SB1497 EngrossedLRB103 26129 CPF 52485 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 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
16any manual method or physical or mechanical device, material,
17or equipment attached or adjacent to a resident's body that
18the resident cannot remove easily and restricts freedom of
19movement or normal access to one's body, and . Devices used for
20positioning, including but not limited to bed rails, gait
21belts, and cushions, shall not be considered to be restraints
22for purposes of this Section; (ii) a chemical restraint is any

 

 

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1drug used for discipline or convenience and not required to
2treat medical symptoms.
3    Devices used for positioning, including, but not limited
4to, bed rails and gait belts, shall not be considered to be
5physical restraints for purposes of this Act unless the device
6is used to restrain or otherwise limit the patient's freedom
7to move. A device used for positioning must be requested by the
8resident, the resident's guardian, or the resident's
9authorized representative, or the need for that device must be
10physically demonstrated by the resident and documented in the
11resident's care plan. The physically demonstrated need of the
12resident for a device used for positioning must be revisited
13in every comprehensive assessment of the resident.
14    The Department shall by rule, designate certain devices as
15restraints, including at least all those devices which have
16been determined to be restraints by the United States
17Department of Health and Human Services in interpretive
18guidelines issued for the purposes of administering Titles
19XVIII and XIX of the Social Security Act.
20    (b) Neither restraints nor confinements shall be employed
21for the purpose of punishment or for the convenience of any
22facility personnel. No restraints or confinements shall be
23employed except as ordered by a physician who documents the
24need for such restraints or confinements in the resident's
25clinical record.
26    (c) A restraint may be used only with the informed consent

 

 

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1of the resident, the resident's guardian, or other authorized
2representative. A restraint may be used only for specific
3periods, if it is the least restrictive means necessary to
4attain and maintain the resident's highest practicable
5physical, mental or psychosocial well-being, including brief
6periods of time to provide necessary life-saving treatment. A
7restraint may be used only after consultation with appropriate
8health professionals, such as occupational or physical
9therapists, and a trial of less restrictive measures has led
10to the determination that the use of less restrictive measures
11would not attain or maintain the resident's highest
12practicable physical, mental or psychosocial well-being.
13However, if the resident needs emergency care, restraints may
14be used for brief periods to permit medical treatment to
15proceed unless the facility has notice that the resident has
16previously made a valid refusal of the treatment in question.
17    (d) A restraint may be applied only by a person trained in
18the application of the particular type of restraint.
19    (e) Whenever a period of use of a restraint is initiated,
20the resident shall be advised of his or her right to have a
21person or organization of his or her choosing, including the
22Guardianship and Advocacy Commission, notified of the use of
23the restraint. A recipient who is under guardianship may
24request that a person or organization of his or her choosing be
25notified of the restraint, whether or not the guardian
26approves the notice. If the resident so chooses, the facility

 

 

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1shall make the notification within 24 hours, including any
2information about the period of time that the restraint is to
3be used. Whenever the Guardianship and Advocacy Commission is
4notified that a resident has been restrained, it shall contact
5the resident to determine the circumstances of the restraint
6and whether further action is warranted.
7    (f) Whenever a restraint is used on a resident whose
8primary mode of communication is sign language, the resident
9shall be permitted to have his or her hands free from restraint
10for brief periods each hour, except when this freedom may
11result in physical harm to the resident or others.
12    (g) The requirements of this Section are intended to
13control in any conflict with the requirements of Sections
141-126 and 2-108 of the Mental Health and Developmental
15Disabilities Code.
16(Source: P.A. 97-135, eff. 7-14-11.)
 
17    (210 ILCS 45/2-106.1)
18    Sec. 2-106.1. Drug treatment.
19    (a) A resident shall not be given unnecessary drugs. An
20unnecessary drug is any drug used in an excessive dose,
21including in duplicative therapy; for excessive duration;
22without adequate monitoring; without adequate indications for
23its use; or in the presence of adverse consequences that
24indicate the drugs should be reduced or discontinued. The
25Department shall adopt, by rule, the standards for unnecessary

 

 

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1drugs contained in interpretive guidelines issued by the
2United States Department of Health and Human Services for the
3purposes of administering Titles XVIII and XIX of the Social
4Security Act.
5    (b) State laws, regulations, and policies related to
6psychotropic medication are intended to ensure psychotropic
7medications are used only when the medication is appropriate
8to treat a resident's specific, diagnosed, and documented
9condition and the medication is beneficial to the resident, as
10demonstrated by monitoring and documentation of the resident's
11response to the medication.
12    (b-3) Except in the case of an emergency, psychotropic
13medication shall not be administered without the informed
14consent of the resident or the resident's surrogate decision
15maker. Psychotropic medication shall only be given in both
16emergency and nonemergency situations if the diagnosis of the
17resident supports the benefit of the medication and clinical
18documentation in the resident's medical record supports the
19benefit of the medication over the contraindications related
20to other prescribed medications. "Psychotropic medication"
21means medication that is used for or listed as used for
22psychotropic, antidepressant, antimanic, or antianxiety
23behavior modification or behavior management purposes in the
24latest editions of the AMA Drug Evaluations or the Physician's
25Desk Reference. "Emergency" has the same meaning as in Section
261-112 of the Nursing Home Care Act. A facility shall (i)

 

 

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1document the alleged emergency in detail, including the facts
2surrounding the medication's need, and (ii) present this
3documentation to the resident and the resident's
4representative. The Department shall adopt, by rule, a
5protocol specifying how informed consent for psychotropic
6medication may be obtained or refused. The protocol shall
7require, at a minimum, a discussion between (i) the resident
8or the resident's surrogate decision maker and (ii) the
9resident's physician, a registered pharmacist, or a licensed
10nurse about the possible risks and benefits of a recommended
11medication and the use of standardized consent forms
12designated by the Department. The protocol shall include
13informing the resident, surrogate decision maker, or both of
14the existence of a copy of: the resident's care plan; the
15facility policies and procedures adopted in compliance with
16subsection (b-15) of this Section; and a notification that the
17most recent of the resident's care plans and the facility's
18policies are available to the resident or surrogate decision
19maker upon request. Each form designated or developed by the
20Department (i) shall be written in plain language, (ii) shall
21be able to be downloaded from the Department's official
22website or another website designated by the Department, (iii)
23shall include information specific to the psychotropic
24medication for which consent is being sought, and (iv) shall
25be used for every resident for whom psychotropic drugs are
26prescribed. The Department shall utilize the rules, protocols,

 

 

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1and forms developed and implemented under the Specialized
2Mental Health Rehabilitation Act of 2013 in effect on the
3effective date of this amendatory Act of the 101st General
4Assembly, except to the extent that this Act requires a
5different procedure, and except that the maximum possible
6period for informed consent shall be until: (1) a change in the
7prescription occurs, either as to type of psychotropic
8medication or an increase or decrease in dosage, dosage range,
9or titration schedule of the prescribed medication that was
10not included in the original informed consent; or (2) a
11resident's care plan changes. The Department may further amend
12the rules after January 1, 2021 pursuant to existing
13rulemaking authority. In addition to creating those forms, the
14Department shall approve the use of any other informed consent
15forms that meet criteria developed by the Department. At the
16discretion of the Department, informed consent forms may
17include side effects that the Department reasonably believes
18are more common, with a direction that more complete
19information can be found via a link on the Department's
20website to third-party websites with more complete
21information, such as the United States Food and Drug
22Administration's website. The Department or a facility shall
23incur no liability for information provided on a consent form
24so long as the consent form is substantially accurate based
25upon generally accepted medical principles and if the form
26includes the website links.

 

 

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1    Informed consent shall be sought from the resident. For
2the purposes of this Section, "surrogate decision maker" means
3an individual representing the resident's interests as
4permitted by this Section. Informed consent shall be sought by
5the resident's guardian of the person if one has been named by
6a court of competent jurisdiction. In the absence of a
7court-ordered guardian, informed consent shall be sought from
8a health care agent under the Illinois Power of Attorney Act
9who has authority to give consent. If neither a court-ordered
10guardian of the person nor a health care agent under the
11Illinois Power of Attorney Act is available and the attending
12physician determines that the resident lacks capacity to make
13decisions, informed consent shall be sought from the
14resident's attorney-in-fact designated under the Mental Health
15Treatment Preference Declaration Act, if applicable, or the
16resident's representative.
17    In addition to any other penalty prescribed by law, a
18facility that is found to have violated this subsection, or
19the federal certification requirement that informed consent be
20obtained before administering a psychotropic medication, shall
21thereafter be required to obtain the signatures of 2 licensed
22health care professionals on every form purporting to give
23informed consent for the administration of a psychotropic
24medication, certifying the personal knowledge of each health
25care professional that the consent was obtained in compliance
26with the requirements of this subsection.

 

 

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1    (b-5) A facility must obtain voluntary informed consent,
2in writing, from a resident or the resident's surrogate
3decision maker before administering or dispensing a
4psychotropic medication to that resident. When informed
5consent is not required for a change in dosage, the facility
6shall note in the resident's file that the resident was
7informed of the dosage change prior to the administration of
8the medication or that verbal, written, or electronic notice
9has been communicated to the resident's surrogate decision
10maker that a change in dosage has occurred.
11    (b-10) No facility shall deny continued residency to a
12person on the basis of the person's or resident's, or the
13person's or resident's surrogate decision maker's, refusal of
14the administration of psychotropic medication, unless the
15facility can demonstrate that the resident's refusal would
16place the health and safety of the resident, the facility
17staff, other residents, or visitors at risk.
18    A facility that alleges that the resident's refusal to
19consent to the administration of psychotropic medication will
20place the health and safety of the resident, the facility
21staff, other residents, or visitors at risk must: (1) document
22the alleged risk in detail; (2) present this documentation to
23the resident or the resident's surrogate decision maker, to
24the Department, and to the Office of the State Long Term Care
25Ombudsman; and (3) inform the resident or his or her surrogate
26decision maker of his or her right to appeal to the Department.

 

 

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1The documentation of the alleged risk shall include a
2description of all nonpharmacological or alternative care
3options attempted and why they were unsuccessful.
4    (b-15) Within 100 days after the effective date of any
5rules adopted by the Department under subsection (b-3) (b) of
6this Section, all facilities shall implement written policies
7and procedures for compliance with this Section. When the
8Department conducts its annual survey of a facility, the
9surveyor may review these written policies and procedures and
10either:
11        (1) give written notice to the facility that the
12    policies or procedures are sufficient to demonstrate the
13    facility's intent to comply with this Section; or
14        (2) provide written notice to the facility that the
15    proposed policies and procedures are deficient, identify
16    the areas that are deficient, and provide 30 days for the
17    facility to submit amended policies and procedures that
18    demonstrate its intent to comply with this Section.
19    A facility's failure to submit the documentation required
20under this subsection is sufficient to demonstrate its intent
21to not comply with this Section and shall be grounds for review
22by the Department.
23    All facilities must provide training and education on the
24requirements of this Section to all personnel involved in
25providing care to residents and train and educate such
26personnel on the methods and procedures to effectively

 

 

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1implement the facility's policies. Training and education
2provided under this Section must be documented in each
3personnel file.
4    (b-20) Upon the receipt of a report of any violation of
5this Section, the Department shall investigate and, upon
6finding sufficient evidence of a violation of this Section,
7may proceed with disciplinary action against the licensee of
8the facility. In any administrative disciplinary action under
9this subsection, the Department shall have the discretion to
10determine the gravity of the violation and, taking into
11account mitigating and aggravating circumstances and facts,
12may adjust the disciplinary action accordingly.
13    (b-25) A violation of informed consent that, for an
14individual resident, lasts for 7 days or more under this
15Section is, at a minimum, a Type "B" violation. A second
16violation of informed consent within a year from a previous
17violation in the same facility regardless of the duration of
18the second violation is, at a minimum, a Type "B" violation.
19    (b-30) Any violation of this Section by a facility may be
20enforced by an action brought by the Department in the name of
21the People of Illinois for injunctive relief, civil penalties,
22or both injunctive relief and civil penalties. The Department
23may initiate the action upon its own complaint or the
24complaint of any other interested party.
25    (b-35) Any resident who has been administered a
26psychotropic medication in violation of this Section may bring

 

 

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1an action for injunctive relief, civil damages, and costs and
2attorney's fees against any facility responsible for the
3violation.
4    (b-40) An action under this Section must be filed within 2
5years of either the date of discovery of the violation that
6gave rise to the claim or the last date of an instance of a
7noncompliant administration of psychotropic medication to the
8resident, whichever is later.
9    (b-45) A facility subject to action under this Section
10shall be liable for damages of up to $500 for each day after
11discovery of a violation that the facility violates the
12requirements of this Section.
13    (b-55) The rights provided for in this Section are
14cumulative to existing resident rights. No part of this
15Section shall be interpreted as abridging, abrogating, or
16otherwise diminishing existing resident rights or causes of
17action at law or equity.
18    (c) The requirements of this Section are intended to
19control in a conflict with the requirements of Sections 2-102
20and 2-107.2 of the Mental Health and Developmental
21Disabilities Code with respect to the administration of
22psychotropic medication.
23    (d) In this Section only, "licensed nurse" means an
24advanced practice registered nurse, a registered nurse, or a
25licensed practical nurse.
26(Source: P.A. 101-10, eff. 6-5-19; 102-646, eff. 8-27-21.)