101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB5571

 

Introduced , by Rep. Maurice A. West, II

 

SYNOPSIS AS INTRODUCED:
 
210 ILCS 45/2-106.1

    Amends the Nursing Home Care Act. Provides that the maximum possible period for informed consent to administration of psychotropic medication shall be until: a change in the prescription occurs, either as to type of psychotropic medication or an increase in the dosage, unless the physician's order provides for a change in the type of medication or an increase in dosage (rather that as to type of psychotropic medication or dosage); or a resident's care plan changes. Requires informed consent to be sought from (rather than by) a resident's guardian of the person if one has been named by a court of competent jurisdiction. Effective immediately.


LRB101 17793 CPF 67222 b

 

 

A BILL FOR

 

HB5571LRB101 17793 CPF 67222 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 changing
5Section 2-106.1 as follows:
 
6    (210 ILCS 45/2-106.1)
7    Sec. 2-106.1. Drug treatment.
8    (a) A resident shall not be given unnecessary drugs. An
9unnecessary drug is any drug used in an excessive dose,
10including in duplicative therapy; for excessive duration;
11without adequate monitoring; without adequate indications for
12its use; or in the presence of adverse consequences that
13indicate the drugs should be reduced or discontinued. The
14Department shall adopt, by rule, the standards for unnecessary
15drugs contained in interpretive guidelines issued by the United
16States Department of Health and Human Services for the purposes
17of administering Titles XVIII and XIX of the Social Security
18Act.
19    (b) Except in the case of an emergency, psychotropic
20medication shall not be administered without the informed
21consent of the resident or the resident's surrogate decision
22maker. "Psychotropic medication" means medication that is used
23for or listed as used for psychotropic, antidepressant,

 

 

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1antimanic, or antianxiety behavior modification or behavior
2management purposes in the latest editions of the AMA Drug
3Evaluations or the Physician's Desk Reference. "Emergency" has
4the same meaning as in Section 1-112 of the Nursing Home Care
5Act. A facility shall (i) document the alleged emergency in
6detail, including the facts surrounding the medication's need,
7and (ii) present this documentation to the resident and the
8resident's representative. No later than January 1, 2021, the
9Department shall adopt, by rule, a protocol specifying how
10informed consent for psychotropic medication may be obtained or
11refused. The protocol shall require, at a minimum, a discussion
12between (i) the resident or the resident's surrogate decision
13maker and (ii) the resident's physician, a registered
14pharmacist (who is not a dispensing pharmacist for the facility
15where the resident lives), or a licensed nurse about the
16possible risks and benefits of a recommended medication and the
17use of standardized consent forms designated by the Department.
18The protocol shall include informing the resident, surrogate
19decision maker, or both of the existence of a copy of: the
20resident's care plan; the facility policies and procedures
21adopted in compliance with subsection (b-15) of this Section;
22and a notification that the most recent of the resident's care
23plans and the facility's policies are available to the resident
24or surrogate decision maker upon request. Each form developed
25by the Department (i) shall be written in plain language, (ii)
26shall be able to be downloaded from the Department's official

 

 

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1website, (iii) shall include information specific to the
2psychotropic medication for which consent is being sought, and
3(iv) shall be used for every resident for whom psychotropic
4drugs are prescribed. The Department shall utilize the rules,
5protocols, and forms developed and implemented under the
6Specialized Mental Health Rehabilitation Act of 2013 in effect
7on the effective date of this amendatory Act of the 101st
8General Assembly, except to the extent that this Act requires a
9different procedure, and except that the maximum possible
10period for informed consent shall be until: (1) a change in the
11prescription occurs, either as to type of psychotropic
12medication or an increase in the dosage, unless the physician's
13order provides for a change in the type of medication or an
14increase in dosage; or (2) a resident's care plan changes. The
15Department may further amend the rules after January 1, 2021
16pursuant to existing rulemaking authority. In addition to
17creating those forms, the Department shall approve the use of
18any other informed consent forms that meet criteria developed
19by the Department. At the discretion of the Department,
20informed consent forms may include side effects that the
21Department reasonably believes are more common, with a
22direction that more complete information can be found via a
23link on the Department's website to third-party websites with
24more complete information, such as the United States Food and
25Drug Administration's website. The Department or a facility
26shall incur no liability for information provided on a consent

 

 

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

 

 

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1medication, certifying the personal knowledge of each health
2care professional that the consent was obtained in compliance
3with the requirements of this subsection.
4    (b-5) A facility must obtain voluntary informed consent, in
5writing, from a resident or the resident's surrogate decision
6maker before administering or dispensing a psychotropic
7medication to that resident.
8    (b-10) No facility shall deny continued residency to a
9person on the basis of the person's or resident's, or the
10person's or resident's surrogate decision maker's, refusal of
11the administration of psychotropic medication, unless the
12facility can demonstrate that the resident's refusal would
13place the health and safety of the resident, the facility
14staff, other residents, or visitors at risk.
15    A facility that alleges that the resident's refusal to
16consent to the administration of psychotropic medication will
17place the health and safety of the resident, the facility
18staff, other residents, or visitors at risk must: (1) document
19the alleged risk in detail; (2) present this documentation to
20the resident or the resident's surrogate decision maker, to the
21Department, and to the Office of the State Long Term Care
22Ombudsman; and (3) inform the resident or his or her surrogate
23decision maker of his or her right to appeal to the Department.
24The documentation of the alleged risk shall include a
25description of all nonpharmacological or alternative care
26options attempted and why they were unsuccessful.

 

 

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

 

 

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

 

 

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1    (b-40) An action under this Section must be filed within 2
2years of either the date of discovery of the violation that
3gave rise to the claim or the last date of an instance of a
4noncompliant administration of psychotropic medication to the
5resident, whichever is later.
6    (b-45) A facility subject to action under this Section
7shall be liable for damages of up to $500 for each day after
8discovery of a violation that the facility violates the
9requirements of this Section.
10    (b-55) The rights provided for in this Section are
11cumulative to existing resident rights. No part of this Section
12shall be interpreted as abridging, abrogating, or otherwise
13diminishing existing resident rights or causes of action at law
14or equity.
15    (c) The requirements of this Section are intended to
16control in a conflict with the requirements of Sections 2-102
17and 2-107.2 of the Mental Health and Developmental Disabilities
18Code with respect to the administration of psychotropic
19medication.
20(Source: P.A. 101-10, eff. 6-5-19.)
 
21    Section 99. Effective date. This Act takes effect upon
22becoming law.