Public Act 103-0890
 
SB0860 EnrolledLRB103 03319 KTG 48325 b

    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