1. 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

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

3. 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 Definitions
SUBPART D: ADVANCED PRACTICE REGISTERED NURSE
Section Prescriptive Authority
Section 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 Definitions
SUBPART D: ADVANCED PRACTICE NURSE
Section Section
Consider talking about:
Grandfather exception

4. 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 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

5. 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

6. 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

7. 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

8. 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

9. 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)

10. 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

11. 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 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 of the IL Controlled Substance Act

12. 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

13. 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

14. 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

15. 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

16. 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

17. Sources of information
Illinois Health & Hospital Association
Illinois Society for Advanced Practice Nursing
Illinois Academy of Physician Assistants
Illinois Department of Professional Regulation