HB4154 93RD GENERAL ASSEMBLY

LRB093 14689 DRJ 42024 b

93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB4154

Introduced 1/21/2004, by Elizabeth Coulson - Tom Cross - Eileen Lyons - Kathleen A. Ryg - Karen A. Yarbrough, et al.

SYNOPSIS AS INTRODUCED:

New Act
30 ILCS 805/8.28 new
225 ILCS 65/5-15
225 ILCS 95/5	from Ch. 111, par. 4605

Creates the Care of Students with Diabetes Act and amends the Nursing and Advanced Practice Nursing Act and the Physician Assistant Practice Act of 1987. Requires the State Board of Education, in consultation with the Department of Public Health, to adopt guidelines that must meet or exceed those set by the American Diabetes Association for the management of children with diabetes in the school or day care setting for the training of school employees. Requires school districts and governing bodies of charter and private elementary and secondary schools to ensure that training is provided to at least 3 school employees at each school attended by a student with diabetes. Requires a medical management plan for each student who seeks care for diabetes at school. Establishes standards for the care of students with diabetes. Establishes immunity from civil liability in connection with activities authorized under the Care of Students with Diabetes Act. Provides that neither the Nursing and Advanced Practice Nursing Act nor the Physician Assistant Practice Act of 1987 prohibits the activities authorized under the Care of Students with Diabetes Act. Amends the State Mandates Act to provide that no reimbursement by the State is required for the implementation of any mandate created by the Care of Students with Diabetes Act. Effective immediately.

FISCAL NOTE ACT MAY APPLY

STATE MANDATES ACT MAY REQUIRE REIMBURSEMENT

A BILL FOR

AN ACT concerning schools.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Care of Students with Diabetes Act.

Section 5. Legislative findings. The General Assembly finds as follows:

(1) Diabetes is a serious chronic disease that interferes with the body's ability to produce or use insulin, impairing the body's ability to metabolize food. Diabetes must be managed 24 hours a day in order to (i) avoid the potentially life-threatening short-term consequences of blood sugar levels that are either too high or too low and (ii) avoid or delay the serious long-term complications of high blood sugar levels that include blindness, amputation, heart disease, and kidney failure.

(2) In order to manage their disease, students with diabetes must have access to the means to balance food, medications, and physical activity levels while at school and at school-related activities.

(3) The school nurse is the most appropriate person in the school setting to provide care for a student with diabetes. Many schools in Illinois, however, do not have a full-time nurse. Moreover, even if a nurse is assigned to a school on a full-time basis, the nurse will not always be available during the school day, during extracurricular activities, or on field trips.

(4) Because diabetes management is needed at all times, additional school personnel need to be prepared to provide diabetes care at school and all school-related activities in order for students with diabetes to be medically safe and have the same access to educational opportunities as all other students in Illinois.

(5) Because of the significant number of students with Type I diabetes and the increasing prevalence of Type II diabetes, the effect of diabetes on a student's ability to learn, and the risk for serious long-term and short-term medical complications, the General Assembly deems it in the public interest to enact this Act.

Section 10. Definitions. In this Act:

"Medical management plan" means a document that (i) is developed by the parent or guardian of a student with diabetes and the student's personal health care team, (ii) sets out the health services needed by the student at school, and (iii) is signed by the parent or guardian and the student's personal health care team.

"School" means a primary or secondary public, charter, or private school located in this State.

"School employee" means a person who is employed by a public school district or private school, a person who is employed by a local health department and assigned to a school, or a person who contracts with a school or school district to perform services in connection with the care of students with diabetes.

"Student's personal health care team" means the health care professionals with expertise in diabetes with whom the student regularly consults for the management and treatment of his or her diabetes.

"Trained diabetes care provider" means a school employee who is trained in accordance with the guidelines adopted under Section 15.

Section 15. Training of diabetes care providers.

(a) The State Board of Education, in consultation with the Department of Public Health, shall adopt guidelines that must meet or exceed those set by the American Diabetes Association for the management of children with diabetes in the school or day care setting for the training of school employees. In developing the guidelines, the Board shall solicit recommendations from at least the following: the American Diabetes Association; the American Association of Diabetes Educators; the Illinois State Medical Society; the Illinois Chapter of the American Academy of Pediatrics; the Illinois Nurses Association; and the Illinois Association of School Nurses. The training guidelines shall provide for instruction in the following:

(1) Recognizing and treating hypoglycemia and hyperglycemia.

(2) Understanding the appropriate actions to take when a student's blood glucose levels are outside the target ranges indicated by the student's medical management plan.

(3) Understanding physician instructions concerning diabetes medication drug dosage, frequency, and manner of administration.

(4) Performing finger-stick blood glucose checking and ketone checking, and recording the results.

(5) Administering glucagon and insulin, and recording the results.

(6) Understanding recommended schedules and food intake for meals and snacks, the effect of physical activity on blood glucose levels, and actions to be implemented in the case of schedule disruption.

A trained diabetes care provider need not be a licensed or certified health care professional.

(b) The Board shall adopt the training guidelines no later than January 1, 2005.

(c) Every public school district, and every governing body of a charter or private school, shall ensure that the training described in subsection (a) is provided, at a minimum, to 3 school employees at each school that is attended by a student with diabetes. If a school has a school nurse, the nurse shall be one of the employees to whom the training is provided.

(d) The training described in subsection (a) shall be provided annually by a health care professional with expertise in diabetes and shall take place (i) before the commencement of each school year or (ii) as needed when a student with diabetes is newly enrolled at a school or a student is newly diagnosed with diabetes.

(e) Every public school district, and every governing body of a charter or private school, shall provide training in the following to all bus drivers responsible for the transportation of a student with diabetes:

(1) The recognition of hypoglycemia and hyperglycemia.

(2) Actions to take in response to emergency situations.

Section 20. Medical management plan. The parent or guardian of each student with diabetes who seeks diabetes care while at school must submit a medical management plan to the school prior to the beginning of each school year. School personnel, as designated by the public school district or by the governing body of a charter or private school, must review the plan before the beginning of each school year or upon the enrollment of the student or the diagnosis of the student's diabetes.

Section 25. Required care.

(a) In accordance with the request of a parent or guardian of a student with diabetes and the student's medical management plan, trained diabetes care providers shall perform functions that include, but need not be limited to, the following:

(1) Responding to blood glucose levels that are outside the student's target range.

(2) Administering glucagon.

(3) Administering insulin, or assisting a student in administering insulin, through the insulin delivery system that the student uses.

(4) Providing oral diabetes medications.

(5) Checking and recording blood glucose levels and ketone levels, or assisting a student in such checking and recording.

(6) Following instructions regarding meals, snacks, and physical activity.

(b) The school nurse assigned to a particular school shall coordinate the provision of diabetes care at that school in accordance with the student's medical management plan and shall serve as the lead trained diabetes care provider at that school.

(c) At each school attended by a student with diabetes, at least one of the school's trained diabetes care providers must be on site and available to provide care to each student with diabetes as set forth in subsection (a). Such a person must be on site and available:

(1) During regular school hours.

(2) During school sponsored, before school and after school care programs.

(3) During field trips.

(4) During extracurricular activities.

(5) On buses when the bus driver has not completed the necessary training.

(d) There must be trained diabetes care providers at each school in which a student with diabetes is enrolled, and a student's choice of schools may not be restricted in any way because the student has diabetes.

(e) The activities set fourth in subsection (a) do not constitute the practice of nursing and are exempt from all applicable statutory or regulatory provisions that restrict the activities that may be delegated to a person who is not a licensed health care professional.

Section 30. Independent monitoring and treatment. Upon the written request of the student's parent or guardian and authorization by the student's medical management plan, a student with diabetes shall be permitted to do the following in the classroom, in any area of the school or school grounds, and at any school-related activity or event:

(1) Perform blood glucose checks.

(2) Administer insulin through the insulin delivery system that the student uses.

(3) Treat hypoglycemia and hyperglycemia, and otherwise attend to the care and management of his or her diabetes.

(4) Possess on his or her person, at all times, the supplies and equipment necessary to perform the monitoring and treatment functions described in paragraphs (1) through (3).

Section 35. Civil immunity. A physician, nurse, school employee, public school district, or governing body of a charter or private school is not liable for civil damages as a result of the actions authorized by this Act when those actions are taken in the same manner as a reasonably prudent person would have acted under the same or similar circumstances.

Section 90. The State Mandates Act is amended by adding Section 8.28 as follows:

(30 ILCS 805/8.28 new)

Sec. 8.28. Exempt mandate. Notwithstanding Sections 6 and 8 of this Act, no reimbursement by the State is required for the implementation of any mandate created by the Care of Students with Diabetes Act.

Section 93. The Nursing and Advanced Practice Nursing Act is amended by changing Section 5-15 as follows:

(225 ILCS 65/5-15)

(Section scheduled to be repealed on January 1, 2008)

Sec. 5-15. Policy; application of Act. For the protection of life and the promotion of health, and the prevention of illness and communicable diseases, any person practicing or offering to practice professional and practical nursing in Illinois shall submit evidence that he or she is qualified to practice, and shall be licensed as provided under this Act. No person shall practice or offer to practice professional or practical nursing in Illinois or use any title, sign, card or device to indicate that such a person is practicing professional or practical nursing unless such person has been licensed under the provisions of this Act.

This Act does not prohibit the following:

(a) The practice of nursing in Federal employment in the discharge of the employee's duties by a person who is employed by the United States government or any bureau, division or agency thereof and is a legally qualified and licensed nurse of another state or territory and not in conflict with Sections 10-5, 10-30, and 10-45 of this Act.

(b) Nursing that is included in their program of study by students enrolled in programs of nursing or in current nurse practice update courses approved by the Department.

(c) The furnishing of nursing assistance in an emergency.

(d) The practice of nursing by a nurse who holds an active license in another state when providing services to patients in Illinois during a bonafide emergency or in immediate preparation for or during interstate transit.

(e) The incidental care of the sick by members of the family, domestic servants or housekeepers, or care of the sick where treatment is by prayer or spiritual means.

(f) Persons from being employed as nursing aides, attendants, orderlies, and other auxiliary workers in private homes, long term care facilities, nurseries, hospitals or other institutions.

(g) The practice of practical nursing by one who has applied in writing to the Department in form and substance satisfactory to the Department, for a license as a licensed practical nurse and who has complied with all the provisions under Section 10-30, except the passing of an examination to be eligible to receive such license, until: the decision of the Department that the applicant has failed to pass the next available examination authorized by the Department or has failed, without an approved excuse, to take the next available examination authorized by the Department or until the withdrawal of the application, but not to exceed 3 months. An applicant practicing practical nursing under this Section who passes the examination, however, may continue to practice under this Section until such time as he or she receives his or her license to practice or until the Department notifies him or her that the license has been denied. No applicant for licensure practicing under the provisions of this paragraph shall practice practical nursing except under the direct supervision of a registered professional nurse licensed under this Act or a licensed physician, dentist or podiatrist. In no instance shall any such applicant practice or be employed in any supervisory capacity.

(h) The practice of practical nursing by one who is a licensed practical nurse under the laws of another U.S. jurisdiction and has applied in writing to the Department, in form and substance satisfactory to the Department, for a license as a licensed practical nurse and who is qualified to receive such license under Section 10-30, until (1) the expiration of 6 months after the filing of such written application, (2) the withdrawal of such application, or (3) the denial of such application by the Department.

(i) The practice of professional nursing by one who has applied in writing to the Department in form and substance satisfactory to the Department for a license as a registered professional nurse and has complied with all the provisions under Section 10-30 except the passing of an examination to be eligible to receive such license, until the decision of the Department that the applicant has failed to pass the next available examination authorized by the Department or has failed, without an approved excuse, to take the next available examination authorized by the Department or until the withdrawal of the application, but not to exceed 3 months. An applicant practicing professional nursing under this Section who passes the examination, however, may continue to practice under this Section until such time as he or she receives his or her license to practice or until the Department notifies him or her that the license has been denied. No applicant for licensure practicing under the provisions of this paragraph shall practice professional nursing except under the direct supervision of a registered professional nurse licensed under this Act. In no instance shall any such applicant practice or be employed in any supervisory capacity.

(j) The practice of professional nursing by one who is a registered professional nurse under the laws of another state, territory of the United States or country and has applied in writing to the Department, in form and substance satisfactory to the Department, for a license as a registered professional nurse and who is qualified to receive such license under Section 10-30, until (1) the expiration of 6 months after the filing of such written application, (2) the withdrawal of such application, or (3) the denial of such application by the Department.

(k) The practice of professional nursing that is included in a program of study by one who is a registered professional nurse under the laws of another state or territory of the United States or foreign country, territory or province and who is enrolled in a graduate nursing education program or a program for the completion of a baccalaureate nursing degree in this State, which includes clinical supervision by faculty as determined by the educational institution offering the program and the health care organization where the practice of nursing occurs. The educational institution will file with the Department each academic term a list of the names and origin of license of all professional nurses practicing nursing as part of their programs under this provision.

(l) Any person licensed in this State under any other Act from engaging in the practice for which she or he is licensed.

(m) Delegation to authorized direct care staff trained under Section 15.4 of the Mental Health and Developmental Disabilities Administrative Act.

(n) The performance of activities authorized under the Care of Students with Diabetes Act.

An applicant for license practicing under the exceptions set forth in subparagraphs (g), (h), (i), and (j) of this Section shall use the title R.N. Lic. Pend. or L.P.N. Lic. Pend. respectively and no other.

(Source: P.A. 93-265, eff. 7-22-03.)

Section 95. The Physician Assistant Practice Act of 1987 is amended by changing Section 5 as follows:

(225 ILCS 95/5) (from Ch. 111, par. 4605)

(Section scheduled to be repealed on January 1, 2008)

Sec. 5. This Act does not prohibit:

1. Any person licensed in this State under any other Act from engaging in the practice for which he is licensed;

2. The practice as a physician assistant by a person who is employed by the United States government or any bureau, division or agency thereof while in the discharge of the employee's official duties;

3. The practice as a physician assistant which is included in their program of study by students enrolled in schools or in refresher courses approved by the Department.

4. The performance of activities authorized under the Care of Students with Diabetes Act.

(Source: P.A. 85-1209.)

Section 99. Effective date. This Act takes effect upon becoming law.