Sen. Don Harmon

Filed: 4/17/2024





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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 in an injectable or auto-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
8    "GLP-1 receptor agonists in an injectable or
9auto-injectable form" means an anti-diabetic medication used
10for the treatment of type 1 and type 2 diabetes. Authorized
11direct care staff may administer insulin or GLP-1 receptor
12agonists via auto-injection or pen pre-filled by the
13manufacturer as delegated by the registered professional nurse
14and , as ordered by a physician, advanced practice registered
15nurse, or physician assistant, if: (i) the staff has
16successfully completed a Department-approved advanced training
17program specific to insulin or GLP-1 receptor agonist
18administration developed in consultation with professional
19associations listed in subsection (a) of this Section, and
20(ii) the staff consults with the registered nurse, prior to
21administration, of any insulin or GLP-1 receptor agonist dose
22that is determined 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, unless directed to do so by the registered nurse. An
3individual may self-administer insulin or GLP-1 receptor
4agonists in any form if the individual is deemed independent
5by the nurse-trainer through the use of the Department's
6required standardized screening and assessment instruments.
7    "Nurse-trainer training program" means a standardized,
8competency-based medication administration train-the-trainer
9program provided by the Department of Human Services and
10conducted by a Department of Human Services master
11nurse-trainer for the purpose of training nurse-trainers to
12train persons employed or under contract to provide direct
13care or treatment to individuals receiving services to
14administer medications and provide self-administration of
15medication training to individuals under the supervision and
16monitoring of the nurse-trainer. The program incorporates
17adult learning styles, teaching strategies, classroom
18management, and a curriculum overview, including the ethical
19and legal aspects of supervising those administering
21    "Self-administration of medications" means an individual
22administers his or her own medications or a portion of his or
23her own medications. To be considered capable to
24self-administer their own medication, individuals must, at a
25minimum, be able to identify their medication by size, shape,
26or color, know when they should take the medication, and know



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1the amount of medication to be taken each time. The use of
2assistive or enabling technologies can be used to demonstrate
3a person's capability to administer his or her own
5    "Training program" means a standardized medication
6administration training program approved by the Department of
7Human Services and conducted by a registered professional
8nurse for the purpose of training persons employed or under
9contract to provide direct care or treatment to individuals
10receiving services to administer medications and provide
11self-administration of medication training to individuals
12under the delegation and supervision of a nurse-trainer. The
13program incorporates adult learning styles, teaching
14strategies, classroom management, curriculum overview,
15including ethical-legal aspects, and standardized
16competency-based evaluations on administration of medications
17and self-administration of medication training programs.
18    (c) Training and authorization of non-licensed direct care
19staff by nurse-trainers must meet the requirements of this
21        (1) Prior to training non-licensed direct care staff
22    to administer medication, the nurse-trainer shall perform
23    the following for each individual to whom medication will
24    be administered by non-licensed direct care staff:
25            (A) An assessment of the individual's health
26        history and physical and mental status.



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1            (B) An evaluation of the medications prescribed.
2        (2) Non-licensed authorized direct care staff shall
3    meet the following criteria:
4            (A) Be 18 years of age or older.
5            (B) Have completed high school or have a State of
6        Illinois High School Diploma.
7            (C) Have demonstrated functional literacy.
8            (D) Have satisfactorily completed the Health and
9        Safety component of a Department of Human Services
10        authorized direct care staff training program.
11            (E) Have successfully completed the training
12        program, pass the written portion of the comprehensive
13        exam, and score 100% on the competency-based
14        assessment demonstrating proficiency in the skill of
15        administering medication specific to the individual
16        and his or her medications.
17            (F) Have received additional competency-based
18        assessment by the nurse-trainer as deemed necessary by
19        the nurse-trainer whenever it is determined that
20        additional skill development and training is needed to
21        administer a medication a change of medication occurs
22        or a new individual that requires medication
23        administration enters the program.
24        (3) Authorized direct care staff shall be re-evaluated
25    by a nurse-trainer at least annually or more frequently at
26    the discretion of the registered professional nurse. Any



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1    necessary retraining shall be to the extent that is
2    necessary to ensure competency of the authorized direct
3    care staff to administer medication.
4        (4) Authorization of direct care staff to administer
5    medication shall be revoked if, in the opinion of the
6    registered professional nurse, the authorized direct care
7    staff is no longer competent to administer medication.
8        (5) The registered professional nurse shall assess an
9    individual's health status at least annually or more
10    frequently at the discretion of the registered
11    professional nurse.
12    This subsection only applies to settings where the
13registered professional nurse has jurisdiction. If direct care
14staff move to other settings, they shall consult with the
15registered professional nurse who has jurisdiction of that
17    (d) Medication self-administration shall meet the
18following requirements:
19        (1) As part of the normalization process, in order for
20    each individual to attain the highest possible level of
21    independent functioning, all individuals shall be
22    permitted to participate in their total health care
23    program. This program shall include, but not be limited
24    to, individual training in preventive health and
25    self-administration of medication self-medication
26    procedures.



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



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1        and
2            (B) approved to self-administer medication by the
3        individual's Community Support Team or
4        Interdisciplinary Team, which includes a registered
5        professional nurse or an advanced practice registered
6        nurse.
7    (e) Quality Assurance.
8        (1) A registered professional nurse, advanced practice
9    registered nurse, licensed practical nurse, physician
10    licensed to practice medicine in all its branches,
11    physician assistant, or pharmacist shall review the
12    following for all individuals:
13            (A) Medication orders.
14            (B) Medication labels, including medications
15        listed on the medication administration record for
16        persons who are not self-administering medication
17        self-medicating to ensure the labels match the orders
18        issued by the physician licensed to practice medicine
19        in all its branches, advanced practice registered
20        nurse, or physician assistant.
21            (C) Medication administration records for persons
22        who are not self-administering medication
23        self-medicating to ensure that the records are
24        completed appropriately for:
25                (i) medication administered as prescribed;
26                (ii) refusal by the individual; and



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1                (iii) full signatures provided for all
2            initials used.
3        (2) Reviews shall occur at least quarterly, but may be
4    done more frequently at the discretion of the registered
5    professional nurse or advanced practice registered nurse.
6        (3) A quality assurance review of medication errors
7    and data collection for the purpose of monitoring and
8    recommending corrective action shall be conducted within 7
9    days and included in the required annual review.
10    (f) Programs using authorized direct care staff to
11administer medications are responsible for documenting and
12maintaining records on the training that is completed.
13    (g) The absence of this training program constitutes a
14threat to the public interest, safety, and welfare and
15necessitates emergency rulemaking by the Departments of Human
16Services and Public Health under Section 5-45 of the Illinois
17Administrative Procedure Act.
18    (h) Direct care staff who fail to qualify for delegated
19authority to administer medications pursuant to the provisions
20of this Section shall be given additional education and
21testing to meet criteria for delegation authority to
22administer medications. Any direct care staff person who fails
23to qualify as an authorized direct care staff after initial
24training and testing must within 3 months be given another
25opportunity for retraining and retesting. A direct care staff
26person who fails to meet criteria for delegated authority to



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1administer medication, including, but not limited to, failure
2of the written test on 2 occasions shall be given
3consideration for shift transfer or reassignment, if possible.
4No employee shall be terminated for failure to qualify during
5the 3-month time period following initial testing. Refusal to
6complete training and testing required by this Section may be
7grounds for immediate dismissal.
8    (i) No authorized direct care staff person delegated to
9administer medication shall be subject to suspension or
10discharge for errors resulting from the staff person's acts or
11omissions when performing the functions unless the staff
12person's actions or omissions constitute willful and wanton
13conduct. Nothing in this subsection is intended to supersede
14paragraph (4) of subsection (c).
15    (j) A registered professional nurse, advanced practice
16registered nurse, physician licensed to practice medicine in
17all its branches, or physician assistant shall be on duty or on
18call at all times in any program covered by this Section.
19    (k) The employer shall be responsible for maintaining
20liability insurance for any program covered by this Section.
21    (l) Any direct care staff person who qualifies as
22authorized direct care staff pursuant to this Section shall be
23granted consideration for a one-time additional salary
24differential. The Department shall determine and provide the
25necessary funding for the differential in the base. This
26subsection (l) is inoperative on and after June 30, 2000.



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1(Source: P.A. 102-1100, eff. 1-1-23.)".