Full Text of SB0860 103rd General Assembly
SB0860ham002 103RD GENERAL ASSEMBLY | Rep. Natalie A. Manley Filed: 5/8/2024 | | 10300SB0860ham002 | | LRB103 03319 KTG 73249 a |
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| 1 | | AMENDMENT TO SENATE BILL 860
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 860 by replacing | 3 | | everything after the enacting clause with the following: | 4 | | "Section 5. The Mental Health and Developmental | 5 | | Disabilities Administrative Act is amended by changing Section | 6 | | 15.4 as follows: | 7 | | (20 ILCS 1705/15.4) | 8 | | Sec. 15.4. Authorization for nursing delegation to permit | 9 | | direct care staff to administer medications. | 10 | | (a) This Section applies to (i) all residential programs | 11 | | for persons with a developmental disability in settings of 16 | 12 | | persons or fewer that are funded or licensed by the Department | 13 | | of Human Services and that distribute or administer | 14 | | medications, (ii) all intermediate care facilities for persons | 15 | | with developmental disabilities with 16 beds or fewer that are | 16 | | licensed by the Department of Public Health, and (iii) all day |
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| 1 | | programs certified to serve persons with developmental | 2 | | disabilities by the Department of Human Services. The | 3 | | Department of Human Services shall develop a training program | 4 | | for authorized direct care staff to administer medications | 5 | | under the supervision and monitoring of a registered | 6 | | professional nurse. The training program for authorized direct | 7 | | care staff shall include educational and oversight components | 8 | | for staff who work in day programs that are similar to those | 9 | | for staff who work in residential programs. This training | 10 | | program shall be developed in consultation with professional | 11 | | associations representing (i) physicians licensed to practice | 12 | | medicine in all its branches, (ii) registered professional | 13 | | nurses, and (iii) pharmacists. | 14 | | (b) For the purposes of this Section: | 15 | | "Authorized direct care staff" means non-licensed persons | 16 | | who have successfully completed a medication administration | 17 | | training program approved by the Department of Human Services | 18 | | and conducted by a nurse-trainer. This authorization is | 19 | | specific to an individual receiving service in a specific | 20 | | agency and does not transfer to another agency. | 21 | | "Medications" means oral , injectable, auto-injectable, and | 22 | | topical medications, insulin in an injectable form , oxygen, | 23 | | epinephrine auto-injectors, and vaginal and rectal creams and | 24 | | suppositories. "Oral" includes inhalants and medications | 25 | | administered through enteral tubes, utilizing aseptic | 26 | | technique. "Topical" includes eye, ear, and nasal medications. |
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| 1 | | Any controlled substances must be packaged specifically for an | 2 | | identified individual. | 3 | | "Insulin in an injectable or auto-injectable form" means a | 4 | | subcutaneous injection , auto-injection, or other technology | 5 | | including, but not limited to: (i) an insulin pump; (ii) an | 6 | | insulin pod; (iii) via an insulin pen pre-filled by the | 7 | | manufacturer ; and (iv) a syringe . | 8 | | "GLP-1 receptor agonists in an injectable or | 9 | | auto-injectable form" means medication used for the treatment | 10 | | of type 1 and type 2 diabetes and obesity. Authorized direct | 11 | | care staff may administer insulin or GLP-1 receptor agonists | 12 | | via auto-injection or an insulin pen pre-filled by the | 13 | | manufacturer as delegated by the registered nurse and , as | 14 | | ordered by a physician, advanced practice registered nurse, or | 15 | | physician assistant, if: (i) the staff has successfully | 16 | | completed a Department-approved advanced training program | 17 | | specific to insulin or GLP-1 receptor agonist administration | 18 | | developed in consultation with professional associations | 19 | | listed in subsection (a) of this Section, and (ii) the staff | 20 | | consults with the registered nurse, prior to administration, | 21 | | of any insulin or GLP-1 receptor agonist dose that is | 22 | | determined based on a blood glucose test result. The | 23 | | authorized direct care staff shall not: (i) calculate the | 24 | | insulin or GLP-1 receptor agonist dosage needed when the dose | 25 | | is dependent upon a blood glucose test result, or (ii) | 26 | | administer insulin or GLP-1 receptor agonists to individuals |
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| 1 | | who require blood glucose monitoring greater than 3 times | 2 | | daily, without consultation with and unless directed to do so | 3 | | by the registered nurse. An individual may self-administer | 4 | | insulin or GLP-1 receptor agonists in any form if the | 5 | | individual is deemed independent by the nurse-trainer through | 6 | | the use of the Department's required standardized screening | 7 | | and assessment instruments. | 8 | | "Nurse-trainer training program" means a standardized, | 9 | | competency-based medication administration train-the-trainer | 10 | | program provided by the Department of Human Services and | 11 | | conducted by a Department of Human Services master | 12 | | nurse-trainer for the purpose of training nurse-trainers to | 13 | | train persons employed or under contract to provide direct | 14 | | care or treatment to individuals receiving services to | 15 | | administer medications and provide self-administration of | 16 | | medication training to individuals under the supervision and | 17 | | monitoring of the nurse-trainer. The program incorporates | 18 | | adult learning styles, teaching strategies, classroom | 19 | | management, and a curriculum overview, including the ethical | 20 | | and legal aspects of supervising those administering | 21 | | medications. | 22 | | "Self-administration of medications" means an individual | 23 | | administers his or her own medications or a portion of his or | 24 | | her own medications . To be considered capable to | 25 | | self-administer their own medication, individuals must, at a | 26 | | minimum, be able to identify their medication by size, shape, |
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| 1 | | or color, know when they should take the medication, and know | 2 | | the amount of medication to be taken each time. The use of | 3 | | assistive or enabling technologies can be used to demonstrate | 4 | | a person's capability to administer his or her own | 5 | | medications. | 6 | | "Training program" means a standardized medication | 7 | | administration training program approved by the Department of | 8 | | Human Services and conducted by a registered professional | 9 | | nurse for the purpose of training persons employed or under | 10 | | contract to provide direct care or treatment to individuals | 11 | | receiving services to administer medications and provide | 12 | | self-administration of medication training to individuals | 13 | | under the delegation and supervision of a nurse-trainer. The | 14 | | program incorporates adult learning styles, teaching | 15 | | strategies, classroom management, curriculum overview, | 16 | | including ethical-legal aspects, and standardized | 17 | | competency-based evaluations on administration of medications | 18 | | and self-administration of medication training programs. | 19 | | (c) Training and authorization of non-licensed direct care | 20 | | staff by nurse-trainers must meet the requirements of this | 21 | | subsection. | 22 | | (1) Prior to training non-licensed direct care staff | 23 | | to administer medication, the nurse-trainer shall perform | 24 | | the following for each individual to whom medication will | 25 | | be administered by non-licensed direct care staff: | 26 | | (A) An assessment of the individual's health |
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| 1 | | history and physical and mental status. | 2 | | (B) An evaluation of the medications prescribed. | 3 | | (2) Non-licensed authorized direct care staff shall | 4 | | meet the following criteria: | 5 | | (A) Be 18 years of age or older. | 6 | | (B) Have completed high school or have a State of | 7 | | Illinois High School Diploma. | 8 | | (C) Have demonstrated functional literacy. | 9 | | (D) Have satisfactorily completed the Health and | 10 | | Safety component of a Department of Human Services | 11 | | authorized direct care staff training program. | 12 | | (E) Have successfully completed the training | 13 | | program, pass the written portion of the comprehensive | 14 | | exam, and score 100% on the competency-based | 15 | | assessment demonstrating proficiency in the skill of | 16 | | administering medication specific to the individual | 17 | | and his or her medications . | 18 | | (F) Have received additional competency-based | 19 | | assessment or training by the nurse-trainer when the | 20 | | nurse-trainer determines additional skill development | 21 | | is needed to administer medication by the | 22 | | nurse-trainer as deemed necessary by the nurse-trainer | 23 | | whenever a change of medication occurs or a new | 24 | | individual that requires medication administration | 25 | | enters the program . | 26 | | (3) Authorized direct care staff shall be re-evaluated |
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| 1 | | by a nurse-trainer at least annually or more frequently at | 2 | | the discretion of the registered professional nurse. Any | 3 | | necessary retraining shall be to the extent that is | 4 | | necessary to ensure competency of the authorized direct | 5 | | care staff to administer medication. | 6 | | (4) Authorization of direct care staff to administer | 7 | | medication shall be revoked if, in the opinion of the | 8 | | registered professional nurse, the authorized direct care | 9 | | staff is no longer competent to administer medication. | 10 | | (5) The registered professional nurse shall assess an | 11 | | individual's health status at least annually or more | 12 | | frequently at the discretion of the registered | 13 | | professional nurse. | 14 | | This subsection only applies to settings where the | 15 | | registered professional nurse has jurisdiction. If direct care | 16 | | staff move to other settings, they shall consult with the | 17 | | registered professional nurse who has jurisdiction of that | 18 | | setting. | 19 | | (d) Medication self-administration shall meet the | 20 | | following requirements: | 21 | | (1) As part of the normalization process, in order for | 22 | | each individual to attain the highest possible level of | 23 | | independent functioning, all individuals shall be | 24 | | permitted to participate in their total health care | 25 | | program. This program shall include, but not be limited | 26 | | to, individual training in preventive health and |
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| 1 | | self-administration of medication self-medication | 2 | | procedures. | 3 | | (A) Every program shall adopt written policies and | 4 | | procedures for assisting individuals who choose to | 5 | | obtain in obtaining preventative health and | 6 | | self-administration of medication self-medication | 7 | | skills in consultation with a registered professional | 8 | | nurse, advanced practice registered nurse, physician | 9 | | assistant, or physician licensed to practice medicine | 10 | | in all its branches. | 11 | | (B) If an individual desires to gain independence | 12 | | in self-administration of medication, the individual | 13 | | Individuals shall be evaluated to determine the | 14 | | individual's their ability to self-administer | 15 | | medication self-medicate by the nurse-trainer through | 16 | | the use of the Department's required, standardized | 17 | | screening and assessment instruments. | 18 | | (C) (Blank). When the results of the screening and | 19 | | assessment indicate an individual not to be capable to | 20 | | self-administer his or her own medications, programs | 21 | | shall be developed in consultation with the Community | 22 | | Support Team or Interdisciplinary Team to provide | 23 | | individuals with self-medication administration. | 24 | | (2) Each individual shall be presumed to be competent | 25 | | to self-administer medications if: | 26 | | (A) authorized by an order of a physician licensed |
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| 1 | | to practice medicine in all its branches, an advanced | 2 | | practice registered nurse, or a physician assistant; | 3 | | and | 4 | | (B) approved to self-administer medication by the | 5 | | individual's Community Support Team or | 6 | | Interdisciplinary Team, which includes a registered | 7 | | professional nurse or an advanced practice registered | 8 | | nurse. | 9 | | (e) Quality Assurance. | 10 | | (1) A registered professional nurse, advanced practice | 11 | | registered nurse, licensed practical nurse, physician | 12 | | licensed to practice medicine in all its branches, | 13 | | physician assistant, or pharmacist shall review the | 14 | | following for all individuals: | 15 | | (A) Medication orders. | 16 | | (B) Medication labels, including medications | 17 | | listed on the medication administration record for | 18 | | persons who are not self-administering medication | 19 | | self-medicating to ensure the labels match the orders | 20 | | issued by the physician licensed to practice medicine | 21 | | in all its branches, advanced practice registered | 22 | | nurse, or physician assistant. | 23 | | (C) Medication administration records for persons | 24 | | who are not self-administering medication | 25 | | self-medicating to ensure that the records are | 26 | | completed appropriately for: |
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| 1 | | (i) medication administered as prescribed; | 2 | | (ii) refusal by the individual; and | 3 | | (iii) full signatures provided for all | 4 | | initials used. | 5 | | (2) Reviews shall occur at least quarterly, but may be | 6 | | done more frequently at the discretion of the registered | 7 | | professional nurse or advanced practice registered nurse. | 8 | | (3) A quality assurance review of medication errors | 9 | | and data collection for the purpose of monitoring and | 10 | | recommending corrective action shall be conducted within 7 | 11 | | days and included in the required annual review. | 12 | | (f) Programs using authorized direct care staff to | 13 | | administer medications are responsible for documenting and | 14 | | maintaining records on the training that is completed. | 15 | | (g) The absence of this training program constitutes a | 16 | | threat to the public interest, safety, and welfare and | 17 | | necessitates emergency rulemaking by the Departments of Human | 18 | | Services and Public Health under Section 5-45 of the Illinois | 19 | | Administrative Procedure Act. | 20 | | (h) Direct care staff who fail to qualify for delegated | 21 | | authority to administer medications pursuant to the provisions | 22 | | of this Section shall be given additional education and | 23 | | testing to meet criteria for delegation authority to | 24 | | administer medications. Any direct care staff person who fails | 25 | | to qualify as an authorized direct care staff after initial | 26 | | training and testing must within 3 months be given another |
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| 1 | | opportunity for retraining and retesting. A direct care staff | 2 | | person who fails to meet criteria for delegated authority to | 3 | | administer medication, including, but not limited to, failure | 4 | | of the written test on 2 occasions shall be given | 5 | | consideration for shift transfer or reassignment, if possible. | 6 | | No employee shall be terminated for failure to qualify during | 7 | | the 3-month time period following initial testing. Refusal to | 8 | | complete training and testing required by this Section may be | 9 | | grounds for immediate dismissal. | 10 | | (i) No authorized direct care staff person delegated to | 11 | | administer medication shall be subject to suspension or | 12 | | discharge for errors resulting from the staff person's acts or | 13 | | omissions when performing the functions unless the staff | 14 | | person's actions or omissions constitute willful and wanton | 15 | | conduct. Nothing in this subsection is intended to supersede | 16 | | paragraph (4) of subsection (c). | 17 | | (j) A registered professional nurse, advanced practice | 18 | | registered nurse, physician licensed to practice medicine in | 19 | | all its branches, or physician assistant shall be on duty or on | 20 | | call at all times in any program covered by this Section. | 21 | | (k) The employer shall be responsible for maintaining | 22 | | liability insurance for any program covered by this Section. | 23 | | (l) Any direct care staff person who qualifies as | 24 | | authorized direct care staff pursuant to this Section shall be | 25 | | granted consideration for a one-time additional salary | 26 | | differential. The Department shall determine and provide the |
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| 1 | | necessary funding for the differential in the base. This | 2 | | subsection (l) is inoperative on and after June 30, 2000. | 3 | | (Source: P.A. 102-1100, eff. 1-1-23 .)". |
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