SB 3021

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Full Text of SB3021
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	SB3021 - 104th General Assembly
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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
SB3021
Introduced 1/28/2026, by Sen. Adriane Johnson
SYNOPSIS AS INTRODUCED:
210 ILCS 5/6.5
210 ILCS 85/10.7
225 ILCS 60/54.5
225 ILCS 65/65-45	  was 225 ILCS 65/15-25
Amends the Ambulatory Surgical Treatment Center Act and the Hospital Licensing Act. Removes the requirement that an anesthesiologist must remain physically present during the delivery of anesthesia services. Amends the Medical Practice Act of 1987. In provisions concerning delegation of authority, removes the requirement that an anesthesiologist or physician must remain physically present during the delivery of anesthesia services by a certified registered nurse anesthetist. Amends the Nurse Practice Act. Removes the requirement that an anesthesiologist, physician, dentist, or podiatric physician must remain physically present during the delivery of anesthesia services by a certified registered nurse anesthetist.
LRB104 17373 BAB 30798 b
A BILL FOR
		SB3021		LRB104 17373 BAB 30798 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 Ambulatory Surgical Treatment Center Act is
5amended by changing Section 6.5 as follows:
6    (210 ILCS 5/6.5)
7    Sec. 6.5. Clinical privileges; advanced practice
8registered nurses. All ambulatory surgical treatment centers
9(ASTC) licensed under this Act shall comply with the following
10requirements:
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
		SB3021	- 2 -	LRB104 17373 BAB 30798 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
		SB3021	- 3 -	LRB104 17373 BAB 30798 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) 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:
		SB3021	- 4 -	LRB104 17373 BAB 30798 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, an anesthesiologist
12        shall participate through discussion of and agreement
13        with the anesthesia plan and shall [remain physically ]
14        [present and] be available [on the premises] during the
15        delivery of anesthesia services for diagnosis,
16        consultation, and treatment of emergency medical
17        conditions. In the absence of 24-hour availability of
18        anesthesiologists with clinical privileges, an
19        alternate policy (requiring participation[, presence,]
20        and availability of a physician licensed to practice
21        medicine in all its branches) shall be developed by
22        the medical staff consulting committee in consultation
23        with the anesthesia service and included in the
24        medical staff consulting committee policies.
25            (C) A certified registered nurse anesthetist is
26        not required to possess prescriptive authority or a
		SB3021	- 5 -	LRB104 17373 BAB 30798 b
1        written collaborative agreement meeting the
2        requirements of Section 65-35 of the Nurse Practice
3        Act to provide anesthesia services ordered by a
4        licensed physician, dentist, or podiatric physician.
5        Licensed certified registered nurse anesthetists are
6        authorized to select, order, and administer drugs and
7        apply the appropriate medical devices in the provision
8        of anesthesia services under the anesthesia plan
9        agreed with by the anesthesiologist or, in the absence
10        of an available anesthesiologist with clinical
11        privileges, agreed with by the operating physician,
12        operating dentist, or operating podiatric physician in
13        accordance with the medical staff consulting committee
14        policies of a licensed ambulatory surgical treatment
15        center.
16(Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18.)
17    Section 10. The Hospital Licensing Act is amended by
18changing Section 10.7 as follows:
19    (210 ILCS 85/10.7)
20    Sec. 10.7. Clinical privileges; advanced practice
21registered nurses.  All hospitals licensed under this Act
22shall comply with the following requirements:
23        (1) No hospital policy, rule, regulation, or practice
24    shall be inconsistent with the provision of adequate
		SB3021	- 6 -	LRB104 17373 BAB 30798 b
1    collaboration and consultation in accordance with Section
2    54.5 of the Medical Practice Act of 1987.
3        (2) Operative surgical procedures shall be performed
4    only by a physician licensed to practice medicine in all
5    its branches under the Medical Practice Act of 1987, a
6    dentist licensed under the Illinois Dental Practice Act,
7    or a podiatric physician licensed under the Podiatric
8    Medical Practice Act of 1987, with medical staff
9    membership and surgical clinical privileges granted at the
10    hospital. A licensed physician, dentist, or podiatric
11    physician may be assisted by a physician licensed to
12    practice medicine in all its branches, dentist, dental
13    assistant, podiatric physician, licensed advanced practice
14    registered nurse, licensed physician assistant, licensed
15    registered nurse, licensed practical nurse, surgical
16    assistant, surgical technician, or other individuals
17    granted clinical privileges to assist in surgery at the
18    hospital. Payment for services rendered by an assistant in
19    surgery who is not a hospital employee shall be paid at the
20    appropriate non-physician modifier rate if the payor would
21    have made payment had the same services been provided by a
22    physician.
23        (2.5) A registered nurse licensed under the Nurse
24    Practice Act and qualified by training and experience in
25    operating room nursing shall be present in the operating
26    room and function as the circulating nurse during all
		SB3021	- 7 -	LRB104 17373 BAB 30798 b
1    invasive or operative procedures. For purposes of this
2    paragraph (2.5), "circulating nurse" means a registered
3    nurse who is responsible for coordinating all nursing
4    care, patient safety needs, and the needs of the surgical
5    team in the operating room during an invasive or operative
6    procedure.
7        (3) An advanced practice registered nurse is not
8    required to possess prescriptive authority or a written
9    collaborative agreement meeting the requirements of the
10    Nurse Practice Act to provide advanced practice registered
11    nursing services in a hospital. An advanced practice
12    registered nurse must possess clinical privileges
13    recommended by the medical staff and granted by the
14    hospital in order to provide services. Individual advanced
15    practice registered nurses may also be granted clinical
16    privileges to order, select, and administer medications,
17    including controlled substances, to provide delineated
18    care. The attending physician must determine the advanced
19    practice registered nurse's role in providing care for his
20    or her patients, except as otherwise provided in medical
21    staff bylaws. The medical staff shall periodically review
22    the services of advanced practice registered nurses
23    granted privileges. This review shall be conducted in
24    accordance with item (2) of subsection (a) of Section 10.8
25    of this Act for advanced practice registered nurses
26    employed by the hospital.
		SB3021	- 8 -	LRB104 17373 BAB 30798 b
1        (4) The anesthesia service shall be under the
2    direction of a physician licensed to practice medicine in
3    all its branches who has had specialized preparation or
4    experience in the area or who has completed a residency in
5    anesthesiology. An anesthesiologist, Board certified or
6    Board eligible, is recommended. Anesthesia services may
7    only be administered pursuant to the order of a physician
8    licensed to practice medicine in all its branches,
9    licensed dentist, or licensed podiatric physician.
10            (A) The individuals who, with clinical privileges
11        granted at the hospital, may administer anesthesia
12        services are limited to the following:
13                (i) an anesthesiologist; or
14                (ii) a physician licensed to practice medicine
15            in all its branches; or
16                (iii) a dentist with authority to administer
17            anesthesia under Section 8.1 of the Illinois
18            Dental Practice Act; or
19                (iv) a licensed certified registered nurse
20            anesthetist; or
21                (v) a podiatric physician licensed under the
22            Podiatric Medical Practice Act of 1987.
23            (B) For anesthesia services, an anesthesiologist
24        shall participate through discussion of and agreement
25        with the anesthesia plan and shall [remain physically ]
26        [present and] be available [on the premises] during the
		SB3021	- 9 -	LRB104 17373 BAB 30798 b
1        delivery of anesthesia services for diagnosis,
2        consultation, and treatment of emergency medical
3        conditions. In the absence of 24-hour availability of
4        anesthesiologists with medical staff privileges, an
5        alternate policy (requiring participation[, presence,]
6        and availability of a physician licensed to practice
7        medicine in all its branches) shall be developed by
8        the medical staff and licensed hospital in
9        consultation with the anesthesia service.
10            (C) A certified registered nurse anesthetist is
11        not required to possess prescriptive authority or a
12        written collaborative agreement meeting the
13        requirements of Section 65-35 of the Nurse Practice
14        Act to provide anesthesia services ordered by a
15        licensed physician, dentist, or podiatric physician.
16        Licensed certified registered nurse anesthetists are
17        authorized to select, order, and administer drugs and
18        apply the appropriate medical devices in the provision
19        of anesthesia services under the anesthesia plan
20        agreed with by the anesthesiologist or, in the absence
21        of an available anesthesiologist with clinical
22        privileges, agreed with by the operating physician,
23        operating dentist, or operating podiatric physician in
24        accordance with the hospital's alternative policy.
25(Source: P.A. 99-642, eff. 7-28-16; 100-513, eff. 1-1-18.)
		SB3021	- 10 -	LRB104 17373 BAB 30798 b
1    Section 15. The Medical Practice Act of 1987 is amended by
2changing Section 54.5 as follows:
3    (225 ILCS 60/54.5)
4    (Section scheduled to be repealed on January 1, 2027)
5    Sec. 54.5. Physician delegation of authority to physician
6assistants, advanced practice registered nurses without full
7practice authority, and prescribing psychologists.
8    (a) Physicians licensed to practice medicine in all its
9branches may delegate care and treatment responsibilities to a
10physician assistant under guidelines in accordance with the
11requirements of the Physician Assistant Practice Act of 1987.
12A physician licensed to practice medicine in all its branches
13may enter into collaborative agreements with no more than 7
14full-time equivalent physician assistants, except in a
15hospital, hospital affiliate, or ambulatory surgical treatment
16center as set forth by Section 7.7 of the Physician Assistant
17Practice Act of 1987 and as provided in subsection (a-5).
18    (a-5) A physician licensed to practice medicine in all its
19branches may collaborate with more than 7 physician assistants
20when the services are provided in a federal primary care
21health professional shortage area with a Health Professional
22Shortage Area score greater than or equal to 12, as determined
23by the United States Department of Health and Human Services.
24    The collaborating physician must keep appropriate
25documentation of meeting this exemption and make it available
		SB3021	- 11 -	LRB104 17373 BAB 30798 b
1to the Department upon request.
2    (b) A physician licensed to practice medicine in all its
3branches in active clinical practice may collaborate with an
4advanced practice registered nurse in accordance with the
5requirements of the Nurse Practice Act. Collaboration is for
6the purpose of providing medical consultation, and no
7employment relationship is required. A written collaborative
8agreement shall conform to the requirements of Section 65-35
9of the Nurse Practice Act. The written collaborative agreement
10shall be for services for which the collaborating physician
11can provide adequate collaboration. A written collaborative
12agreement shall be adequate with respect to collaboration with
13advanced practice registered nurses if all of the following
14apply:
15        (1) The agreement is written to promote the exercise
16    of professional judgment by the advanced practice
17    registered nurse commensurate with his or her education
18    and experience.
19        (2) The advanced practice registered nurse provides
20    services based upon a written collaborative agreement with
21    the collaborating physician, except as set forth in
22    subsection (b-5) of this Section. With respect to labor
23    and delivery, the collaborating physician must provide
24    delivery services in order to participate with a certified
25    nurse midwife.
26        (3) Methods of communication are available with the
		SB3021	- 12 -	LRB104 17373 BAB 30798 b
1    collaborating physician in person or through
2    telecommunications for consultation, collaboration, and
3    referral as needed to address patient care needs.
4    (b-5) An anesthesiologist or physician licensed to
5practice medicine in all its branches may collaborate with a
6certified registered nurse anesthetist in accordance with
7Section 65-35 of the Nurse Practice Act for the provision of
8anesthesia services. With respect to the provision of
9anesthesia services, the collaborating anesthesiologist or
10physician shall have training and experience in the delivery
11of anesthesia services consistent with Department rules.
12Collaboration shall be adequate if:
13        (1) an anesthesiologist or a physician participates in
14    the joint formulation and joint approval of orders or
15    guidelines and periodically reviews such orders and the
16    services provided patients under such orders; and
17        (2) for anesthesia services, the anesthesiologist or
18    physician participates through discussion of and agreement
19    with the anesthesia plan and is [physically present and]
20    available [on the premises] during the delivery of
21    anesthesia services for diagnosis, consultation, and
22    treatment of emergency medical conditions. Anesthesia
23    services in a hospital shall be conducted in accordance
24    with Section 10.7 of the Hospital Licensing Act and in an
25    ambulatory surgical treatment center in accordance with
26    Section 6.5 of the Ambulatory Surgical Treatment Center
		SB3021	- 13 -	LRB104 17373 BAB 30798 b
1    Act.
2    (b-10) The anesthesiologist or operating physician must
3agree with the anesthesia plan prior to the delivery of
4services.
5    (c) The collaborating physician shall have access to the
6medical records of all patients attended by a physician
7assistant. The collaborating physician shall have access to
8the medical records of all patients attended to by an advanced
9practice registered nurse.
10    (d) (Blank).
11    (e) A physician shall not be liable for the acts or
12omissions of a prescribing psychologist, physician assistant,
13or advanced practice registered nurse solely on the basis of
14having signed a supervision agreement or guidelines or a
15collaborative agreement, an order, a standing medical order, a
16standing delegation order, or other order or guideline
17authorizing a prescribing psychologist, physician assistant,
18or advanced practice registered nurse to perform acts, unless
19the physician has reason to believe the prescribing
20psychologist, physician assistant, or advanced practice
21registered nurse lacked the competency to perform the act or
22acts or commits willful and wanton misconduct.
23    (f) A collaborating physician may, but is not required to,
24delegate prescriptive authority to an advanced practice
25registered nurse as part of a written collaborative agreement,
26and the delegation of prescriptive authority shall conform to
		SB3021	- 14 -	LRB104 17373 BAB 30798 b
1the requirements of Section 65-40 of the Nurse Practice Act.
2    (g) A collaborating physician may, but is not required to,
3delegate prescriptive authority to a physician assistant as
4part of a written collaborative agreement, and the delegation
5of prescriptive authority shall conform to the requirements of
6Section 7.5 of the Physician Assistant Practice Act of 1987.
7    (h) (Blank).
8    (i) A collaborating physician shall delegate prescriptive
9authority to a prescribing psychologist as part of a written
10collaborative agreement, and the delegation of prescriptive
11authority shall conform to the requirements of Section 4.3 of
12the Clinical Psychologist Licensing Act.
13    (j) As set forth in Section 22.2 of this Act, a licensee
14under this Act may not directly or indirectly divide, share,
15or split any professional fee or other form of compensation
16for professional services with anyone in exchange for a
17referral or otherwise, other than as provided in Section 22.2.
18(Source: P.A. 103-228, eff. 1-1-24.)
19    Section 20. The Nurse Practice Act is amended by changing
20Section 65-45 as follows:
21    (225 ILCS 65/65-45)  (was 225 ILCS 65/15-25)
22    (Section scheduled to be repealed on January 1, 2028)
23    Sec. 65-45. Advanced practice registered nursing in
24hospitals, hospital affiliates, or ambulatory surgical
		SB3021	- 15 -	LRB104 17373 BAB 30798 b
1treatment centers.
2    (a) An advanced practice registered nurse may provide
3services in a hospital or a hospital affiliate as those terms
4are defined in the Hospital Licensing Act or the University of
5Illinois Hospital Act or a licensed ambulatory surgical
6treatment center without a written collaborative agreement
7pursuant to Section 65-35 of this Act. An advanced practice
8registered nurse must possess clinical privileges recommended
9by the hospital medical staff and granted by the hospital or
10the consulting medical staff committee and ambulatory surgical
11treatment center in order to provide services. The medical
12staff or consulting medical staff committee shall periodically
13review the services of all advanced practice registered nurses
14granted clinical privileges, including any care provided in a
15hospital affiliate. Authority may also be granted when
16recommended by the hospital medical staff and granted by the
17hospital or recommended by the consulting medical staff
18committee and ambulatory surgical treatment center to
19individual advanced practice registered nurses to select,
20order, and administer medications, including controlled
21substances, to provide delineated care. In a hospital,
22hospital affiliate, or ambulatory surgical treatment center,
23the attending physician shall determine an advanced practice
24registered nurse's role in providing care for his or her
25patients, except as otherwise provided in the medical staff
26bylaws or consulting committee policies.
		SB3021	- 16 -	LRB104 17373 BAB 30798 b
1    (a-2) An advanced practice registered nurse privileged to
2order medications, including controlled substances, may
3complete discharge prescriptions provided the prescription is
4in the name of the advanced practice registered nurse and the
5attending or discharging physician.
6    (a-3) Advanced practice registered nurses practicing in a
7hospital or an ambulatory surgical treatment center are not
8required to obtain a mid-level controlled substance license to
9order controlled substances under Section 303.05 of the
10Illinois Controlled Substances Act.
11    (a-4) An advanced practice registered nurse meeting the
12requirements of Section 65-43 may be privileged to complete
13discharge orders and prescriptions under the advanced practice
14registered nurse's name.
15    (a-5) For anesthesia services provided by a certified
16registered nurse anesthetist, an anesthesiologist, physician,
17dentist, or podiatric physician shall participate through
18discussion of and agreement with the anesthesia plan and shall
19remain [physically present and be] available [on the premises]
20during the delivery of anesthesia services for diagnosis,
21consultation, and treatment of emergency medical conditions,
22unless hospital policy adopted pursuant to clause (B) of
23subdivision (3) of Section 10.7 of the Hospital Licensing Act
24or ambulatory surgical treatment center policy adopted
25pursuant to clause (B) of subdivision (3) of Section 6.5 of the
26Ambulatory Surgical Treatment Center Act provides otherwise. A
		SB3021	- 17 -	LRB104 17373 BAB 30798 b
1certified registered nurse anesthetist may select, order, and
2administer medication for anesthesia services under the
3anesthesia plan agreed to by the anesthesiologist or the
4physician, in accordance with hospital alternative policy or
5the medical staff consulting committee policies of a licensed
6ambulatory surgical treatment center.
7    (b) An advanced practice registered nurse who provides
8services in a hospital shall do so in accordance with Section
910.7 of the Hospital Licensing Act and, in an ambulatory
10surgical treatment center, in accordance with Section 6.5 of
11the Ambulatory Surgical Treatment Center Act. Nothing in this
12Act shall be construed to require an advanced practice
13registered nurse to have a collaborative agreement to practice
14in a hospital, hospital affiliate, or ambulatory surgical
15treatment center.
16    (c) Advanced practice registered nurses certified as nurse
17practitioners, nurse midwives, or clinical nurse specialists
18practicing in a hospital affiliate may be, but are not
19required to be, privileged to prescribe Schedule II through V
20controlled substances when such authority is recommended by
21the appropriate physician committee of the hospital affiliate
22and granted by the hospital affiliate. This authority may, but
23is not required to, include prescription of, selection of,
24orders for, administration of, storage of, acceptance of
25samples of, and dispensing over-the-counter medications,
26legend drugs, medical gases, and controlled substances
		SB3021	- 18 -	LRB104 17373 BAB 30798 b
1categorized as Schedule II through V controlled substances, as
2defined in Article II of the Illinois Controlled Substances
3Act, and other preparations, including, but not limited to,
4botanical and herbal remedies.
5    To prescribe controlled substances under this subsection
6(c), an advanced practice registered nurse certified as a
7nurse practitioner, nurse midwife, or clinical nurse
8specialist must obtain a controlled substance license.
9Medication orders shall be reviewed periodically by the
10appropriate hospital affiliate physicians committee or its
11physician designee.
12    The hospital affiliate shall file with the Department
13notice of a grant of prescriptive authority consistent with
14this subsection (c) and termination of such a grant of
15authority, in accordance with rules of the Department. Upon
16receipt of this notice of grant of authority to prescribe any
17Schedule II through V controlled substances, the licensed
18advanced practice registered nurse certified as a nurse
19practitioner, nurse midwife, or clinical nurse specialist may
20register for a mid-level practitioner controlled substance
21license under Section 303.05 of the Illinois Controlled
22Substances Act.
23    In addition, a hospital affiliate may, but is not required
24to, privilege an advanced practice registered nurse certified
25as a nurse practitioner, nurse midwife, or clinical nurse
26specialist to prescribe any Schedule II controlled substances,
		SB3021	- 19 -	LRB104 17373 BAB 30798 b
1if all of the following conditions apply:
2        (1) specific Schedule II controlled substances by oral
3    dosage or topical or transdermal application may be
4    designated, provided that the designated Schedule II
5    controlled substances are routinely prescribed by advanced
6    practice registered nurses in their area of certification;
7    the privileging documents must identify the specific
8    Schedule II controlled substances by either brand name or
9    generic name; privileges to prescribe or dispense Schedule
10    II controlled substances to be delivered by injection or
11    other route of administration may not be granted;
12        (2) any privileges must be controlled substances
13    limited to the practice of the advanced practice
14    registered nurse;
15        (3) any prescription must be limited to no more than a
16    30-day supply;
17        (4) the advanced practice registered nurse must
18    discuss the condition of any patients for whom a
19    controlled substance is prescribed monthly with the
20    appropriate physician committee of the hospital affiliate
21    or its physician designee; and
22        (5) the advanced practice registered nurse must meet
23    the education requirements of Section 303.05 of the
24    Illinois Controlled Substances Act.
25    (d) An advanced practice registered nurse meeting the
26requirements of Section 65-43 may be privileged to prescribe
		SB3021	- 20 -	LRB104 17373 BAB 30798 b
1controlled substances categorized as Schedule II through V in
2accordance with Section 65-43.
3(Source: P.A. 99-173, eff. 7-29-15; 100-513, eff. 1-1-18.)