Illinois General Assembly - Full Text of HB2383
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Full Text of HB2383  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. Provides that the training program for authorized direct care staff shall include educational and oversight components for staff who work in day programs that are similar to those for staff who work in residential programs. Effective January 1, 2018.

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HB2383LRB100 00361 RLC 10365 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. The training program for authorized direct
23care staff shall include educational and oversight components



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



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1insulin administration developed in consultation with
2professional associations listed in subsection (a) of this
3Section, and (ii) the staff consults with the registered nurse,
4prior to administration, of any insulin dose that is determined
5based on a blood glucose test result. The authorized direct
6care staff shall not: (i) calculate the insulin dosage needed
7when the dose is dependent upon a blood glucose test result, or
8(ii) administer insulin to individuals who require blood
9glucose monitoring greater than 3 times daily, unless directed
10to do so by the registered nurse.
11    "Nurse-trainer training program" means a standardized,
12competency-based medication administration train-the-trainer
13program provided by the Department of Human Services and
14conducted by a Department of Human Services master
15nurse-trainer for the purpose of training nurse-trainers to
16train persons employed or under contract to provide direct care
17or treatment to individuals receiving services to administer
18medications and provide self-administration of medication
19training to individuals under the supervision and monitoring of
20the nurse-trainer. The program incorporates adult learning
21styles, teaching strategies, classroom management, and a
22curriculum overview, including the ethical and legal aspects of
23supervising those administering medications.
24    "Self-administration of medications" means an individual
25administers his or her own medications. To be considered
26capable to self-administer their own medication, individuals



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1must, at a minimum, be able to identify their medication by
2size, shape, or color, know when they should take the
3medication, and know the amount of medication to be taken each
5    "Training program" means a standardized medication
6administration training program approved by the Department of
7Human Services and conducted by a registered professional nurse
8for the purpose of training persons employed or under contract
9to provide direct care or treatment to individuals receiving
10services to administer medications and provide
11self-administration of medication training to individuals
12under the delegation and supervision of a nurse-trainer. The
13program incorporates adult learning styles, teaching
14strategies, classroom management, curriculum overview,
15including ethical-legal aspects, and standardized
16competency-based evaluations on administration of medications
17and self-administration of medication training programs.
18    (c) Training and authorization of non-licensed direct care
19staff by nurse-trainers must meet the requirements of this
21        (1) Prior to training non-licensed direct care staff to
22    administer medication, the nurse-trainer shall perform the
23    following for each individual to whom medication will be
24    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 high
6        school equivalency certificate.
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 specific to the individual and his or her
15        medications.
16            (F) Have received additional competency-based
17        assessment by the nurse-trainer as deemed necessary by
18        the nurse-trainer whenever a change of medication
19        occurs or a new individual that requires medication
20        administration enters the program.
21        (3) Authorized direct care staff shall be re-evaluated
22    by a nurse-trainer at least annually or more frequently at
23    the discretion of the registered professional nurse. Any
24    necessary retraining shall be to the extent that is
25    necessary to ensure competency of the authorized direct
26    care staff to administer medication.



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1        (4) Authorization of direct care staff to administer
2    medication shall be revoked if, in the opinion of the
3    registered professional nurse, the authorized direct care
4    staff is no longer competent to administer medication.
5        (5) The registered professional nurse shall assess an
6    individual's health status at least annually or more
7    frequently at the discretion of the registered
8    professional nurse.
9    (d) Medication self-administration shall meet the
10following requirements:
11        (1) As part of the normalization process, in order for
12    each individual to attain the highest possible level of
13    independent functioning, all individuals shall be
14    permitted to participate in their total health care
15    program. This program shall include, but not be limited to,
16    individual training in preventive health and
17    self-medication procedures.
18            (A) Every program shall adopt written policies and
19        procedures for assisting individuals in obtaining
20        preventative health and self-medication skills in
21        consultation with a registered professional nurse,
22        advanced practice nurse, physician assistant, or
23        physician licensed to practice medicine in all its
24        branches.
25            (B) Individuals shall be evaluated to determine
26        their ability to self-medicate by the nurse-trainer



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



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



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



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1all times in any program covered by this Section.
2    (k) The employer shall be responsible for maintaining
3liability insurance for any program covered by this Section.
4    (l) Any direct care staff person who qualifies as
5authorized direct care staff pursuant to this Section shall be
6granted consideration for a one-time additional salary
7differential. The Department shall determine and provide the
8necessary funding for the differential in the base. This
9subsection (l) is inoperative on and after June 30, 2000.
10(Source: P.A. 98-718, eff. 1-1-15; 98-901, eff. 8-15-14; 99-78,
11eff. 7-20-15; 99-143, eff. 7-27-15; 99-581, eff. 1-1-17.)
12    Section 99. Effective date. This Act takes effect January
131, 2018.