SB1497 EnrolledLRB103 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 or, if the resident is unable to consent, the
9resident's guardian or authorized representative, or the need
10for that device must be physically demonstrated by the
11resident and documented in the resident's care plan. The
12physically demonstrated need of the resident for a device used
13for positioning must be revisited in every comprehensive
14assessment of the resident.
15    The Department shall by rule, designate certain devices as
16restraints, including at least all those devices which have
17been determined to be restraints by the United States
18Department of Health and Human Services in interpretive
19guidelines issued for the purposes of administering Titles
20XVIII and XIX of the Social Security Act.
21    (b) Neither restraints nor confinements shall be employed
22for the purpose of punishment or for the convenience of any
23facility personnel. No restraints or confinements shall be
24employed except as ordered by a physician who documents the
25need for such restraints or confinements in the resident's
26clinical record.

 

 

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

 

 

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1approves the notice. If the resident so chooses, the facility
2shall make the notification within 24 hours, including any
3information about the period of time that the restraint is to
4be used. Whenever the Guardianship and Advocacy Commission is
5notified that a resident has been restrained, it shall contact
6the resident to determine the circumstances of the restraint
7and whether further action is warranted.
8    (f) Whenever a restraint is used on a resident whose
9primary mode of communication is sign language, the resident
10shall be permitted to have his or her hands free from restraint
11for brief periods each hour, except when this freedom may
12result in physical harm to the resident or others.
13    (g) The requirements of this Section are intended to
14control in any conflict with the requirements of Sections
151-126 and 2-108 of the Mental Health and Developmental
16Disabilities Code.
17(Source: P.A. 97-135, eff. 7-14-11.)
 
18    (210 ILCS 45/2-106.1)
19    Sec. 2-106.1. Drug treatment.
20    (a) A resident shall not be given unnecessary drugs. An
21unnecessary drug is any drug used in an excessive dose,
22including in duplicative therapy; for excessive duration;
23without adequate monitoring; without adequate indications for
24its use; or in the presence of adverse consequences that
25indicate the drugs should be reduced or discontinued. The

 

 

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1Department shall adopt, by rule, the standards for unnecessary
2drugs contained in interpretive guidelines issued by the
3United States Department of Health and Human Services for the
4purposes of administering Titles XVIII and XIX of the Social
5Security Act.
6    (b) State laws, regulations, and policies related to
7psychotropic medication are intended to ensure psychotropic
8medications are used only when the medication is appropriate
9to treat a resident's specific, diagnosed, and documented
10condition and the medication is beneficial to the resident, as
11demonstrated by monitoring and documentation of the resident's
12response to the medication.
13    (b-3) Except in the case of an emergency, psychotropic
14medication shall not be administered without the informed
15consent of the resident or the resident's surrogate decision
16maker. Psychotropic medication shall only be given in both
17emergency and nonemergency situations if the diagnosis of the
18resident supports the benefit of the medication and clinical
19documentation in the resident's medical record supports the
20benefit of the medication over the contraindications related
21to other prescribed medications. "Psychotropic medication"
22means medication that is used for or listed as used for
23psychotropic, antidepressant, antimanic, or antianxiety
24behavior modification or behavior management purposes in the
25latest editions of the AMA Drug Evaluations or the Physician's
26Desk Reference. "Emergency" has the same meaning as in Section

 

 

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11-112 of the Nursing Home Care Act. A facility shall (i)
2document the alleged emergency in detail, including the facts
3surrounding the medication's need, and (ii) present this
4documentation to the resident and the resident's
5representative. The Department shall adopt, by rule, a
6protocol specifying how informed consent for psychotropic
7medication may be obtained or refused. The protocol shall
8require, at a minimum, a discussion between (i) the resident
9or the resident's surrogate decision maker and (ii) the
10resident's physician, a registered pharmacist, or a licensed
11nurse about the possible risks and benefits of a recommended
12medication and the use of standardized consent forms
13designated by the Department. The protocol shall include
14informing the resident, surrogate decision maker, or both of
15the existence of a copy of: the resident's care plan; the
16facility policies and procedures adopted in compliance with
17subsection (b-15) of this Section; and a notification that the
18most recent of the resident's care plans and the facility's
19policies are available to the resident or surrogate decision
20maker upon request. Each form designated or developed by the
21Department (i) shall be written in plain language, (ii) shall
22be able to be downloaded from the Department's official
23website or another website designated by the Department, (iii)
24shall include information specific to the psychotropic
25medication for which consent is being sought, and (iv) shall
26be used for every resident for whom psychotropic drugs are

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1(Source: P.A. 101-10, eff. 6-5-19; 102-646, eff. 8-27-21.)