97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB1982

 

Introduced 2/10/2011, by Sen. Heather A. Steans

 

SYNOPSIS AS INTRODUCED:
 
210 ILCS 45/1-114.2 new
210 ILCS 45/2-106.1
210 ILCS 45/2-106.2 new
210 ILCS 45/2-202  from Ch. 111 1/2, par. 4152-202
405 ILCS 5/2-107  from Ch. 91 1/2, par. 2-107

    Amends the Nursing Home Care Act. Sets forth a definition for "institution for mental diseases". Provides that electroconvulsive therapy may only be administered to a resident who has provided informed consent pursuant the Mental Health and Developmental Disabilities Code or under a Court order pursuant to the Mental Health and Developmental Disabilities Code. Provides that no adult may be admitted to institutions for mental diseases or to certain sections of nursing homes except as provided for in certain provisions of the Mental Health and Developmental Disabilities Code. Makes other changes. Amends the Mental Health and Developmental Disabilities Code to make changes in provisions concerning emergency administration of psychotropic medication. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB1982LRB097 07037 RPM 47130 b

1    AN ACT concerning health facilities.
 
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
5Sections 2-106.1 and 2-202 and by adding Sections 1-114.2 and
62-106.2 as follows:
 
7    (210 ILCS 45/1-114.2 new)
8    Sec. 1-114.2. Institution for mental diseases.
9"Institution for mental diseases" means a nursing facility that
10is primarily engaged in providing diagnosis, treatment, or care
11of persons with mental diseases, including medical attention,
12nursing care, and related services.
 
13    (210 ILCS 45/2-106.1)
14    Sec. 2-106.1. Drug treatment.
15    (a) A resident shall not be given unnecessary drugs. An
16unnecessary drug is any drug used in an excessive dose,
17including in duplicative therapy; for excessive duration;
18without adequate monitoring; without adequate indications for
19its use; or in the presence of adverse consequences that
20indicate the drugs should be reduced or discontinued. The
21Department shall adopt, by rule, the standards for unnecessary
22drugs contained in interpretive guidelines issued by the United

 

 

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1States Department of Health and Human Services for the purposes
2of administering Titles XVIII and XIX of the Social Security
3Act.
4    (b) Psychotropic medication shall not be prescribed
5without the informed consent of the resident except as provided
6in subsection (d) of this Section , the resident's guardian, or
7other authorized representative. "Psychotropic medication"
8means medication that is used for or listed as used for
9antipsychotic, antidepressant, antimanic, or antianxiety
10behavior modification or behavior management purposes in the
11latest editions of the AMA Drug Evaluations or the Physician's
12Desk Reference. The Department shall adopt, by rule, a protocol
13specifying how informed consent for psychotropic medication
14may be obtained or refused. The protocol shall require, at a
15minimum, a discussion between (i) the resident or the
16resident's authorized representative and (ii) the resident's
17physician, a registered pharmacist (who is not a dispensing
18pharmacist for the facility where the resident lives), or a
19licensed nurse about the possible risks and benefits of a
20recommended medication and the use of standardized consent
21forms designated by the Department. Each form developed by the
22Department (i) shall be written in plain language, (ii) shall
23be able to be downloaded from the Department's official
24website, (iii) shall include information specific to the
25psychotropic medication for which consent is being sought, and
26(iv) shall be used for every resident for whom psychotropic

 

 

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1drugs are prescribed. In addition to creating those forms, the
2Department shall approve the use of any other informed consent
3forms that meet criteria developed by the Department.
4    In addition to any other penalty prescribed by law, a
5facility that is found to have violated this subsection, or the
6federal certification requirement that informed consent be
7obtained before administering a psychotropic medication, shall
8thereafter be required to obtain the signatures of 2 licensed
9health care professionals on every form purporting to give
10informed consent for the administration of a psychotropic
11medication, certifying the personal knowledge of each health
12care professional that the consent was obtained in compliance
13with the requirements of this subsection.
14    (c) The requirements of this Section are intended to
15control in a conflict with the requirements of Sections 2-102
16and 2-107.2 of the Mental Health and Developmental Disabilities
17Code with respect to the administration of psychotropic
18medication.
19    (d) If the resident is unable to give informed consent to
20psychotropic medication pursuant to subsection (b) of this
21Section, then such medications may only be administered
22pursuant to Sections 2-107 or 2-107.1 of the Mental Health and
23Developmental Disabilities Code.
24(Source: P.A. 95-331, eff. 8-21-07; 96-1372, eff. 7-29-10.)
 
25    (210 ILCS 45/2-106.2 new)

 

 

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1    Sec. 2-106.2. Electroconvulsive therapy. Electroconvulsive
2therapy may only be administered to a resident who has provided
3informed consent pursuant to Section 2-102 of the Mental Health
4and Developmental Disabilities Code or under a court order
5pursuant to Section 2-107.1 of the Mental Health and
6Developmental Disabilities Code.
 
7    (210 ILCS 45/2-202)  (from Ch. 111 1/2, par. 4152-202)
8    Sec. 2-202. (a) Before a person is admitted to a facility,
9or at the expiration of the period of previous contract, or
10when the source of payment for the resident's care changes from
11private to public funds or from public to private funds, a
12written contract shall be executed between a licensee and the
13following in order of priority:
14        (1) the person, or if the person is a minor, his parent
15    or guardian; or
16        (2) the person's guardian, if any, or agent, if any, as
17    defined in Section 2-3 of the Illinois Power of Attorney
18    Act; or
19        (3) a member of the person's immediate family.
20    An adult person shall be presumed to have the capacity to
21contract for admission to a long term care facility unless he
22has been adjudicated a "disabled person" within the meaning of
23Section 11a-2 of the Probate Act of 1975, or unless a petition
24for such an adjudication is pending in a circuit court of
25Illinois.

 

 

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1    If there is no guardian, agent or member of the person's
2immediate family available, able or willing to execute the
3contract required by this Section and a physician determines
4that a person is so disabled as to be unable to consent to
5placement in a facility, or if a person has already been found
6to be a "disabled person", but no order has been entered
7allowing residential placement of the person, that person may
8be admitted to a facility before the execution of a contract
9required by this Section; provided that a petition for
10guardianship or for modification of guardianship is filed
11within 15 days of the person's admission to a facility, and
12provided further that such a contract is executed within 10
13days of the disposition of the petition.
14    No adult shall be admitted to a facility if he objects,
15orally or in writing, to such admission, except as otherwise
16provided in Chapters III and IV of the Mental Health and
17Developmental Disabilities Code or Section 11a-14.1 of the
18Probate Act of 1975. Notwithstanding any other provision in
19this Act, no adult may be admitted to institutions for mental
20diseases or to those sections of nursing homes that are
21primarily engaged in providing diagnosis, treatment, or care of
22persons with mental diseases, except as provided for in
23Chapters III and IV of the Mental Health and Developmental
24Disabilities Code.
25    If a person has not executed a contract as required by this
26Section, then such a contract shall be executed on or before

 

 

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1July 1, 1981, or within 10 days after the disposition of a
2petition for guardianship or modification of guardianship that
3was filed prior to July 1, 1981, whichever is later.
4    Before a licensee enters a contract under this Section, it
5shall provide the prospective resident and his guardian, if
6any, with written notice of the licensee's policy regarding
7discharge of a resident whose private funds for payment of care
8are exhausted.
9    (b) A resident shall not be discharged or transferred at
10the expiration of the term of a contract, except as provided in
11Sections 3-401 through 3-423.
12    (c) At the time of the resident's admission to the
13facility, a copy of the contract shall be given to the
14resident, his guardian, if any, and any other person who
15executed the contract.
16    (d) A copy of the contract for a resident who is supported
17by nonpublic funds other than the resident's own funds shall be
18made available to the person providing the funds for the
19resident's support.
20    (e) The original or a copy of the contract shall be
21maintained in the facility and be made available upon request
22to representatives of the Department and the Department of
23Healthcare and Family Services.
24    (f) The contract shall be written in clear and unambiguous
25language and shall be printed in not less than 12-point type.
26The general form of the contract shall be prescribed by the

 

 

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1Department.
2    (g) The contract shall specify:
3        (1) the term of the contract;
4        (2) the services to be provided under the contract and
5    the charges for the services;
6        (3) the services that may be provided to supplement the
7    contract and the charges for the services;
8        (4) the sources liable for payments due under the
9    contract;
10        (5) the amount of deposit paid; and
11        (6) the rights, duties and obligations of the resident,
12    except that the specification of a resident's rights may be
13    furnished on a separate document which complies with the
14    requirements of Section 2-211.
15    (h) The contract shall designate the name of the resident's
16representative, if any. The resident shall provide the facility
17with a copy of the written agreement between the resident and
18the resident's representative which authorizes the resident's
19representative to inspect and copy the resident's records and
20authorizes the resident's representative to execute the
21contract on behalf of the resident required by this Section.
22    (i) The contract shall provide that if the resident is
23compelled by a change in physical or mental health to leave the
24facility, the contract and all obligations under it shall
25terminate on 7 days notice. No prior notice of termination of
26the contract shall be required, however, in the case of a

 

 

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1resident's death. The contract shall also provide that in all
2other situations, a resident may terminate the contract and all
3obligations under it with 30 days notice. All charges shall be
4prorated as of the date on which the contract terminates, and,
5if any payments have been made in advance, the excess shall be
6refunded to the resident. This provision shall not apply to
7life-care contracts through which a facility agrees to provide
8maintenance and care for a resident throughout the remainder of
9his life nor to continuing-care contracts through which a
10facility agrees to supplement all available forms of financial
11support in providing maintenance and care for a resident
12throughout the remainder of his life.
13    (j) In addition to all other contract specifications
14contained in this Section admission contracts shall also
15specify:
16        (1) whether the facility accepts Medicaid clients;
17        (2) whether the facility requires a deposit of the
18    resident or his family prior to the establishment of
19    Medicaid eligibility;
20        (3) in the event that a deposit is required, a clear
21    and concise statement of the procedure to be followed for
22    the return of such deposit to the resident or the
23    appropriate family member or guardian of the person;
24        (4) that all deposits made to a facility by a resident,
25    or on behalf of a resident, shall be returned by the
26    facility within 30 days of the establishment of Medicaid

 

 

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1    eligibility, unless such deposits must be drawn upon or
2    encumbered in accordance with Medicaid eligibility
3    requirements established by the Department of Healthcare
4    and Family Services.
5    (k) It shall be a business offense for a facility to
6knowingly and intentionally both retain a resident's deposit
7and accept Medicaid payments on behalf of that resident.
8(Source: P.A. 95-331, eff. 8-21-07.)
 
9    Section 10. The Mental Health and Developmental
10Disabilities Code is amended by changing Section 2-107 as
11follows:
 
12    (405 ILCS 5/2-107)  (from Ch. 91 1/2, par. 2-107)
13    Sec. 2-107. Refusal of services; informing of risks.
14    (a) An adult recipient of services or the recipient's
15guardian, if the recipient is under guardianship, and the
16recipient's substitute decision maker, if any, must be informed
17of the recipient's right to refuse medication or
18electroconvulsive therapy. The recipient and the recipient's
19guardian or substitute decision maker shall be given the
20opportunity to refuse generally accepted mental health or
21developmental disability services, including but not limited
22to medication or electroconvulsive therapy. If such services
23are refused, they shall not be given unless such services are
24necessary to prevent the recipient from causing serious and

 

 

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1imminent physical harm to the recipient or others and no less
2restrictive alternative is available. The facility director
3shall inform a recipient, guardian, or substitute decision
4maker, if any, who refuses such services of alternate services
5available and the risks of such alternate services, as well as
6the possible consequences to the recipient of refusal of such
7services.
8    (b) Psychotropic medication or electroconvulsive therapy
9may be administered under this Section for up to 24 hours only
10if the circumstances leading up to the need for emergency
11treatment are set forth in writing in the recipient's record.
12    (c) Administration of medication or electroconvulsive
13therapy may not be continued unless the need for such treatment
14is redetermined at least every 24 hours based upon a personal
15examination of the recipient by a physician or a nurse under
16the supervision of a physician and the circumstances
17demonstrating that need are set forth in writing in the
18recipient's record.
19    (d) Neither psychotropic medication nor electroconvulsive
20therapy may be administered under this Section for a period in
21excess of 72 hours, excluding Saturdays, Sundays, and holidays,
22unless a petition is filed under Section 2-107.1 and the
23treatment continues to be necessary under subsection (a) of
24this Section. Once the petition has been filed, treatment may
25continue in compliance with subsections (a), (b), and (c) of
26this Section until the final outcome of the hearing on the

 

 

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1petition.
2    (e) The Department shall issue rules designed to insure
3that in State-operated mental health facilities psychotropic
4medication and electroconvulsive therapy are administered in
5accordance with this Section and only when appropriately
6authorized and monitored by a physician or a nurse under the
7supervision of a physician in accordance with accepted medical
8practice. The facility director of each mental health facility
9not operated by the State shall issue rules designed to insure
10that in that facility psychotropic medication and
11electroconvulsive therapy are administered in accordance with
12this Section and only when appropriately authorized and
13monitored by a physician or a nurse under the supervision of a
14physician in accordance with accepted medical practice. Such
15rules shall be available for public inspection and copying
16during normal business hours.
17    (f) The provisions of this Section with respect to the
18emergency administration of psychotropic medication and
19electroconvulsive therapy do not apply to facilities licensed
20under the Nursing Home Care Act or the MR/DD Community Care
21Act. The provisions of this Section concerning the emergency
22administration of psychotropic medication do not apply to
23facilities licensed under the MR/DD Community Care Act.
24    (g) Under no circumstances may long-acting psychotropic
25medications be administered under this Section.
26    (h) Whenever psychotropic medication or electroconvulsive

 

 

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1therapy is refused pursuant to subsection (a) of this Section
2at least once that day, the physician shall determine and state
3in writing the reasons why the recipient did not meet the
4criteria for administration of medication or electroconvulsive
5therapy under subsection (a) and whether the recipient meets
6the standard for administration of psychotropic medication or
7electroconvulsive therapy under Section 2-107.1 of this Code.
8If the physician determines that the recipient meets the
9standard for administration of psychotropic medication or
10electroconvulsive therapy under Section 2-107.1, the facility
11director or his or her designee shall petition the court for
12administration of psychotropic medication or electroconvulsive
13therapy pursuant to that Section unless the facility director
14or his or her designee states in writing in the recipient's
15record why the filing of such a petition is not warranted. This
16subsection (h) applies only to State-operated mental health
17facilities.
18    (i) The Department shall conduct annual trainings for all
19physicians and registered nurses working in State-operated
20mental health facilities on the appropriate use of emergency
21administration of psychotropic medication and
22electroconvulsive therapy, standards for their use, and the
23methods of authorization under this Section.
24(Source: P.A. 95-172, eff. 8-14-07; 96-339, eff. 7-1-10.)
 
25    Section 99. Effective date. This Act takes effect upon
26becoming law.