Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.05-049 - Rules for the Arkansas Long Term Care Facility Nursing Assistant Traning Program
Current through Register Vol. 49, No. 9, September, 2024
Section I AUTHORITY
The following rules and regulations for the Long Term Care Facility Nursing Assistant Training Program are duly adopted and promulgated by the Department of Health and Human Services pursuant to Arkansas Code 20-10-701 et seq.
This initiative is pursuant to the Federal mandates of Public Law 100-203 (the Nursing Home Reform Act, Subtitle C of the Omnibus Budget and Reconciliation Act of 1987 and technical amendments of OBRA 1989 and 1990) concerning the training and competency evaluation of nursing assistants employed in long term care facilities and the registry of certified nursing assistants.
The Federal Omnibus Budget Reconciliation Act of 1987, 1989, and 1990 (OBRA) and regulations issued by the Department of Health and Human Services - Health Care Financing Administration (HCFA) established the minimum requirements for nursing assistant training and competency evaluation programs in Section 1819(a) - (f) and 1919(a) - (f) of the Social Security Act.
Section II PURPOSE
To develop and approve training and competency evaluation programs for individuals who provide nursing or nursing-related services to residents in long term care facilities and who are not licensed health professionals or volunteers who provide services without monetary compensations.
These requirements are designed to assist long term care facilities and other educational institutions with training and competency programs for nursing assistants. The objective of the Nursing Assistant Training Program is the provision of quality services to residents by nursing assistants who are able to:
The training program must teach the attitudes and behaviors (which reflect attitudes) which promote the healthy functioning of residents both physically and emotionally, and focus on the restoration and maintenance of the resident in an independent as possible status. These attitudes and behaviors of staff are demonstrable in the day-to-day care environment in the facility.
Section III DEFINITIONS
The following words and terms, when used in this section, shall have the following meaning, unless the context clearly indicates otherwise.
Abuse - The willful, knowing, or reckless act of mistreatment of a resident through words or physical action which results in physical, emotional, or mental injury to a resident.
Act - Public Law 100-203 (the Federal Nursing Home Reform Act, Subtitle C of the Omnibus Budget and Reconciliation Act) of 1987 and technical amendments of OBRA 1989 and 1990. Also may refer to Arkansas Code 20-10-701 et seq.
Competency Evaluation - An examination which includes manual (skills) and written (or oral component for those with limited literacy skills) evaluations.
Department - The Arkansas Department of Health and Human Services.
Division - The Division of Medical Services within the Department of Health and Human Services.
Educational Institution - An institution which is licensed by the Arkansas State Board of Private Career Education as defined by Act 906 of 1989 (i.e. career colleges, proprietary school, etc).
Examination - (See competency evaluation) A competency evaluation which includes manual (skills) and written evaluations.
Facility - A long term care facility/nursing facility (nursing home) licensed by the Office of Long Term Care. A nursing facility which provides nursing care and supportive care on a 24-hour basis to residents. Facility "premises" include all structures and surrounding property.
Facility Based Program - A nursing assistant training program offered by or in a long term care facility.
Instructor Training Program - A train-the-trainer program of instruction in educational teaching techniques and methods for Primary Instructors and Team Instructors approved by the Office of Long Term Care.
Licensed Health Professional - A physician, physician assistant, nurse practitioner, physical, speech, or occupational therapist, physical or occupational assistant, registered professional nurse, licensed practical nurse, or certified social worker.
Misappropriation of resident property - The taking, secretion, misapplication, deprivation, transfer, or attempted transfer to any person not entitled to receive any property, real or personal, or anything of value belonging to or under the effective control of a resident or other appropriate legal authority, or the taking of any action contrary to any duty imposed by law prescribing conduct relating to the custody or disposition of property of a resident.
Neglect - An act of omission or an act without due care which causes physical or emotional harm to a resident or adversely affects the resident's health, safety, or welfare in any way.
Non-facility based program - A nursing assistant training program not offered by or in a facility (i.e. career college, community college, Vo-Tech school, proprietary school, etc.)
Nursing Assistant - An individual providing nursing or nursing-related services to residents in a long term care facility who has successfully completed a training and/or competency evaluation program and is competent to provide such services but not an individual who is a licensed health professional or who volunteers to provide such services without monetary compensation.
Orientation Program - A program which provides the nursing assistant with explanations of facility structure, policies, procedures, philosophy of care, description of the resident population and employee rules. This orientation phase is not included as part of the Nursing Assistant Training Program.
Performance Record - A list of the major duties/skills to be learned in the program and the trainee's performance of each.
Petitioner - A person who appeals a finding that such person has, while acting as a nursing assistant in a facility or while being used by a facility in providing services to a resident, abused or neglected a resident, or has misappropriated a resident's property.
Primary Instructor (PI) - An individual approved by the Office of Long Term Care to provide instruction in a program and who has overall responsibility for conducting a program.
Program Trainer - A registered nurse, licensed practical nurse, or other licensed health professionals who conduct specific classroom lectures based upon an expertise in a given subject area, under the direct supervision of the Primary Instructor.
Office - The Office of Long Term Care within the Division of Medical Services.
Regi stry - A listing of all individuals who have satisfactorily completed a training and competency evaluation program or a competency evaluation program approved by the Office of Long Term Care.
Resident - A patient residing in a facility.
Skills training - Training composed of both skills demonstration in the classroom lab and skills performance in the clinical area with residents in a long term care facility.
Team (Additional) Instructor - A RN or LPN who, under the general supervision of the Primary Instructor, may provide classroom and skills training.
Trainee - An individual who is enrolled in a nursing assistant training program and who is not permitted to perform nursing services for residents during the training period for which he/she have not been trained and found to be competent.
Section IV NURSING ASSISTANT TRAINING
GENERAL RULE: A facility must not use any individual working in the facility as a nursing assistant for more than four (4) months unless that individual has successfully completed a training program and competency evaluation approved by the Office of Long Term Care as described in these regulations.
Nursing assistant training programs must include materials which provide a basic level of both knowledge and demonstrable skills for each individual completing the program.
Each course must be prepared and administered in accordance with the training course guidelines prescribed in the "Arkansas LTCF Nursing Assistant Training Curriculum". This curriculum is to be used as a guide for conducting training in both facility and non-facility programs.
These guidelines essentially provide the outline for each training program and can be enhanced by the inclusion of current information to keep training relevant to changing needs. The content provides fundamental information and leaves open the opportunity for an instructor to function as necessary in response to perceived student requirements. It is important to recognize that the curriculum guidelines identify the limitations of the LTCF nursing assistants' direct care responsibilities.
Each training program must use the behavioral stated objectives in the "Arkansas LTCF Nursing Assistant Training Curriculum" for each unit of instruction. These objectives state the measurable performance criteria which serve as the basis for the state competency evaluation test. Review the unit objectives with the trainees at the beginning of each unit so that each trainee knows what is expected of him/her in each part of the training program.
Upon successful completion of the required training, the trainee must pass the state competency evaluation/
examination administered by the Department (see Section VII). An individual must complete the state competency examination within 12 months of graduation from a training program or retraining will be required.
Each course shall consist of a combination of classroom and clinical instruction. The requirement for state certification will be minimum of 75 hours of training with a balance between theory instruction and skills training. Skills training is composed of both skills demonstration in the classroom lab and skills performance in the clinical area with residents in a long term care facility. The clinical site must be a long term care facility which has not been disqualified by restrictions as described in Section V (B).
A minimum of 16 hours initial classroom instruction is required in Part I. This will include both theory instruction and skills demonstration in the classroom lab. During Part I the trainee is not allowed on the floor as part of a facility's staffing pattern. After completion of Part I, a trainee may be used in a facility's staffing pattern but only assigned to duties for which they have demonstrated competency. Documentation of acceptable performance of all skills and duties shall be on file with the Primary Instructor (see item C - Trainee Activities).
Part II requires the completion of the remaining 59 hours of training consisting of theory, classroom lab and clinical skills training. Clinical skills training must include at least 16 hours of supervised practical training in a facility performing tasks on an individual under the direct supervision of the instructor.
The ratio of trainees to instructors in skills training must be adequate (maximum of 12/1) to ensure safe and effective assistance and supervision.
In programs that are facility-based, who wish to use student trainees in staffing while in training following completion of Part I, a minimum often (10) hours per week must be spent in the training program until completed. This provides for the completion of the training program allowing time for students to challenge and successfully pass the competency evaluation test within the four (4) month limit.
Each program shall issue to each trainee, upon successful completion of the program, a written statement in the form of a certificate of completion, which shall include the program's name, the student's name and social security number, the date of completion and the signature of the Primary Instructor. Such certificate, or copies thereof, shall serve as evidence of successful completion of a training program in order to be eligible to take the state certification/competency test.
Clearly identify each trainee during all skills training portions. Identification must be recognizable to residents, family members, visitors, and staff.
A nursing assistant who has begun a training program, whether facility-based or not, and who has not completed the program, may be hired by a facility to provide care for which he/she has received training and has demonstrated competence. In other words, nursing assistants are not permitted to perform services for residents during the training period for which they have not been trained and found by the training program to be competent.
Documentation of each trainee's acceptable performance of each skill/procedure must be maintained by the Primary Instructor on the Task Performance Record provided by the Department (Form DMS-741). This record will consist of a listing of the duties/skills expected to be learned in the program, space to record when the trainee performs this duty/skill, and spaces to note satisfactory or unsatisfactory performance, and the instructor supervising the performance.
A program must terminate a trainee when provided with substantial evidence or a determination that the trainee is guilty of resident neglect or abuse, or misappropriation of resident property. The program shall establish procedures for a review of the allegations when requested by the trainee. The program shall inform the Department of any trainees terminated under these circumstances.
The nursing assistant training program shall require the provision of physical facilities as follows:
Comfortable temperatures.
Clean and safe conditions.
Adequate lighting.
Adequate space to accommodate all students.
All equipment needed, including audio-visual equipment and that needed for simulating resident care.
The physical facilities including classrooms, laboratories, conference space, library and educational materials shall be adequate to meet the needs of the program, the number of trainees, and the instructional staff.
Suggested training material/resources may include (but not be limited to) a blackboard, flipchart, projector/screen, VCR, interactive video machine, anatomical chart, mannequin, bed, lavatory/sink, etc.
The Department will not require or endorse any one textbook or other material such as video-tapes, films, etc. There are several textbooks, video-tapes, etc. on the market and each facility or school will have the choice in selecting their materials. The curriculum guide is to be used in identifying the information to be taught in order that each program will know the objectives and procedures expected to be communicated to the nursing assistant trainee in order for them to pass the state competency evaluation.
All nursing assistants must receive an orientation program which includes, but is not limited to, an explanation of:
The organizational structure of the facility;
Policies and procedures (including fire/disaster plans, etc.)
The philosophy of care of the facility;
The description of the resident population; and
Employee rules.
This facility orientation training program is not included in the required 75 hours of nursing assistant training.
All facilities will continue to provide ongoing in-service training on a routine basis both in groups and as necessary in specific situations on a one-to-one basis. Each nursing assistant must receive one (1) hour of in-service training per month.
The facility must complete a performance review of each nursing assistant at least once per year and provide regular in-service training based on the outcome of these reviews. The in-service training should address areas of weakness and be sufficient to ensure the continuing competence of the nursing assistants.
In addition to training needs identified by performance reviews, in-service training should also address the special needs of residents as determined by each facility. Training can be received on the unit as long as it is directed toward skills improvement, provided by appropriately trained staff and documented (for example, skills demonstration with return demonstration recorded on a check list).
Nursing assistants who are employed/leased through a temporary hiring service must have completed an approved training program and passed the state competency evaluation test prior to employment and use by a facility.
Section V APPROVAL OF PROGRAMS
Nursing assistant training programs may be offered by or in nursing facilities, as well as outside facilities. The clinical portion of the training must in all cases utilize a nursing facility and its residents. Nursing facilities may offer complete training program themselves and/or may contract with another organization to provide the training.
Other groups and/or institutions such as employee organizations, vocational/technical schools, community colleges, and private institutions may conduct programs, dependent upon Department approval.
Programs offered to the public and that charge a tuition fee must be licensed through the State Board of Private Career Education, 612 Summit, Suite 102, Little Rock, AR 72201, (501) 682-2565. This provision would not apply to the state schools (Vo-Tech, community colleges, etc.) or programs offered by nursing facilities who train their own employees (or potential "on-call" employees).
The Department shall not approve a program offered by or in a nursing facility which, in the previous two years:
* Extended survey is defined for this provision as a survey which includes a review of facility policy and procedures pertinent to Level A deficiencies in Resident Rights, Resident Behavior and Facility Practices, Quality of Life or Quality of Care. Partial extended survey is defined as a survey conducted as a result of a deficiency in Level A requirements other than those listed above in the extended survey definition.
Facility-based training programs are prohibited from charging tuitions/training fees to their nursing assistant employees (or those who have received an offer of employment) for any portion of the program (including any fees for textbooks or other required course materials). See Section X regarding reimbursements.
Each facility or entity that desires to offer a program shall file an Application for Program Approval form prescribed by the Department (Form DMS-724). Application forms are available on request by calling the Nursing Assistant Training Program at 682-1807.
If the course to be offered differs in content or length from the guidelines prescribed in the "Arkansas LTCF Nursing Assistant Training Curriculum", a basic outline must be attached to the application showing the lesson plans/teaching modules your program will offer to cover the curriculum contents. This should specify the elements covered in each module, hours of classroom theory, hours of lab (return demonstrations), and hours in the clinical area in a nursing home. Additional information deemed important in consideration of the program may be requested by the Department.
If applicable, verification of school licensure by the State Board of Private Career Education will be required (see item A of this section).
Application must be submitted to the Department eight weeks prior to the start of the first course and every two years thereafter. An application must be completed and signed by the Primary Instructor. All official application forms must be notarized.
Applications which are received incomplete may cause postponement of the program starting date. A notice of deficiency in the application will be mailed to an applicant within 15 days of the date of filing. The applicant will be given an opportunity to correct any deficiencies.
Notice of approval or disapproval of the application will be given to the entity within 15 work days of the receipt of a complete application. If the application is to be disapproved, the reasons for disapproval shall be given in the notice.
An applicant may request a hearing on a disapproval in writing within 10 days of receipt of the notice of the proposed disapproval. If no request is made, the entity is deemed to have waived the opportunity for a hearing.
Prior to major changes in the course, an application must be resubmitted for approval.
Major changes include:
Change in training provider Change in classroom site
Change in clinical site
Change in instructor
Complete revision of course structure
Major changes do NOT include:
Change in materials (handouts, textbooks, videos, etc.)
Change in hours allotted to one or more modules
Change in order in which modules are taught
Addition of modules/tasks not required by regulations or guidelines
The Department shall withdraw approval of a training program when;
one or more restrictions exists as listed in Section V (B).
the entity offering the program refuses to permit unannounced visits by the Department. (Also, any facility that refuses to permit unannounced visits is subject to having its provider agreement terminated.)
curriculum and implementation requirements specified in these regulations are not met by the program.
an excessive failure rate exists for trainees on the state competency evaluation test.
Provisions for monitoring and review of compliance with program requirements are specified in Section IX of these regulations.
When the Department withdraws approval from a training program, it shall:
notify the program in writing, indicating the reason (or reasons) for withdrawal of approval,
permit students who have already started the program to finish it.
Section VI QUALIFICATIONS OF INSTRUCTORS
The training of nursing assistants must be performed by or under the general supervision of a registered nurse (licensed in Arkansas) who possesses a minimum of two (2) years of nursing experience, at least one (1) year of which must be in the provision of long-term care facility services.
In addition to the above nursing experience requirements, instructors of nursing assistants must have at least one of the following;
have completed a course in teaching adults (train-the-trainer workshop,
etc.)
have experience in teaching adults have experience in supervising nursing assistants.
In a facility-based program, the training of nursing assistants may be performed under the general supervision of the Director of Nursing (DON), who is prohibited from performing the actual training (unless replacement DON coverage is provided).
An individual who will be the Primary Instructor and meets the above criteria may submit the Application for Program Approval (Form DMS-724) identifying their qualifications to teach. This must include nursing experience, supervisory experience, teaching experience and/or certificate of attendance in an instructor workshop.
There must be one, and only one, Primary Instructor for each course. All questions and correspondence referring to the course will be directed to this person. The PI should participate in the planning of each lesson/teaching module - including clinical instruction - whether or not the PI teaches the lesson.
The Primary Instructor of a nursing assistant training program shall be responsible for ensuring that the following requirements are met:
Instructors may use other qualified resource personnel from the health field as guest instructors in the program to meet the objectives for a specific unit. Examples are pharmacists, dietitians, social workers, sanitarians, advocates, gerontologists, nursing home administrators, etc. Guest instructors must have a minimum of one (1) year of experience in their respective fields.
Licensed Practical Nurses (LPN's) may be used to provide classroom and skills training and supervision. They must be under the general supervision of the Primary Instructor, and have a minimum of one (1) year of long term care experience. (All final skills check-off reviews must be performed by the Primary Instructor.)
The Application of Program Approval (Form DMS-724) shall be used to identify each additional instructor/trainer and their qualifications to teach.
Section VII REQUIREMENTS FOR TESTING AND CERTIFICATION
The initial implementation of these training and testing requirements have covered three basic phases:
A nursing assistant shall be deemed to have satisfied the requirement of completing a training and competency evaluation program approved by the State if the nursing assistant:
Individuals will not qualify for these waivers if they have not provided nursing or nursing-related services for a period of 24 months or longer since completing training. They will be required to complete a new training program and state test to obtain current certification.
Facilities who wish to obtain certification for the above described individuals should submit to OLTC Form DMS-798, Exemption/Reciprocity Request Form, with attached copies of documents/certificates verifying course completion, number of hours in course, etc.
All individuals working as nursing assistants in Arkansas nursing facilities as of July 1, 1989 were allowed to become certified by passing the state competency test but were not required to complete the "formal" 75 hour training course.
This phase was completed by October 1, 1990 and does not apply thereafter. Therefore, all individuals must now complete the 75 hour training requirements to qualify to take the state test regardless of past employment status on July 1, 1989.
Effective July 1, 1989 a facility must not use any individual working in the facility as a nursing assistant for more than four (4) months unless that individual has successfully completed a training program and competency evaluation approved by the Office of Long Term Care as described in these regulations.
The Department or its appointed agency shall be responsible for administering the competency evaluation/examination. The exam shall be based upon the training curriculum requirements specified in the LTCF Nursing Assistant Training Curriculum Guide.
The examination will be in English. A secondary language version shall not be offered as there are not any facilities in Arkansas with a substantial number of non-English speaking resident population.
The competency examination shall consist of two components; a written (or oral) exam and a skills demonstration. Each test candidate will be allowed to choose between a written or oral exam. The oral examination will be read from a prepared text in a neutral manner.
The written/oral component shall be developed from a pool of test questions, only a portion of which is used in any one exam. The skills demonstration shall consist of a demonstration of five randomly selected items drawn from a pool of tasks ranked according to difficulty.
The skills demonstration component will be performed in a facility (which has not been disqualified by criteria specified in Section V, item B.) or laboratory setting similar to the setting in which the individual will function.
The skills demonstration will be administered and evaluated by a registered nurse (RN) with at least one (1) year experience in providing care for the elderly or chronically ill of any age.
The skills demonstration component may be proctored by facility/training site personnel (RNs as described above) if secure, standardized, and scored by the testing agency approved by the Department. "Proctoring" will not be approved in facilities subject to prohibitions specified in Section V (item B).
To complete the competency evaluation successfully, an individual must pass both the written (or oral) examination and the skills demonstration. If an individual does not complete the evaluation satisfactorily, they will be advised of areas which he/she did not pass and their right to take the test three times.
All test candidates will be allowed up to three opportunities to successfully complete the examination. Failure after three attempts will require re-training to qualify for further testing opportunities. A maximum time limit of 12 months shall be imposed on an individual to complete the test. Verification of new retraining will be required after this 12 month limit for further testing opportunities.
Effective upon notification of test results, any person who has failed the competency evaluation (either the written/oral or skills portion) after three attempts is prohibited from providing nursing services to residents in a nursing facility. However, based on the program regulations, these individuals may maintain their employment status if they re-enroll in a new training program. They would be required to follow the program implementation requirements of completing the first 16 hours (Part I) training prior to direct resident contact and can only be assigned to job duties thereafter in which they have been "checked-off" as competent to perform as they complete the remainder of the full 75 hours of training. Upon successful completion of their training, they should be scheduled for the next available competency exam.
All individuals who successfully complete the competency examination shall be placed on the CNA registry and issued a state certificate. Information on the registry shall be made available for public inquiry (see Section VIII).
Testing will be made available once per month at multiple sites geographically dispersed throughout the state. Schedules of times, locations, and registration requirements will be announced in a timely manner by the Department or designated testing agent.
At the option of the NA, the competency evaluation (both written/oral and skills components) may be administered in the facility at which the NA is (or will be) employed (unless the facility is disqualified by the Department under criteria specified in Section V, item B).
Each test candidate must have appropriate verification of completion of the training requirements. This will be in form of a "certificate of completion" from an approved training program or other acceptable documents (see item D of this section).
There will be a fee charged to take the state competency evaluation. The amount of the fee will be announced in a timely manner by the Department or designated testing agent.
The Department will be responsible to pay the test fee for individuals who are employed by a Medicaid certified nursing facility or those individuals that have a commitment ("letter of intent") to be employed in a Medicaid certified nursing home. Independent test candidates who are taking the competency test without an employment connection to a long term care facility will be responsible to pay their own test fee.
The following list identifies those individuals who qualify for the state competency exam.
This provision does not apply to "personal care aides" as their training requirements of 40 hours does not meet the LTCF Nursing Assistant Training Program's 75 hours or curriculum content.
All other persons trained in programs that have not received approval from the Department as a training provider shall not qualify and shall not be allowed to take the examination. Such programs may include hospitals, emergency medical technicians, medical assistant programs, personal care aides, correspondence courses, independent study or on-the-job training/in-service training as they are not acceptable in lieu of the approved training program.
Section VIII REGISTRY
The Department shall establish and maintain a registry of all individuals who have satisfactorily completed the training and competency evaluation program requirements. The nursing assistant registry shall be incorporated into the Long Term Care Facility Employment Clearance Registry (ECR), which also includes criminal record disqualifications for applicable employees and job applicants, and substantiated administrative findings of abuse, neglect or misappropriation of resident property for employees.
The information in the registry shall be made available to the public. Registry information shall be open for inquiries 24 hours per day, 7 days per week (except for scheduled maintenance or at times of technical problems), by telephone through an automated voice response system or by computer through an online website system (see Subsection B of this section).
The nursing assistant registry record, for each individual who has successfully obtained certification as a LTCF nursing assistant shall contain the following information:
* individual's full name;
* date of birth;
* Social Security Number;
* name and date of the State approved training program successfully completed;
* certification number and date of issuance;
* most recent re-certification date; and
* documentation of investigations showing substantiated findings of resident neglect, abuse, or misappropriation of resident property by the nursing assistant including a summary of the findings, and where applicable, the date and results of the hearing or date of a waiver of hearing, and a statement by the nursing assistant disputing the findings of the investigation.
The Department shall review and investigate allegations of neglect, abuse, or misappropriation of resident property by a nursing assistant. A nursing assistant shall be given written notice by the Department of a finding on an allegation and must request, in writing, a formal hearing within 30 days of receipt of the notice or the right to a hearing shall be waived. Following any appeal the registry and the nursing assistant shall be notified of the findings. If the finding is substantiated either by the individual's failure to appeal or by issuance of a final administrative order, the registry shall include the documented findings involving an individual listed in the registry, as well as any brief statement of the individual disputing the findings. (See Subsection E of this Section for the process to petition to remove findings of neglect.)
The Department, in the case of inquiries to the registry, shall verify if the individual is listed in the registry and shall disclose any information concerning a finding of resident neglect, resident abuse, or misappropriation of resident property involving an individual listed in the registry. It shall also disclose any statement by the individual related to the finding or a clear and accurate summary of such a statement.
A facility must inquire of the registry as to information in the registry concerning any individual to be used as a nursing assistant. A facility may not use an individual as a nursing assistant until registry inquiry and clearance is obtained. A facility must document all inquiries and must include such documentation in the personnel file of each nursing assistant used by the facility.
Regi stry clearance shall be obtained by contacting the automated voice response system or by computer access to the online website system. The telephone number to the automated voice response system and the URL address to the online website system shall be issued by the OLTC, or its designated agent, and may be subject to change. If needed, facilities should contact the OLTC for the latest contact information for either system.
Both the automated voice response system and the online website system will maintain an internal log of each inquiry made by Arkansas nursing facilities using a numeric code (Registry Identification Number) assigned to each facility. The internal log shall be monitored by OLTC to verify each facility's compliance with inquiry requirements.
If utilizing the automated voice response telephone system, the facility shall document date, time and results of the registry contact in the individual's personnel file. The online website system is capable of providing a printable registry clearance verification report document for the nursing facility's use in record keeping. If utilizing the online website system, the facility shall be required to print the registry clearance report and maintain this report in the employee's personnel file.
Regi stry clearances accessed through the automated voice response system requires the nursing assistant's Social Security Number (SSN). The online website system may be accessed by either the SSN or certification number. Facilities are required to access by using the SSN or certification number in order to assure an accurate inquiry.
NAME SEARCHES ARE NOT POSSIBLE ON THE AUTOMATED VOICE RESPONSE SYSTEM. NAME SEARCHES ARE POSSIBLE ON THE ONLINE SYSTEM BUT ACCURACY IS NOT ASSURED. NAME SEARCHES MAY ALSO BE OBTAINED BY CALLING THE OLTC.
PLEASE NOTE, HOWEVER, THAT NAME SEARCHES BY CALLING OLTC DO NOT GENERATE A VERIFICATION LOG OF THE CLEARANCE. THEREFORE, FACILITIES SHALL AVOID THE USE OF NAME SEARCHES WHEN THE NEED FOR DOCUMENTATION AND ACCURACY OF THE REGISTRY CHECK IS REQUIRED.
If an individual has completed a training and competency evaluation program and become registered as a nursing assistant in other state(s) that meet federal guidelines, reciprocity may be granted without further training or testing. The DMS-798, Exemption/Reciprocity Request Form, must be submitted to OLTC with a copy of each other state's certificate/registration document. OLTC will contact each other state to clear the individual's status for the transfer of their certification through reciprocity. However, this process may take several weeks to complete and the facility may not use the individual until each other state's registry is cleared. If the facility wishes, they may telephone each other state's registry, document the contact in the individual's file and use the NA in staffing (if in good standing on the other state's registry) while OLTC processes the official transfer. Contact must be made to all states the individual has worked as a nursing assistant.
This process for out-of-state registry verification becomes complicated if the individual is not officially registered under the new federal standards. Facilities may not use these individuals in staffing until their qualifications have been cleared by OLTC. The same process described above, of submitting the DMS-798, Exemption/Reciprocity Request Form, with copies of certificates or documents attached, also applies. Some of these individuals may qualify for registration under certain exemption criteria, some may be required to take the Arkansas state test, and some may be required to complete both training and testing. In any case, OLTC has the responsibility to make these determinations and notify the facility and/or individual of the results.
The initial certification period is valid for 24 months. Each certificate contains an expiration date. The Department will develop a plan and procedure to e erenew each nursing assistant certification listed in the registry on a biennial basis (every two years). The e e renewal process will require the nursing assistant to document having worked as a nursing assistant for monetary compensation during the prior two years. This provision shall be defined by at least one documented day (e.g. eight (8) hours) of employment providing nursing or nursing-related services for monetary compensation in any setting.
Employing facilities and/or individuals shall be required to submit update information to the registry to establish ongoing eligibility for active status. The registry shall make "inactive" those individuals who cannot document having worked in an aide capacity within a 24-month period. Nursing assistants who are currently employed as a nursing assistant at the time of their renewal will be renewed for 24 months. Nursing assistants who are not currently employed will be renewed for 24 months beginning with the last day employed as a nursing assistant. A certification that has been expired for a period longer than 24 months cannot be renewed and the individual must retest to re-certify to an active status.
An individual will be required to successfully complete a new competency evaluation test to become recertified (see Section VII, item D-7) if documentation of having worked in an aide capacity within the previous 24-month period can not be provided or for any certification that has been expired for over 24 months.
The process to renew a nursing assistant certification shall be implemented by the Department or its agent. Each certified nursing assistant will be mailed a renewal form approximately 60 calendar days before the expiration of their certification. The renewal form shall be mailed to the home address currently listed in the registry database when the nursing assistant was initially tested or renewed. It is the responsibility of each nursing assistant to update their mailing address by contacting the Department or its designated agent. It is the responsibility of each nursing assistant to renew their certification regardless if they have received the mailed renewal notice. Renewal forms may be obtained from the OLTC or its designated agent.
Nursing assistant certifications may not be renewed more than 60 calendar days prior to the expiration date.
Renewals may be conducted either by mail or through an online website. The Department or its designated agent shall provide instructions for the online renewal process attached to the renewal notice.
The Arkansas Nursing Assistant Registry Renewal Form must be fully completed, and the information in the form must be accurate to the best of the knowledge and information of the nursing assistant. Failure to fully complete the form, or the inclusion of false or inaccurate information, shall constitute the basis for denial of certification renewal.
When a nursing assistant renewal is processed (either by mail or online) and the nursing assistant is determined to be eligible for renewal, a new certificate showing the new expiration date will be mailed to the individual and their registry record shall be updated to reflect the new certification period.
Pursuant to federal law 42 U.S.C. § 1395i-3(g)(1)(D), in the case of a finding of neglect under Subsection A of Section VIII of these regulations, the Office of
Long Term Care shall establish a procedure that permits a certified nursing assistant to petition for the removal of a substantiated finding of neglect. The procedure to file a petition shall be as follows:
* The neglect that resulted in a finding was a singular occurrence as identified in the incident investigation file.
* The petition applicant does not have a criminal conviction related to neglect, abusive behavior or physical violence.
* The petition applicant's name does not appear on the DHHS/Division of Aging and Adult Services' Adult Abuse Registry or the DHHS/Division of Children and Family Services' Child Abuse Registry.
* Whether a pattern of abusive behavior or neglect is discovered through reference checks with prior employers or other parties.
* Character references as provided by the petition applicant.
Office of Long Term Care
Nursing Assistant Training Program
Mail Slot S-405
P.O. Box 8059
Little Rock, AR 72203-8059
* Full name and current mailing address
* Day-time phone number
* Social Security Number
* Date of birth
* Name and day-time phone number of at least two personal character references
* Letters of reference from any employment within the previous year from the date of the petition request. This letter must include a statement attesting to the petition applicant's work performance in relation to the lack of any incidents involving abusive or negligent behavior.
* A current criminal record report from the Arkansas State Police. If the petition applicant is currently or has recently (within the previous 12 months) lived in another state, a criminal record report must be provided from that state. All criminal record reports must be an original document and copies will not be accepted.
The Department of Health and Human Services, Office of Chief Counsel, will issue the subpoenas, pursuant to the terms and authority of Ark. Code Ann. § 20-76-103.
Section I X METHODOLOGY FOR REVI EW OF COMPLI ANCE
WI TH PROGRAM REQUIREMENTS
A program is subject to inspection at any reasonable time by personnel authorized by the Department. After initial approval of a training program, the Department shall do an on-site visit review to determine the program's implementation of and compliance with the requirements. The Department shall review the program on-site at least every two years.
An inspector will file a written report with the Department. The report will specify strengths and deficiencies of the program and be available to the program. The Department will terminate those programs not meeting minimum requirements which do not provide an acceptable plan for correcting deficiencies.
Each training program shall provide for secure maintenance of records. Records to be maintained shall include but not be limited to:
names of enrollees names of those who successfully complete the program dates of initiation and termination of program curricular revisions tests, grades, course documents, skills checklist credentials of instructors documentation of state approval record of complaints
The program monitoring shall review for compliance with requirements, at a minimum:
The quality of care provided by individual nursing assistants that is monitored during a licensure and/or survey and certification survey shall be one part of the program review. The monitoring of "quality of care" shall apply only to graduates of the facility-based training program being surveyed.
The graduates' success rate on the state competency examination will be monitored by the Department and may be utilized as a criteria for revoking program approval.
Programs that do not meet these minimum standards shall be notified in form of a letter. This letter shall list all deficiencies that require corrective action. The program will be required to respond in writing within 15 days specifying actions to correct the deficiencies. Failure to respond or inadequate corrective actions may cause withdrawal of the Department's approval of the program.
Section X REIMBURSEMENTS
This section sets forth policy for direct reimbursement for allowable nursing assistant training costs incurred by Medicaid certified nursing facilities. Allowable training costs will be separately tracked, documented and submitted monthly as described herein. All reimbursements shall be made directly to the Medicaid certified nursing facility.
Based on Federal regulations, nursing assistants who are employed by (or who have an offer of employment from) a nursing facility may not be charged for any portion of the program (including any fees for textbooks or other required course material).
Allowable costs for nursing assistant training reimbursement may include the costs for operation of an approved nursing assistant training program, the costs associated with a cooperative training effort with a neighboring approved training program (not claimed by that program) and the costs of having nursing assistants trained in an approved non-facility based training program (paid by the facility). Nursing Assistant salaries and fringe benefits, including amounts paid while in training, and in-service/continuing education costs are not directly reimbursable but are included on the facility's annual cost report and reimbursed through the per diem rates.
Reimbursement of nursing facility costs for training of nursing assistants must be allocated between Medicaid, Medicare and private pay patients. Medicaid may not be charged for that portion of these costs which are properly charged to Medicare or private pay activities. Therefore, the Office of Long Term Care will pay only the percentage of the total billed or maximum limit (see item D) for nursing assistant training based on the percentage of Medicaid recipients indicated on the billing. Facilities should continue to bill for the total amount of expenses incurred. The recipient information should reflect the midnight census for the last day of the month.
The following costs are allowable for nursing assistant training:
Facilities should not include the time spent proctoring the skills test as training activity reported to OLTC for reimbursement. Information reported to OLTC on the BDMS-755 is strictly for training, not testing activity.
Any purchase of books, training equipment, instructional videos, or other training materials exceeding $500.00 must be prior authorized by the Office of Long Term Care. Requests for prior authorization should be submitted to OLTC, Nursing Assistant Training Program.
Claims for reimbursement of expenses incurred for NA training costs shall be submitted to the Office of Long Term Care on a monthly basis on form BDMS-755. Claims can be submitted no earlier than the first day of the month following the expense month. The report forms will be designed to capture the above cost categories by use area in either formal "approved" or combined/cooperative training. Therefore, documentation of these costs should be accounted for in a manner consistent with these categories.
Claims must be submitted to the Office of Long Term Care within 30 days following the end of the expense month. Claims not submitted timely will not be accepted for payment.
A claim for reimbursement may not be submitted for any month in which no students completed training. Unclaimed costs in this circumstance may be carried over to the month when students complete training and will still be subject to the $400.00 maximum cost limit per student (see item D - Maximum Cost Limit).
All claim forms (DMS-755) must be submitted with original signatures of the nursing facility Administrator or designee. "Copied" signatures will not be accepted.
In efforts to establish proper and efficient administration of training costs reimbursements, a reasonable maximum cost limit shall be imposed. Based on analysis of nursing assistant training costs, $400.00 per student will be the maximum paid to facilities on their claims. This limit shall be imposed based on the number of students who finish the training program. Claims must show actual costs incurred and reimbursements will be made for actual costs but not to exceed the maximum limit of $400.00 per student who complete the training.
Example: Claim form shows actual costs are $1250.00 with four students completing the course. As $1250.00 is less than $1600.00 (4 students x $400 =
$1600 maximum) the actual costs will be reimbursed. If this example had only two students completing, the maximum would be $800.00 (2 students x $400) and the reimbursement would be capped at $800.00 rather than paying the full $1250.00 actual expenses.
NA training costs directly reimbursed by the Department of Health and Human Services shall be included in the nursing facility's annual Financial and Statistical Cost Report (FSR) and shall be reported as revenue offsets to NA training costs. Facilities must retain receipts/documentation of NA training costs submitted to the OLTC for reimbursement for a period of not less than five (5) years or until all audit findings are final. Any facility claiming reimbursement for costs not actually incurred or not properly documented will be required to provide restitution to the Department of Health and Human Services and will be subject to fines and/or prosecution as authorized by State and/or Federal Statutes.
