0239
- 14 -
LRB104 07525 BAB 17569 b
1

telecommunications for consultation, collaboration, and
2

referral as needed to address patient care needs.

With
3

respect to the provision of anesthesia services, the
4

collaborating anesthesiologist or physician shall have
5

training and experience in the delivery of anesthesia
6

services consistent with Department rules. Collaboration
7

shall be adequate if:
8

(1) an anesthesiologist or a physician participates in
9

the joint formulation and joint approval of orders or
10

guidelines and periodically reviews such orders and the
11

services provided patients under such orders; and
12

(2) for anesthesia services, the anesthesiologist or
13

physician participates through discussion of and agreement
14

with the anesthesia plan and is physically present and
15

available on the premises during the delivery of
16

anesthesia services for diagnosis, consultation, and
17

treatment of emergency medical conditions.

Collaboration
18

with respect to an anesthesia and related

Anesthesia

19

services in a hospital shall be conducted in accordance
20

with Section 10.7 of the Hospital Licensing Act and in an
21

ambulatory surgical treatment center in accordance with
22

Section 6.5 of the Ambulatory Surgical Treatment Center
23

Act.
24

(b-10)
For anesthesia services, a certified registered
25
nurse anesthetist shall consult with the collaborating
26
physician or other appropriate health care professionals

SB0239
- 15 -
LRB104 07525 BAB 17569 b
1
regarding development of an anesthesia plan and treatment of a
2
patient as is appropriate to the certified registered nurse
3
anesthetist's level of expertise and scope of practice and as
4
is warranted by the needs of the patient

The anesthesiologist
5
or operating physician must agree with the anesthesia plan
6
prior to the delivery of services
.
7

(c) The collaborating physician shall have access to the
8
medical records of all patients attended by a physician
9
assistant. The collaborating physician shall have access to
10
the medical records of all patients attended to by an advanced
11
practice registered nurse.
12

(d) (Blank).
13

(e) A physician shall not be liable for the acts or
14
omissions of a prescribing psychologist, physician assistant,
15
or advanced practice registered nurse solely on the basis of
16
having signed a supervision agreement or guidelines or a
17
collaborative agreement, an order, a standing medical order, a
18
standing delegation order, or other order or guideline
19
authorizing a prescribing psychologist, physician assistant,
20
or advanced practice registered nurse to perform acts, unless
21
the physician has reason to believe the prescribing
22
psychologist, physician assistant, or advanced practice
23
registered nurse lacked the competency to perform the act or
24
acts or commits willful and wanton misconduct.
25

(f) A collaborating physician may, but is not required to,
26
delegate prescriptive authority to an advanced practice

SB0239
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LRB104 07525 BAB 17569 b
1
registered nurse as part of a written collaborative agreement,
2
and the delegation of prescriptive authority shall conform to
3
the requirements of Section 65-40 of the Nurse Practice Act.
4

(g) A collaborating physician may, but is not required to,
5
delegate prescriptive authority to a physician assistant as
6
part of a written collaborative agreement, and the delegation
7
of prescriptive authority shall conform to the requirements of
8
Section 7.5 of the Physician Assistant Practice Act of 1987.
9

(h) (Blank).
10

(i) A collaborating physician shall delegate prescriptive
11
authority to a prescribing psychologist as part of a written
12
collaborative agreement, and the delegation of prescriptive
13
authority shall conform to the requirements of Section 4.3 of
14
the Clinical Psychologist Licensing Act.
15

(j) As set forth in Section 22.2 of this Act, a licensee
16
under this Act may not directly or indirectly divide, share,
17
or split any professional fee or other form of compensation
18
for professional services with anyone in exchange for a
19
referral or otherwise, other than as provided in Section 22.2.
20
(Source: P.A. 103-228, eff. 1-1-24
.)

21

Section 20.
The Nurse Practice Act is amended by changing
22
Sections 65-35 and 65-45 and by adding Section 65-70 as
23
follows:

24

(225 ILCS 65/65-35)

(was 225 ILCS 65/15-15)

SB0239
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LRB104 07525 BAB 17569 b
1

(Section scheduled to be repealed on January 1, 2028)
2

Sec. 65-35.
Written collaborative agreements.
3

(a) A written collaborative agreement is required for all
4
advanced practice registered nurses engaged in clinical
5
practice prior to meeting the requirements of Section 65-43,
6
except for advanced practice registered nurses who are
7
privileged to practice in a hospital, hospital affiliate, or
8
ambulatory surgical treatment center.
9

(a-5) If an advanced practice registered nurse engages in
10
clinical practice outside of a hospital, hospital affiliate,
11
or ambulatory surgical treatment center in which he or she is
12
privileged to practice, the advanced practice registered nurse
13
must have a written collaborative agreement, except as set
14
forth in Section 65-43
and 65-70
.
15

(b) A written collaborative agreement shall describe the
16
relationship of the advanced practice registered nurse with
17
the collaborating physician and shall describe the categories
18
of care, treatment, or procedures to be provided by the
19
advanced practice registered nurse. A collaborative agreement
20
with a podiatric physician must be in accordance with
21
subsection (c-5) or (c-15) of this Section. A collaborative
22
agreement with a dentist must be in accordance with subsection
23
(c-10) of this Section. A collaborative agreement with a
24
podiatric physician must be in accordance with subsection
25
(c-5) of this Section. Collaboration does not require an
26
employment relationship between the collaborating physician

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and the advanced practice registered nurse.
2

The collaborative relationship under an agreement shall
3
not be construed to require the personal presence of a
4
collaborating physician at the place where services are
5
rendered. Methods of communication shall be available for
6
consultation with the collaborating physician in person or by
7
telecommunications or electronic communications as set forth
8
in the written agreement.
9

(b-5) Absent an employment relationship, a written
10
collaborative agreement may not (1) restrict the categories of
11
patients of an advanced practice registered nurse within the
12
scope of the advanced practice registered nurses training and
13
experience, (2) limit third party payors or government health
14
programs, such as the medical assistance program or Medicare
15
with which the advanced practice registered nurse contracts,
16
or (3) limit the geographic area or practice location of the
17
advanced practice registered nurse in this State.
18

(c) In the case of anesthesia services provided by a
19
certified registered nurse anesthetist,
a certified registered
20
nurse anesthetist shall seek consultation regarding
21
development of an anesthesia plan and treatment of patients as
22
is appropriate to the certified registered nurse anesthetist's
23
level of expertise and scope of practice and as is warranted by
24
the needs of the patient

an anesthesiologist, a physician, a
25
dentist, or a podiatric physician must participate through
26
discussion of and agreement with the anesthesia plan and

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1
remain physically present and available on the premises during
2
the delivery of anesthesia services for diagnosis,
3
consultation, and treatment of emergency medical conditions
.
4

(c-5) A certified registered nurse anesthetist, who
5
provides anesthesia
and related
services outside of a hospital
6
or ambulatory surgical treatment center shall enter into a
7
written collaborative agreement with an anesthesiologist or
8
the physician licensed to practice medicine in all its
9
branches or the podiatric physician performing the procedure.
10
The collaborative agreement may, but is not required to,
11
include the following terms: (i) that the certified registered
12
nurse anesthetist providing anesthesia services and the
13
anesthesiologist, physician, or podiatric physician
14
participate through discussion of and reach agreement on the
15
anesthesia plan or (ii) that anesthesia services shall only be
16
delivered when the anesthesiologist, physician, or podiatric
17
physician is present and available on the premises for
18
diagnosis, consultation, and treatment of emergency medical
19
conditions.
Outside of a hospital or ambulatory surgical
20
treatment center, the certified registered nurse anesthetist
21
may provide only those services that the collaborating
22
podiatric physician is authorized to provide pursuant to the
23
Podiatric Medical Practice Act of 1987 and rules adopted
24
thereunder. A certified registered nurse anesthetist may
25
select, order, and administer medication, including controlled
26
substances, and apply appropriate medical devices for delivery

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1
of anesthesia
and related
services
under the anesthesia plan
2
agreed with by the anesthesiologist or the operating physician
3
or operating podiatric physician
.
4

(c-10) A certified registered nurse anesthetist who
5
provides anesthesia services in a dental office shall enter
6
into a written collaborative agreement with an
7
anesthesiologist or the physician licensed to practice
8
medicine in all its branches or the operating dentist
9
performing the procedure. The agreement shall describe the
10
working relationship of the certified registered nurse
11
anesthetist and dentist and shall authorize the categories of
12
care, treatment, or procedures to be performed by the
13
certified registered nurse anesthetist.
The collaborative
14
agreement may, but is not required to, include the following
15
terms: (i) that the certified registered nurse anesthetist
16
providing anesthesia services and the anesthesiologist,
17
physician, or podiatric physician participate through
18
discussion of and reach agreement on the anesthesia plan or
19
(ii) that anesthesia services shall only be delivered when the
20
anesthesiologist, physician, or podiatric physician is present
21
and available on the premises for diagnosis, consultation, and
22
treatment of emergency medical conditions.
In a collaborating
23
dentist's office, the certified registered nurse anesthetist
24
may only provide those services that the operating dentist
25
with the appropriate permit is authorized to provide pursuant
26
to the Illinois Dental Practice Act and rules adopted

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thereunder. For anesthesia services,
a certified registered
2
nurse anesthetist shall seek consultation regarding
3
development of an anesthesia plan and treatment of patients as
4
is appropriate to the certified registered nurse anesthetist's
5
level of expertise and scope of practice and as is warranted by
6
the needs of the patient

an anesthesiologist, physician, or
7
operating dentist shall participate through discussion of and
8
agreement with the anesthesia plan and shall remain physically
9
present and be available on the premises during the delivery
10
of anesthesia services for diagnosis, consultation, and
11
treatment of emergency medical conditions
. A certified
12
registered nurse anesthetist may select, order, and administer
13
medication, including controlled substances, and apply
14
appropriate medical devices for delivery of anesthesia
and
15
related
services
under the anesthesia plan agreed with by the
16
operating dentist
.
17

(c-15) An advanced practice registered nurse who had a
18
written collaborative agreement with a podiatric physician
19
immediately before the effective date of Public Act 100-513
20
may continue in that collaborative relationship or enter into
21
a new written collaborative relationship with a podiatric
22
physician under the requirements of this Section and Section
23
65-40, as those Sections existed immediately before the
24
amendment of those Sections by Public Act 100-513 with regard
25
to a written collaborative agreement between an advanced
26
practice registered nurse and a podiatric physician.

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(d) A copy of the signed, written collaborative agreement
2
must be available to the Department upon request from both the
3
advanced practice registered nurse and the collaborating
4
physician, dentist, or podiatric physician.
5

(e) Nothing in this Act shall be construed to limit the
6
delegation of tasks or duties by a physician to a licensed
7
practical nurse, a registered professional nurse, or other
8
persons in accordance with Section 54.2 of the Medical
9
Practice Act of 1987. Nothing in this Act shall be construed to
10
limit the method of delegation that may be authorized by any
11
means, including, but not limited to, oral, written,
12
electronic, standing orders, protocols, guidelines, or verbal
13
orders.
14

(e-5) Nothing in this Act shall be construed to authorize
15
an advanced practice registered nurse to provide health care
16
services required by law or rule to be performed by a
17
physician. The scope of practice of an advanced practice
18
registered nurse does not include operative surgery. Nothing
19
in this Section shall be construed to preclude an advanced
20
practice registered nurse from assisting in surgery.
21

(f) An advanced practice registered nurse shall inform
22
each collaborating physician, dentist, or podiatric physician
23
of all collaborative agreements he or she has signed and
24
provide a copy of these to any collaborating physician,
25
dentist, or podiatric physician upon request.
26

(g) (Blank).

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1
(Source: P.A. 100-513, eff. 1-1-18; 100-577, eff. 1-26-18;
2
100-1096, eff. 8-26-18; 101-13, eff. 6-12-19.)

3

(225 ILCS 65/65-45)

(was 225 ILCS 65/15-25)
4

(Section scheduled to be repealed on January 1, 2028)
5

Sec. 65-45.
Advanced practice registered nursing in
6
hospitals, hospital affiliates, or ambulatory surgical
7
treatment centers.
8

(a) An advanced practice registered nurse may provide
9
services in a hospital or a hospital affiliate as those terms
10
are defined in the Hospital Licensing Act or the University of
11
Illinois Hospital Act or a licensed ambulatory surgical
12
treatment center without a written collaborative agreement
13
pursuant to Section 65-35 of this Act. An advanced practice
14
registered nurse must possess clinical privileges recommended
15
by the hospital medical staff and granted by the hospital or
16
the consulting medical staff committee and ambulatory surgical
17
treatment center in order to provide services. The medical
18
staff or consulting medical staff committee shall periodically
19
review the services of all advanced practice registered nurses
20
granted clinical privileges, including any care provided in a
21
hospital affiliate. Authority may also be granted when
22
recommended by the hospital medical staff and granted by the
23
hospital or recommended by the consulting medical staff
24
committee and ambulatory surgical treatment center to
25
individual advanced practice registered nurses to select,

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order, and administer medications, including controlled
2
substances, to provide delineated care. In a hospital,
3
hospital affiliate, or ambulatory surgical treatment center,
4
the attending physician shall determine an advanced practice
5
registered nurse's role in providing care for his or her
6
patients, except as otherwise provided in the medical staff
7
bylaws or consulting committee policies.
8

(a-2) An advanced practice registered nurse privileged to
9
order medications, including controlled substances, may
10
complete discharge prescriptions provided the prescription is
11
in the name of the advanced practice registered nurse and the
12
attending or discharging physician.
13

(a-3) Advanced practice registered nurses practicing in a
14
hospital or an ambulatory surgical treatment center are not
15
required to obtain a mid-level controlled substance license to
16
order controlled substances under Section 303.05 of the
17
Illinois Controlled Substances Act.
18

(a-4) An advanced practice registered nurse meeting the
19
requirements of Section 65-43
or 65-70
may be privileged to
20
complete discharge orders and prescriptions under the advanced
21
practice registered nurse's name.
22

(a-5) For anesthesia services provided by a certified
23
registered nurse anesthetist,
certified registered nurse
24
anesthetist shall seek consultation regarding development of
25
an anesthesia plan and treatment of patients as is appropriate
26
to the certified registered nurse anesthetist's level of

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1
expertise and scope of practice and as is warranted by the
2
needs of the patient

an anesthesiologist, physician, dentist,
3
or podiatric physician shall participate through discussion of
4
and agreement with the anesthesia plan and shall remain
5
physically present and be available on the premises during the
6
delivery of anesthesia services for diagnosis, consultation,
7
and treatment of emergency medical conditions, unless hospital
8
policy adopted pursuant to clause (B) of subdivision (3) of
9
Section 10.7 of the Hospital Licensing Act or ambulatory
10
surgical treatment center policy adopted pursuant to clause
11
(B) of subdivision (3) of Section 6.5 of the Ambulatory
12
Surgical Treatment Center Act provides otherwise
. A certified
13
registered nurse anesthetist may select, order, and administer
14
medication for anesthesia
and related
services
under the
15
anesthesia plan agreed to by the anesthesiologist or the
16
physician,
in accordance with hospital
alternative
policy or
17
the medical staff consulting committee policies of a licensed
18
ambulatory surgical treatment center.
19

(b) An advanced practice registered nurse who provides
20
services in a hospital shall do so in accordance with Section
21
10.7 of the Hospital Licensing Act and, in an ambulatory
22
surgical treatment center, in accordance with Section 6.5 of
23
the Ambulatory Surgical Treatment Center Act. Nothing in this
24
Act shall be construed to require an advanced practice
25
registered nurse to have a collaborative agreement to practice
26
in a hospital, hospital affiliate, or ambulatory surgical

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1
treatment center.
2

(c) Advanced practice registered nurses certified as nurse
3
practitioners, nurse midwives, or clinical nurse specialists
4
practicing in a hospital affiliate may be, but are not
5
required to be, privileged to prescribe Schedule II through V
6
controlled substances when such authority is recommended by
7
the appropriate physician committee of the hospital affiliate
8
and granted by the hospital affiliate. This authority may, but
9
is not required to, include prescription of, selection of,
10
orders for, administration of, storage of, acceptance of
11
samples of, and dispensing over-the-counter medications,
12
legend drugs, medical gases, and controlled substances
13
categorized as Schedule II through V controlled substances, as
14
defined in Article II of the Illinois Controlled Substances
15
Act, and other preparations, including, but not limited to,
16
botanical and herbal remedies.
17

To prescribe controlled substances under this subsection
18
(c), an advanced practice registered nurse certified as a
19
nurse practitioner, nurse midwife, or clinical nurse
20
specialist must obtain a controlled substance license.
21
Medication orders shall be reviewed periodically by the
22
appropriate hospital affiliate physicians committee or its
23
physician designee.
24

The hospital affiliate shall file with the Department
25
notice of a grant of prescriptive authority consistent with
26
this subsection (c) and termination of such a grant of

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1
authority, in accordance with rules of the Department. Upon
2
receipt of this notice of grant of authority to prescribe any
3
Schedule II through V controlled substances, the licensed
4
advanced practice registered nurse certified as a nurse
5
practitioner, nurse midwife, or clinical nurse specialist may
6
register for a mid-level practitioner controlled substance
7
license under Section 303.05 of the Illinois Controlled
8
Substances Act.
9

In addition, a hospital affiliate may, but is not required
10
to, privilege an advanced practice registered nurse certified
11
as a nurse practitioner, nurse midwife, or clinical nurse
12
specialist to prescribe any Schedule II controlled substances,
13
if all of the following conditions apply:
14

(1) specific Schedule II controlled substances by oral
15

dosage or topical or transdermal application may be
16

designated, provided that the designated Schedule II
17

controlled substances are routinely prescribed by advanced
18

practice registered nurses in their area of certification;
19

the privileging documents must identify the specific
20

Schedule II controlled substances by either brand name or
21

generic name; privileges to prescribe or dispense Schedule
22

II controlled substances to be delivered by injection or
23

other route of administration may not be granted;
24

(2) any privileges must be controlled substances
25

limited to the practice of the advanced practice
26

registered nurse;

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1

(3) any prescription must be limited to no more than a
2

30-day supply;
3

(4) the advanced practice registered nurse must
4

discuss the condition of any patients for whom a
5

controlled substance is prescribed monthly with the
6

appropriate physician committee of the hospital affiliate
7

or its physician designee; and
8

(5) the advanced practice registered nurse must meet
9

the education requirements of Section 303.05 of the
10

Illinois Controlled Substances Act.
11

(d) An advanced practice registered nurse meeting the
12
requirements of Section 65-43 may be privileged to prescribe
13
controlled substances categorized as Schedule II through V in
14
accordance with Section 65-43.
15
(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18
.)

16

(225 ILCS 65/65-70 new)
17

Sec. 65-70.
Conditions under
which a written collaborative
18
agreement not required.

19

(a) An Illinois-licensed advanced practice registered
20
nurse certified as a certified registered nurse anesthetist
21
shall be deemed by law to possess the ability to practice
22
without a written collaborative agreement as set forth in this
23
Act.
24

(b) An advanced practice registered nurse certified as a
25
certified registered nurse anesthetist who (i) has attained

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1
national certification and completed a professional practice
2
doctorate or (ii) files with the Department a notarized
3
attestation of completion of at least 250 hours of continuing
4
education or training and at least 4,000 hours of clinical
5
experience after first attaining national certification, shall
6
not require a written collaborative agreement. Documentation
7
of successful completion shall be provided to the Department
8
upon request. Continuing education or training hours required
9
by this subsection shall be in the certified registered nurse
10
anesthetist's area of certification as set forth by Department
11
rule.
12

The clinical experience must be in the certified
13
registered nurse anesthetist's area of certification. The
14
clinical experience shall be in collaboration with a physician
15
or physicians or a certified registered nurse anesthetist with
16
full practice authority. Completion of the clinical experience
17
must be attested to by the collaborating physician or
18
physicians or employer, collaborating certified registered
19
nurse anesthetist and the certified registered nurse
20
anesthetist. If the collaborating physician or physicians
21
collaborating certified nurse anesthetist, or employer is
22
unable to attest to the completion of the clinical experience,
23
the Department may accept other evidence of clinical
24
experience as established by rule.
25

(c) The scope of practice of a certified registered nurse
26
anesthetist with full practice authority includes:

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1

(1) all matters included in subsection (c) of Section
2

65-30 of this Act;
3

(2) practicing without a written collaborative
4

agreement in all practice settings consistent with
5

national certification;
6

(3) authority to prescribe both legend drugs and
7

Schedule II through V controlled substances; this
8

authority includes prescription of, selection of, orders
9

for, administration of, storage of, acceptance of samples
10

of, and dispensing over the counter medications, legend
11

drugs, and controlled substances categorized as any
12

Schedule II through V controlled substances, as defined in
13

Article II of the Illinois Controlled Substances Act, and
14

other preparations, including, but not limited to,
15

botanical and herbal remedies;
16

(4) prescribing benzodiazepines or Schedule II
17

narcotic drugs, such as opioids; and
18

(5) authority to obtain an Illinois controlled
19

substance license and a federal Drug Enforcement
20

Administration number.

21

(d) The Department may adopt rules necessary to administer
22
this Section, including, but not limited to, requiring the
23
completion of forms and the payment of fees.
24

(e) Nothing in this Act shall be construed to authorize a
25
certified registered nurse anesthetist with full practice
26
authority to provide health care services required by law or

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1
rule to be performed by a physician.

2

Section 25.
The Illinois Dental Practice Act is amended by
3
changing Section 8.1 as follows:

4

(225 ILCS 25/8.1)

(from Ch. 111, par. 2308.1)
5

(Section scheduled to be repealed on January 1, 2026)
6

Sec. 8.1.
Permit for the administration of anesthesia and
7
sedation.

8

(a) No licensed dentist shall administer general
9
anesthesia, deep sedation, or moderate sedation without first
10
applying for and obtaining a permit for such purpose from the
11
Department. The Department shall issue such permit only after
12
ascertaining that the applicant possesses the minimum
13
qualifications necessary to protect public safety. A person
14
with a dental degree who administers anesthesia, deep
15
sedation, or moderate sedation in an approved hospital
16
training program under the supervision of either a licensed
17
dentist holding such permit or a physician licensed to
18
practice medicine in all its branches shall not be required to
19
obtain such permit.
20

(b) The minimum requirements for a permit to administer
21
moderate sedation issued after the effective date of this
22
amendatory Act of the 103rd General Assembly shall include the
23
completion of a minimum of 75 hours of didactic and supervised
24
clinical study in either:

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(1) an American Dental Association Commission on
2

Dental Accreditation accredited dental specialty program,
3

general practice residency, or advanced education in
4

general dentistry residency that includes training and
5

documentation in moderate sedation techniques appropriate
6

for each specialty or an American Dental Association
7

Commission on Dental Accreditation accredited dental
8

anesthesiology residency program and proof of completion
9

of 20 individually managed patients utilizing appropriate
10

routes of administration, in which the applicant is the
11

sole provider, which can include, but are not limited to,
12

intravenous, oral, intranasal, or intramuscular or
13

combinations thereof; or
14

(2) a structured course of study provided by an
15

approved continuing education provider that includes
16

training and documentation in moderate sedation, physical
17

evaluation, venipuncture, advanced airway management,
18

technical administration, recognition and management of
19

complications and emergencies and monitoring with
20

additional supervised experience and documentation
21

demonstrating competence in providing moderate sedation
22

utilizing enteral and parenteral routes of administration
23

of medications to competency to 20 individual patient
24

experiences on a 1 to 1 ratio with an instructor, in which
25

the applicant is the sole provider of sedation over a
26

continuous time frame as set by the Department and as

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1

provided in the American Dental Association's Guidelines
2

for Teaching Pain Control and Sedation to Dentists and
3

Dental Students.
4

(b-5) The minimum requirements for a permit to administer
5
deep sedation and general anesthesia issued after the
6
effective date of this amendatory Act of the 103rd General
7
Assembly shall include:
8

(1) the completion of a minimum of 2 years of advanced
9

training in anesthesiology beyond the pre-doctoral level
10

in a training program approved by the American Dental
11

Association's Council on Dental Education and Licensure,
12

as outlined in Guidelines for Teaching Pain Control and
13

Sedation to Dentists and Dental Students, as published by
14

the American Dental Association's Council on Dental
15

Education and Licensure;
16

(2) a specialty license in oral and maxillofacial
17

surgery;
18

(3) completion of an accredited oral or maxillofacial
19

surgery residency program; or
20

(4) the completion of an American Dental Association
21

Commission on Dental Accreditation accredited dental
22

anesthesiology residency program.
23

(b-10) The Department may establish, by rule, additional
24
training programs and training requirements consistent with
25
this Section to ensure patient safety in dental offices
26
administering anesthesia, which shall include, but not be

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1
limited to the following:
2

(1) (blank);
3

(2) establish the standards for properly equipped
4

dental facilities (other than licensed hospitals and
5

ambulatory surgical treatment centers) in which general
6

anesthesia, deep sedation, or moderate sedation is
7

administered, as necessary to protect public safety;
8

(3) establish minimum requirements for all persons who
9

assist the dentist in the administration of general
10

anesthesia, deep sedation, or moderate sedation, including
11

minimum training requirements for each member of the
12

dental team, monitoring requirements, recordkeeping
13

requirements, and emergency procedures;
14

(4) ensure that the dentist has completed and
15

maintains current certification in advanced cardiac life
16

support or pediatric advanced life support and all persons
17

assisting the dentist or monitoring the administration of
18

general anesthesia, deep sedation, or moderate sedation
19

maintain current certification in Basic Life Support
20

(BLS); and
21

(5) establish continuing education requirements in
22

sedation techniques and airway management for dentists who
23

possess a permit under this Section.
24

The Department shall adopt rules that ensure that a
25
continuing education course designed to meet the permit
26
requirements for moderate sedation training is reviewed and

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1
certified by the Department if the course is not accredited by
2
the American Dental Association Commission on Dental
3
Accreditation.
4

When establishing requirements under this Section, the
5
Department shall consider the current American Dental
6
Association guidelines on sedation and general anesthesia, the
7
current "Guidelines for Monitoring and Management of Pediatric
8
Patients During and After Sedation for Diagnostic and
9
Therapeutic Procedures" established by the American Academy of
10
Pediatrics and the American Academy of Pediatric Dentistry,
11
and the current parameters of care and Office Anesthesia
12
Evaluation (OAE) Manual established by the American
13
Association of Oral and Maxillofacial Surgeons.
14

(c) A licensed dentist must hold an appropriate permit
15
issued under this Section in order to perform dentistry while
16
a nurse anesthetist administers moderate sedation, and a valid
17
written collaborative agreement must exist between the dentist
18
and the nurse anesthetist, in accordance with the Nurse
19
Practice Act
, unless the nurse anesthetist has full practice
20
authority under the requirements of Section 65-70
.
21

A licensed dentist must hold an appropriate permit issued
22
under this Section in order to perform dentistry while a nurse
23
anesthetist administers deep sedation or general anesthesia,
24
and a valid written collaborative agreement must exist between
25
the dentist and the nurse anesthetist, in accordance with the
26
Nurse Practice Act
, unless the nurse anesthetist has full

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1
practice authority under the requirements of Section 65-70
.
2

For the purposes of this subsection (c), "nurse
3
anesthetist" means a licensed certified registered nurse
4
anesthetist who holds a license as an advanced practice
5
registered nurse.
6
(Source: P.A. 103-628, eff. 7-1-24.)

7

Section 30.
The Podiatric Medical Practice Act of 1987 is
8
amended by changing Section 20.5 as follows:

9

(225 ILCS 100/20.5)
10

(Section scheduled to be repealed on January 1, 2028)
11

Sec. 20.5.
Delegation of authority to advanced practice
12
registered nurses.

13

(a) A podiatric physician in active clinical practice may
14
collaborate with an advanced practice registered nurse in
15
accordance with the requirements of the Nurse Practice Act.
16
Collaboration shall be for the purpose of providing podiatric
17
care and no employment relationship shall be required. A
18
written collaborative agreement shall conform to the
19
requirements of Section 65-35 of the Nurse Practice Act. A
20
written collaborative agreement and podiatric physician
21
collaboration and consultation shall be adequate with respect
22
to advanced practice registered nurses if all of the following
23
apply:
24

(1) With respect to the provision of anesthesia

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1

services by a certified registered nurse anesthetist, the
2

collaborating podiatric physician must have training and
3

experience in the delivery of anesthesia consistent with
4

Department rules
unless the certified registered nurse
5

anesthetist has full practice authority under the
6

requirements of Section 65-70
.
7

(2) Methods of communication are available with the
8

collaborating podiatric physician in person or through
9

telecommunications or electronic communications for
10

consultation, collaboration, and referral as needed to
11

address patient care needs.
12

(3) With respect to the provision of anesthesia
13

services by a certified registered nurse anesthetist,
14

certified registered nurse anesthetist shall seek
15

consultation regarding development of an anesthesia plan
16

and treatment of patients as is appropriate to the
17

certified registered nurse anesthetist's level of
18

expertise and scope of practice and as is warranted by the
19

needs of the patient

an anesthesiologist, physician, or
20

podiatric physician shall participate through discussion
21

of and agreement with the anesthesia plan and shall remain
22

physically present and be available on the premises during
23

the delivery of anesthesia services for diagnosis,
24

consultation, and treatment of emergency medical
25

conditions. The anesthesiologist or operating podiatric
26

physician must agree with the anesthesia plan prior to the

SB0239
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1

delivery of services
.
2

(b) The collaborating podiatric physician shall have
3
access to the records of all patients attended to by an
4
advanced practice registered nurse.
5

(c) Nothing in this Section shall be construed to limit
6
the delegation of tasks or duties by a podiatric physician to a
7
licensed practical nurse, a registered professional nurse, or
8
other appropriately trained persons.
9

(d) A podiatric physician shall not be liable for the acts
10
or omissions of an advanced practice registered nurse solely
11
on the basis of having signed guidelines or a collaborative
12
agreement, an order, a standing order, a standing delegation
13
order, or other order or guideline authorizing an advanced
14
practice registered nurse to perform acts, unless the
15
podiatric physician has reason to believe the advanced
16
practice registered nurse lacked the competency to perform the
17
act or acts or commits willful or wanton misconduct.
18

(e) A podiatric physician, may, but is not required to
19
delegate prescriptive authority to an advanced practice
20
registered nurse as part of a written collaborative agreement
21
and the delegation of prescriptive authority shall conform to
22
the requirements of Section 65-40 of the Nurse Practice Act.
23
(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18
.)

24

Section 99.
Effective date.
This Act takes effect upon
25
becoming law.

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1

INDEX

2

Statutes amended in order of appearance

3

210 ILCS 5/6.5
4

210 ILCS 85/10.7
5

225 ILCS 60/54.5
6

225 ILCS 65/65-35
was 225 ILCS 65/15-15
7

225 ILCS 65/65-45
was 225 ILCS 65/15-25
8

225 ILCS 65/65-70 new
9

225 ILCS 25/8.1
from Ch. 111, par. 2308.1
10

225 ILCS 100/20.5

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