Physician assistants and Advanced practice registered Nurses Regulatory Differences Susan y swart Ed.D, rn, cae Executive director Ana-Illinois Illinois society for advanced practice nursing

Contents Overview Illinois Regulation Licensure Requirements Education Certification Written Agreements Prescriptive Authority Hospitals, Hospital Affiliates & ASTCs Scope of Practice Differences & Similarities

ILLINOIS REGULATION ADVANCE PRACTICE REGISTERED NURSES PHYSICIAN ASSISTANTS 225 ILCS 65/ Nurse Practice Act Article 65 – Advanced Practice Registered Nurses TITLE 68: Professions & Occupations CHAPTER VII: IDFPR SUBCHAPTER b: Professions & Occupations PART 1300: Nurse Practice Act SUBPART A: GENERAL PROVISIONS Section 1300.10 Definitions SUBPART D: ADVANCED PRACTICE REGISTERED NURSE Section 1300.430 Prescriptive Authority Section 1300.440 APRN Scope of Practice 225 ILCS 95/ Physician Assistant Practice Act of 1987 TITLE 68: Professions & Occupations CHAPTER VII: IDFPR SUBCHAPTER b: Professions & Occupations PART 1350: Physician Assistant Practice Act of 1987 SUBPART A: GENERAL PROVISIONS Section 1300.10 Definitions SUBPART D: ADVANCED PRACTICE NURSE Section 1300.400 - Section 1300.480 Consider talking about: Grandfather exception

Other Illinois Regulation 225 ILCS 60 - Medical Practice Act TITLE 68: Professions and Occupations CHAPTER VII: Department of Financial & Professional Regulation SUBCHAPTER v: Professions and Occupations PART 1285: Medical Practice Act of 1987 720 ILCS 570 - Illinois Controlled Substance Act TITLE 77: Public Health CHAPTER XV: Department of Financial & Professional Regulation PART 3100: Illinois Controlled Substance Act 210 ILCS 85 - Illinois Hospital Licensing Act TITLE 77: Public Health CHAPTER I: DPH SUBCHAPTER b: Hospitals & Ambulatory Care Facilities PART 250: Hospital Licensing Requirements Other Illinois Regulation

Other Illinois Regulation 110 ILCS 330 – University of Illinois Hospital Licensing Act TITLE 77: Public Health CHAPTER I: Department of Public Health SUBCHAPTER b: Hospitals & Ambulatory Care Facilities PART 250: Hospital Licensing Requirements 210 ILCS 5 – Ambulatory Surgical Treatment Center Act TITLE 77: Public Health CHAPTER I: Department of Public Health SUBCHAPTER b: Hospitals & Ambulatory Care Facilities PART 205: Ambulatory Surgical Treatment Center Licensing Requirements Other Illinois Regulation

Licensure requirements ADVANCED PRACTICE REGISTERED NURSES PHYSICIAN ASSISTANTS RN license Graduate degree or post-master’s certificate CRNA – prior 1999, certified – current and continuous National certification Renewal every 2 years (May of even years) 80 hrs of CE – includes 20 pharm with 10 opioid/substance abuse Proof of National Certification Exception - Licensed since 2001 – not eligible for national certification Pass the National Certification exam National Commission on the Certification of Physician Assistants Renewal every 2 years (March of even years) 50 hrs of CE Maintenance of certification not required for renewal of license

LICENSURE REQUIREMENTS – FULL PRACTICE AUTHORITY Applies to Cnm, cnp, cns MAY WORK WITHOUT A WRITTEN COLLABORATIVE AGREEMENT Notarized attestation document filed with IDFPR 4000 hrs of practice with a Written Collaborative Agreement in area of certification Only with a physician 250 hrs of CE or training in area of certification after first attaining national certification License number will begin with 210 Controlled substance License number will begin with 310

EDUCATION ADVANCED PRACTICE REGISTERED NURSES PHYSICIAN ASSISTANTS Graduate Degree appropriate for national certification in a clinical APRN specialty Graduate Degree or post-master’s certification from a graduate level program in a clinical APRN specialty Exception for CRNA completing a program prior to 1999 Based on the accredited program

CERTIFICATION ADVANCED PRACTICE REGISTERED NURSES PHYSICIAN ASSISTANTS Graduate of an accredited program in the clinical specialty Recertification Every 4 -5 years Continuing Education (# of hours varies by specialty) 75 – 100 hrs Or reexamination 100 hrs of CME every two years 50 Category I 50 Category II or combination of both Pass recertification exam every 10 years (2014)

Written agreements* (NOT REQUIRED IN HOSPITALS, HOSPITAL AFFILIATES, or AMBULATORY SURGICAL TREATMENT FACILITIES) APRN WRITTEN COLLABORATIVE AGREEMENT (WCA) PA WRITTEN COLLABORATIVE AGREEMENT (WCA) *notice of WCA filed with IDFPR *change for podiatry – no new WCA Describe the relationship between the APRN & collaborating physician (CP) – employment relationship not required Categories of care, treatments or procedures Personal presence of CP not required exception for CRNA Consultation includes in person, telecommunications or electronic Cannot restrict the categories of patients, limit third party payors, government plans or geographic area or practice location CRNA – joint anesthesia plan, physical presence of collaborator 90 day waiver Notify all CP of other WCAs Services the collaborating physician (CP) is authorized to and generally provides Must specify which procedures require the presence of the CP Physical presence of CP not required Joint formulation/approval of orders or guidelines Periodic review of orders & services provided Consultation at least once a month Copy of WCA available upon request Notify all CP of other WCAs Ratio – 1 Physician to 5 FTE PAs

Prescriptive Authority ADVANCED PRACTICE REGISTERED NURSES PHYSICIAN ASSISTANTS Delegation of prescriptive authority - filed by CP – initiation and termination File will Prescription Monitoring Program (PMP) & IDFPR Prescribe, select, order, administer, store, accept samples, dispense OTC, legend drugs, medical gases, controlled substances, botanical and herbal remedies Mid-level provider controlled substance license & DEA # Name of CP on all prescriptions Prescriptions reviewed periodically by CP Schedule II – Oral, topical, transdermal Routinely prescribed by the CP Specific drugs identified 30 day supply, continuation after prior approval of CP Discuss condition of patients who receive monthly prescriptions Meet the educational requirements of Section 303.05 of the IL Controlled Substance Act Delegation of prescriptive authority - filed by CP – initiation and termination Prescribe, select, order, administer, store, accept samples, dispense medical devices and OTC drugs, legend drugs, medical gases, controlled substances, botanical and herbal remedies Mid-level provider controlled substance license & DEA # Name of CP on all prescriptions Prescriptions reviewed periodically by CP Schedule II – Oral, topical, transdermal Routinely prescribed by the CP Specific drugs identified 30 day supply, continuation after prior approval of CP Discuss condition of patients who receive monthly prescriptions Meet the educational requirements of Section 303.05 of the IL Controlled Substance Act

Hospitals, Hospital Affiliates, or ambulatory surgical treatment centers ADVANCED PRACTICE REGISTERED NURSES PHYSICIAN ASSISTANTS Clinical Privileges Medical staff or consulting medical staff committee – periodically review the services select, order, and administer medications, including controlled substances, to provide delineated care Discharge medication in name of APRN and attending/discharging physician Mid-level provider controlled substance license not needed in hospital or ASTC Hospital Affiliates - NP, CNS, CNMs only May prescribe with mid-level controlled substance license & DEA # Same restrictions as with prescribing authority in other settings Hospital files delegated prescriptive authority form with IDFPR Clinical Privileges Medical staff or consulting medical staff committee – periodically review the services select, order, and administer medications, including controlled substances, to provide delineated care Discharge medication in name of PA and attending/discharging physician Mid-level provider controlled substance license not needed No ratios

Hospitals, Hospital Affiliates, or ambulatory surgical treatment centers CNM, CNP, CNS – FULL PRACTICE AUTHORITY Clinical Privileges Medical staff or consulting medical staff committee – periodically review the services select, order, and administer medications, including controlled substances, to provide delineated care Discharge orders and medication in name of APRN Mid-level provider controlled substance license not needed in hospital or ASTC Hospital Affiliates - NP, CNS, CNMs only May be privileged to prescribe according to section 65-43

SCOPE ADVANCED PRACTICE REGISTERED NURSES PHYSICIAN ASSISTANTS Advanced assessment & diagnosis Ordering diagnostic and therapeutic tests and procedures Ordering treatments and medical devices Providing palliative and end-of-life care Counseling, education and advocacy Delegated prescriptive authority Delegation to other health care personnel Medical/surgical services delegated by CP Within the PA’s skills Within current scope of practice of CP Must specify which procedures require the presence of the CP Physical presence of CP not required Provided under the supervision & direction of the SP Joint formulation/approval of orders or guidelines Supervision/consultation at least once a month Copy of WCA available upon request Notify all CP of other WCAs

SCOPE Section 65-43 full practice authority Everything previously stated Work without a written collaborative agreement in all practice settings Practice consistent with national certification Prescriptive authority Legend Drugs Schedule II – V Benzodiazepines and Opioids Consulting physician Controlled Substance License Only local anesthetic Does not include operative surgery

Difference & similarities APRNs – can bill in their name PAs- employer must bill for the services provided Must use the PAs NPI number APRNs – collaborating physician until they meet the requirements of section 65-43 Ratio for PAs – Limited to 5 FTE EXEMPT - hospitals, hospital affiliates, ASTCs

Sources of information Illinois Health & Hospital Association www.team-iha.org Illinois Society for Advanced Practice Nursing www.isapn.org Illinois Academy of Physician Assistants www.illinoispa.org Illinois Department of Professional Regulation www.idfpr.com