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Illinois Senate Bill SB0860

Illinois 2023-2024 Regular Session

Illinois Senate Bill SB0860 Compare Versions

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1-Public Act 103-0890
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4-AN ACT concerning State government.
5-Be it enacted by the People of the State of Illinois,
6-represented in the General Assembly:
7-Section 5. The Mental Health and Developmental
8-Disabilities Administrative Act is amended by changing Section
9-15.4 as follows:
3+1 AN ACT concerning State government.
4+2 Be it enacted by the People of the State of Illinois,
5+3 represented in the General Assembly:
6+4 Section 5. The Mental Health and Developmental
7+5 Disabilities Administrative Act is amended by changing Section
8+6 15.4 as follows:
9+7 (20 ILCS 1705/15.4)
10+8 Sec. 15.4. Authorization for nursing delegation to permit
11+9 direct care staff to administer medications.
12+10 (a) This Section applies to (i) all residential programs
13+11 for persons with a developmental disability in settings of 16
14+12 persons or fewer that are funded or licensed by the Department
15+13 of Human Services and that distribute or administer
16+14 medications, (ii) all intermediate care facilities for persons
17+15 with developmental disabilities with 16 beds or fewer that are
18+16 licensed by the Department of Public Health, and (iii) all day
19+17 programs certified to serve persons with developmental
20+18 disabilities by the Department of Human Services. The
21+19 Department of Human Services shall develop a training program
22+20 for authorized direct care staff to administer medications
23+21 under the supervision and monitoring of a registered
24+22 professional nurse. The training program for authorized direct
25+23 care staff shall include educational and oversight components
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34+1 for staff who work in day programs that are similar to those
35+2 for staff who work in residential programs. This training
36+3 program shall be developed in consultation with professional
37+4 associations representing (i) physicians licensed to practice
38+5 medicine in all its branches, (ii) registered professional
39+6 nurses, and (iii) pharmacists.
40+7 (b) For the purposes of this Section:
41+8 "Authorized direct care staff" means non-licensed persons
42+9 who have successfully completed a medication administration
43+10 training program approved by the Department of Human Services
44+11 and conducted by a nurse-trainer. This authorization is
45+12 specific to an individual receiving service in a specific
46+13 agency and does not transfer to another agency.
47+14 "Medications" means oral, injectable, auto-injectable, and
48+15 topical medications, insulin in an injectable form, oxygen,
49+16 epinephrine auto-injectors, and vaginal and rectal creams and
50+17 suppositories. "Oral" includes inhalants and medications
51+18 administered through enteral tubes, utilizing aseptic
52+19 technique. "Topical" includes eye, ear, and nasal medications.
53+20 Any controlled substances must be packaged specifically for an
54+21 identified individual.
55+22 "Insulin in an injectable or auto-injectable form" means a
56+23 subcutaneous injection, auto-injection, or other technology
57+24 including, but not limited to: (i) an insulin pump; (ii) an
58+25 insulin pod; (iii) via an insulin pen pre-filled by the
59+26 manufacturer; and (iv) a syringe.
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70+1 "GLP-1 receptor agonists in an injectable or
71+2 auto-injectable form" means medication used for the treatment
72+3 of type 1 and type 2 diabetes and obesity. Authorized direct
73+4 care staff may administer insulin or GLP-1 receptor agonists
74+5 via auto-injection or an insulin pen pre-filled by the
75+6 manufacturer as delegated by the registered nurse and , as
76+7 ordered by a physician, advanced practice registered nurse, or
77+8 physician assistant, if: (i) the staff has successfully
78+9 completed a Department-approved advanced training program
79+10 specific to insulin or GLP-1 receptor agonist administration
80+11 developed in consultation with professional associations
81+12 listed in subsection (a) of this Section, and (ii) the staff
82+13 consults with the registered nurse, prior to administration,
83+14 of any insulin or GLP-1 receptor agonist dose that is
84+15 determined based on a blood glucose test result. The
85+16 authorized direct care staff shall not: (i) calculate the
86+17 insulin or GLP-1 receptor agonist dosage needed when the dose
87+18 is dependent upon a blood glucose test result, or (ii)
88+19 administer insulin or GLP-1 receptor agonists to individuals
89+20 who require blood glucose monitoring greater than 3 times
90+21 daily, without consultation with and unless directed to do so
91+22 by the registered nurse. An individual may self-administer
92+23 insulin or GLP-1 receptor agonists in any form if the
93+24 individual is deemed independent by the nurse-trainer through
94+25 the use of the Department's required standardized screening
95+26 and assessment instruments.
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106+1 "Nurse-trainer training program" means a standardized,
107+2 competency-based medication administration train-the-trainer
108+3 program provided by the Department of Human Services and
109+4 conducted by a Department of Human Services master
110+5 nurse-trainer for the purpose of training nurse-trainers to
111+6 train persons employed or under contract to provide direct
112+7 care or treatment to individuals receiving services to
113+8 administer medications and provide self-administration of
114+9 medication training to individuals under the supervision and
115+10 monitoring of the nurse-trainer. The program incorporates
116+11 adult learning styles, teaching strategies, classroom
117+12 management, and a curriculum overview, including the ethical
118+13 and legal aspects of supervising those administering
119+14 medications.
120+15 "Self-administration of medications" means an individual
121+16 administers his or her own medications or a portion of his or
122+17 her own medications. To be considered capable to
123+18 self-administer their own medication, individuals must, at a
124+19 minimum, be able to identify their medication by size, shape,
125+20 or color, know when they should take the medication, and know
126+21 the amount of medication to be taken each time. The use of
127+22 assistive or enabling technologies can be used to demonstrate
128+23 a person's capability to administer his or her own
129+24 medications.
130+25 "Training program" means a standardized medication
131+26 administration training program approved by the Department of
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142+1 Human Services and conducted by a registered professional
143+2 nurse for the purpose of training persons employed or under
144+3 contract to provide direct care or treatment to individuals
145+4 receiving services to administer medications and provide
146+5 self-administration of medication training to individuals
147+6 under the delegation and supervision of a nurse-trainer. The
148+7 program incorporates adult learning styles, teaching
149+8 strategies, classroom management, curriculum overview,
150+9 including ethical-legal aspects, and standardized
151+10 competency-based evaluations on administration of medications
152+11 and self-administration of medication training programs.
153+12 (c) Training and authorization of non-licensed direct care
154+13 staff by nurse-trainers must meet the requirements of this
155+14 subsection.
156+15 (1) Prior to training non-licensed direct care staff
157+16 to administer medication, the nurse-trainer shall perform
158+17 the following for each individual to whom medication will
159+18 be administered by non-licensed direct care staff:
160+19 (A) An assessment of the individual's health
161+20 history and physical and mental status.
162+21 (B) An evaluation of the medications prescribed.
163+22 (2) Non-licensed authorized direct care staff shall
164+23 meet the following criteria:
165+24 (A) Be 18 years of age or older.
166+25 (B) Have completed high school or have a State of
167+26 Illinois High School Diploma.
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178+1 (C) Have demonstrated functional literacy.
179+2 (D) Have satisfactorily completed the Health and
180+3 Safety component of a Department of Human Services
181+4 authorized direct care staff training program.
182+5 (E) Have successfully completed the training
183+6 program, pass the written portion of the comprehensive
184+7 exam, and score 100% on the competency-based
185+8 assessment demonstrating proficiency in the skill of
186+9 administering medication specific to the individual
187+10 and his or her medications.
188+11 (F) Have received additional competency-based
189+12 assessment or training by the nurse-trainer when the
190+13 nurse-trainer determines additional skill development
191+14 is needed to administer medication by the
192+15 nurse-trainer as deemed necessary by the nurse-trainer
193+16 whenever a change of medication occurs or a new
194+17 individual that requires medication administration
195+18 enters the program.
196+19 (3) Authorized direct care staff shall be re-evaluated
197+20 by a nurse-trainer at least annually or more frequently at
198+21 the discretion of the registered professional nurse. Any
199+22 necessary retraining shall be to the extent that is
200+23 necessary to ensure competency of the authorized direct
201+24 care staff to administer medication.
202+25 (4) Authorization of direct care staff to administer
203+26 medication shall be revoked if, in the opinion of the
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214+1 registered professional nurse, the authorized direct care
215+2 staff is no longer competent to administer medication.
216+3 (5) The registered professional nurse shall assess an
217+4 individual's health status at least annually or more
218+5 frequently at the discretion of the registered
219+6 professional nurse.
220+7 This subsection only applies to settings where the
221+8 registered professional nurse has jurisdiction. If direct care
222+9 staff move to other settings, they shall consult with the
223+10 registered professional nurse who has jurisdiction of that
224+11 setting.
225+12 (d) Medication self-administration shall meet the
226+13 following requirements:
227+14 (1) As part of the normalization process, in order for
228+15 each individual to attain the highest possible level of
229+16 independent functioning, all individuals shall be
230+17 permitted to participate in their total health care
231+18 program. This program shall include, but not be limited
232+19 to, individual training in preventive health and
233+20 self-administration of medication self-medication
234+21 procedures.
235+22 (A) Every program shall adopt written policies and
236+23 procedures for assisting individuals who choose to
237+24 obtain in obtaining preventative health and
238+25 self-administration of medication self-medication
239+26 skills in consultation with a registered professional
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250+1 nurse, advanced practice registered nurse, physician
251+2 assistant, or physician licensed to practice medicine
252+3 in all its branches.
253+4 (B) If an individual desires to gain independence
254+5 in self-administration of medication, the individual
255+6 Individuals shall be evaluated to determine the
256+7 individual's their ability to self-administer
257+8 medication self-medicate by the nurse-trainer through
258+9 the use of the Department's required, standardized
259+10 screening and assessment instruments.
260+11 (C) (Blank). When the results of the screening and
261+12 assessment indicate an individual not to be capable to
262+13 self-administer his or her own medications, programs
263+14 shall be developed in consultation with the Community
264+15 Support Team or Interdisciplinary Team to provide
265+16 individuals with self-medication administration.
266+17 (2) Each individual shall be presumed to be competent
267+18 to self-administer medications if:
268+19 (A) authorized by an order of a physician licensed
269+20 to practice medicine in all its branches, an advanced
270+21 practice registered nurse, or a physician assistant;
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272+23 (B) approved to self-administer medication by the
273+24 individual's Community Support Team or
274+25 Interdisciplinary Team, which includes a registered
275+26 professional nurse or an advanced practice registered
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286+1 nurse.
287+2 (e) Quality Assurance.
288+3 (1) A registered professional nurse, advanced practice
289+4 registered nurse, licensed practical nurse, physician
290+5 licensed to practice medicine in all its branches,
291+6 physician assistant, or pharmacist shall review the
292+7 following for all individuals:
293+8 (A) Medication orders.
294+9 (B) Medication labels, including medications
295+10 listed on the medication administration record for
296+11 persons who are not self-administering medication
297+12 self-medicating to ensure the labels match the orders
298+13 issued by the physician licensed to practice medicine
299+14 in all its branches, advanced practice registered
300+15 nurse, or physician assistant.
301+16 (C) Medication administration records for persons
302+17 who are not self-administering medication
303+18 self-medicating to ensure that the records are
304+19 completed appropriately for:
305+20 (i) medication administered as prescribed;
306+21 (ii) refusal by the individual; and
307+22 (iii) full signatures provided for all
308+23 initials used.
309+24 (2) Reviews shall occur at least quarterly, but may be
310+25 done more frequently at the discretion of the registered
311+26 professional nurse or advanced practice registered nurse.
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322+1 (3) A quality assurance review of medication errors
323+2 and data collection for the purpose of monitoring and
324+3 recommending corrective action shall be conducted within 7
325+4 days and included in the required annual review.
326+5 (f) Programs using authorized direct care staff to
327+6 administer medications are responsible for documenting and
328+7 maintaining records on the training that is completed.
329+8 (g) The absence of this training program constitutes a
330+9 threat to the public interest, safety, and welfare and
331+10 necessitates emergency rulemaking by the Departments of Human
332+11 Services and Public Health under Section 5-45 of the Illinois
333+12 Administrative Procedure Act.
334+13 (h) Direct care staff who fail to qualify for delegated
335+14 authority to administer medications pursuant to the provisions
336+15 of this Section shall be given additional education and
337+16 testing to meet criteria for delegation authority to
338+17 administer medications. Any direct care staff person who fails
339+18 to qualify as an authorized direct care staff after initial
340+19 training and testing must within 3 months be given another
341+20 opportunity for retraining and retesting. A direct care staff
342+21 person who fails to meet criteria for delegated authority to
343+22 administer medication, including, but not limited to, failure
344+23 of the written test on 2 occasions shall be given
345+24 consideration for shift transfer or reassignment, if possible.
346+25 No employee shall be terminated for failure to qualify during
347+26 the 3-month time period following initial testing. Refusal to
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