Sen. Karina Villa

Filed: 3/10/2023

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 1497

2    AMENDMENT NO. ______. Amend Senate Bill 1497 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Nursing Home Care Act is amended by
5changing Sections 1-112, 2-106, and 2-106.1 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
8condition, or one or more practices, methods, or operations
9which present imminent danger of death or serious physical or
10mental harm to residents of a facility and are clinically
11documented 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. Restraints.
15    (a) For purposes of this Act, (i) a physical restraint is

 

 

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1any manual method or physical or mechanical device, material,
2or equipment attached or adjacent to a resident's body that
3the resident cannot remove easily and restricts freedom of
4movement or normal access to one's body, and . Devices used for
5positioning, including but not limited to bed rails, gait
6belts, and cushions, shall not be considered to be restraints
7for purposes of this Section; (ii) a chemical restraint is any
8drug used for discipline or convenience and not required to
9treat medical symptoms.
10    Devices used for positioning, including, but not limited
11to, bed rails and gait belts, shall not be considered to be
12physical restraints for purposes of this Act unless the device
13is used to restrain or otherwise limit the patient's freedom
14to move. A device used for positioning must be requested by the
15resident, the resident's guardian, or the resident's
16authorized representative, or the need for that device must be
17physically demonstrated by the resident and documented in the
18resident's care plan. The physically demonstrated need of the
19resident for a device used for positioning must be revisited
20in every comprehensive assessment of the resident.
21    The Department shall by rule, designate certain devices as
22restraints, including at least all those devices which have
23been determined to be restraints by the United States
24Department of Health and Human Services in interpretive
25guidelines issued for the purposes of administering Titles
26XVIII and XIX of the Social Security Act.

 

 

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1    (b) Neither restraints nor confinements shall be employed
2for the purpose of punishment or for the convenience of any
3facility personnel. No restraints or confinements shall be
4employed except as ordered by a physician who documents the
5need for such restraints or confinements in the resident's
6clinical record.
7    (c) A restraint may be used only with the informed consent
8of the resident, the resident's guardian, or other authorized
9representative. A restraint may be used only for specific
10periods, if it is the least restrictive means necessary to
11attain and maintain the resident's highest practicable
12physical, mental or psychosocial well-being, including brief
13periods of time to provide necessary life-saving treatment. A
14restraint may be used only after consultation with appropriate
15health professionals, such as occupational or physical
16therapists, and a trial of less restrictive measures has led
17to the determination that the use of less restrictive measures
18would not attain or maintain the resident's highest
19practicable physical, mental or psychosocial well-being.
20However, if the resident needs emergency care, restraints may
21be used for brief periods to permit medical treatment to
22proceed unless the facility has notice that the resident has
23previously made a valid refusal of the treatment in question.
24    (d) A restraint may be applied only by a person trained in
25the application of the particular type of restraint.
26    (e) Whenever a period of use of a restraint is initiated,

 

 

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1the resident shall be advised of his or her right to have a
2person or organization of his or her choosing, including the
3Guardianship and Advocacy Commission, notified of the use of
4the restraint. A recipient who is under guardianship may
5request that a person or organization of his or her choosing be
6notified of the restraint, whether or not the guardian
7approves the notice. If the resident so chooses, the facility
8shall make the notification within 24 hours, including any
9information about the period of time that the restraint is to
10be used. Whenever the Guardianship and Advocacy Commission is
11notified that a resident has been restrained, it shall contact
12the resident to determine the circumstances of the restraint
13and whether further action is warranted.
14    (f) Whenever a restraint is used on a resident whose
15primary mode of communication is sign language, the resident
16shall be permitted to have his or her hands free from restraint
17for brief periods each hour, except when this freedom may
18result in physical harm to the resident or others.
19    (g) The requirements of this Section are intended to
20control in any conflict with the requirements of Sections
211-126 and 2-108 of the Mental Health and Developmental
22Disabilities Code.
23(Source: P.A. 97-135, eff. 7-14-11.)
 
24    (210 ILCS 45/2-106.1)
25    Sec. 2-106.1. Drug treatment.

 

 

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1    (a) A resident shall not be given unnecessary drugs. An
2unnecessary drug is any drug used in an excessive dose,
3including in duplicative therapy; for excessive duration;
4without adequate monitoring; without adequate indications for
5its use; or in the presence of adverse consequences that
6indicate the drugs should be reduced or discontinued. The
7Department shall adopt, by rule, the standards for unnecessary
8drugs contained in interpretive guidelines issued by the
9United States Department of Health and Human Services for the
10purposes of administering Titles XVIII and XIX of the Social
11Security Act.
12    (b) State laws, regulations, and policies related to
13psychotropic medication are intended to ensure psychotropic
14medications are used only when the medication is appropriate
15to treat a resident's specific, diagnosed, and documented
16condition and the medication is beneficial to the resident, as
17demonstrated by monitoring and documentation of the resident's
18response to the medication.
19    (b-3) Except in the case of an emergency, psychotropic
20medication shall not be administered without the informed
21consent of the resident or the resident's surrogate decision
22maker. Psychotropic medication shall only be given in both
23emergency and nonemergency situations if the diagnosis of the
24resident supports the benefit of the medication and clinical
25documentation in the resident's medical record supports the
26benefit of the medication over the contraindications related

 

 

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1to other prescribed medications. "Psychotropic medication"
2means medication that is used for or listed as used for
3psychotropic, antidepressant, antimanic, or antianxiety
4behavior modification or behavior management purposes in the
5latest editions of the AMA Drug Evaluations or the Physician's
6Desk Reference. "Emergency" has the same meaning as in Section
71-112 of the Nursing Home Care Act. A facility shall (i)
8document the alleged emergency in detail, including the facts
9surrounding the medication's need, and (ii) present this
10documentation to the resident and the resident's
11representative. The Department shall adopt, by rule, a
12protocol specifying how informed consent for psychotropic
13medication may be obtained or refused. The protocol shall
14require, at a minimum, a discussion between (i) the resident
15or the resident's surrogate decision maker and (ii) the
16resident's physician, a registered pharmacist, or a licensed
17nurse about the possible risks and benefits of a recommended
18medication and the use of standardized consent forms
19designated by the Department. The protocol shall include
20informing the resident, surrogate decision maker, or both of
21the existence of a copy of: the resident's care plan; the
22facility policies and procedures adopted in compliance with
23subsection (b-15) of this Section; and a notification that the
24most recent of the resident's care plans and the facility's
25policies are available to the resident or surrogate decision
26maker upon request. Each form designated or developed by the

 

 

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1Department (i) shall be written in plain language, (ii) shall
2be able to be downloaded from the Department's official
3website or another website designated by the Department, (iii)
4shall include information specific to the psychotropic
5medication for which consent is being sought, and (iv) shall
6be used for every resident for whom psychotropic drugs are
7prescribed. The Department shall utilize the rules, protocols,
8and forms developed and implemented under the Specialized
9Mental Health Rehabilitation Act of 2013 in effect on the
10effective date of this amendatory Act of the 101st General
11Assembly, except to the extent that this Act requires a
12different procedure, and except that the maximum possible
13period for informed consent shall be until: (1) a change in the
14prescription occurs, either as to type of psychotropic
15medication or an increase or decrease in dosage, dosage range,
16or titration schedule of the prescribed medication that was
17not included in the original informed consent; or (2) a
18resident's care plan changes. The Department may further amend
19the rules after January 1, 2021 pursuant to existing
20rulemaking authority. In addition to creating those forms, the
21Department shall approve the use of any other informed consent
22forms that meet criteria developed by the Department. At the
23discretion of the Department, informed consent forms may
24include side effects that the Department reasonably believes
25are more common, with a direction that more complete
26information can be found via a link on the Department's

 

 

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1website to third-party websites with more complete
2information, such as the United States Food and Drug
3Administration's website. The Department or a facility shall
4incur no liability for information provided on a consent form
5so long as the consent form is substantially accurate based
6upon generally accepted medical principles and if the form
7includes the website links.
8    Informed consent shall be sought from the resident. For
9the purposes of this Section, "surrogate decision maker" means
10an individual representing the resident's interests as
11permitted by this Section. Informed consent shall be sought by
12the resident's guardian of the person if one has been named by
13a court of competent jurisdiction. In the absence of a
14court-ordered guardian, informed consent shall be sought from
15a health care agent under the Illinois Power of Attorney Act
16who has authority to give consent. If neither a court-ordered
17guardian of the person nor a health care agent under the
18Illinois Power of Attorney Act is available and the attending
19physician determines that the resident lacks capacity to make
20decisions, informed consent shall be sought from the
21resident's attorney-in-fact designated under the Mental Health
22Treatment Preference Declaration Act, if applicable, or the
23resident's representative.
24    In addition to any other penalty prescribed by law, a
25facility that is found to have violated this subsection, or
26the federal certification requirement that informed consent be

 

 

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1obtained before administering a psychotropic medication, shall
2thereafter be required to obtain the signatures of 2 licensed
3health care professionals on every form purporting to give
4informed consent for the administration of a psychotropic
5medication, certifying the personal knowledge of each health
6care professional that the consent was obtained in compliance
7with the requirements of this subsection.
8    (b-5) A facility must obtain voluntary informed consent,
9in writing, from a resident or the resident's surrogate
10decision maker before administering or dispensing a
11psychotropic medication to that resident. When informed
12consent is not required for a change in dosage, the facility
13shall note in the resident's file that the resident was
14informed of the dosage change prior to the administration of
15the medication or that verbal, written, or electronic notice
16has been communicated to the resident's surrogate decision
17maker that a change in dosage has occurred.
18    (b-10) No facility shall deny continued residency to a
19person on the basis of the person's or resident's, or the
20person's or resident's surrogate decision maker's, refusal of
21the administration of psychotropic medication, unless the
22facility can demonstrate that the resident's refusal would
23place the health and safety of the resident, the facility
24staff, other residents, or visitors at risk.
25    A facility that alleges that the resident's refusal to
26consent to the administration of psychotropic medication will

 

 

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1place the health and safety of the resident, the facility
2staff, other residents, or visitors at risk must: (1) document
3the alleged risk in detail; (2) present this documentation to
4the resident or the resident's surrogate decision maker, to
5the Department, and to the Office of the State Long Term Care
6Ombudsman; and (3) inform the resident or his or her surrogate
7decision maker of his or her right to appeal to the Department.
8The documentation of the alleged risk shall include a
9description of all nonpharmacological or alternative care
10options attempted and why they were unsuccessful.
11    (b-15) Within 100 days after the effective date of any
12rules adopted by the Department under subsection (b-3) (b) of
13this Section, all facilities shall implement written policies
14and procedures for compliance with this Section. When the
15Department conducts its annual survey of a facility, the
16surveyor may review these written policies and procedures and
17either:
18        (1) give written notice to the facility that the
19    policies or procedures are sufficient to demonstrate the
20    facility's intent to comply with this Section; or
21        (2) provide written notice to the facility that the
22    proposed policies and procedures are deficient, identify
23    the areas that are deficient, and provide 30 days for the
24    facility to submit amended policies and procedures that
25    demonstrate its intent to comply with this Section.
26    A facility's failure to submit the documentation required

 

 

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1under this subsection is sufficient to demonstrate its intent
2to not comply with this Section and shall be grounds for review
3by the Department.
4    All facilities must provide training and education on the
5requirements of this Section to all personnel involved in
6providing care to residents and train and educate such
7personnel on the methods and procedures to effectively
8implement the facility's policies. Training and education
9provided under this Section must be documented in each
10personnel file.
11    (b-20) Upon the receipt of a report of any violation of
12this Section, the Department shall investigate and, upon
13finding sufficient evidence of a violation of this Section,
14may proceed with disciplinary action against the licensee of
15the facility. In any administrative disciplinary action under
16this subsection, the Department shall have the discretion to
17determine the gravity of the violation and, taking into
18account mitigating and aggravating circumstances and facts,
19may adjust the disciplinary action accordingly.
20    (b-25) A violation of informed consent that, for an
21individual resident, lasts for 7 days or more under this
22Section is, at a minimum, a Type "B" violation. A second
23violation of informed consent within a year from a previous
24violation in the same facility regardless of the duration of
25the second violation is, at a minimum, a Type "B" violation.
26    (b-30) Any violation of this Section by a facility may be

 

 

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1enforced by an action brought by the Department in the name of
2the People of Illinois for injunctive relief, civil penalties,
3or both injunctive relief and civil penalties. The Department
4may initiate the action upon its own complaint or the
5complaint of any other interested party.
6    (b-35) Any resident who has been administered a
7psychotropic medication in violation of this Section may bring
8an action for injunctive relief, civil damages, and costs and
9attorney's fees against any facility responsible for the
10violation.
11    (b-40) An action under this Section must be filed within 2
12years of either the date of discovery of the violation that
13gave rise to the claim or the last date of an instance of a
14noncompliant administration of psychotropic medication to the
15resident, whichever is later.
16    (b-45) A facility subject to action under this Section
17shall be liable for damages of up to $500 for each day after
18discovery of a violation that the facility violates the
19requirements of this Section.
20    (b-55) The rights provided for in this Section are
21cumulative to existing resident rights. No part of this
22Section shall be interpreted as abridging, abrogating, or
23otherwise diminishing existing resident rights or causes of
24action at law or equity.
25    (c) The requirements of this Section are intended to
26control in a conflict with the requirements of Sections 2-102

 

 

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1and 2-107.2 of the Mental Health and Developmental
2Disabilities Code with respect to the administration of
3psychotropic medication.
4    (d) In this Section only, "licensed nurse" means an
5advanced practice registered nurse, a registered nurse, or a
6licensed practical nurse.
7(Source: P.A. 101-10, eff. 6-5-19; 102-646, eff. 8-27-21.)".