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Public Act 100-0050


 

Public Act 0050 100TH GENERAL ASSEMBLY

  
  
  

 


 
Public Act 100-0050
 
HB2383 EnrolledLRB100 00361 RLC 10365 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, and (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 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 form" means a subcutaneous
injection via an insulin pen pre-filled by the manufacturer.
Authorized direct care staff may administer insulin, as ordered
by a physician, advanced practice nurse, or physician
assistant, if: (i) the staff has successfully completed a
Department-approved advanced training program specific to
insulin 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 dose that is determined
based on a blood glucose test result. The authorized direct
care staff shall not: (i) calculate the insulin dosage needed
when the dose is dependent upon a blood glucose test result, or
(ii) administer insulin to individuals who require blood
glucose monitoring greater than 3 times daily, unless directed
to do so by the registered nurse.
    "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. 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.
    "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 high
        school equivalency certificate.
            (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 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 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.
    (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-medication procedures.
            (A) Every program shall adopt written policies and
        procedures for assisting individuals in obtaining
        preventative health and self-medication skills in
        consultation with a registered professional nurse,
        advanced practice nurse, physician assistant, or
        physician licensed to practice medicine in all its
        branches.
            (B) Individuals shall be evaluated to determine
        their ability to self-medicate by the nurse-trainer
        through the use of the Department's required,
        standardized screening and assessment instruments.
            (C) 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 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 nurse.
    (e) Quality Assurance.
        (1) A registered professional nurse, advanced practice
    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-medicating to ensure the
        labels match the orders issued by the physician
        licensed to practice medicine in all its branches,
        advanced practice nurse, or physician assistant.
            (C) Medication administration records for persons
        who are not 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 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
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. 98-718, eff. 1-1-15; 98-901, eff. 8-15-14; 99-78,
eff. 7-20-15; 99-143, eff. 7-27-15; 99-581, eff. 1-1-17.)
 
    Section 10. The MC/DD Act is amended by adding Section
3-301.1 as follows:
 
    (210 ILCS 46/3-301.1 new)
    Sec. 3-301.1. Administration of medication by direct care
staff at day programs. For the purposes of this Act, violations
cited against a facility as a result of actions involving
administration of medication by direct care staff of day
programs certified to serve persons with developmental
disabilities by the Department of Human Services under Section
15.4 of the Mental Health and Developmental Disabilities
Administrative Act will not result in:
        (1) the facility being issued a "Type AA" violation as
    defined in Section 1-128.5 of this Act;
        (2) the facility being issued a "Type A" violation as
    defined in Section 1-129 of this Act;
        (3) the facility being issued a "Type B" violation as
    defined in Section 1-130 of this Act;
        (4) denial of the facility's license under Section
    3-117 of this Act;
        (5) the facility being placed on the Department's
    quarterly list of facilities which the Department has taken
    action against prepared under Section 3-304 of this Act;
        (6) the facility being assessed a penalty or fine under
    Section 3-305 of this Act;
        (7) the facility being issued a conditional license
    under Section 3-311 of this Act; or
        (8) the Department's suspension or revocation of a
    facility's license or refusal to renew a facility's license
    under Section 3-119 of this Act.
    The Department shall notify the Division of Developmental
Disabilities of the Department of Human Services when it
becomes aware of a medication error at a day program or that a
resident is injured or is subject to alleged abuse or neglect
at a day program.
 
    Section 15. The ID/DD Community Care Act is amended by
adding Section 3-301.1 as follows:
 
    (210 ILCS 47/3-301.1 new)
    Sec. 3-301.1. Administration of medication by direct care
staff at day programs. For the purposes of this Act, violations
cited against a facility as a result of actions involving
administration of medication by direct care staff of day
programs certified to serve persons with developmental
disabilities by the Department of Human Services under Section
15.4 of the Mental Health and Developmental Disabilities
Administrative Act will not result in:
        (1) the facility being issued a "Type AA" violation as
    defined in Section 1-128.5 of this Act;
        (2) the facility being issued a "Type A" violation as
    defined in Section 1-129 of this Act;
        (3) the facility being issued a "Type B" violation as
    defined in Section 1-130 of this Act;
        (4) denial of the facility's license under Section
    3-117 of this Act;
        (5) the facility being placed on the Department's
    quarterly list of facilities which the Department has taken
    action against prepared under Section 3-304 of this Act;
        (6) the facility being assessed a penalty or fine under
    Section 3-305 of this Act;
        (7) the facility being issued a conditional license
    under Section 3-311 of this Act; or
        (8) the Department's suspension or revocation of a
    facility's license or refusal to renew a facility's license
    under Section 3-119 of this Act.
    The Department shall notify the Division of Developmental
Disabilities of the Department of Human Services when it
becomes aware of a medication error at a day program or that a
resident is injured or is subject to alleged abuse or neglect
at a day program.
 
    Section 99. Effective date. This Act takes effect January
1, 2018.

Effective Date: 1/1/2018