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Public Act 103-0890 Public Act 0890 103RD GENERAL ASSEMBLY | Public Act 103-0890 | SB0860 Enrolled | LRB103 03319 KTG 48325 b |
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| AN ACT concerning State government. | Be it enacted by the People of the State of Illinois, | represented in the General Assembly: | Section 5. The Mental Health and Developmental | Disabilities Administrative Act is amended by changing Section | 15.4 as follows: | (20 ILCS 1705/15.4) | Sec. 15.4. Authorization for nursing delegation to permit | direct care staff to administer medications. | (a) This Section applies to (i) all residential programs | for persons with a developmental disability in settings of 16 | persons or fewer that are funded or licensed by the Department | of Human Services and that distribute or administer | medications, (ii) all intermediate care facilities for persons | with developmental disabilities with 16 beds or fewer that are | licensed by the Department of Public Health, and (iii) all day | programs certified to serve persons with developmental | disabilities by the Department of Human Services. The | Department of Human Services shall develop a training program | for authorized direct care staff to administer medications | under the supervision and monitoring of a registered | professional nurse. The training program for authorized direct | care staff shall include educational and oversight components |
| for staff who work in day programs that are similar to those | for staff who work in residential programs. This training | program shall be developed in consultation with professional | associations representing (i) physicians licensed to practice | medicine in all its branches, (ii) registered professional | nurses, and (iii) pharmacists. | (b) For the purposes of this Section: | "Authorized direct care staff" means non-licensed persons | who have successfully completed a medication administration | training program approved by the Department of Human Services | and conducted by a nurse-trainer. This authorization is | specific to an individual receiving service in a specific | agency and does not transfer to another agency. | "Medications" means oral , injectable, auto-injectable, and | topical medications, insulin in an injectable form , oxygen, | epinephrine auto-injectors, and vaginal and rectal creams and | suppositories. "Oral" includes inhalants and medications | administered through enteral tubes, utilizing aseptic | technique. "Topical" includes eye, ear, and nasal medications. | Any controlled substances must be packaged specifically for an | identified individual. | "Insulin in an injectable or auto-injectable form" means a | subcutaneous injection , auto-injection, or other technology | including, but not limited to: (i) an insulin pump; (ii) an | insulin pod; (iii) via an insulin pen pre-filled by the | manufacturer ; and (iv) a syringe . |
| "GLP-1 receptor agonists in an injectable or | auto-injectable form" means medication used for the treatment | of type 1 and type 2 diabetes and obesity. Authorized direct | care staff may administer insulin or GLP-1 receptor agonists | via auto-injection or an insulin pen pre-filled by the | manufacturer as delegated by the registered nurse and , as | ordered by a physician, advanced practice registered nurse, or | physician assistant, if: (i) the staff has successfully | completed a Department-approved advanced training program | specific to insulin or GLP-1 receptor agonist administration | developed in consultation with professional associations | listed in subsection (a) of this Section, and (ii) the staff | consults with the registered nurse, prior to administration, | of any insulin or GLP-1 receptor agonist dose that is | determined based on a blood glucose test result. The | authorized direct care staff shall not: (i) calculate the | insulin or GLP-1 receptor agonist dosage needed when the dose | is dependent upon a blood glucose test result, or (ii) | administer insulin or GLP-1 receptor agonists to individuals | who require blood glucose monitoring greater than 3 times | daily, without consultation with and unless directed to do so | by the registered nurse. An individual may self-administer | insulin or GLP-1 receptor agonists in any form if the | individual is deemed independent by the nurse-trainer through | the use of the Department's required standardized screening | and assessment instruments. |
| "Nurse-trainer training program" means a standardized, | competency-based medication administration train-the-trainer | program provided by the Department of Human Services and | conducted by a Department of Human Services master | nurse-trainer for the purpose of training nurse-trainers to | train persons employed or under contract to provide direct | care or treatment to individuals receiving services to | administer medications and provide self-administration of | medication training to individuals under the supervision and | monitoring of the nurse-trainer. The program incorporates | adult learning styles, teaching strategies, classroom | management, and a curriculum overview, including the ethical | and legal aspects of supervising those administering | medications. | "Self-administration of medications" means an individual | administers his or her own medications or a portion of his or | her own medications . To be considered capable to | self-administer their own medication, individuals must, at a | minimum, be able to identify their medication by size, shape, | or color, know when they should take the medication, and know | the amount of medication to be taken each time. The use of | assistive or enabling technologies can be used to demonstrate | a person's capability to administer his or her own | medications. | "Training program" means a standardized medication | administration training program approved by the Department of |
| Human Services and conducted by a registered professional | nurse for the purpose of training persons employed or under | contract to provide direct care or treatment to individuals | receiving services to administer medications and provide | self-administration of medication training to individuals | under the delegation and supervision of a nurse-trainer. The | program incorporates adult learning styles, teaching | strategies, classroom management, curriculum overview, | including ethical-legal aspects, and standardized | competency-based evaluations on administration of medications | and self-administration of medication training programs. | (c) Training and authorization of non-licensed direct care | staff by nurse-trainers must meet the requirements of this | subsection. | (1) Prior to training non-licensed direct care staff | to administer medication, the nurse-trainer shall perform | the following for each individual to whom medication will | be administered by non-licensed direct care staff: | (A) An assessment of the individual's health | history and physical and mental status. | (B) An evaluation of the medications prescribed. | (2) Non-licensed authorized direct care staff shall | meet the following criteria: | (A) Be 18 years of age or older. | (B) Have completed high school or have a State of | Illinois High School Diploma. |
| (C) Have demonstrated functional literacy. | (D) Have satisfactorily completed the Health and | Safety component of a Department of Human Services | authorized direct care staff training program. | (E) Have successfully completed the training | program, pass the written portion of the comprehensive | exam, and score 100% on the competency-based | assessment demonstrating proficiency in the skill of | administering medication specific to the individual | and his or her medications . | (F) Have received additional competency-based | assessment or training by the nurse-trainer when the | nurse-trainer determines additional skill development | is needed to administer medication by the | nurse-trainer as deemed necessary by the nurse-trainer | whenever a change of medication occurs or a new | individual that requires medication administration | enters the program . | (3) Authorized direct care staff shall be re-evaluated | by a nurse-trainer at least annually or more frequently at | the discretion of the registered professional nurse. Any | necessary retraining shall be to the extent that is | necessary to ensure competency of the authorized direct | care staff to administer medication. | (4) Authorization of direct care staff to administer | medication shall be revoked if, in the opinion of the |
| registered professional nurse, the authorized direct care | staff is no longer competent to administer medication. | (5) The registered professional nurse shall assess an | individual's health status at least annually or more | frequently at the discretion of the registered | professional nurse. | This subsection only applies to settings where the | registered professional nurse has jurisdiction. If direct care | staff move to other settings, they shall consult with the | registered professional nurse who has jurisdiction of that | setting. | (d) Medication self-administration shall meet the | following requirements: | (1) As part of the normalization process, in order for | each individual to attain the highest possible level of | independent functioning, all individuals shall be | permitted to participate in their total health care | program. This program shall include, but not be limited | to, individual training in preventive health and | self-administration of medication self-medication | procedures. | (A) Every program shall adopt written policies and | procedures for assisting individuals who choose to | obtain in obtaining preventative health and | self-administration of medication self-medication | skills in consultation with a registered professional |
| nurse, advanced practice registered nurse, physician | assistant, or physician licensed to practice medicine | in all its branches. | (B) If an individual desires to gain independence | in self-administration of medication, the individual | Individuals shall be evaluated to determine the | individual's their ability to self-administer | medication self-medicate by the nurse-trainer through | the use of the Department's required, standardized | screening and assessment instruments. | (C) (Blank). When the results of the screening and | assessment indicate an individual not to be capable to | self-administer his or her own medications, programs | shall be developed in consultation with the Community | Support Team or Interdisciplinary Team to provide | individuals with self-medication administration. | (2) Each individual shall be presumed to be competent | to self-administer medications if: | (A) authorized by an order of a physician licensed | to practice medicine in all its branches, an advanced | practice registered nurse, or a physician assistant; | and | (B) approved to self-administer medication by the | individual's Community Support Team or | Interdisciplinary Team, which includes a registered | professional nurse or an advanced practice registered |
| nurse. | (e) Quality Assurance. | (1) A registered professional nurse, advanced practice | registered nurse, licensed practical nurse, physician | licensed to practice medicine in all its branches, | physician assistant, or pharmacist shall review the | following for all individuals: | (A) Medication orders. | (B) Medication labels, including medications | listed on the medication administration record for | persons who are not self-administering medication | self-medicating to ensure the labels match the orders | issued by the physician licensed to practice medicine | in all its branches, advanced practice registered | nurse, or physician assistant. | (C) Medication administration records for persons | who are not self-administering medication | self-medicating to ensure that the records are | completed appropriately for: | (i) medication administered as prescribed; | (ii) refusal by the individual; and | (iii) full signatures provided for all | initials used. | (2) Reviews shall occur at least quarterly, but may be | done more frequently at the discretion of the registered | professional nurse or advanced practice registered nurse. |
| (3) A quality assurance review of medication errors | and data collection for the purpose of monitoring and | recommending corrective action shall be conducted within 7 | days and included in the required annual review. | (f) Programs using authorized direct care staff to | administer medications are responsible for documenting and | maintaining records on the training that is completed. | (g) The absence of this training program constitutes a | threat to the public interest, safety, and welfare and | necessitates emergency rulemaking by the Departments of Human | Services and Public Health under Section 5-45 of the Illinois | Administrative Procedure Act. | (h) Direct care staff who fail to qualify for delegated | authority to administer medications pursuant to the provisions | of this Section shall be given additional education and | testing to meet criteria for delegation authority to | administer medications. Any direct care staff person who fails | to qualify as an authorized direct care staff after initial | training and testing must within 3 months be given another | opportunity for retraining and retesting. A direct care staff | person who fails to meet criteria for delegated authority to | administer medication, including, but not limited to, failure | of the written test on 2 occasions shall be given | consideration for shift transfer or reassignment, if possible. | No employee shall be terminated for failure to qualify during | the 3-month time period following initial testing. Refusal to |
| complete training and testing required by this Section may be | grounds for immediate dismissal. | (i) No authorized direct care staff person delegated to | administer medication shall be subject to suspension or | discharge for errors resulting from the staff person's acts or | omissions when performing the functions unless the staff | person's actions or omissions constitute willful and wanton | conduct. Nothing in this subsection is intended to supersede | paragraph (4) of subsection (c). | (j) A registered professional nurse, advanced practice | registered nurse, physician licensed to practice medicine in | all its branches, or physician assistant shall be on duty or on | call at all times in any program covered by this Section. | (k) The employer shall be responsible for maintaining | liability insurance for any program covered by this Section. | (l) Any direct care staff person who qualifies as | authorized direct care staff pursuant to this Section shall be | granted consideration for a one-time additional salary | differential. The Department shall determine and provide the | necessary funding for the differential in the base. This | subsection (l) is inoperative on and after June 30, 2000. | (Source: P.A. 102-1100, eff. 1-1-23 .) |
Effective Date: 1/1/2025
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