Bill Text: IL SB0860 | 2023-2024 | 103rd General Assembly | Engrossed

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Bill Title: Amends the Mental Health and Developmental Disabilities Administrative Act. In provisions requiring the Department of Human Services to develop a medication administration training program for authorized directed staff at certain facilities for individuals with a developmental disability, provides that non-licensed authorized direct care staff must (i) score 100% on the competency-based assessment demonstrating proficiency in the skill of administering medication and (ii) have received additional competency-based assessment by the nurse-trainer whenever it is determined that additional skill development and training is needed to administer a medication. Provides that to assist each individual in attaining the highest possible level of independent functioning, an individual's total health care program shall include individual training in preventive health and self-administration of medication procedures (rather than training in preventive health and self-medication procedures). Requires each program to adopt written policies and procedures for assisting individuals who choose to obtain preventative health and self-administration of medication skills in consultation with a registered professional nurse, advanced practice registered nurse, physician assistant, or licensed physician. For quality assurance, requires a registered professional nurse, advanced practice registered nurse, licensed practical nurse, licensed physician, physician assistant, or pharmacist to review medication labels, including medications listed on the medication administration record for individuals who are not self-administering medication. Adds auto-injectors (rather than epinephrine auto-injectors) to the definition of "medications". Defines "insulin in an injectable or auto-injectable form" (rather than "insulin in an injectable form"). Defines "GLP-1 receptor agonists in an injectable or auto-injectable form". Makes other changes.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Engrossed) 2024-04-30 - Committee Deadline Extended-Rule 9(b) May 10, 2024 [SB0860 Detail]

Download: Illinois-2023-SB0860-Engrossed.html

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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

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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 and topical medications,
auto-injectors, 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 technologies
available including, but not limited to, insulin pumps,
insulin pods, or via an insulin pen pre-filled by the
manufacturer.

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"GLP-1 receptor agonists in an injectable or
auto-injectable form" means an anti-diabetic medication used
for the treatment of type 1 and type 2 diabetes. Authorized
direct care staff may administer insulin or GLP-1 receptor
agonists via auto-injection or pen pre-filled by the
manufacturer as delegated by the registered professional 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, 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,

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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

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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.

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(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 by the nurse-trainer as deemed necessary by
the nurse-trainer whenever it is determined that
additional skill development and training is needed to
administer a medication 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.

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(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

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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.

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(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

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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.

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