103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1497 Introduced 2/7/2023, by Sen. Karina Villa SYNOPSIS AS INTRODUCED: 210 ILCS 45/1-112 from Ch. 111 1/2, par. 4151-112 210 ILCS 45/2-106 from Ch. 111 1/2, par. 4152-106210 ILCS 45/2-106.1 210 ILCS 45/3-615 new Amends the Nursing Home Care Act. Provides that "emergency" means a situation, physical condition, or one or more practices, methods, or operations that present imminent danger of death or serious physical or mental harm to residents of a facility and that are clinically documented in the resident's medical record (rather than only a situation, physical condition or one or more practices, methods or operations that present imminent danger of death or serious physical or mental harm to residents of a facility). Requires the need for positioning devices to be demonstrated and documented in the resident's care plan. Requires that assessment to be revisited in every comprehensive assessment of the resident. Provides that psychotropic medication shall be administered to a resident only if clinical documentation in the resident's medical record supports the benefit of the psychotropic medication over contraindications related to other prescribed medications and supports the diagnosis of the resident. Provides that, notwithstanding any other provision of law, if a resident is in a state of emergency, the emergency shall be clinically documented in the resident's medical record. LRB103 26129 CPF 52485 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1497 Introduced 2/7/2023, by Sen. Karina Villa SYNOPSIS AS INTRODUCED: 210 ILCS 45/1-112 from Ch. 111 1/2, par. 4151-112 210 ILCS 45/2-106 from Ch. 111 1/2, par. 4152-106210 ILCS 45/2-106.1 210 ILCS 45/3-615 new 210 ILCS 45/1-112 from Ch. 111 1/2, par. 4151-112 210 ILCS 45/2-106 from Ch. 111 1/2, par. 4152-106 210 ILCS 45/2-106.1 210 ILCS 45/3-615 new Amends the Nursing Home Care Act. Provides that "emergency" means a situation, physical condition, or one or more practices, methods, or operations that present imminent danger of death or serious physical or mental harm to residents of a facility and that are clinically documented in the resident's medical record (rather than only a situation, physical condition or one or more practices, methods or operations that present imminent danger of death or serious physical or mental harm to residents of a facility). Requires the need for positioning devices to be demonstrated and documented in the resident's care plan. Requires that assessment to be revisited in every comprehensive assessment of the resident. Provides that psychotropic medication shall be administered to a resident only if clinical documentation in the resident's medical record supports the benefit of the psychotropic medication over contraindications related to other prescribed medications and supports the diagnosis of the resident. Provides that, notwithstanding any other provision of law, if a resident is in a state of emergency, the emergency shall be clinically documented in the resident's medical record. LRB103 26129 CPF 52485 b LRB103 26129 CPF 52485 b A BILL FOR
103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1497 Introduced 2/7/2023, by Sen. Karina Villa SYNOPSIS AS INTRODUCED:
210 ILCS 45/1-112 from Ch. 111 1/2, par. 4151-112 210 ILCS 45/2-106 from Ch. 111 1/2, par. 4152-106210 ILCS 45/2-106.1 210 ILCS 45/3-615 new 210 ILCS 45/1-112 from Ch. 111 1/2, par. 4151-112 210 ILCS 45/2-106 from Ch. 111 1/2, par. 4152-106 210 ILCS 45/2-106.1 210 ILCS 45/3-615 new
210 ILCS 45/1-112 from Ch. 111 1/2, par. 4151-112
210 ILCS 45/2-106 from Ch. 111 1/2, par. 4152-106
210 ILCS 45/2-106.1
210 ILCS 45/3-615 new
Amends the Nursing Home Care Act. Provides that "emergency" means a situation, physical condition, or one or more practices, methods, or operations that present imminent danger of death or serious physical or mental harm to residents of a facility and that are clinically documented in the resident's medical record (rather than only a situation, physical condition or one or more practices, methods or operations that present imminent danger of death or serious physical or mental harm to residents of a facility). Requires the need for positioning devices to be demonstrated and documented in the resident's care plan. Requires that assessment to be revisited in every comprehensive assessment of the resident. Provides that psychotropic medication shall be administered to a resident only if clinical documentation in the resident's medical record supports the benefit of the psychotropic medication over contraindications related to other prescribed medications and supports the diagnosis of the resident. Provides that, notwithstanding any other provision of law, if a resident is in a state of emergency, the emergency shall be clinically documented in the resident's medical record.
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A BILL FOR
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1 AN ACT concerning regulation.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Nursing Home Care Act is amended by
5 changing Sections 1-112, 2-106, 2-106.1, and 3-615 as follows:
6 (210 ILCS 45/1-112) (from Ch. 111 1/2, par. 4151-112)
7 Sec. 1-112. "Emergency" means a situation, physical
8 condition, or one or more practices, methods, or operations
9 which present imminent danger of death or serious physical or
10 mental harm to residents of a facility and are clinically
11 documented in the resident's medical record.
12 (Source: P.A. 81-223.)
13 (210 ILCS 45/2-106) (from Ch. 111 1/2, par. 4152-106)
14 Sec. 2-106. (a) For purposes of this Act, (i) a physical
15 restraint is any manual method or physical or mechanical
16 device, material, or equipment attached or adjacent to a
17 resident's body that the resident cannot remove easily and
18 restricts freedom of movement or normal access to one's body.
19 Devices used for positioning, including but not limited to bed
20 rails, gait belts, and cushions, shall not be considered to be
21 restraints for purposes of this Section; (ii) a chemical
22 restraint is any drug used for discipline or convenience and
103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1497 Introduced 2/7/2023, by Sen. Karina Villa SYNOPSIS AS INTRODUCED:
210 ILCS 45/1-112 from Ch. 111 1/2, par. 4151-112 210 ILCS 45/2-106 from Ch. 111 1/2, par. 4152-106210 ILCS 45/2-106.1 210 ILCS 45/3-615 new 210 ILCS 45/1-112 from Ch. 111 1/2, par. 4151-112 210 ILCS 45/2-106 from Ch. 111 1/2, par. 4152-106 210 ILCS 45/2-106.1 210 ILCS 45/3-615 new
210 ILCS 45/1-112 from Ch. 111 1/2, par. 4151-112
210 ILCS 45/2-106 from Ch. 111 1/2, par. 4152-106
210 ILCS 45/2-106.1
210 ILCS 45/3-615 new
Amends the Nursing Home Care Act. Provides that "emergency" means a situation, physical condition, or one or more practices, methods, or operations that present imminent danger of death or serious physical or mental harm to residents of a facility and that are clinically documented in the resident's medical record (rather than only a situation, physical condition or one or more practices, methods or operations that present imminent danger of death or serious physical or mental harm to residents of a facility). Requires the need for positioning devices to be demonstrated and documented in the resident's care plan. Requires that assessment to be revisited in every comprehensive assessment of the resident. Provides that psychotropic medication shall be administered to a resident only if clinical documentation in the resident's medical record supports the benefit of the psychotropic medication over contraindications related to other prescribed medications and supports the diagnosis of the resident. Provides that, notwithstanding any other provision of law, if a resident is in a state of emergency, the emergency shall be clinically documented in the resident's medical record.
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A BILL FOR
210 ILCS 45/1-112 from Ch. 111 1/2, par. 4151-112
210 ILCS 45/2-106 from Ch. 111 1/2, par. 4152-106
210 ILCS 45/2-106.1
210 ILCS 45/3-615 new
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1 not required to treat medical symptoms. The need for devices
2 used for positioning must be demonstrated by the resident and
3 documented in the resident's care plan. The demonstrated need
4 must be revisited in every comprehensive assessment of the
5 resident. The Department shall by rule, designate certain
6 devices as restraints, including at least all those devices
7 which have been determined to be restraints by the United
8 States Department of Health and Human Services in interpretive
9 guidelines issued for the purposes of administering Titles
10 XVIII and XIX of the Social Security Act.
11 (b) Neither restraints nor confinements shall be employed
12 for the purpose of punishment or for the convenience of any
13 facility personnel. No restraints or confinements shall be
14 employed except as ordered by a physician who documents the
15 need for such restraints or confinements in the resident's
16 clinical record.
17 (c) A restraint may be used only with the informed consent
18 of the resident, the resident's guardian, or other authorized
19 representative. A restraint may be used only for specific
20 periods, if it is the least restrictive means necessary to
21 attain and maintain the resident's highest practicable
22 physical, mental or psychosocial well-being, including brief
23 periods of time to provide necessary life-saving treatment. A
24 restraint may be used only after consultation with appropriate
25 health professionals, such as occupational or physical
26 therapists, and a trial of less restrictive measures has led
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1 to the determination that the use of less restrictive measures
2 would not attain or maintain the resident's highest
3 practicable physical, mental or psychosocial well-being.
4 However, if the resident needs emergency care, restraints may
5 be used for brief periods to permit medical treatment to
6 proceed unless the facility has notice that the resident has
7 previously made a valid refusal of the treatment in question.
8 (d) A restraint may be applied only by a person trained in
9 the application of the particular type of restraint.
10 (e) Whenever a period of use of a restraint is initiated,
11 the resident shall be advised of his or her right to have a
12 person or organization of his or her choosing, including the
13 Guardianship and Advocacy Commission, notified of the use of
14 the restraint. A recipient who is under guardianship may
15 request that a person or organization of his or her choosing be
16 notified of the restraint, whether or not the guardian
17 approves the notice. If the resident so chooses, the facility
18 shall make the notification within 24 hours, including any
19 information about the period of time that the restraint is to
20 be used. Whenever the Guardianship and Advocacy Commission is
21 notified that a resident has been restrained, it shall contact
22 the resident to determine the circumstances of the restraint
23 and whether further action is warranted.
24 (f) Whenever a restraint is used on a resident whose
25 primary mode of communication is sign language, the resident
26 shall be permitted to have his or her hands free from restraint
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1 for brief periods each hour, except when this freedom may
2 result in physical harm to the resident or others.
3 (g) The requirements of this Section are intended to
4 control in any conflict with the requirements of Sections
5 1-126 and 2-108 of the Mental Health and Developmental
6 Disabilities Code.
7 (Source: P.A. 97-135, eff. 7-14-11.)
8 (210 ILCS 45/2-106.1)
9 Sec. 2-106.1. Drug treatment.
10 (a) A resident shall not be given unnecessary drugs. An
11 unnecessary drug is any drug used in an excessive dose,
12 including in duplicative therapy; for excessive duration;
13 without adequate monitoring; without adequate indications for
14 its use; or in the presence of adverse consequences that
15 indicate the drugs should be reduced or discontinued. The
16 Department shall adopt, by rule, the standards for unnecessary
17 drugs contained in interpretive guidelines issued by the
18 United States Department of Health and Human Services for the
19 purposes of administering Titles XVIII and XIX of the Social
20 Security Act.
21 (b) Except in the case of an emergency, psychotropic
22 medication shall not be administered without the informed
23 consent of the resident or the resident's surrogate decision
24 maker. If there is an emergency and the resident or resident's
25 surrogate's informed consent has been obtained, the
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1 psychotropic medication shall be administered only if clinical
2 documentation in the resident's medical record supports the
3 benefit of the psychotropic medication over contraindications
4 related to other prescribed medications and supports the
5 diagnosis of the resident. "Psychotropic medication" means
6 medication that is used for or listed as used for
7 psychotropic, antidepressant, antimanic, or antianxiety
8 behavior modification or behavior management purposes in the
9 latest editions of the AMA Drug Evaluations or the Physician's
10 Desk Reference. "Emergency" has the same meaning as in Section
11 1-112 of the Nursing Home Care Act. A facility shall (i)
12 document the alleged emergency in detail, including the facts
13 surrounding the medication's need, and (ii) present this
14 documentation to the resident and the resident's
15 representative. The Department shall adopt, by rule, a
16 protocol specifying how informed consent for psychotropic
17 medication may be obtained or refused. The protocol shall
18 require, at a minimum, a discussion between (i) the resident
19 or the resident's surrogate decision maker and (ii) the
20 resident's physician, a registered pharmacist, or a licensed
21 nurse about the possible risks and benefits of a recommended
22 medication and the use of standardized consent forms
23 designated by the Department. The protocol shall include
24 informing the resident, surrogate decision maker, or both of
25 the existence of a copy of: the resident's care plan; the
26 facility policies and procedures adopted in compliance with
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1 subsection (b-15) of this Section; and a notification that the
2 most recent of the resident's care plans and the facility's
3 policies are available to the resident or surrogate decision
4 maker upon request. Each form designated or developed by the
5 Department (i) shall be written in plain language, (ii) shall
6 be able to be downloaded from the Department's official
7 website or another website designated by the Department, (iii)
8 shall include information specific to the psychotropic
9 medication for which consent is being sought, and (iv) shall
10 be used for every resident for whom psychotropic drugs are
11 prescribed. The Department shall utilize the rules, protocols,
12 and forms developed and implemented under the Specialized
13 Mental Health Rehabilitation Act of 2013 in effect on the
14 effective date of this amendatory Act of the 101st General
15 Assembly, except to the extent that this Act requires a
16 different procedure, and except that the maximum possible
17 period for informed consent shall be until: (1) a change in the
18 prescription occurs, either as to type of psychotropic
19 medication or an increase or decrease in dosage, dosage range,
20 or titration schedule of the prescribed medication that was
21 not included in the original informed consent; or (2) a
22 resident's care plan changes. The Department may further amend
23 the rules after January 1, 2021 pursuant to existing
24 rulemaking authority. In addition to creating those forms, the
25 Department shall approve the use of any other informed consent
26 forms that meet criteria developed by the Department. At the
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1 discretion of the Department, informed consent forms may
2 include side effects that the Department reasonably believes
3 are more common, with a direction that more complete
4 information can be found via a link on the Department's
5 website to third-party websites with more complete
6 information, such as the United States Food and Drug
7 Administration's website. The Department or a facility shall
8 incur no liability for information provided on a consent form
9 so long as the consent form is substantially accurate based
10 upon generally accepted medical principles and if the form
11 includes the website links.
12 Informed consent shall be sought from the resident. For
13 the purposes of this Section, "surrogate decision maker" means
14 an individual representing the resident's interests as
15 permitted by this Section. Informed consent shall be sought by
16 the resident's guardian of the person if one has been named by
17 a court of competent jurisdiction. In the absence of a
18 court-ordered guardian, informed consent shall be sought from
19 a health care agent under the Illinois Power of Attorney Act
20 who has authority to give consent. If neither a court-ordered
21 guardian of the person nor a health care agent under the
22 Illinois Power of Attorney Act is available and the attending
23 physician determines that the resident lacks capacity to make
24 decisions, informed consent shall be sought from the
25 resident's attorney-in-fact designated under the Mental Health
26 Treatment Preference Declaration Act, if applicable, or the
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1 resident's representative.
2 In addition to any other penalty prescribed by law, a
3 facility that is found to have violated this subsection, or
4 the federal certification requirement that informed consent be
5 obtained before administering a psychotropic medication, shall
6 thereafter be required to obtain the signatures of 2 licensed
7 health care professionals on every form purporting to give
8 informed consent for the administration of a psychotropic
9 medication, certifying the personal knowledge of each health
10 care professional that the consent was obtained in compliance
11 with the requirements of this subsection.
12 (b-5) A facility must obtain voluntary informed consent,
13 in writing, from a resident or the resident's surrogate
14 decision maker before administering or dispensing a
15 psychotropic medication to that resident. When informed
16 consent is not required for a change in dosage, the facility
17 shall note in the resident's file that the resident was
18 informed of the dosage change prior to the administration of
19 the medication or that verbal, written, or electronic notice
20 has been communicated to the resident's surrogate decision
21 maker that a change in dosage has occurred.
22 (b-10) No facility shall deny continued residency to a
23 person on the basis of the person's or resident's, or the
24 person's or resident's surrogate decision maker's, refusal of
25 the administration of psychotropic medication, unless the
26 facility can demonstrate that the resident's refusal would
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1 place the health and safety of the resident, the facility
2 staff, other residents, or visitors at risk.
3 A facility that alleges that the resident's refusal to
4 consent to the administration of psychotropic medication will
5 place the health and safety of the resident, the facility
6 staff, other residents, or visitors at risk must: (1) document
7 the alleged risk in detail; (2) present this documentation to
8 the resident or the resident's surrogate decision maker, to
9 the Department, and to the Office of the State Long Term Care
10 Ombudsman; and (3) inform the resident or his or her surrogate
11 decision maker of his or her right to appeal to the Department.
12 The documentation of the alleged risk shall include a
13 description of all nonpharmacological or alternative care
14 options attempted and why they were unsuccessful.
15 (b-15) Within 100 days after the effective date of any
16 rules adopted by the Department under subsection (b) of this
17 Section, all facilities shall implement written policies and
18 procedures for compliance with this Section. When the
19 Department conducts its annual survey of a facility, the
20 surveyor may review these written policies and procedures and
21 either:
22 (1) give written notice to the facility that the
23 policies or procedures are sufficient to demonstrate the
24 facility's intent to comply with this Section; or
25 (2) provide written notice to the facility that the
26 proposed policies and procedures are deficient, identify
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1 the areas that are deficient, and provide 30 days for the
2 facility to submit amended policies and procedures that
3 demonstrate its intent to comply with this Section.
4 A facility's failure to submit the documentation required
5 under this subsection is sufficient to demonstrate its intent
6 to not comply with this Section and shall be grounds for review
7 by the Department.
8 All facilities must provide training and education on the
9 requirements of this Section to all personnel involved in
10 providing care to residents and train and educate such
11 personnel on the methods and procedures to effectively
12 implement the facility's policies. Training and education
13 provided under this Section must be documented in each
14 personnel file.
15 (b-20) Upon the receipt of a report of any violation of
16 this Section, the Department shall investigate and, upon
17 finding sufficient evidence of a violation of this Section,
18 may proceed with disciplinary action against the licensee of
19 the facility. In any administrative disciplinary action under
20 this subsection, the Department shall have the discretion to
21 determine the gravity of the violation and, taking into
22 account mitigating and aggravating circumstances and facts,
23 may adjust the disciplinary action accordingly.
24 (b-25) A violation of informed consent that, for an
25 individual resident, lasts for 7 days or more under this
26 Section is, at a minimum, a Type "B" violation. A second
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1 violation of informed consent within a year from a previous
2 violation in the same facility regardless of the duration of
3 the second violation is, at a minimum, a Type "B" violation.
4 (b-30) Any violation of this Section by a facility may be
5 enforced by an action brought by the Department in the name of
6 the People of Illinois for injunctive relief, civil penalties,
7 or both injunctive relief and civil penalties. The Department
8 may initiate the action upon its own complaint or the
9 complaint of any other interested party.
10 (b-35) Any resident who has been administered a
11 psychotropic medication in violation of this Section may bring
12 an action for injunctive relief, civil damages, and costs and
13 attorney's fees against any facility responsible for the
14 violation.
15 (b-40) An action under this Section must be filed within 2
16 years of either the date of discovery of the violation that
17 gave rise to the claim or the last date of an instance of a
18 noncompliant administration of psychotropic medication to the
19 resident, whichever is later.
20 (b-45) A facility subject to action under this Section
21 shall be liable for damages of up to $500 for each day after
22 discovery of a violation that the facility violates the
23 requirements of this Section.
24 (b-55) The rights provided for in this Section are
25 cumulative to existing resident rights. No part of this
26 Section shall be interpreted as abridging, abrogating, or
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1 otherwise diminishing existing resident rights or causes of
2 action at law or equity.
3 (c) The requirements of this Section are intended to
4 control in a conflict with the requirements of Sections 2-102
5 and 2-107.2 of the Mental Health and Developmental
6 Disabilities Code with respect to the administration of
7 psychotropic medication.
8 (d) In this Section only, "licensed nurse" means an
9 advanced practice registered nurse, a registered nurse, or a
10 licensed practical nurse.
11 (Source: P.A. 101-10, eff. 6-5-19; 102-646, eff. 8-27-21.)
12 (210 ILCS 45/3-615 new)
13 Sec. 3-615. Resident emergency; documentation in medical
14 record. Notwithstanding any other provision of law, if a
15 resident is in a state of emergency, the emergency shall be
16 clinically documented in the resident's medical record.
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