99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB0408
 
Introduced , by Rep. Michael J. Zalewski
 
SYNOPSIS AS INTRODUCED:



    
225 ILCS 106/10
225 ILCS 106/15
225 ILCS 106/22 new

 Amends the Respiratory Care Practice Act. Makes changes in the definitions of "basic respiratory care activities", "licensed health care professional", and "respiratory care". Allows individuals without a license to practice respiratory care to perform basic screening spirometry if certified by the National Institute for Occupational Safety and Health, the American Association for Respiratory Care, or other similarly accepted certification programs. Allows respiratory care practitioners licensed in other jurisdictions to provide respiratory care in this State (i) in a declared emergency in this State, (ii) as a member of an organ procurement team, or (iii) as part of a medical transport team that is transporting a patient into or out of this State. Provides that unlicensed and non-credentialed individuals who deliver respiratory care equipment may deliver, set up, calibrate, and demonstrate the mechanical operation of the device to patients, family, and caregivers if the individuals received training and demonstrated competency using the specific devices under the supervision of a respiratory care practitioner licensed by this State or some other licensed practitioner operating within his or her scope of practice. Provides that patients, family, and caregivers must be taught to use the equipment for the intended clinical application by a licensed respiratory care practitioner or other licensed health care professional operating within his or her scope of practice. Provides that instructions to the patient regarding the clinical use of equipment, patient monitoring, patient assessment, or any other procedure used with the intent of evaluating the effectiveness of the treatment must be performed by a respiratory care practitioner licensed by this State or any other licensed practitioner operating within his or her scope of practice. Makes other changes.



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A BILL FOR
 


HB0408LRB099 04331 AMC 24358 b



1 AN ACT concerning regulation.


2 Be it enacted by the People of the State of Illinois,

3represented in the General Assembly:



4 Section 5. The Respiratory Care Practice Act is amended by 
5changing Sections 10 and 15 and by adding Section 22 as 
6follows:




7 (225 ILCS 106/10)


8 (Section scheduled to be repealed on January 1, 2016)

9 Sec. 10. Definitions. In this Act:

10 "Advanced practice nurse" means an advanced practice nurse 
11licensed under the Nurse Practice Act.

12 "Board" means the Respiratory Care Board appointed by the 
13Director.
14 "Basic respiratory care activities" means and includes all 
15of the following activities:
16   (1) Cleaning, disinfecting, and sterilizing equipment 
17 used in the practice of respiratory care as delegated by a 
18 licensed health care professional or other authorized 
19 licensed personnel.
20  (2) Assembling equipment used in the practice of 
21 respiratory care as delegated by a licensed health care 
22 professional or other authorized licensed personnel.
23  (3) Collecting and reviewing patient data through 
 
 
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1 non-invasive means, provided that the collection and 
2 review does not include the individual's interpretation of 
3 the clinical significance of the data. Collecting and 
4 reviewing patient data includes the performance of pulse 
5 oximetry and non-invasive monitoring procedures in order 
6 to obtain vital signs and notification to licensed health 
7 care professionals and other authorized licensed personnel 
8 in a timely manner.
9  (4) Maintaining a nasal cannula or face mask for oxygen 
10 therapy in the proper position on the patient's face.
11  (4.5) The transferring of oxygen devices, including, 
12 but not limited to, nasal cannulas, face masks, or similar 
13 devices, with a liter flow of 6 liters per minute or less, 
14 as specified by a licensed health care professional, from 
15 the wall flowmeter to the oxygen cylinder and back while 
16 under the proximate supervision of a licensed health care 
17 professional or other authorized licensed personnel if an 
18 unlicensed practitioner has received the training required 
19 under subsection (j) of Section 15 of this Act. This item 
20 (4.5) does not include neonatal and pediatric oxygen 
21 transports. 
22  (5) Assembling a nasal cannula or face mask for oxygen 
23 therapy at patient bedside in preparation for use.
24  (6) Maintaining a patient's natural airway by 
25 physically manipulating the jaw and neck, suctioning the 
26 oral cavity, or suctioning the mouth or nose with a bulb 
 
 
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1 syringe.
2  (7) Performing assisted ventilation during emergency 
3 resuscitation using a manual resuscitator.
4  (8) Using a manual resuscitator at the direction of a 
5 licensed health care professional or other authorized 
6 licensed personnel who is present and performing routine 
7 airway suctioning. These activities do not include care of 
8 a patient's artificial airway or the adjustment of 
9 mechanical ventilator settings while a patient is 
10 connected to the ventilator.


11"Basic respiratory care activities" does not mean activities 
12that involve any of the following:

13  (1) Specialized knowledge that results from a course of 
14 education or training in respiratory care.
15  (2) An unreasonable risk of a negative outcome for the 
16 patient.
17  (3) The assessment or making of a decision concerning 
18 patient care.
19  (4) The administration of aerosol medication or 
20 medical gas oxygen.
21  (5) The insertion and maintenance of an artificial 
22 airway.
23  (6) Mechanical ventilatory support.
24  (7) Patient assessment.
25  (8) Patient education.

26 "Department" means the Department of Professional 
 
 
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1Regulation.

2 "Director" means the Director of
Professional Regulation.

3 "Licensed" means that which is required to hold oneself
out 
4as
a respiratory care
practitioner as defined in this Act.

5 "Licensed health care professional" means a physician 
6licensed to practice medicine in all its branches, a certified 
7registered nurse anesthetist, an advanced practice nurse who 
8has a written collaborative agreement with a collaborating 
9physician that authorizes the advanced practice nurse to 
10transmit orders to a respiratory care practitioner, or a 
11physician assistant who has been delegated the authority to 
12transmit orders to a respiratory care practitioner by his or 
13her supervising physician.

14 "Order" means a written, oral, or telecommunicated 
15authorization for respiratory care services for a patient by 
16(i) a licensed health care professional who maintains medical 
17supervision of the patient and makes a diagnosis or verifies 
18that the patient's condition is such that it may be treated by 
19a respiratory care practitioner or (ii) a certified registered 
20nurse anesthetist in a licensed hospital or ambulatory surgical 
21treatment center.

22 "Other authorized licensed personnel" means a licensed 
23respiratory care practitioner, a licensed registered nurse, or 
24a licensed practical nurse whose scope of practice authorizes 
25the professional to supervise an individual who is not 
26licensed, certified, or registered as a health professional.
 
 
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1 "Proximate supervision" means a situation in which an 
2individual is
responsible for directing the actions of another 
3individual in the facility and is physically close enough to be 
4readily available, if needed, by the supervised individual.

5 "Respiratory care" and "cardiorespiratory care"
mean 
6preventative services, evaluation and assessment services, 
7therapeutic services, cardiopulmonary disease management, and 
8rehabilitative services under the order of a licensed health 
9care professional or a certified registered nurse anesthetist 
10in a licensed hospital for an individual with a disorder, 
11disease, or abnormality of the cardiopulmonary system. These 
12terms include, but are not limited to, measuring, observing, 
13assessing, and monitoring signs and symptoms, reactions, 
14general behavior, and general physical response of individuals 
15to respiratory care services, including the determination of 
16whether those signs, symptoms, reactions, behaviors, or 
17general physical responses exhibit abnormal characteristics; 
18the administration of pharmacological and therapeutic agents 
19and procedures related to respiratory care services; the 
20collection of blood specimens and other bodily fluids and 
21tissues for, and the performance of, cardiopulmonary 
22diagnostic testing procedures, including, but not limited to, 
23blood gas analysis; development, implementation, and 
24modification of respiratory care treatment plans based on 
25assessed abnormalities of the cardiopulmonary system, 
26respiratory care guidelines, referrals, and orders of a 
 
 
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1licensed health care professional; application, operation, and 
2management of mechanical ventilatory support and other means of 
3life support, including, but not limited to, hemodynamic 
4cardiovascular support; and the initiation of emergency 
5procedures under the rules promulgated by the Department. A 
6respiratory care practitioner shall refer to a physician 
7licensed to practice medicine in all its branches any patient 
8whose condition, at the time of evaluation or treatment, is 
9determined to be beyond the scope of practice of the 
10respiratory care practitioner.

11 "Respiratory care education program" means a course of 
12academic study leading
to eligibility for registry or 
13certification in respiratory care. The training
is to be 
14approved by an accrediting agency recognized by the Board and 
15shall
include an evaluation of competence through a 
16standardized testing mechanism
that is determined by the Board 
17to be both valid and reliable.

18 "Respiratory care practitioner" means a person who is 
19licensed by the
Department of Professional Regulation and meets 
20all of the following
criteria:


21  (1) The person is engaged in the practice of 
22 cardiorespiratory care and
has the knowledge and skill 
23 necessary to administer respiratory care.


24  (2) The person is capable of serving as a resource to 
25 the
licensed
health care professional in
relation to the 
26 technical aspects of cardiorespiratory care and the safe 
 
 
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1 and
effective methods for administering cardiorespiratory 
2 care modalities.


3  (3) The person is able to function in situations of 
4 unsupervised patient
contact requiring great individual 
5 judgment.

6(Source: P.A. 94-523, eff. 1-1-06; 95-639, eff. 10-5-07.)





7 (225 ILCS 106/15)



8 (Section scheduled to be repealed on January 1, 2016)

9 Sec. 15. Exemptions. 

10 (a) This Act does not prohibit a person legally regulated 
11in this State by
any other Act from engaging in any practice 
12for which he or she is authorized.

13 (b) Nothing in this Act shall prohibit the practice of 
14respiratory care by a
person who is employed by the United 
15States government or any bureau, division,
or agency thereof

16while in the discharge of the employee's official duties.

17 (c) Nothing in this Act shall be construed to limit the 
18activities and
services of a person enrolled in an approved 
19course of study leading to a
degree or certificate of registry 
20or certification eligibility in respiratory
care if these 
21activities and services constitute a part of a supervised 
22course
of study and if the person is designated by a title 
23which clearly indicates his
or her status as a student or 
24trainee. Status as a student or trainee shall
not exceed 3 
25years from the date of enrollment in an approved course.

 
 
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1 (d) Nothing in this Act shall prohibit a person from 
2treating ailments by
spiritual means through prayer alone in 
3accordance with the tenets and
practices of a recognized church 
4or religious denomination.

5 (e) Nothing in this Act shall be construed to prevent a 
6person who is a
registered nurse, an advanced practice nurse, a 
7licensed
practical nurse, a physician assistant, or a physician 
8licensed to practice medicine in all its branches from 
9providing respiratory care.

10 (f) Nothing in this Act shall limit a person who is 
11credentialed by the
National Society for Cardiopulmonary 
12Technology or the National Board for
Respiratory Care from 
13performing pulmonary function tests and
respiratory care 
14procedures related to the pulmonary function test. Individuals 
15who do not possess a license to practice respiratory care or a 
16license in another health care field may perform basic 
17screening spirometry limited to peak flow, forced vital 
18capacity, slow vital capacity, and maximum voluntary 
19ventilation if they possess spirometry certification from the 
20National Institute for Occupational Safety and Health, an 
21Office Spirometry Certificate from the American Association 
22for Respiratory Care, or other similarly accepted 
23certification training. 

24 (g) Nothing in this Act shall prohibit the collection and 
25analysis of blood
by clinical laboratory personnel meeting the 
26personnel standards of the
Illinois Clinical Laboratory Act.

 
 
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1 (h)
Nothing in this Act shall prohibit a polysomnographic 
2technologist, technician, or trainee, as defined in the job 
3descriptions jointly accepted by the American Academy of Sleep 
4Medicine, the Association of Polysomnographic Technologists, 
5the Board of Registered Polysomnographic Technologists, and 
6the American Society of Electroneurodiagnostic Technologists, 
7from performing activities within the scope of practice of 
8polysomnographic technology while under the direction of a 
9physician licensed in this State.

10 (i)
Nothing in this Act shall prohibit a family member from 
11providing respiratory care services to an ill person.

12 (j) Nothing in this Act shall be construed to limit an 
13unlicensed practitioner in a licensed hospital who is working 
14under the proximate supervision of a licensed health care 
15professional or other authorized licensed personnel and 
16providing direct patient care services from performing basic 
17respiratory care activities if the unlicensed practitioner
(i) 
18has been trained to perform the basic respiratory care 
19activities at the facility that employs or contracts with the 
20individual and (ii) at a minimum, has annually received an 
21evaluation of the unlicensed practitioner's performance of 
22basic respiratory care activities documented by the facility.

23 (k) Nothing in this Act shall be construed to prohibit a 
24person enrolled in a respiratory care education program or an 
25approved course of study leading to a degree or certification 
26in a health care-related discipline that provides respiratory 
 
 
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1care activities within his or her scope of practice and 
2employed in a licensed hospital in order to provide direct 
3patient care services under the direction of other authorized 
4licensed personnel from providing respiratory care activities.
5 (l) Nothing in this Act prohibits a person licensed as a 
6respiratory care practitioner in another jurisdiction from 
7providing respiratory care: (i) in a declared emergency in this 
8State; (ii) as a member of an organ procurement team; or (iii) 
9as part of a medical transport team that is transporting a 
10patient into or out of this State.

11(Source: P.A. 96-456, eff. 8-14-09.)


12 (225 ILCS 106/22 new)
13 Sec. 22. Durable medical equipment use and training.
14 (a) Notwithstanding any other provision of this Act, 
15unlicensed or non-credentialed individuals who deliver 
16prescribed respiratory care equipment, including, but not 
17limited to, oxygen, oxygen concentrators, pulmonary hygiene 
18devices, aerosol compressors and generators, suction machines, 
19positive airway pressure devices, and mechanical ventilators, 
20may deliver, set up, calibrate, and demonstrate the mechanical 
21operation of the device to the patient, family, and caregivers. 
22Demonstration of the mechanical operation of the device 
23includes demonstration of the on-off switches, emergency 
24buttons, and alarm silence and reset buttons, as appropriate. 
25In order for unlicensed or non-credentialed personnel to 
 
 
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1deliver, set up, calibrate, and demonstrate the equipment as 
2allowed in this subsection (a), the employer must document that 
3the employee has both received training and demonstrated 
4competency using the specific devices under the supervision of 
5a respiratory care practitioner licensed by this State or some 
6other licensed practitioner operating within his or her scope 
7of practice.
8 Equipment demonstration is not to be interpreted as 
9teaching, administration, or performance of respiratory care. 
10Unlicensed or non-credentialed individuals may not attach the 
11equipment to the patient or instruct the patient, family, or 
12caregiver on the use of the equipment beyond the mechanical 
13functions of the device.
14 (b) Patients, family, and caregivers must be taught to use 
15the equipment for the intended clinical application by a 
16licensed respiratory care practitioner or other licensed 
17health care professional operating within his or her scope of 
18practice. This instruction may occur through follow-up after 
19delivery, with an identical model in the health care facility 
20prior to discharge or with an identical model at the medical 
21supply office. Instructions to the patient regarding the 
22clinical use of equipment, patient monitoring, patient 
23assessment, or any other procedure used with the intent of 
24evaluating the effectiveness of the treatment must be performed 
25by a respiratory care practitioner licensed by this State or 
26any other licensed practitioner operating within his or her 
 
 
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1scope of practice.