Illinois General Assembly - Full Text of HB2853
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Full Text of HB2853  100th General Assembly




State of Illinois
2017 and 2018


Introduced , by Rep. Randy E. Frese


20 ILCS 1705/15.4

    Amends the Mental Health and Developmental Disabilities Administrative Act. Provides that the provision requiring the Department of Human Services to develop a training program for authorized direct care staff to administer medications under the supervision and monitoring of a registered professional nurse applies to (i) all residential (rather than all programs) for persons with a developmental disability in settings of 16 persons or fewer that are funded or licensed by the Department of Human Services and that distribute or administer medications, and (ii) all day programs certified to serve persons with developmental disabilities by the Department of Human Services. Effective January 1, 2018.

LRB100 10309 RLC 20498 b





HB2853LRB100 10309 RLC 20498 b

1    AN ACT concerning State government.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 5. The Mental Health and Developmental
5Disabilities Administrative Act is amended by changing Section
615.4 as follows:
7    (20 ILCS 1705/15.4)
8    Sec. 15.4. Authorization for nursing delegation to permit
9direct care staff to administer medications.
10    (a) This Section applies to (i) all residential programs
11for persons with a developmental disability in settings of 16
12persons or fewer that are funded or licensed by the Department
13of Human Services and that distribute or administer
14medications, and (ii) all intermediate care facilities for
15persons with developmental disabilities with 16 beds or fewer
16that are licensed by the Department of Public Health, and (iii)
17all day programs certified to serve persons with developmental
18disabilities by the Department of Human Services. The
19Department of Human Services shall develop a training program
20for authorized direct care staff to administer medications
21under the supervision and monitoring of a registered
22professional nurse. This training program shall be developed in
23consultation with professional associations representing (i)



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1physicians licensed to practice medicine in all its branches,
2(ii) registered professional nurses, and (iii) pharmacists.
3    (b) For the purposes of this Section:
4    "Authorized direct care staff" means non-licensed persons
5who have successfully completed a medication administration
6training program approved by the Department of Human Services
7and conducted by a nurse-trainer. This authorization is
8specific to an individual receiving service in a specific
9agency and does not transfer to another agency.
10    "Medications" means oral and topical medications, insulin
11in an injectable form, oxygen, epinephrine auto-injectors, and
12vaginal and rectal creams and suppositories. "Oral" includes
13inhalants and medications administered through enteral tubes,
14utilizing aseptic technique. "Topical" includes eye, ear, and
15nasal medications. Any controlled substances must be packaged
16specifically for an identified individual.
17    "Insulin in an injectable form" means a subcutaneous
18injection via an insulin pen pre-filled by the manufacturer.
19Authorized direct care staff may administer insulin, as ordered
20by a physician, advanced practice nurse, or physician
21assistant, if: (i) the staff has successfully completed a
22Department-approved advanced training program specific to
23insulin administration developed in consultation with
24professional associations listed in subsection (a) of this
25Section, and (ii) the staff consults with the registered nurse,
26prior to administration, of any insulin dose that is determined



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1based on a blood glucose test result. The authorized direct
2care staff shall not: (i) calculate the insulin dosage needed
3when the dose is dependent upon a blood glucose test result, or
4(ii) administer insulin to individuals who require blood
5glucose monitoring greater than 3 times daily, unless directed
6to do so by the registered nurse.
7    "Nurse-trainer training program" means a standardized,
8competency-based medication administration train-the-trainer
9program provided by the Department of Human Services and
10conducted by a Department of Human Services master
11nurse-trainer for the purpose of training nurse-trainers to
12train persons employed or under contract to provide direct care
13or treatment to individuals receiving services to administer
14medications and provide self-administration of medication
15training to individuals under the supervision and monitoring of
16the nurse-trainer. The program incorporates adult learning
17styles, teaching strategies, classroom management, and a
18curriculum overview, including the ethical and legal aspects of
19supervising those administering medications.
20    "Self-administration of medications" means an individual
21administers his or her own medications. To be considered
22capable to self-administer their own medication, individuals
23must, at a minimum, be able to identify their medication by
24size, shape, or color, know when they should take the
25medication, and know the amount of medication to be taken each



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1    "Training program" means a standardized medication
2administration training program approved by the Department of
3Human Services and conducted by a registered professional nurse
4for the purpose of training persons employed or under contract
5to provide direct care or treatment to individuals receiving
6services to administer medications and provide
7self-administration of medication training to individuals
8under the delegation and supervision of a nurse-trainer. The
9program incorporates adult learning styles, teaching
10strategies, classroom management, curriculum overview,
11including ethical-legal aspects, and standardized
12competency-based evaluations on administration of medications
13and self-administration of medication training programs.
14    (c) Training and authorization of non-licensed direct care
15staff by nurse-trainers must meet the requirements of this
17        (1) Prior to training non-licensed direct care staff to
18    administer medication, the nurse-trainer shall perform the
19    following for each individual to whom medication will be
20    administered by non-licensed direct care staff:
21            (A) An assessment of the individual's health
22        history and physical and mental status.
23            (B) An evaluation of the medications prescribed.
24        (2) Non-licensed authorized direct care staff shall
25    meet the following criteria:
26            (A) Be 18 years of age or older.



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1            (B) Have completed high school or have a high
2        school equivalency certificate.
3            (C) Have demonstrated functional literacy.
4            (D) Have satisfactorily completed the Health and
5        Safety component of a Department of Human Services
6        authorized direct care staff training program.
7            (E) Have successfully completed the training
8        program, pass the written portion of the comprehensive
9        exam, and score 100% on the competency-based
10        assessment specific to the individual and his or her
11        medications.
12            (F) Have received additional competency-based
13        assessment by the nurse-trainer as deemed necessary by
14        the nurse-trainer whenever a change of medication
15        occurs or a new individual that requires medication
16        administration enters the program.
17        (3) Authorized direct care staff shall be re-evaluated
18    by a nurse-trainer at least annually or more frequently at
19    the discretion of the registered professional nurse. Any
20    necessary retraining shall be to the extent that is
21    necessary to ensure competency of the authorized direct
22    care staff to administer medication.
23        (4) Authorization of direct care staff to administer
24    medication shall be revoked if, in the opinion of the
25    registered professional nurse, the authorized direct care
26    staff is no longer competent to administer medication.



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1        (5) The registered professional nurse shall assess an
2    individual's health status at least annually or more
3    frequently at the discretion of the registered
4    professional nurse.
5    (d) Medication self-administration shall meet the
6following requirements:
7        (1) As part of the normalization process, in order for
8    each individual to attain the highest possible level of
9    independent functioning, all individuals shall be
10    permitted to participate in their total health care
11    program. This program shall include, but not be limited to,
12    individual training in preventive health and
13    self-medication procedures.
14            (A) Every program shall adopt written policies and
15        procedures for assisting individuals in obtaining
16        preventative health and self-medication skills in
17        consultation with a registered professional nurse,
18        advanced practice nurse, physician assistant, or
19        physician licensed to practice medicine in all its
20        branches.
21            (B) Individuals shall be evaluated to determine
22        their ability to self-medicate by the nurse-trainer
23        through the use of the Department's required,
24        standardized screening and assessment instruments.
25            (C) When the results of the screening and
26        assessment indicate an individual not to be capable to



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1        self-administer his or her own medications, programs
2        shall be developed in consultation with the Community
3        Support Team or Interdisciplinary Team to provide
4        individuals with self-medication administration.
5        (2) Each individual shall be presumed to be competent
6    to self-administer medications if:
7            (A) authorized by an order of a physician licensed
8        to practice medicine in all its branches, an advanced
9        practice nurse, or a physician assistant; and
10            (B) approved to self-administer medication by the
11        individual's Community Support Team or
12        Interdisciplinary Team, which includes a registered
13        professional nurse or an advanced practice nurse.
14    (e) Quality Assurance.
15        (1) A registered professional nurse, advanced practice
16    nurse, licensed practical nurse, physician licensed to
17    practice medicine in all its branches, physician
18    assistant, or pharmacist shall review the following for all
19    individuals:
20            (A) Medication orders.
21            (B) Medication labels, including medications
22        listed on the medication administration record for
23        persons who are not self-medicating to ensure the
24        labels match the orders issued by the physician
25        licensed to practice medicine in all its branches,
26        advanced practice nurse, or physician assistant.



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1            (C) Medication administration records for persons
2        who are not self-medicating to ensure that the records
3        are completed appropriately for:
4                (i) medication administered as prescribed;
5                (ii) refusal by the individual; and
6                (iii) full signatures provided for all
7            initials used.
8        (2) Reviews shall occur at least quarterly, but may be
9    done more frequently at the discretion of the registered
10    professional nurse or advanced practice nurse.
11        (3) A quality assurance review of medication errors and
12    data collection for the purpose of monitoring and
13    recommending corrective action shall be conducted within 7
14    days and included in the required annual review.
15    (f) Programs using authorized direct care staff to
16administer medications are responsible for documenting and
17maintaining records on the training that is completed.
18    (g) The absence of this training program constitutes a
19threat to the public interest, safety, and welfare and
20necessitates emergency rulemaking by the Departments of Human
21Services and Public Health under Section 5-45 of the Illinois
22Administrative Procedure Act.
23    (h) Direct care staff who fail to qualify for delegated
24authority to administer medications pursuant to the provisions
25of this Section shall be given additional education and testing
26to meet criteria for delegation authority to administer



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1medications. Any direct care staff person who fails to qualify
2as an authorized direct care staff after initial training and
3testing must within 3 months be given another opportunity for
4retraining and retesting. A direct care staff person who fails
5to meet criteria for delegated authority to administer
6medication, including, but not limited to, failure of the
7written test on 2 occasions shall be given consideration for
8shift transfer or reassignment, if possible. No employee shall
9be terminated for failure to qualify during the 3-month time
10period following initial testing. Refusal to complete training
11and testing required by this Section may be grounds for
12immediate dismissal.
13    (i) No authorized direct care staff person delegated to
14administer medication shall be subject to suspension or
15discharge for errors resulting from the staff person's acts or
16omissions when performing the functions unless the staff
17person's actions or omissions constitute willful and wanton
18conduct. Nothing in this subsection is intended to supersede
19paragraph (4) of subsection (c).
20    (j) A registered professional nurse, advanced practice
21nurse, physician licensed to practice medicine in all its
22branches, or physician assistant shall be on duty or on call at
23all times in any program covered by this Section.
24    (k) The employer shall be responsible for maintaining
25liability insurance for any program covered by this Section.
26    (l) Any direct care staff person who qualifies as



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1authorized direct care staff pursuant to this Section shall be
2granted consideration for a one-time additional salary
3differential. The Department shall determine and provide the
4necessary funding for the differential in the base. This
5subsection (l) is inoperative on and after June 30, 2000.
6(Source: P.A. 98-718, eff. 1-1-15; 98-901, eff. 8-15-14; 99-78,
7eff. 7-20-15; 99-143, eff. 7-27-15; 99-581, eff. 1-1-17.)
8    Section 99. Effective date. This Act takes effect January
91, 2018.