Staff Training Reimbursement Methodology for Insulin & Enteral Tubes

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.19.001 FINAL


This Information Bulletin describes the development of and process of a staff training methodology for Community Integrated Living Arrangements (CILA), Community Day Services (CDS) and Intermediate Care Facilities for Intellectual Disabilities (ICF/IDD) for Insulin and Enteral Tubes.


The development of a rate methodology for reimbursement of staff training of Insulin injections and Enteral Tubes is necessary due to amendments to nursing rules and changes to Administrative Rule 116 which allows properly trained staff to perform insulin injections and care of Enteral Tubes. These changes will affect people served in 60D CILA and CDS Programs and ICF/IDD 16 and fewer facilities.

Rate Calculations:

The staff training methodology consists of general classroom training for both Insulin and Enteral Tubes as well as individual-specific training for Insulin and Enteral Tubes. The training reimbursement rates are specific for CILA, Day Services staff and ICF/DD or ICF/DD Day Training staff. The development of this training methodology is modeled after existing staff training methodologies.

Classroom training is only funded once per Direct Service Person (DSP) or Aide for both Insulin and Enteral Tubes. In order to allow for economies of scale, we encourage classroom training of multiple staff at one time. Each trainee MUST pass the classroom written exam furnished by DHS with a minimum 80 percent accuracy for the CILA, CDS or ICF/IDD provider to bill for training reimbursement.

Individual-specific training for Insulin and Enteral Tubes must be conducted on a single student (staff) to single client/participant basis by the RN Trainer. As a result, this portion of the training is reimbursable for each staff person who is trained for each individual client/participant. Each trainee MUST demonstrate 100 percent competency, as documented by Competency Based Training Assessments (CBTAs) specific to insulin injections via insulin pen and enteral tube nutrition and medication administration, under the direct observation and supervision of the RN-Trainer. A minimum 100 percent accuracy is required to pass the individual training and for the CILA, CDS or ICF/IDD provider to bill for training reimbursement.

All RN Trainers must use the Department approved Insulin and Enteral Tube curriculum, written exams and CBTAs. All RN Trainers must access and view the Insulin and Enteral Tube Advanced Training Webinars on the DDD Provider Training Website before the DDD will furnish the applicable curriculum and CBTAs to the RN Trainers. The RN Trainer can access the webinars at: When complete the RN Trainer must then contact the Division at: to receive access to the training curriculums, exams and CBTA forms.

Before billing the Department for Insulin or Enteral Tube training the RN Trainer must have received the Training curriculums, written exams and CBTA forms AND the employee must successfully complete the applicable training and the applicable CBTAs. The CILA, CDS agency and/or ICF/IDD facility is required to maintain each employee's training records and CBTAs. The Curriculum, exam and CBTA for Insulin training was first available after May 27, 2017. The Curriculum, exam and CBTAs for Enteral Tubes were first available after May 3, 2018.

Employees who were trained prior to the release of this Information Bulletin must have on file the applicable written exam and CBTAs with passing grades on or after the dates listed above for reimbursement from the department. CILA, CDS and ICF/IDD providers may bill for previously trained employees so long as the employee has passed the appropriate written exams and CBTAs after the dates listed above and on file with the agency.

Please see attached for specific staff training requirements, reimbursement components and rates. The billing form should be filled out on-line, printed and submitted. The form can be obtained at:

The information contained herein should not be considered a substitute for the appropriate official statutes, rules, regulations, or the advice of legal counsel.

Effective Date:

January 25, 2019.  Revised: March 7, 2019