Sen. Don Harmon

Filed: 4/4/2024





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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 and topical medications,
22auto-injectors, 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 or semaglutides in an injectable form" means a
4subcutaneous injection, auto-injection, or other technologies
5available including, but not limited to, insulin pumps,
6insulin pods, or via an insulin pen pre-filled by the
7manufacturer. Authorized direct care staff may administer
8insulin or semaglutides, as ordered by a physician, advanced
9practice registered nurse, or physician assistant, if: (i) the
10staff has successfully completed a Department-approved
11advanced training program specific to insulin or semaglutides
12administration developed in consultation with professional
13associations listed in subsection (a) of this Section, and
14(ii) the staff consults with the registered nurse, prior to
15administration, of any insulin or semaglutides dose that is
16determined based on a blood glucose test result. The
17authorized direct care staff shall not: (i) calculate the
18insulin or semaglutides dosage needed when the dose is
19dependent upon a blood glucose test result, or (ii) administer
20insulin or semaglutides to individuals who require blood
21glucose monitoring greater than 3 times daily, unless directed
22to do so by the registered nurse.
23    "Nurse-trainer training program" means a standardized,
24competency-based medication administration train-the-trainer
25program provided by the Department of Human Services and
26conducted by a Department of Human Services master



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1nurse-trainer for the purpose of training nurse-trainers to
2train persons employed or under contract to provide direct
3care or treatment to individuals receiving services to
4administer medications and provide self-administration of
5medication training to individuals under the supervision and
6monitoring of the nurse-trainer. The program incorporates
7adult learning styles, teaching strategies, classroom
8management, and a curriculum overview, including the ethical
9and legal aspects of supervising those administering
11    "Self-administration of medications" means an individual
12administers his or her own medications, or a portion of his or
13her own medications. To be considered capable to
14self-administer their own medication, individuals must, at a
15minimum, be able to identify their medication by size, shape,
16or color, know when they should take the medication, and know
17the amount of medication to be taken each time. The use of
18assistive or enabling technologies can be used to demonstrate
19a person's capability to administer his or her own
21    "Training program" means a standardized medication
22administration training program approved by the Department of
23Human Services and conducted by a registered professional
24nurse for the purpose of training persons employed or under
25contract to provide direct care or treatment to individuals
26receiving services to administer medications and provide



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



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



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



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



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



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



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1person's actions or omissions constitute willful and wanton
2conduct. Nothing in this subsection is intended to supersede
3paragraph (4) of subsection (c).
4    (j) A registered professional nurse, advanced practice
5registered nurse, physician licensed to practice medicine in
6all its branches, or physician assistant shall be on duty or on
7call at all times in any program covered by this Section.
8    (k) The employer shall be responsible for maintaining
9liability insurance for any program covered by this Section.
10    (l) Any direct care staff person who qualifies as
11authorized direct care staff pursuant to this Section shall be
12granted consideration for a one-time additional salary
13differential. The Department shall determine and provide the
14necessary funding for the differential in the base. This
15subsection (l) is inoperative on and after June 30, 2000.
16(Source: P.A. 102-1100, eff. 1-1-23.)".