Public Act 103-0890
 
SB0860 EnrolledLRB103 03319 KTG 48325 b

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

Effective Date:  1/1/2025