Insulin Pump Management in CILA Waiver Settings

Department of Human Services

Division of Developmental Disabilities

Information Bulletin

DD.25.011

Purpose:

This information bulletin is meant to provide Community Integrated Living Arrangement (CILA) and Community Day Service (CDS)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 who is currently in their care, their guardian if applicable, and the individual's medical provider determine that they might benefit from an insulin pump.

If an individual is new to waiver services and has an insulin pump, the provider who anticipates providing services should reach out to the Bureau of Clinical Services (BCS) as the training process will look different due to the availability of assessments, historical training documents, and timeline of initiating services.

The provider is required to notify the 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. Prior to notifying BCS, the provider should complete the Readiness for Insulin Pump SAMA. The Readiness for Insulin Pump SAMA is a tool that the Nurse Trainer (RN Trainer) should use in determining whether the individual is ready to use an insulin pump. Please reach out to BCS to obtain the Readiness for Insulin Pump SAMA: DHS.ClinicalServices@illinois.gov.

If the Readiness for Insulin Pump SAMA demonstrates that the individual can manage their diabetes independently, the RN Trainer must complete the Insulin Pump Advanced Training Program. Please note, the IDHS-Approved RN Trainer Diabetes and Insulin Curriculum should have already been completed and reviewed (if necessary).

After the RN Trainer completes the Insulin Pump Advanced Training Program, the RN Trainer should then complete the Independence with Insulin Pump SAMA with the individual.

The RN Trainer must use their professional judgement when determining if the individual is independent with using the insulin pump. The RN Trainer should consider the following when making that determination:

  • Input from the individual's physicians.
  • The information gathered from the Independent with Insulin Pump SAMA (please reach out to BCS to obtain this document).
  • 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.

If the RN Trainer determines that the individual is independent with managing the insulin pump, then the provider must provide all required diabetes and insulin advanced training to the Authorized Direct Support Professionals (ADSPs). This includes the following steps:

  • The RN Trainer must contact the BCS to request the advanced training curriculum and test for the ADSPs.
    • ADSPs should have already completed the IDHS Approved Advanced Training on Diabetes and Insulin Injections by Pen.
  • The ADSP then must pass take the Insulin Pump Advanced Training Program and pass the written test.
    • It is recommended that ADSPs with at least 3 months of experience administering insulin work with individuals with insulin pumps.
    • If an ADSP with at least 3 months of experience administering insulin is not available, the provider must ensure that the ADSP has completed the Advanced Training on Diabetes and Insulin Injections by Pen. If the ADSP has not completed this initial training, then they cannot work alone in the home with an individual who uses insulin injections or an insulin pump.

Requirements for Starting an Insulin Pump

The individual is required to have current and up to date medical assessments, including the Independence with Insulin Pump SAMA. Some of these documents may not be available if the individual is new to waiver services and already using an insulin pump. Exceptions can be made in these instances; please contact BCS.

When notifying the DDD of the anticipated 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.
    1. If the individual does not see an endocrinologist, the prescribing provider should have expertise and be working within their scope of practice.
  2. Diabetes educator notes.
    1. For individuals who are new to CILA services, they should contact a diabetes educator to discuss how to best manage the insulin pump in a CILA setting.
  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 Pump Trainer (CPT) who will be doing the training. RN Trainers are not able to train on insulin pumps unless they are CPTs.
  6. A CPT is a health care professional who is certified by a pump manufacturer to provide insulin pump start-up training. CPTs are usually registered nurses (RNs), registered dieticians (RDS), or Doctor of Pharmacy (PharmDs) who are also Certified Diabetes Care and Education Specialists.
    1. Policy and procedures governing the insulin pump.
  7. Emergency Sick Day Management Plan (ESDMP).
    1. The ESDMP is the plan for when the individual is sick or there is a malfunction with the insulin pump or infusion site.
    2. This should include who the individual and/or staff would contact if the pump malfunctioned. If the individual lives alone, the individual should know who to contact and how to contact that person.
  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 RN Trainer and other licensed professional(s).
    1. The RN Trainer and any RN Trainers who are on-call or have responsibilities for supporting individuals who use insulin pumps must be trained on using the pump the individual will be using.
  2. The role of the ADSPS and what they should do in the event of a malfunction with the insulin pump or infusion site.
  3. The process to ensure that all staff that are supporting the individual are properly trained.
  4. The individual is responsible for managing the insulin pump.
    1. This should also include a trial period with a saline insulin pump so that the individual has an opportunity to demonstrate independence or learn to manage the insulin pump independently.
  5. The process to safeguard the individual if the pump delivery system fails.
  6. The ESDMP
    1. If the individual lives alone, the individual must be able to identify signs that the pump is malfunctioning, if there is a problem with the infusion site, and who to contact if these things occur.

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 use 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.