Sen. Don Harmon
Filed: 4/17/2024
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1 | AMENDMENT TO SENATE BILL 860 | ||||||
2 | AMENDMENT NO. ______. Amend Senate Bill 860 by replacing | ||||||
3 | everything after the enacting clause with the following: | ||||||
4 | "Section 5. The Mental Health and Developmental | ||||||
5 | Disabilities Administrative Act is amended by changing Section | ||||||
6 | 15.4 as follows: | ||||||
7 | (20 ILCS 1705/15.4) | ||||||
8 | Sec. 15.4. Authorization for nursing delegation to permit | ||||||
9 | direct care staff to administer medications. | ||||||
10 | (a) This Section applies to (i) all residential programs | ||||||
11 | for persons with a developmental disability in settings of 16 | ||||||
12 | persons or fewer that are funded or licensed by the Department | ||||||
13 | of Human Services and that distribute or administer | ||||||
14 | medications, (ii) all intermediate care facilities for persons | ||||||
15 | with developmental disabilities with 16 beds or fewer that are | ||||||
16 | licensed by the Department of Public Health, and (iii) all day |
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1 | programs certified to serve persons with developmental | ||||||
2 | disabilities by the Department of Human Services. The | ||||||
3 | Department of Human Services shall develop a training program | ||||||
4 | for authorized direct care staff to administer medications | ||||||
5 | under the supervision and monitoring of a registered | ||||||
6 | professional nurse. The training program for authorized direct | ||||||
7 | care staff shall include educational and oversight components | ||||||
8 | for staff who work in day programs that are similar to those | ||||||
9 | for staff who work in residential programs. This training | ||||||
10 | program shall be developed in consultation with professional | ||||||
11 | associations representing (i) physicians licensed to practice | ||||||
12 | medicine in all its branches, (ii) registered professional | ||||||
13 | nurses, and (iii) pharmacists. | ||||||
14 | (b) For the purposes of this Section: | ||||||
15 | "Authorized direct care staff" means non-licensed persons | ||||||
16 | who have successfully completed a medication administration | ||||||
17 | training program approved by the Department of Human Services | ||||||
18 | and conducted by a nurse-trainer. This authorization is | ||||||
19 | specific to an individual receiving service in a specific | ||||||
20 | agency and does not transfer to another agency. | ||||||
21 | "Medications" means oral and topical medications, | ||||||
22 | auto-injectors, insulin in an injectable form, oxygen, | ||||||
23 | epinephrine auto-injectors, and vaginal and rectal creams and | ||||||
24 | suppositories. "Oral" includes inhalants and medications | ||||||
25 | administered through enteral tubes, utilizing aseptic | ||||||
26 | technique. "Topical" includes eye, ear, and nasal medications. |
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1 | Any controlled substances must be packaged specifically for an | ||||||
2 | identified individual. | ||||||
3 | "Insulin in an injectable or auto-injectable form" means a | ||||||
4 | subcutaneous injection , auto-injection, or other technologies | ||||||
5 | available including, but not limited to, insulin pumps, | ||||||
6 | insulin pods, or via an insulin pen pre-filled by the | ||||||
7 | manufacturer. | ||||||
8 | "GLP-1 receptor agonists in an injectable or | ||||||
9 | auto-injectable form" means an anti-diabetic medication used | ||||||
10 | for the treatment of type 1 and type 2 diabetes. Authorized | ||||||
11 | direct care staff may administer insulin or GLP-1 receptor | ||||||
12 | agonists via auto-injection or pen pre-filled by the | ||||||
13 | manufacturer as delegated by the registered professional nurse | ||||||
14 | and , as ordered by a physician, advanced practice registered | ||||||
15 | nurse, or physician assistant, if: (i) the staff has | ||||||
16 | successfully completed a Department-approved advanced training | ||||||
17 | program specific to insulin or GLP-1 receptor agonist | ||||||
18 | administration developed in consultation with professional | ||||||
19 | associations listed in subsection (a) of this Section, and | ||||||
20 | (ii) the staff consults with the registered nurse, prior to | ||||||
21 | administration, of any insulin or GLP-1 receptor agonist dose | ||||||
22 | that is determined based on a blood glucose test result. The | ||||||
23 | authorized direct care staff shall not: (i) calculate the | ||||||
24 | insulin or GLP-1 receptor agonist dosage needed when the dose | ||||||
25 | is dependent upon a blood glucose test result, or (ii) | ||||||
26 | administer insulin or GLP-1 receptor agonists to individuals |
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1 | who require blood glucose monitoring greater than 3 times | ||||||
2 | daily, unless directed to do so by the registered nurse. An | ||||||
3 | individual may self-administer insulin or GLP-1 receptor | ||||||
4 | agonists in any form if the individual is deemed independent | ||||||
5 | by the nurse-trainer through the use of the Department's | ||||||
6 | required standardized screening and assessment instruments. | ||||||
7 | "Nurse-trainer training program" means a standardized, | ||||||
8 | competency-based medication administration train-the-trainer | ||||||
9 | program provided by the Department of Human Services and | ||||||
10 | conducted by a Department of Human Services master | ||||||
11 | nurse-trainer for the purpose of training nurse-trainers to | ||||||
12 | train persons employed or under contract to provide direct | ||||||
13 | care or treatment to individuals receiving services to | ||||||
14 | administer medications and provide self-administration of | ||||||
15 | medication training to individuals under the supervision and | ||||||
16 | monitoring of the nurse-trainer. The program incorporates | ||||||
17 | adult learning styles, teaching strategies, classroom | ||||||
18 | management, and a curriculum overview, including the ethical | ||||||
19 | and legal aspects of supervising those administering | ||||||
20 | medications. | ||||||
21 | "Self-administration of medications" means an individual | ||||||
22 | administers his or her own medications or a portion of his or | ||||||
23 | her own medications . To be considered capable to | ||||||
24 | self-administer their own medication, individuals must, at a | ||||||
25 | minimum, be able to identify their medication by size, shape, | ||||||
26 | or color, know when they should take the medication, and know |
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1 | the amount of medication to be taken each time. The use of | ||||||
2 | assistive or enabling technologies can be used to demonstrate | ||||||
3 | a person's capability to administer his or her own | ||||||
4 | medications. | ||||||
5 | "Training program" means a standardized medication | ||||||
6 | administration training program approved by the Department of | ||||||
7 | Human Services and conducted by a registered professional | ||||||
8 | nurse for the purpose of training persons employed or under | ||||||
9 | contract to provide direct care or treatment to individuals | ||||||
10 | receiving services to administer medications and provide | ||||||
11 | self-administration of medication training to individuals | ||||||
12 | under the delegation and supervision of a nurse-trainer. The | ||||||
13 | program incorporates adult learning styles, teaching | ||||||
14 | strategies, classroom management, curriculum overview, | ||||||
15 | including ethical-legal aspects, and standardized | ||||||
16 | competency-based evaluations on administration of medications | ||||||
17 | and self-administration of medication training programs. | ||||||
18 | (c) Training and authorization of non-licensed direct care | ||||||
19 | staff by nurse-trainers must meet the requirements of this | ||||||
20 | subsection. | ||||||
21 | (1) Prior to training non-licensed direct care staff | ||||||
22 | to administer medication, the nurse-trainer shall perform | ||||||
23 | the following for each individual to whom medication will | ||||||
24 | be administered by non-licensed direct care staff: | ||||||
25 | (A) An assessment of the individual's health | ||||||
26 | history and physical and mental status. |
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1 | (B) An evaluation of the medications prescribed. | ||||||
2 | (2) Non-licensed authorized direct care staff shall | ||||||
3 | meet the following criteria: | ||||||
4 | (A) Be 18 years of age or older. | ||||||
5 | (B) Have completed high school or have a State of | ||||||
6 | Illinois High School Diploma. | ||||||
7 | (C) Have demonstrated functional literacy. | ||||||
8 | (D) Have satisfactorily completed the Health and | ||||||
9 | Safety component of a Department of Human Services | ||||||
10 | authorized direct care staff training program. | ||||||
11 | (E) Have successfully completed the training | ||||||
12 | program, pass the written portion of the comprehensive | ||||||
13 | exam, and score 100% on the competency-based | ||||||
14 | assessment demonstrating proficiency in the skill of | ||||||
15 | administering medication specific to the individual | ||||||
16 | and his or her medications . | ||||||
17 | (F) Have received additional competency-based | ||||||
18 | assessment by the nurse-trainer as deemed necessary by | ||||||
19 | the nurse-trainer whenever it is determined that | ||||||
20 | additional skill development and training is needed to | ||||||
21 | administer a medication a change of medication occurs | ||||||
22 | or a new individual that requires medication | ||||||
23 | administration enters the program . | ||||||
24 | (3) Authorized direct care staff shall be re-evaluated | ||||||
25 | by a nurse-trainer at least annually or more frequently at | ||||||
26 | the discretion of the registered professional nurse. Any |
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1 | necessary retraining shall be to the extent that is | ||||||
2 | necessary to ensure competency of the authorized direct | ||||||
3 | care staff to administer medication. | ||||||
4 | (4) Authorization of direct care staff to administer | ||||||
5 | medication shall be revoked if, in the opinion of the | ||||||
6 | registered professional nurse, the authorized direct care | ||||||
7 | staff is no longer competent to administer medication. | ||||||
8 | (5) The registered professional nurse shall assess an | ||||||
9 | individual's health status at least annually or more | ||||||
10 | frequently at the discretion of the registered | ||||||
11 | professional nurse. | ||||||
12 | This subsection only applies to settings where the | ||||||
13 | registered professional nurse has jurisdiction. If direct care | ||||||
14 | staff move to other settings, they shall consult with the | ||||||
15 | registered professional nurse who has jurisdiction of that | ||||||
16 | setting. | ||||||
17 | (d) Medication self-administration shall meet the | ||||||
18 | following requirements: | ||||||
19 | (1) As part of the normalization process, in order for | ||||||
20 | each individual to attain the highest possible level of | ||||||
21 | independent functioning, all individuals shall be | ||||||
22 | permitted to participate in their total health care | ||||||
23 | program. This program shall include, but not be limited | ||||||
24 | to, individual training in preventive health and | ||||||
25 | self-administration of medication self-medication | ||||||
26 | procedures. |
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1 | (A) Every program shall adopt written policies and | ||||||
2 | procedures for assisting individuals who choose to | ||||||
3 | obtain in obtaining preventative health and | ||||||
4 | self-administration of medication self-medication | ||||||
5 | skills in consultation with a registered professional | ||||||
6 | nurse, advanced practice registered nurse, physician | ||||||
7 | assistant, or physician licensed to practice medicine | ||||||
8 | in all its branches. | ||||||
9 | (B) If an individual desires to gain independence | ||||||
10 | in self-administration of medication, the individual | ||||||
11 | Individuals shall be evaluated to determine the | ||||||
12 | individual's their ability to self-administer | ||||||
13 | medication self-medicate by the nurse-trainer through | ||||||
14 | the use of the Department's required, standardized | ||||||
15 | screening and assessment instruments. | ||||||
16 | (C) (Blank). When the results of the screening and | ||||||
17 | assessment indicate an individual not to be capable to | ||||||
18 | self-administer his or her own medications, programs | ||||||
19 | shall be developed in consultation with the Community | ||||||
20 | Support Team or Interdisciplinary Team to provide | ||||||
21 | individuals with self-medication administration. | ||||||
22 | (2) Each individual shall be presumed to be competent | ||||||
23 | to self-administer medications if: | ||||||
24 | (A) authorized by an order of a physician licensed | ||||||
25 | to practice medicine in all its branches, an advanced | ||||||
26 | practice registered nurse, or a physician assistant; |
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1 | and | ||||||
2 | (B) approved to self-administer medication by the | ||||||
3 | individual's Community Support Team or | ||||||
4 | Interdisciplinary Team, which includes a registered | ||||||
5 | professional nurse or an advanced practice registered | ||||||
6 | nurse. | ||||||
7 | (e) Quality Assurance. | ||||||
8 | (1) A registered professional nurse, advanced practice | ||||||
9 | registered nurse, licensed practical nurse, physician | ||||||
10 | licensed to practice medicine in all its branches, | ||||||
11 | physician assistant, or pharmacist shall review the | ||||||
12 | following for all individuals: | ||||||
13 | (A) Medication orders. | ||||||
14 | (B) Medication labels, including medications | ||||||
15 | listed on the medication administration record for | ||||||
16 | persons who are not self-administering medication | ||||||
17 | self-medicating to ensure the labels match the orders | ||||||
18 | issued by the physician licensed to practice medicine | ||||||
19 | in all its branches, advanced practice registered | ||||||
20 | nurse, or physician assistant. | ||||||
21 | (C) Medication administration records for persons | ||||||
22 | who are not self-administering medication | ||||||
23 | self-medicating to ensure that the records are | ||||||
24 | completed appropriately for: | ||||||
25 | (i) medication administered as prescribed; | ||||||
26 | (ii) refusal by the individual; and |
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1 | (iii) full signatures provided for all | ||||||
2 | initials used. | ||||||
3 | (2) Reviews shall occur at least quarterly, but may be | ||||||
4 | done more frequently at the discretion of the registered | ||||||
5 | professional nurse or advanced practice registered nurse. | ||||||
6 | (3) A quality assurance review of medication errors | ||||||
7 | and data collection for the purpose of monitoring and | ||||||
8 | recommending corrective action shall be conducted within 7 | ||||||
9 | days and included in the required annual review. | ||||||
10 | (f) Programs using authorized direct care staff to | ||||||
11 | administer medications are responsible for documenting and | ||||||
12 | maintaining records on the training that is completed. | ||||||
13 | (g) The absence of this training program constitutes a | ||||||
14 | threat to the public interest, safety, and welfare and | ||||||
15 | necessitates emergency rulemaking by the Departments of Human | ||||||
16 | Services and Public Health under Section 5-45 of the Illinois | ||||||
17 | Administrative Procedure Act. | ||||||
18 | (h) Direct care staff who fail to qualify for delegated | ||||||
19 | authority to administer medications pursuant to the provisions | ||||||
20 | of this Section shall be given additional education and | ||||||
21 | testing to meet criteria for delegation authority to | ||||||
22 | administer medications. Any direct care staff person who fails | ||||||
23 | to qualify as an authorized direct care staff after initial | ||||||
24 | training and testing must within 3 months be given another | ||||||
25 | opportunity for retraining and retesting. A direct care staff | ||||||
26 | person who fails to meet criteria for delegated authority to |
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1 | administer medication, including, but not limited to, failure | ||||||
2 | of the written test on 2 occasions shall be given | ||||||
3 | consideration for shift transfer or reassignment, if possible. | ||||||
4 | No employee shall be terminated for failure to qualify during | ||||||
5 | the 3-month time period following initial testing. Refusal to | ||||||
6 | complete training and testing required by this Section may be | ||||||
7 | grounds for immediate dismissal. | ||||||
8 | (i) No authorized direct care staff person delegated to | ||||||
9 | administer medication shall be subject to suspension or | ||||||
10 | discharge for errors resulting from the staff person's acts or | ||||||
11 | omissions when performing the functions unless the staff | ||||||
12 | person's actions or omissions constitute willful and wanton | ||||||
13 | conduct. Nothing in this subsection is intended to supersede | ||||||
14 | paragraph (4) of subsection (c). | ||||||
15 | (j) A registered professional nurse, advanced practice | ||||||
16 | registered nurse, physician licensed to practice medicine in | ||||||
17 | all its branches, or physician assistant shall be on duty or on | ||||||
18 | call at all times in any program covered by this Section. | ||||||
19 | (k) The employer shall be responsible for maintaining | ||||||
20 | liability insurance for any program covered by this Section. | ||||||
21 | (l) Any direct care staff person who qualifies as | ||||||
22 | authorized direct care staff pursuant to this Section shall be | ||||||
23 | granted consideration for a one-time additional salary | ||||||
24 | differential. The Department shall determine and provide the | ||||||
25 | necessary funding for the differential in the base. This | ||||||
26 | subsection (l) is inoperative on and after June 30, 2000. |
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1 | (Source: P.A. 102-1100, eff. 1-1-23 .)". |