103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB3746

 

Introduced 2/17/2023, by Rep. Natalie A. Manley

 

SYNOPSIS AS INTRODUCED:
 
20 ILCS 1705/15.4

    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 persons with a developmental disability, provides that non-licensed authorized direct care staff must, in addition to other specified requirements, (i) score 100% on the competency-based assessment demonstrating proficiency in the skill of passing medication and (ii) 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. Provides that every facility health care program shall adopt written policies and procedures for assisting individuals who choose to obtain preventative health and self-medication skills in consultation with a professional nurse or other medical personnel as specified. Provides that if an individual desires to gain independence in self-medication administration the individual shall be evaluated to determine the individual's ability to self-medicate by the nurse-trainer through the use of the Department's required, standardized screening and assessment instruments.


LRB103 29607 KTG 56002 b

 

 

A BILL FOR

 

HB3746LRB103 29607 KTG 56002 b

1    AN ACT concerning State government.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
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
17programs certified to serve persons with developmental
18disabilities by the Department of Human Services. The
19Department of Human Services shall develop a training program
20for authorized direct care staff to administer medications
21under the supervision and monitoring of a registered
22professional nurse. The training program for authorized direct
23care staff shall include educational and oversight components

 

 

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1for staff who work in day programs that are similar to those
2for staff who work in residential programs. This training
3program shall be developed in consultation with professional
4associations representing (i) physicians licensed to practice
5medicine in all its branches, (ii) registered professional
6nurses, and (iii) pharmacists.
7    (b) For the purposes of this Section:
8    "Authorized direct care staff" means non-licensed persons
9who have successfully completed a medication administration
10training program approved by the Department of Human Services
11and conducted by a nurse-trainer. This authorization is
12specific to an individual receiving service in a specific
13agency and does not transfer to another agency.
14    "Medications" means oral and topical medications, insulin
15in an injectable form, oxygen, epinephrine auto-injectors, and
16vaginal and rectal creams and suppositories. "Oral" includes
17inhalants and medications administered through enteral tubes,
18utilizing aseptic technique. "Topical" includes eye, ear, and
19nasal medications. Any controlled substances must be packaged
20specifically for an identified individual.
21    "Insulin in an injectable form" means a subcutaneous
22injection via an insulin pen pre-filled by the manufacturer.
23Authorized direct care staff may administer insulin, as
24ordered by a physician, advanced practice registered nurse, or
25physician assistant, if: (i) the staff has successfully
26completed a Department-approved advanced training program

 

 

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1specific to insulin administration developed in consultation
2with professional associations listed in subsection (a) of
3this Section, and (ii) the staff consults with the registered
4nurse, prior to administration, of any insulin dose that is
5determined based on a blood glucose test result. The
6authorized direct care staff shall not: (i) calculate the
7insulin dosage needed when the dose is dependent upon a blood
8glucose test result, or (ii) administer insulin to individuals
9who require blood glucose monitoring greater than 3 times
10daily, unless directed to do so by the registered nurse.
11    "Nurse-trainer training program" means a standardized,
12competency-based medication administration train-the-trainer
13program provided by the Department of Human Services and
14conducted by a Department of Human Services master
15nurse-trainer for the purpose of training nurse-trainers to
16train persons employed or under contract to provide direct
17care or treatment to individuals receiving services to
18administer medications and provide self-administration of
19medication training to individuals under the supervision and
20monitoring of the nurse-trainer. The program incorporates
21adult learning styles, teaching strategies, classroom
22management, and a curriculum overview, including the ethical
23and legal aspects of supervising those administering
24medications.
25    "Self-administration of medications" means an individual
26administers his or her own medications, or a portion of his or

 

 

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1her own medications. To be considered capable to
2self-administer their own medication, individuals must, at a
3minimum, be able to identify their medication by size, shape,
4or color, know when they should take the medication, and know
5the amount of medication to be taken each time. The use of
6assistive or enabling technologies can be used to demonstrate
7a person's capability to administer his or her own
8medications.
9    "Training program" means a standardized medication
10administration training program approved by the Department of
11Human Services and conducted by a registered professional
12nurse for the purpose of training persons employed or under
13contract to provide direct care or treatment to individuals
14receiving services to administer medications and provide
15self-administration of medication training to individuals
16under the delegation and supervision of a nurse-trainer. The
17program incorporates adult learning styles, teaching
18strategies, classroom management, curriculum overview,
19including ethical-legal aspects, and standardized
20competency-based evaluations on administration of medications
21and self-administration of medication training programs.
22    (c) Training and authorization of non-licensed direct care
23staff by nurse-trainers must meet the requirements of this
24subsection.
25        (1) Prior to training non-licensed direct care staff
26    to administer medication, the nurse-trainer shall perform

 

 

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

 

 

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1        administration enters the program.
2        (3) Authorized direct care staff shall be re-evaluated
3    by a nurse-trainer at least annually or more frequently at
4    the discretion of the registered professional nurse. Any
5    necessary retraining shall be to the extent that is
6    necessary to ensure competency of the authorized direct
7    care staff to administer medication.
8        (4) Authorization of direct care staff to administer
9    medication shall be revoked if, in the opinion of the
10    registered professional nurse, the authorized direct care
11    staff is no longer competent to administer medication.
12        (5) The registered professional nurse shall assess an
13    individual's health status at least annually or more
14    frequently at the discretion of the registered
15    professional nurse.
16    (d) Medication self-administration shall meet the
17following requirements:
18        (1) As part of the normalization process, in order for
19    each individual to attain the highest possible level of
20    independent functioning, all individuals shall be
21    permitted to participate in their total health care
22    program. This program shall include, but not be limited
23    to, individual training in preventive health and
24    self-medication procedures.
25            (A) Every program shall adopt written policies and
26        procedures for assisting individuals who choose to

 

 

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

 

 

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1        Interdisciplinary Team, which includes a registered
2        professional nurse or an advanced practice registered
3        nurse.
4    (e) Quality Assurance.
5        (1) A registered professional nurse, advanced practice
6    registered nurse, licensed practical nurse, physician
7    licensed to practice medicine in all its branches,
8    physician assistant, or pharmacist shall review the
9    following for all individuals:
10            (A) Medication orders.
11            (B) Medication labels, including medications
12        listed on the medication administration record for
13        persons who are not self-medicating to ensure the
14        labels match the orders issued by the physician
15        licensed to practice medicine in all its branches,
16        advanced practice registered nurse, or physician
17        assistant.
18            (C) Medication administration records for persons
19        who are not self-medicating to ensure that the records
20        are completed appropriately for:
21                (i) medication administered as prescribed;
22                (ii) refusal by the individual; and
23                (iii) full signatures provided for all
24            initials used.
25        (2) Reviews shall occur at least quarterly, but may be
26    done more frequently at the discretion of the registered

 

 

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1    professional nurse or advanced practice registered nurse.
2        (3) A quality assurance review of medication errors
3    and data collection for the purpose of monitoring and
4    recommending corrective action shall be conducted within 7
5    days and included in the required annual review.
6    (f) Programs using authorized direct care staff to
7administer medications are responsible for documenting and
8maintaining records on the training that is completed.
9    (g) The absence of this training program constitutes a
10threat to the public interest, safety, and welfare and
11necessitates emergency rulemaking by the Departments of Human
12Services and Public Health under Section 5-45 of the Illinois
13Administrative Procedure Act.
14    (h) Direct care staff who fail to qualify for delegated
15authority to administer medications pursuant to the provisions
16of this Section shall be given additional education and
17testing to meet criteria for delegation authority to
18administer medications. Any direct care staff person who fails
19to qualify as an authorized direct care staff after initial
20training and testing must within 3 months be given another
21opportunity for retraining and retesting. A direct care staff
22person who fails to meet criteria for delegated authority to
23administer medication, including, but not limited to, failure
24of the written test on 2 occasions shall be given
25consideration for shift transfer or reassignment, if possible.
26No employee shall be terminated for failure to qualify during

 

 

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1the 3-month time period following initial testing. Refusal to
2complete training and testing required by this Section may be
3grounds for immediate dismissal.
4    (i) No authorized direct care staff person delegated to
5administer medication shall be subject to suspension or
6discharge for errors resulting from the staff person's acts or
7omissions when performing the functions unless the staff
8person's actions or omissions constitute willful and wanton
9conduct. Nothing in this subsection is intended to supersede
10paragraph (4) of subsection (c).
11    (j) A registered professional nurse, advanced practice
12registered nurse, physician licensed to practice medicine in
13all its branches, or physician assistant shall be on duty or on
14call at all times in any program covered by this Section.
15    (k) The employer shall be responsible for maintaining
16liability insurance for any program covered by this Section.
17    (l) Any direct care staff person who qualifies as
18authorized direct care staff pursuant to this Section shall be
19granted consideration for a one-time additional salary
20differential. The Department shall determine and provide the
21necessary funding for the differential in the base. This
22subsection (l) is inoperative on and after June 30, 2000.
23(Source: P.A. 102-1100, eff. 1-1-23.)