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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, (ii) all intermediate care facilities for persons
15with developmental disabilities with 16 beds or fewer that are
16licensed by the Department of Public Health, and (iii) all day
17programs 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,
15auto-injectors, insulin in an injectable form, oxygen,
16epinephrine auto-injectors, and vaginal and rectal creams and
17suppositories. "Oral" includes inhalants and medications
18administered through enteral tubes, utilizing aseptic
19technique. "Topical" includes eye, ear, and nasal medications.
20Any controlled substances must be packaged specifically for an
21identified individual.
22    "Insulin in an injectable or auto-injectable form" means a
23subcutaneous injection, auto-injection, or other technologies
24available including, but not limited to, insulin pumps,
25insulin pods, or via an insulin pen pre-filled by the



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1    "GLP-1 receptor agonists in an injectable or
2auto-injectable form" means an anti-diabetic medication used
3for the treatment of type 1 and type 2 diabetes. Authorized
4direct care staff may administer insulin or GLP-1 receptor
5agonists via auto-injection or pen pre-filled by the
6manufacturer as delegated by the registered professional nurse
7and , as ordered by a physician, advanced practice registered
8nurse, or physician assistant, if: (i) the staff has
9successfully completed a Department-approved advanced training
10program specific to insulin or GLP-1 receptor agonist
11administration developed in consultation with professional
12associations listed in subsection (a) of this Section, and
13(ii) the staff consults with the registered nurse, prior to
14administration, of any insulin or GLP-1 receptor agonist dose
15that is determined based on a blood glucose test result. The
16authorized direct care staff shall not: (i) calculate the
17insulin or GLP-1 receptor agonist dosage needed when the dose
18is dependent upon a blood glucose test result, or (ii)
19administer insulin or GLP-1 receptor agonists to individuals
20who require blood glucose monitoring greater than 3 times
21daily, unless directed to do so by the registered nurse. An
22individual may self-administer insulin or GLP-1 receptor
23agonists in any form if the individual is deemed independent
24by the nurse-trainer through the use of the Department's
25required standardized screening and assessment instruments.
26    "Nurse-trainer training program" means a standardized,



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1competency-based medication administration train-the-trainer
2program provided by the Department of Human Services and
3conducted by a Department of Human Services master
4nurse-trainer for the purpose of training nurse-trainers to
5train persons employed or under contract to provide direct
6care or treatment to individuals receiving services to
7administer medications and provide self-administration of
8medication training to individuals under the supervision and
9monitoring of the nurse-trainer. The program incorporates
10adult learning styles, teaching strategies, classroom
11management, and a curriculum overview, including the ethical
12and legal aspects of supervising those administering
14    "Self-administration of medications" means an individual
15administers his or her own medications or a portion of his or
16her own medications. To be considered capable to
17self-administer their own medication, individuals must, at a
18minimum, be able to identify their medication by size, shape,
19or color, know when they should take the medication, and know
20the amount of medication to be taken each time. The use of
21assistive or enabling technologies can be used to demonstrate
22a person's capability to administer his or her own
24    "Training program" means a standardized medication
25administration training program approved by the Department of
26Human Services and conducted by a registered professional



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1nurse for the purpose of training persons employed or under
2contract to provide direct care or treatment to individuals
3receiving services to administer medications and provide
4self-administration of medication training to individuals
5under the delegation and supervision of a nurse-trainer. The
6program incorporates adult learning styles, teaching
7strategies, classroom management, curriculum overview,
8including ethical-legal aspects, and standardized
9competency-based evaluations on administration of medications
10and self-administration of medication training programs.
11    (c) Training and authorization of non-licensed direct care
12staff by nurse-trainers must meet the requirements of this
14        (1) Prior to training non-licensed direct care staff
15    to administer medication, the nurse-trainer shall perform
16    the following for each individual to whom medication will
17    be administered by non-licensed direct care staff:
18            (A) An assessment of the individual's health
19        history and physical and mental status.
20            (B) An evaluation of the medications prescribed.
21        (2) Non-licensed authorized direct care staff shall
22    meet the following criteria:
23            (A) Be 18 years of age or older.
24            (B) Have completed high school or have a State of
25        Illinois High School Diploma.
26            (C) Have demonstrated functional literacy.



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1            (D) Have satisfactorily completed the Health and
2        Safety component of a Department of Human Services
3        authorized direct care staff training program.
4            (E) Have successfully completed the training
5        program, pass the written portion of the comprehensive
6        exam, and score 100% on the competency-based
7        assessment demonstrating proficiency in the skill of
8        administering medication specific to the individual
9        and his or her medications.
10            (F) Have received additional competency-based
11        assessment by the nurse-trainer as deemed necessary by
12        the nurse-trainer whenever it is determined that
13        additional skill development and training is needed to
14        administer a medication a change of medication occurs
15        or a new individual that requires medication
16        administration enters the program.
17        (3) Authorized direct care staff shall be re-evaluated
18    by a nurse-trainer at least annually or more frequently at
19    the discretion of the registered professional nurse. Any
20    necessary retraining shall be to the extent that is
21    necessary to ensure competency of the authorized direct
22    care staff to administer medication.
23        (4) Authorization of direct care staff to administer
24    medication shall be revoked if, in the opinion of the
25    registered professional nurse, the authorized direct care
26    staff is no longer competent to administer medication.



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1        (5) The registered professional nurse shall assess an
2    individual's health status at least annually or more
3    frequently at the discretion of the registered
4    professional nurse.
5    This subsection only applies to settings where the
6registered professional nurse has jurisdiction. If direct care
7staff move to other settings, they shall consult with the
8registered professional nurse who has jurisdiction of that
10    (d) Medication self-administration shall meet the
11following requirements:
12        (1) As part of the normalization process, in order for
13    each individual to attain the highest possible level of
14    independent functioning, all individuals shall be
15    permitted to participate in their total health care
16    program. This program shall include, but not be limited
17    to, individual training in preventive health and
18    self-administration of medication self-medication
19    procedures.
20            (A) Every program shall adopt written policies and
21        procedures for assisting individuals who choose to
22        obtain in obtaining preventative health and
23        self-administration of medication self-medication
24        skills in consultation with a registered professional
25        nurse, advanced practice registered nurse, physician
26        assistant, or physician licensed to practice medicine



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



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1        (1) A registered professional nurse, advanced practice
2    registered nurse, licensed practical nurse, physician
3    licensed to practice medicine in all its branches,
4    physician assistant, or pharmacist shall review the
5    following for all individuals:
6            (A) Medication orders.
7            (B) Medication labels, including medications
8        listed on the medication administration record for
9        persons who are not self-administering medication
10        self-medicating to ensure the labels match the orders
11        issued by the physician licensed to practice medicine
12        in all its branches, advanced practice registered
13        nurse, or physician assistant.
14            (C) Medication administration records for persons
15        who are not self-administering medication
16        self-medicating to ensure that the records are
17        completed appropriately for:
18                (i) medication administered as prescribed;
19                (ii) refusal by the individual; and
20                (iii) full signatures provided for all
21            initials used.
22        (2) Reviews shall occur at least quarterly, but may be
23    done more frequently at the discretion of the registered
24    professional nurse or advanced practice registered nurse.
25        (3) A quality assurance review of medication errors
26    and data collection for the purpose of monitoring and



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1    recommending corrective action shall be conducted within 7
2    days and included in the required annual review.
3    (f) Programs using authorized direct care staff to
4administer medications are responsible for documenting and
5maintaining records on the training that is completed.
6    (g) The absence of this training program constitutes a
7threat to the public interest, safety, and welfare and
8necessitates emergency rulemaking by the Departments of Human
9Services and Public Health under Section 5-45 of the Illinois
10Administrative Procedure Act.
11    (h) Direct care staff who fail to qualify for delegated
12authority to administer medications pursuant to the provisions
13of this Section shall be given additional education and
14testing to meet criteria for delegation authority to
15administer medications. Any direct care staff person who fails
16to qualify as an authorized direct care staff after initial
17training and testing must within 3 months be given another
18opportunity for retraining and retesting. A direct care staff
19person who fails to meet criteria for delegated authority to
20administer medication, including, but not limited to, failure
21of the written test on 2 occasions shall be given
22consideration for shift transfer or reassignment, if possible.
23No employee shall be terminated for failure to qualify during
24the 3-month time period following initial testing. Refusal to
25complete training and testing required by this Section may be
26grounds for immediate dismissal.



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1    (i) No authorized direct care staff person delegated to
2administer medication shall be subject to suspension or
3discharge for errors resulting from the staff person's acts or
4omissions when performing the functions unless the staff
5person's actions or omissions constitute willful and wanton
6conduct. Nothing in this subsection is intended to supersede
7paragraph (4) of subsection (c).
8    (j) A registered professional nurse, advanced practice
9registered nurse, physician licensed to practice medicine in
10all its branches, or physician assistant shall be on duty or on
11call at all times in any program covered by this Section.
12    (k) The employer shall be responsible for maintaining
13liability insurance for any program covered by this Section.
14    (l) Any direct care staff person who qualifies as
15authorized direct care staff pursuant to this Section shall be
16granted consideration for a one-time additional salary
17differential. The Department shall determine and provide the
18necessary funding for the differential in the base. This
19subsection (l) is inoperative on and after June 30, 2000.
20(Source: P.A. 102-1100, eff. 1-1-23.)