DRAFT - Insulin Pump Management in CILA Waiver Settings

Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.24.XXX

Purpose:

This information bulletin is meant to provide Community Integrate Living Arrangement (CILA) and Community Day Service waiver providers guidance on how to safely support an individual who uses an insulin pump.

Background: Public Act 103-0890 allows insulin pumps to be utilized in all settings governed by Rule 116 beginning January 1, 2025.

Process:

Below is the process the CILA provider is required to follow when an individual, their guardian if applicable, and the individual's medical provider determine that it would benefit an individual to use an insulin pump.

The provider is required to notify the Bureau of Clinical Services (BCS) of all instances where an individual, their guardian if applicable, and the individual's medical provider determine the individual might benefit from an insulin pump.

The individual is required to have current and up to date medical assessments, including but not limited to, a Self-Administration of Medication Assessment (SAMA) that demonstrates that they are independent with administering insulin injections, the Health Risk Screening Tool (HRST), and the annual nursing assessment.

The insulin pump specific SAMA must demonstrate that the individual is independent with managing the insulin pump. For the Nurse (RN) Trainer's consideration, this may include, but is not limited to, being able to demonstrate the ability to handle the technical and mechanical functions of the insulin pump, ability to fill the reservoir/pod with insulin, ability to prime the pod or infusion set tubing, ability to insert the pod/pump infusion catheter, ability to communicate the meaning of basal and bolus insulin, ability to set insulin rates in the pump and make changes to rates if needed, ability to use the bolus calculator if the pump does not automatically do this, ability to respond to pump alarms, ability to communicate pump or site malfunction guidelines, and sick day management guidelines.

The provider must complete all required diabetes and insulin advanced training. The following must be completed:

  • RN Trainer (RNT) must listen to the IDHS-Approved RN Trainer Diabetes and Insulin Curriculum
  • After listening to the webinar, the RN Trainer must contact the Bureau of Clinical Services (BCS) to request the advanced training curriculum and test for the Authorized Direct Support Professionals (ADSPs).
  • The ADSP is then provided the IDHS Approved Advanced Training on Diabetes and Insulin Injections by Pen. The RN Trainers must deliver this training.
  • The ADSP then must pass the insulin advanced training test and Competency Based Training and Assessment.
    • It is recommended that ADSPs with at least 3 months of experience administering insulin work with individuals with insulin pumps

When requesting use of an insulin pump in a CILA waiver setting, the following information must be provided to the BCS:

  1. Endocrinologist's notes that specifically detail current diabetes regimen.
  2. Diabetes educator notes.
  3. Nutrition notes (if not included in other reports).
  4. Type of insulin pump the individual will be using.
  5. The name of the certified insulin pump educator will be doing the training RN Trainers are not able to train on insulin pumps unless they are certified insulin pump educators.
  6. Policy and procedure governing the insulin pump.
  7. Emergency sick day plan.
  8. Confirmation that the CILA provider has written consent for direct communication with all of the individual's medical providers.
  9. Written confirmation from the individual's endocrinologist or diabetes educator that the individual can manage the pump independently by him or herself.

The Division of Developmental Disabilities (DDD) expectation is that the individual receiving services is totally independent with their insulin pump. The waiver service provider's policy and procedure must include the following:

  1. The role of the nurse trainer and other licensed professional(s).
    1. RNT must be trained on using the pump the individual will be using.
  2. The process to ensure that all staff that are supporting the individual are properly trained.
  3. The individual is responsible for managing the insulin pump
  4. The process to safeguard the individual if the pump delivery system fails.
  5. The process for an emergency sick day plan.

After submission of the listed documents, the BCS will review and provide feedback on the policy and procedures within 14 calendar days. Insulin pump regimens should not be implemented prior to the BCS's review of the provider's policy and procedure. The BCS will complete a focused review to ensure all staff training files are in compliance as well as an observation of the individual demonstrating independent us of the insulin pump.

Questions:

For questions about the Insulin Pump Management in CILA Waiver Settings, please email DHS.DDDComments@illinois.gov with "Insulin Pump Management" in the subject line.

Effective Date:

Effective January 1, 2025.