Rep. Natalie A. Manley

Filed: 5/8/2024





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2    AMENDMENT NO. ______. Amend Senate Bill 860 by replacing
3everything after the enacting clause with the following:
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



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1programs certified to serve persons with developmental
2disabilities by the Department of Human Services. The
3Department of Human Services shall develop a training program
4for authorized direct care staff to administer medications
5under the supervision and monitoring of a registered
6professional nurse. The training program for authorized direct
7care staff shall include educational and oversight components
8for staff who work in day programs that are similar to those
9for staff who work in residential programs. This training
10program shall be developed in consultation with professional
11associations representing (i) physicians licensed to practice
12medicine in all its branches, (ii) registered professional
13nurses, and (iii) pharmacists.
14    (b) For the purposes of this Section:
15    "Authorized direct care staff" means non-licensed persons
16who have successfully completed a medication administration
17training program approved by the Department of Human Services
18and conducted by a nurse-trainer. This authorization is
19specific to an individual receiving service in a specific
20agency and does not transfer to another agency.
21    "Medications" means oral, injectable, auto-injectable, and
22topical medications, insulin in an injectable form, oxygen,
23epinephrine auto-injectors, and vaginal and rectal creams and
24suppositories. "Oral" includes inhalants and medications
25administered through enteral tubes, utilizing aseptic
26technique. "Topical" includes eye, ear, and nasal medications.



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1Any controlled substances must be packaged specifically for an
2identified individual.
3    "Insulin in an injectable or auto-injectable form" means a
4subcutaneous injection, auto-injection, or other technology
5including, but not limited to: (i) an insulin pump; (ii) an
6insulin pod; (iii) via an insulin pen pre-filled by the
7manufacturer; and (iv) a syringe.
8    "GLP-1 receptor agonists in an injectable or
9auto-injectable form" means medication used for the treatment
10of type 1 and type 2 diabetes and obesity. Authorized direct
11care staff may administer insulin or GLP-1 receptor agonists
12via auto-injection or an insulin pen pre-filled by the
13manufacturer as delegated by the registered nurse and , as
14ordered by a physician, advanced practice registered nurse, or
15physician assistant, if: (i) the staff has successfully
16completed a Department-approved advanced training program
17specific to insulin or GLP-1 receptor agonist administration
18developed in consultation with professional associations
19listed in subsection (a) of this Section, and (ii) the staff
20consults with the registered nurse, prior to administration,
21of any insulin or GLP-1 receptor agonist dose that is
22determined based on a blood glucose test result. The
23authorized direct care staff shall not: (i) calculate the
24insulin or GLP-1 receptor agonist dosage needed when the dose
25is dependent upon a blood glucose test result, or (ii)
26administer insulin or GLP-1 receptor agonists to individuals



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1who require blood glucose monitoring greater than 3 times
2daily, without consultation with and unless directed to do so
3by the registered nurse. An individual may self-administer
4insulin or GLP-1 receptor agonists in any form if the
5individual is deemed independent by the nurse-trainer through
6the use of the Department's required standardized screening
7and assessment instruments.
8    "Nurse-trainer training program" means a standardized,
9competency-based medication administration train-the-trainer
10program provided by the Department of Human Services and
11conducted by a Department of Human Services master
12nurse-trainer for the purpose of training nurse-trainers to
13train persons employed or under contract to provide direct
14care or treatment to individuals receiving services to
15administer medications and provide self-administration of
16medication training to individuals under the supervision and
17monitoring of the nurse-trainer. The program incorporates
18adult learning styles, teaching strategies, classroom
19management, and a curriculum overview, including the ethical
20and legal aspects of supervising those administering
22    "Self-administration of medications" means an individual
23administers his or her own medications or a portion of his or
24her own medications. To be considered capable to
25self-administer their own medication, individuals must, at a
26minimum, be able to identify their medication by size, shape,



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1or color, know when they should take the medication, and know
2the amount of medication to be taken each time. The use of
3assistive or enabling technologies can be used to demonstrate
4a person's capability to administer his or her own
6    "Training program" means a standardized medication
7administration training program approved by the Department of
8Human Services and conducted by a registered professional
9nurse for the purpose of training persons employed or under
10contract to provide direct care or treatment to individuals
11receiving services to administer medications and provide
12self-administration of medication training to individuals
13under the delegation and supervision of a nurse-trainer. The
14program incorporates adult learning styles, teaching
15strategies, classroom management, curriculum overview,
16including ethical-legal aspects, and standardized
17competency-based evaluations on administration of medications
18and self-administration of medication training programs.
19    (c) Training and authorization of non-licensed direct care
20staff by nurse-trainers must meet the requirements of this
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
15registered professional nurse has jurisdiction. If direct care
16staff move to other settings, they shall consult with the
17registered professional nurse who has jurisdiction of that
19    (d) Medication self-administration shall meet the
20following 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
13administer medications are responsible for documenting and
14maintaining records on the training that is completed.
15    (g) The absence of this training program constitutes a
16threat to the public interest, safety, and welfare and
17necessitates emergency rulemaking by the Departments of Human
18Services and Public Health under Section 5-45 of the Illinois
19Administrative Procedure Act.
20    (h) Direct care staff who fail to qualify for delegated
21authority to administer medications pursuant to the provisions
22of this Section shall be given additional education and
23testing to meet criteria for delegation authority to
24administer medications. Any direct care staff person who fails
25to qualify as an authorized direct care staff after initial
26training and testing must within 3 months be given another



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1opportunity for retraining and retesting. A direct care staff
2person who fails to meet criteria for delegated authority to
3administer medication, including, but not limited to, failure
4of the written test on 2 occasions shall be given
5consideration for shift transfer or reassignment, if possible.
6No employee shall be terminated for failure to qualify during
7the 3-month time period following initial testing. Refusal to
8complete training and testing required by this Section may be
9grounds for immediate dismissal.
10    (i) No authorized direct care staff person delegated to
11administer medication shall be subject to suspension or
12discharge for errors resulting from the staff person's acts or
13omissions when performing the functions unless the staff
14person's actions or omissions constitute willful and wanton
15conduct. Nothing in this subsection is intended to supersede
16paragraph (4) of subsection (c).
17    (j) A registered professional nurse, advanced practice
18registered nurse, physician licensed to practice medicine in
19all its branches, or physician assistant shall be on duty or on
20call at all times in any program covered by this Section.
21    (k) The employer shall be responsible for maintaining
22liability insurance for any program covered by this Section.
23    (l) Any direct care staff person who qualifies as
24authorized direct care staff pursuant to this Section shall be
25granted consideration for a one-time additional salary
26differential. The Department shall determine and provide the



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1necessary funding for the differential in the base. This
2subsection (l) is inoperative on and after June 30, 2000.
3(Source: P.A. 102-1100, eff. 1-1-23.)".