By Alex R. Thiersch, JD, Founder/Director of the American Med Spa Association (AmSpa)
Nurse practitioners in Illinois medical spas and aesthetic practices may soon have more autonomy in the industry. Every 10 years the Illinois Nurse Practice Act expires, so the state’s General Assembly must draft and pass a new version of the act before that happens. The current version of the act is set to expire on January 1, 2018, and on schedule, the General Assembly recently passed a bill that will (likely) replace it. This revised Nurse Practice Act features a few notable elements that could affect the way the med spa business is conducted in the Land of Lincoln.
Initial reactions when the bill was first passed.
A Bump Up
The most significant change in the new version of the Illinois Nurse Practice Act is that, once it is enacted, advanced practice registered nurses (APRNs) can achieve full practice authority adding Illinois to the list of 23 states plus the District of Columbia that grant this level of independence to these providers. This means that nurse practitioners can essentially operate independently, without direct oversight from a physician, provided they meet certain qualifications. Currently, nurse practitioners in Illinois are governed by collaborative agreements with a physician, and those agreements dictate generally what they can and cannot do. If a nurse practitioner wants to perform Botox injections, for example, or see new patients at a med spa, he or she would have to have that written into the collaborative agreement. In addition, they are required to meet with their supervising physician once a month and they must have protocols developed in accordance with the physician. Essentially, an Illinois nurse practitioner’s scope of practice is restricted by what his or her supervising physician feels comfortable putting into the collaborative agreement.
However, once the new Nurse Practice Act takes effect, APRNs—including nurse practitioners, nurse midwives, and clinical nurse specialists—can apply for and be granted full practice authority provided they meet certain requirements, including training, clinical experience, continuing education, and physician collaboration in certain practice areas. If a nurse practitioner achieves full practice authority, he or she is no longer required to have a written collaborative agreement with a physician. This allows nurse practitioners to be fully accountable to their patients and to have their own practices. They can accept referrals, make referrals, write orders, prescribe medications, and essentially operate as an independent entity without being restricted by a collaborative agreement.
What this means for med spas is that instead of employing both a doctor (medical director) and a nurse practitioner, they can potentially enter into an agreement with a nurse practitioner, and that nurse practitioner could independently operate a medical spa. Potentially, this could be very significant.
However, the changes to the Illinois Nurse Practice Act also include provisions regarding fee-splitting, preventing an APRN from splitting any fees they collect for their services. This means that a medical spa wishing to partner with either an APRN or a physician must do so through a management services agreement and may not pay the APRN or physician a percentage of medical revenue.
The revised Nurse Practice Act was passed by both the Illinois Senate and the Illinois House of Representatives on June 25, and was sent to Governor Bruce Rauner on July 24. As of this writing, Governor Rauner has yet to sign the bill into law, so this post is somewhat speculative in nature. However, it is expected that he eventually will sign the bill—nothing in it is particularly controversial from a political standpoint, and both chambers of the General Assembly passed it without a single “no” vote. Stay tuned to AmericanMedSpa.org—we’ll let you if the governor signs the bill, and if not, what the potential ramifications are.
In the meantime, if you are a nurse practitioner or a med spa owner in Illinois, it is worth familiarizing yourself with the bill in order to learn what the future may hold for this segment of the industry.