Current through Register Vol. 49, No. 9, September, 2024
Section I
AUTHORITY
1. The
following rules for the Long Term Care Facility Nursing Assistant Training
Program are duly adopted and promulgated by the Department of Human Services
pursuant to Arkansas Code
20-10-701 et
seq.
2. 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.
3. The Federal Omnibus Budget Reconciliation
Act of 1987, 1989, and 1990 (OBRA) and regulations issued by the U.S.
Department of Health and Human Services - Centers for Medicare and Medicaid
Services (formerly Health Care Financing Administration, or 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
1. 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.
2. 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:
(a)
perform uncomplicated nursing procedures and to assist licensed practical
nurses or registered nurses in direct resident care;
(b) form a relationship, communicate and
interact competently on a one-to-one basis with the residents as part of the
team implementing resident care objectives;
(c) demonstrate sensitivity to residents'
emotional, social, and mental health needs through skillful, directed
interactions;
(d) assist residents
in attaining and maintaining functional independence;
(e) exhibit behavior in support and promotion
of residents' rights;
(f)
demonstrate observational and documenting skills needed in support of the
assessment of residents' health, physical condition and well-being.
3. 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 that includes manual
(skills) and written (or oral component for those with limited literacy skills)
evaluations.
- Department - The Arkansas Department of Human
Services.
- Division - The Division of Medical Services within the
Department of Human Services.
- Educational Institution - An institution that 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 that 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
that 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 (120 calendar
days) unless that individual has successfully completed a training program and
competency evaluation approved by the Office of Long Term Care as described in
these rules.
A.
Training
1. Nursing
assistant training programs must include materials that provide a basic level
of both knowledge and demonstrable skills for each individual completing the
program.
2. 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.
3. 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 (i.e. scope of practice) of the
LTCF nursing assistants' direct care responsibilities.
4. 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 that serve as the basis for the state competency
evaluation test. The instructor shall conduct a review of each unit objective
with 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.
5. 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.
B.
Implementation
Requirements1. Each course shall
consist of a combination of classroom and clinical instruction. The requirement
for state certification will be a minimum of 90 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.
2. The clinical site must
be a long term care facility, skilled nursing unit or rehabilitation unit
located in an acute care facility or inpatient hospice unit which has not been
disqualified by restrictions as described in Section V (B).
3. 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).
4. Parts II and III require the completion of
the remaining 74 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. Supervised practical
training is defined as training in a laboratory or other setting in which the
trainee demonstrates knowledge while performing tasks on an individual under
the direct supervision of a registered or licensed practical nurse. Clinical
training or supervision shall not be performed using the "buddy" system of
assigning the trainee to work with an experienced nursing assistant.
5. The ratio of trainees to instructors in
classroom must not exceed 24 trainees to one instructor and the ratio for
skills training must not exceed 12 trainees to one instructor.
6. For facility-based programs that wish to
use student trainees in staffing while in training following completion of Part
I, a minimum of ten (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 (120 calendar days) limit.
7. 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 a numerical identifier such as a Driver's License Number or
identification number from a valid government issued document that contains a
current photo (such as state or national-issued ID card, alien registration
card, military identification or passport), 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.
C.
Nursing Assistant Trainee
Activities1. Each trainee shall
be clearly identified during all skills training portions. Identification must
be recognizable to residents, family members, visitors, and staff.
2. 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.
3.
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, spaces to note satisfactory
or unsatisfactory performance, and the signature of the instructor supervising
the performance.
4. 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.
D.
Classroom
Facilities & Resources
1.
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.
2. 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.
3.
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.
4. 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 the trainee to pass the state competency
evaluation.
E.
Orientation Program
1. All nursing assistants must receive an
orientation program that 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.
2. This facility orientation training program
is not included in the required 90 hours of nursing assistant
training.
F.
Ongoing In-Service Training
1. 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.
2. 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.
3. 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).
4. Effective July 1, 2006, facilities are
strongly encouraged to offer in-service training for nursing-home-employed CNAs
who were certified in Arkansas prior to July 1, 2006 that covers the Barbara
Broyles Alzheimer and Dementia Training that is included in Arkansas LTCF
Nursing Assistant Training Curriculum. Facilities should maintain records that
verify each employed CNA, who was certified in Arkansas prior to July 1, 2006,
has received this training. After July 1, 2006 and ongoing, the new Alzheimer's
training is strongly encouraged for CNAs registered in Arkansas through
reciprocity from other states and test candidates that are allowed to challenge
the State competency test based on exemptions found in Section VII (D) (3
through 6).
G.
Non-Permanent Employees
1. 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
A.
Location
1. 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 a complete training program
themselves and/or may contract with another organization to provide the
training.
2. Other groups and/or
institutions such as employee organizations, vocational/technical schools,
community colleges, and private institutions may conduct programs, dependent
upon Department approval.
3.
Programs offered to the public and that charge a tuition fee must be licensed
through the State Board of Private Career Education. 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).
B.
Restrictions1. The
Department shall not approve a program offered by or in a nursing facility
which, in the previous two years:
(A) has
operated under a waiver of the nurse staffing requirements in excess of 48
hours during the week;
(B) has been
subject to an extended (or partial extended) * survey;
or
(C) has been subject to a civil
money penalty of not less than $5,000, denial of payment for new admissions,
appointment of temporary management, closure, or transfer of residents.
+ 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.
2.
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.
C.
Application1. 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 501-320-6276 and on the Office of Long Term Care
website.
2. 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 the
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.
3. If
applicable, verification of school licensure by the State Board of Private
Career Education will be required (see item A of this section). A notarized
copy of the school licensure document must be included with applications for
new programs and for renewal of programs. Verification of notification to the
State Board of Private Career Education for additional instructors and/or
changes in instructors shall be required with each application.
4. Application must be submitted to the
Department eight weeks (56 calendar days) 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.
5. Applications that 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 business days of the date of filing. The applicant will be given an
opportunity to correct any deficiencies.
6. Notice of approval or disapproval of the
application will be given to the entity within 15 business 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.
7. An applicant may request a hearing on a
disapproval in writing within 10 business 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.
D.
Changes in
Programs1. Prior to major
changes in the course, an application must be resubmitted for
approval.
2. Major changes include:
- Change in training provider
- Change in classroom site
- Change in clinical site
- Change in instructor
- Complete revision of course structure
3. 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 rules or
guidelines
E.
Withdrawal of Approval
1. Provisions for monitoring and review of
compliance with program requirements are specified in Section IX of these
rules. The Department shall withdraw approval of a training program when;
(a) One or more restrictions exist as listed
in Section V (B).
(b) The entity
offering the program refuses to permit visits by the Department, whether
announced or unannounced. (Also, any facility that refuses to permit
unannounced visits is subject to having its provider agreement
terminated.)
(c) Curriculum and
implementation requirements specified in these rules are not met by the
program.
(d) An excessive failure
rate exists for trainees on the state competency evaluation test.
(e) The program:
1. Purposely makes or causes to be made any
false statement or representation of a material fact used in any application
for payment by any entity for reimbursement of training costs as allowed in
Section X of these rules;
2.
Purposely makes or causes to be made any false statement or representation of a
material fact for use in determining rights to payment to any entity for
training costs as allowed in Section X of these rules;
3. Purposely makes or causes to be made any
false statement or representation that training was provided when training was
not provided;
4. Purposely makes or
causes to be made, or induces or seeks to induce the making of, any false
statement or representation of a material fact with respect to the conditions
or operation of the program in order that the program may qualify either upon
initial approval or re-approval;
5.
Purposely makes or causes to be made any false statement or representation that
the amount of training costs is greater than the actual cost of the training to
obtain Medicaid reimbursement, as allowed in Section X of these rules, that
exceeds the actual cost of training; or,
6. Purposely makes or causes to be made any
false statement or representation of a material fact in violation of these
rules.
2.
When the Department withdraws approval from a training program, it shall:
(a) Notify the program in writing, indicating
the reason (or reasons) for withdrawal of approval,
(b) Permit students who have already started
the program to finish it.
Section VI
QUALIFICATIONS OF
INSTRUCTORS
A.
Primary Instructor (PI)
1. The Primary Instructor shall be a
registered nurse currently licensed in Arkansas and shall not be subject to
disciplinary action by the Arkansas State Board of Nursing. Disciplinary action
includes, but is not limited to: probation, suspension, revocation or voluntary
surrender of license due to disciplinary action.
2. The Primary Instructor must possess a
minimum of two (2) years nursing experience including at least one (1) year of
long term care nursing services within the last five (5) years. Experience may
include, but is not limited to, employment in a nursing assistant education
program or employment in or supervision of nursing students in a nursing
facility or unit, geriatrics department (excluding geriatric psychiatry),
long-term acute care hospital, home care, hospice care or other long term care
setting.
3. 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).
4. 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.
B.
Primary Instructor
Responsibilities1. 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.
2. The Primary Instructor of a nursing
assistant training program shall be responsible for supervision of the program
and ensuring that the following requirements are met:
(a) Course objectives are
accomplished.
(b) Only persons
having appropriate skills and knowledge are selected to conduct any part of the
training. Each instructor shall be monitored and evaluated during classroom,
learning laboratory and clinical training whenever new material is being taught
and at periodic intervals to include, but not limited to, first training calls,
following any complaint on a specific instructor and at least annually.
Performance reviews of instructors must be documented and maintained.
(c) The provision of direct individual care
to assigned residents by a trainee is limited to appropriately supervised
clinical experience. Instructors, not unit or facility staff, are expected to
function as supervisor of trainees while in clinical areas and providing
resident care.
(d) Each trainee
shall demonstrate competence in clinical skills and fundamental principles of
resident care. The task performance record (skills check-off) must be approved
by the Primary Instructor who must sign or initial all final skills check-off
records.
(e) Records are kept to
verify the participation and performance of each trainee in each phase of the
training program. The satisfactory completion of the training program by each
trainee shall be attested on each trainee's record.
(f) Each trainee is issued a certificate of
completion within ten (10) calendar days of course completion and as described
in Section IV (B) (7) of these rules.
C.
Additional
Instructors/Trainers1.
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 and must not
have current disciplinary action by their respective regulatory
board.
2. 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, currently
licensed in Arkansas and shall not be subject to disciplinary action by the
Arkansas State Board of Nursing. Disciplinary action includes, but is not
limited to: probation, suspension, revocation or voluntary surrender of license
due to disciplinary action and have a minimum of one (1) year of long term care
experience. (All final skills check-off reviews must be approved by the Primary
Instructor.)
3. 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
A.
Transition
The initial implementation of these training and testing
requirements have covered three basic phases:
1. Deemed Equivalence Waivers -
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:
a. Completed a program that offered a minimum
of 60 hours of nursing assistant training before July 1, 1989 and if such
received before July 1, 1989 up to 15 hours of supervised and practical nursing
assistant training or regular in-service nursing assistant education (initial
training must be at least 75 hours); or
b. Completed a course of at least 100 hours
of nursing assistant training and was found competent (whether or not by the
State) before January 1, 1989; or
c. Has served as a nursing assistant at one
or more facilities of the same employer in the State for at least 24
consecutive months before December 19, 1989.
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, Interstate Transfer
Form, with attached copies of documents/certificates verifying course
completion, number of hours in course, etc.
2. Employment status as of July 1, 1989 -
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 90 hour training
requirements to qualify to take the state test regardless of past employment
status on July 1, 1989.
3.
July 1, 1989 - Ongoing -
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
(120 calendar days) unless that individual has successfully completed a
training program and competency evaluation approved by the Office of Long Term
Care as described in these rules.
B.
Examination
1. 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.
2. The examination will be in
English.
3. 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.
4. 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.
5. 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.
6.
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.
7. 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).
8. 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.
9. 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 re-training will be
required after this 12-month limit for further testing opportunities.
10. 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 rules, 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 90 hours of training. Upon
successful completion of their training, they should be scheduled for the next
available competency exam.
11. 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).
C.
Test Dates, Locations, and Fees
1. Testing will be made available 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.
2. 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).
3. Each test candidate must
have appropriate verification of completion of the training requirements. This
will be in the form of a "certificate of completion" from an approved training
program or other acceptable documents (see item D of this section and Section
IV(B) of these rules).
4. 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.
5. 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" as defined in Section X (A) (2) of these rules) to be
employed in a Medicaid certified nursing facility. Letters of intent to hire
from Medicaid certified nursing facilities must be dated within 12 months
immediately preceding the date of the application to take the test. 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.
D.
Candidate Qualifications
The following list identifies those individuals who qualify for
the state competency exam.
Note: Individuals listed on the LTCF Employment Clearance
Registry with a disqualification status due to an substantiated administrative
finding of abuse, neglect, misappropriation of resident property or a
disqualifying criminal record in accordance with Ark. Code Ann. §
20-38-101
et seq shall not be eligible to take the competency examination.
1. Nursing assistants who were trained in
approved
non-facility programs (career
colleges, Vo-Tech schools, proprietary schools, etc.) after January 1,
1989.
2. Nursing assistants who
were trained in approved
facility
(nursing homes) programs after July 1, 1989.
3. RN or LPN students who have finished the
basic nursing course (Introduction to Nursing, Fundamentals of Nursing, etc.).
The individual must provide a copy of their school transcript/document showing
successful completion of the basic nursing course in order to qualify to take
the state competency test.
Regi stered nurses or licensed practical nurses that have had
disciplinary action resulting in suspension, revocation or voluntary surrender
of license due to disciplinary action shall not be allowed an exemption to
training or be allowed to challenge the state competency examination.
4. Home health aides who have met
appropriate federal training and/or testing requirements for HHA certification.
Verification must show completion of a minimum of 75 hours training and/or
federal testing requirements as a home health aide.
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 90 hours or curriculum content.
5. Individuals from other states who can
verify completion of a state approved geriatric nursing assistant training
program but who were not tested and registered. (If registered in the other
state, see Section VIII for reciprocity transfers without further testing.)
Verification of course completion rests with the individual and must be
submitted to OLTC for approval to take the Arkansas competency test.
6. Nursing assistants whose certification has
become inactive based on the recertification requirements (see Section VIII,
item D.). These individuals shall be required to be retested for
recertification. Permission for retesting shall require an "admission slip"
obtained from the testing agency prior to the specified test date.
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
A.
Function and
Content
1. 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.
2.
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
computer through an online website system (see Subsection B of this
section).
3. 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.
4. 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.)
5. 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.
B.
Inquiry Process
1. 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. Registry inquiries shall be
performed within five calendar days of the offer of employment and prior to any
resident contact. A facility must document all inquiries and must include such
documentation in the personnel file of each nursing assistant used by the
facility.
2. Registry clearance
shall be obtained by computer access to the online website system. 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 the system.
3. 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.
4. The
online website system is capable of providing a printable registry clearance
verification report document for the nursing facility's use in record keeping.
The facility shall be required to print the registry clearance report and
maintain this report in the employee's personnel file.
5. Registry clearances accessed through the
online system require the nursing assistant's Social Security Number (SSN) and
date of birth. Facilities are required to access by using the SSN or
certification number in order to assure an accurate inquiry.
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.
C.
Inter-state (Reciprocity)
Transfer1. 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, Interstate
Transfer 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.
2. 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, Interstate Transfer 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.
D.
Certification Renewal
1. The initial certification period is valid
for 24 months. Each certificate contains an expiration date. The Department
will develop a plan and procedure to renew each nursing assistant certification
listed in the registry on a biennial basis (every two years). The 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.
2.
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.
3. 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.
4. 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.
5. Individuals listed on the LTCF Employment
Clearance Registry with a disqualification status due to a substantiated
administrative finding of abuse, neglect, misappropriation of resident property
or a disqualifying criminal record in accordance with Ark. Code Ann. §
20-38-101
et seq shall not be eligible to renew their certification. Individuals approved
for removal of a neglect finding pursuant to Subsection VIII (E) shall be
eligible to renew their certification.
6. Nursing assistant certifications may not
be renewed more than 60 calendar days prior to the expiration date.
7. 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.
8. 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.
9. 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.
E.
Petition to Remove Neglect Findings
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 rules,
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:
1. Factors that must be met
are:
a. The certified nursing assistant must
have a substantiated finding of neglect. There shall not be a petition process
available for substantiated findings of physical abuse, verbal abuse or
misappropriation of resident property.
b. The Office of Long Term Care makes a
determination that the petition applicant's employment and personal record does
not reflect a pattern of abusive behavior or neglect. Factors to be considered
shall include, but shall not be limited to:
* 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
DHS/Division of Aging and Adult Services' Adult Abuse Registry or the
DHS/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.
c. At least one
year has passed since the petition applicant's substantiated finding of neglect
was placed on the Registry.
2. The procedure to file for a petition to
remove a neglect finding shall include the following:
a. Petition applicants shall submit a letter
requesting the removal of the neglect finding. The letter shall be addressed
to:
Office of Long Term Care
Nursing Assistant Training Program
Mail Slot S-405, P.O. Box 8059
Little Rock, AR 72203-8059
b. The petition applicant must provide the
following information with their request letter:
* 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.
3. The Office of Long Term Care shall review
each petition request for consideration for removal of the neglect finding. The
review shall be conducted by an administrative review panel consisting of at
least three members appointed by the Office Director. The panel shall meet
within thirty (30) days of any petition request. The review panel shall
consider all information submitted by the petition applicant and may conduct
additional research as needed.
4.
The review panel shall render a decision within thirty (30) calendar days of
the panel's review, and the petition applicant shall be notified in writing
within 10 business days of the review committee's final
determination.
5. If the petition
to remove the neglect finding is approved, the Registry shall be updated within
10 work days to show the petition applicant no longer has the neglect record
and shall be eligible for employment in Arkansas long term care facilities.
Note that any CNA whose certification has been expired for over 24 months must
successfully complete the state competency test to re-establish employment
eligibility as a certified nursing assistant.
6. Any applicant whose petition has been
denied may not re-apply for a subsequent petition request for a period of at
least 12 months from the date of the previous denial.
7. If the petition to remove the neglect
finding is denied by the review panel, any further appeals of the committee's
determination shall be based on the appeals procedures as listed below:
a. Administrative hearings are available to
persons, herein referred to as petitioners, who disagree with determinations to
deny a petition to remove a neglect finding made by the Office of Long Term
Care as described in these rules.
b. When a petitioner wishes to appeal, he/she
may do so by mailing a written notice of appeal to Appeals and Hearings (Slot
1001), Office of Chief Counsel, Arkansas Department of Human Services, P.O. Box
1437, Little Rock, Arkansas 72203. The notice shall be mailed by certified
mail, return receipt requested. The notice of appeal shall state the following:
1. Name of the petitioner;
2. Address of the petitioner;
3. Date of birth of the petitioner;
4. Phone number, if any, of the
petitioner;
5. The petitioner's
place of employment;
6. A short
statement explaining why the petitioner believes the determination/decision is
in error.
c. The notice
of appeal must be received by the Appeals and Hearing Office within 30 calendar
days from the mailing date of the notification document of the determination of
petition denial. No appeal shall be accepted prior to such a
determination/decision.
d. A
hearing shall be conducted by the Appeals and Hearings Section, Office of Chief
Counsel, Department of Human Services. The procedures to conduct the hearing
are as follows:
1. The hearing record will
contain all documents, exhibits and testimony admitted into evidence by the
hearing officer. Within 20 calendar days of receipt of notice that a petitioner
has requested a hearing, the petitioner and the Office of Long Term Care will
prepare a file to be submitted to the Appeals and Hearings Section, and mail a
copy of the file by certified mail, return receipt requested, to the other
party. The file will contain only documentary evidence supporting or tending to
support each party's allegations. The Office of Long Term Care will also submit
an Administrative Hearing Statement summarizing the determination/decision.
This statement is not evidence. Only such portions of each file as are
determined by the hearing officer to be relevant shall be included in the
Administrative Hearing Record.
2.
Both parties will be advised by the Appeals and Hearings Section via certified
mail, return receipt requested, that they have ten (10) calendar days from the
date the certified mail receipt was signed to review the hearing file and
submit a request to subpoena witnesses. The request shall include the name,
address and telephone number of all witnesses not employed by the Department of
Human Services (DHS). DHS employees will be expected to attend hearings and
present testimony without the benefit of a subpoena and will be notified by the
Appeals and Hearings Section of their required presence at the hearing. Each
party will be notified of any witnesses requested and will have five (5)
business days from the receipt of this notice to request subpoenas for rebuttal
witnesses.
The Department of Human Services, Office of Chief Counsel, will
issue the subpoenas, pursuant to the terms and authority of Ark. Code Ann.
§
20-76-103.
3. After the time frame has
expired for subpoenaing witnesses, the hearing officer will schedule the
hearing to afford the petitioner, the Office of Long Term Care, and their
attorneys, if any, at least ten (10) calendar days notice of the date, place
and time of the hearing. The scheduling letter, sent via certified mail with
return receipt requested, shall also contain the name of the hearing officer
who will conduct the hearing. In the event the petitioner, the Office of Long
Term Care representative, or an attorney representing the petitioner suffers
from illness or cannot attend the hearing due to scheduling conflicts, that
party may request the hearing be continued. The hearing will be rescheduled by
the hearing officer upon a showing of good cause. A request for continuance
made by the petitioner or the petitioner's attorney will constitute a waiver of
any objection as to timeliness of the hearing. In each case, the hearing and
hearing record must be completed within one hundred twenty (120) calendar days
of receipt of the request for a hearing.
4. The hearing will take place at a place,
time, and manner determined by the Appeals and Hearing Office. Hearings may be
conducted by telephone, by personal appearance of the parties, or by record
review by the Appeals and Hearings Office.
5. If the petitioner fails to appear for the
hearing when conducted by telephone or by personal appearance of the parties
and does not contact the Appeals and Hearings Section prior to the date of the
hearing of his/her inability to attend, the appeal will be deemed abandoned.
The petitioner will be advised of this fact in the scheduling letter.
6. It is the responsibility of the Office of
Long Term Care to designate a representative prior to the time of the hearing.
The representative should be familiar with the circumstances of the
determination/decision and be able to summarize the pertinent aspects of the
situation and present the documentation to support the basis for the
determination/decision. The representative should also be able to answer
questions posed by the petitioner or the hearing officer relative to the issues
and should be prepared to cross examine adverse witnesses. The representative
may request the services of an Office of Chief Counsel attorney for
representation at the hearing.
7.
If any party is to be represented by an attorney, notice shall be given to all
parties and to the Appeals and Hearings Section at least ten (10) calendar days
prior to the hearing. Failure to furnish notice shall entitle other parties to
a continuance to obtain counsel. Petitioner's failure to furnish notice shall
constitute a waiver of objection as to timeliness of the hearing.
8. The hearing will be conducted by a hearing
officer from the Appeals and Hearings Section who had no part in the
determination/decision upon which the hearing is being conducted.
9. The petitioner may be accompanied by
friends or other persons and may be represented by a friend, legal counsel, or
other designated representative.
10. The hearing officer may not review the
case record or other material either prior to or during the hearing unless such
material is made available to the petitioner or his/her
representative.
11. The hearing
will be conducted in an informal but orderly manner. The hearing officer will
explain the hearing procedure to the petitioner. The administrative hearing
statement will be read by the Office of Long Term Care representative. The
Office of Long Term Care shall then present its case. After completion of the
Office's case, the petitioner's case will be presented. The parties shall have
the opportunity to present witnesses, advance arguments, offer additional
evidence, and to confront and cross examine adverse witnesses. If the
petitioner is unable to present his evidence in a logical manner, the hearing
officer will assist the petitioner. Questioning of all parties will be confined
to the issue(s) involved.
12. The
hearing officer will prepare a comprehensive report of the proceedings. The
report will consist of an introduction, findings of fact, conclusions of law
and decision. The report shall constitute the final agency determination. The
determination shall be mailed to the petitioner and the Office of Long Term
Care.
e. Any further
review must be pursued in accordance with the Administrative Procedure Act,
Arkansas Code Annotated §
25-15-101
et seq.
Section
IX
METHODOLOGY FOR REVIEW OF COMPLIANCE WITH PROGRAM
REQUIREMENTS
A.
Monitoring1. 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.
2. Program reviews may be comprehensive or
partial. Based on the findings of the most current review, a program may be
reviewed with an increased frequency and depth.
3. 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 and that do not provide an acceptable
plan for correcting deficiencies within the specified time frame as established
by the Office of Long Term Care.
B.
Minimum Program
Standards1. 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
2. The program monitoring shall review for
compliance with requirements, at a minimum:
(a) Program curriculum content
(b) Program length
(c) Ratio of classroom to skills
training
(d) Qualifications of
instructors
(e) Quality of skills
training supervision
(f) Access for
clinical training in a nursing facility that was not disqualified based on
criteria specified in Section V (B).
(g) Physical (classroom and lab)
facilities
3. 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.
4. The graduates' success rate on the state
competency examination will be monitored by the Department and shall be
utilized as a criterion for revoking program approval.
5. 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 business 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
A.
General Provisions1.
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.
2. Based on Federal regulations, nursing
assistants who are employed by (or who have a "letter of intent" to be employed
by) a Medicaid certified nursing facility may not be charged for any portion of
the program (including any fees for textbooks or other required course
material). The Department shall be responsible to pay for the training costs
for individuals who are employed by, or have a "letter of intent" to be
employed, by a Medicaid certified nursing facility as set forth in this
Section.
The criteria required for reimbursements under the "letter of
intent" arrangement must meet the following:
a. Letters of intent must be on the facility
letterhead, dated within twelve (12) months immediately preceding the training
and signed by the facility Administrator. Copies of the Administrator's
signature are not allowed;
b. The
facility must have on file a job application completed and signed by the
individual receiving the letter of intent;
c. The facility must complete a criminal
record check on the individual in accordance with Ark. Code Ann. §
20-38-101
et seq; and
d. The facility must
retain copies of documents to verify compliance with these provisions as
specified in Subsection E of this section.
3. 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.
4. 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
that 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.
B.
Allowable Costs
The following costs are allowable for nursing assistant
training:
1.
Nursing
Assistant Transportation Expenses. The dollar amount of
transportation expenses paid directly to or reimbursed for the NA to attend
training or to travel to a NA competency evaluation site.
2.
Books. The dollar
amount spent for books purchased specifically for use in the NA training
program.
3.
Instructional Equipment. The dollar amount spent for
equipment such as overhead projectors, VCRs, film projectors, etc. purchased
specifically for use in the NA training program.
4.
Instructional
Videos. The dollar amount spent for instructional videos, video
disc(s), films, etc. purchased specifically for use in the NA training
program.
5.
Other
Training Materials. The dollar amount spent for other training
materials purchased specifically for use in the NA training program.
6.
Training Space.
The dollar amount spent for the rent of classroom space (outside the facility),
lab equipment, etc. specifically for the NA training program. Construction
costs for training facilities will not be authorized.
7.
Instructor Wages.
The dollar amount of wages paid to the NA Instructor for training time, only
while the NA Instructor is not included in the NF's staffing pattern providing
nursing services.
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 DMS-755 is strictly for training, not
testing activity.
8.
Instructor Fringe Benefits. The dollar amount paid for
fringe benefits for the NA Instructor while training, only while the NA
Instructor is not included in the NF's staffing pattern providing nursing
services.
9.
Nursing
Assistant Consultant Training Fees. The dollar amount paid to a
consultant trainer for NA training.
10.
Consultant Reimbursable
Expenses. The dollar amount paid to a consultant trainer for
reimbursable expenses such as travel and lodging.
11.
Instructor Workshop
Fees. The amount of tuition and registration fees paid for NA
training program instructors to attend instructor workshops. Instructor
workshops must meet requirements established by the Office of Long Term Care to
qualify for reimbursement and participants must be approved for attendance by
the Office of Long Term Care.
12.
Instructor Workshop Travel Expenses. Travel expenses
and lodging paid directly or reimbursed for NA training program instructors to
attend instructor workshops.
13.
Nursing Assistant Training Tuition. The dollar amount
spent on tuition for employees (and potential employees given a "letter of
intent", dated within 12 months immediately preceding the date of the
completion of training) to attend NA training in an approved non-facility
training program. The actual amount of tuition paid for a student, up to a
maximum of $480.00 per student, will be reimbursed as allowable
cost. This amount is based on the provision of the minimum 90 hours training
required by the Department.
C.
Claims Submission
1. 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 DMS-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.
2. Claims must be
submitted to the Office of Long Term Care within 30 calendar days following the
end of the expense month. Claims not submitted timely or claims that are
incomplete will not be accepted for payment and shall be returned to the
facility. Corrected claims must be submitted within 15 calendar days of the
date returned.
3. 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
$480.00 maximum cost limit per student (see item D - Maximum Cost
Limit).
4. All claims submitted
must include a copy of each trainee's Certificate of Completion from the
training program and a copy of the OLTC issued CRC Determination Letter. In
accordance with Section 203.1 of the Rules for Conducting Criminal Record
Checks for Employees of Long Term Care Facilities, the facility must complete
the criminal record check for each trainee prior to conducting the nursing
assistant training or prior to sponsoring the trainee through the "letter for
intent to employ" provisions as specified in item A (2) and B (13) of this
section.
5.
Reimbursements
are not allowed and shall be denied to facilities for the following:
a.
Individuals listed on the LTCF
Employment Clearance Registry with a disqualification status due to a
substantiated administrative finding of abuse, neglect, misappropriation of
resident property or a disqualifying criminal record in accordance with Ark.
Code Ann. §
20-38-101
et seq.
b.
Individuals listed on the LTCF Employment Clearance Registry with an expired
certification. These individuals are not required to be retrained and may
retest in accordance with Section VII (D) (6) of these rules.
c.
Individuals who, prior to training,
did not complete a criminal record check in accordance with Ark. Code Ann.
§
20-38-101
et seq.
6. All
claim forms (DMS-755) must be submitted with original signatures of the nursing
facility Administrator. "Copied" signatures will not be accepted.
D.
Maximum Cost
Limit1. 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, $480.00 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 $480.00 per student who complete the training.
2. Example: Claim form shows actual costs is
$1250.00 with four students completing the course. As $1250.00 is less than
$1920.00 (4 students x $480 = $ 1920 maximum) the actual costs will be
reimbursed. If this example had only two students completing, the maximum would
be $960.00 (2 students x $480) and the reimbursement would be capped at $960.00
rather than paying the full $1250.00 actual expenses.
E.
Cost Reporting and Record
Retention1. NA training costs
directly reimbursed by the Department of 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 Human Services and will be subject to fines and/or
prosecution as authorized by State and/or Federal Statutes.
Nursing Assistant Training Cost Reimbursement Claim
Form
The Nursing Assistant Training Cost Reimbursement Claim Form
(DMS-755) is specific to each facility; the form is not generic.
To obtain a form DMS-755, please call 501-320-6461 or email
Billie Kaiser at Billie.Kaiser@dhs.arkansas.gov. Below is an example of the
form for reference purposes only.
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Nursing Assistant Training Costs Reimbursement Claim
Form
PURPOSE OF FORM
The Nursing Assistant Training Costs Reimbursement Claim Form
is used by nursing facilities to claim reimbursement for allowable nursing
assistant training costs.
COMPLETION OF FORM
Month and Year Section:
Complete the invoice date section for the month and year in
which expenses are being claimed. Use the last day of the month as the invoice
date. Use the month and year for the service date.
Name and Address of Facility Section:
Contact this office if the facility name or address has
changed.
Number of Residents Section:
1. Provide the total number of residents on
the last day of the month.
2.
Provide the number of residents covered by or eligible for Medicaid (or pending
Medicaid) as of the last day of the month.
3. Provide the number of residents whose care
was paid for privately or by private insurance, etc. as of the last day of the
month.
4. Provide the number of
residents whose care was paid for by Medicare as of the last day of the month.
(Medicare certified facilities only).
5. Provide the number of residents that do
not fall into the previous categories as of the last day of the month.
Number of Students that Completed Training Section:
Provide the number of students that completed the nursing
assistant training course. Do not include any students that failed to pass or
complete the training.
You must provide a copy of the State Criminal Background
Determination letter from OLTC and a copy of the Completion of Training
Certificate for each student being claimed.
Expense and Training Cost Section:
Complete by line the dollar and cent amount of cost for each
expense category. Complete the Total Training Expense.
For item #13, list the non-facility training program that
provide training during the month and the tuition costs paid on behalf of the
new trainees. If more than one approved non-facility training program was used
by the facility, list all programs.
Refer to the Nursing Assistant Training Cost Reimbursement
policy, Section X of the Rules for the Arkansas Long Term Care Nursing
Assistant Training Program for details concerning allowable cost items.
Administrator Signature and Date of Signature Section:
The reimbursement claim for monthly nursing assistant training
program costs must be signed by the Nursing Facility Administrator for the
facility. The date of the signature is the date the claim form is signed
(claims may not be submitted earlier than the first day of the month following
the expense month).
Leave the For Office Use Only Section blank.
Submit original form and signature. Copies are not
acceptable. Route completed forms to:
Department of Human Services
Office of Long Term Care
P.O. Box 8059, Mail Slot S405
Little Rock, Arkansas 72203-8059
NURSING ASSISTANT TRAINING PROGRAM (NATP) APPLICATION
INSTRUCTIONS
1.
Review Rules for the Arkansas Long Term Care Facility Nursing Assistant
Training Program. Pay special attention to Section IV. B. Implementation
Requirements, C. Nursing Assistant Trainee Activities, and Section V.
2. Respond to all application items in
compliance with the standards (above) and as required within instructions for
each item.
3. Obtain agreements
from any and all nursing facilities that will be used as clinical training or
testing sites and attach a copy of each agreement. Agreements must either (a)
be current, i.e. signed by facility authority within the past six months, or
(b) specify the time period for which the agreement is valid. Facility
authority is the facility administrator or corporate officer who is a
designated authority.
4. Mail
application with original notarized signatures along with attachments to:
Arkansas Department of Human Services
Division of Medical Services
Office of Long Term Care
Nursing Assistant Training Program
Slot S405
P.O. Box 8059
Little Rock, AR 72203-8059
You Need to Know:
* Incomplete applications will be returned, which
will delay the approval of your program
* If the application contains errors or
discrepancies, you will be notified within 15 days of Department's receipt of
the application and you will be given an opportunity to make corrections. This
may delay the date of approval of your program.
* You should allow AT LEAST 20 DAYS from the date
you mail your application before inquiring about the status of the
application.
* Training shall not be conducted until approval
for instructors, classrooms and/or clinical sites has been received by the
training program.
* Programs offered in or by nursing facilities
that have been subject to one or more of the following actions will not be
approved as per Arkansas Code 20-70-01 et seq.:
(1) Waiver for nurse staffing requirements in
excess of 48 hours during the week;
(2) Extended or partial extended
survey*;
(3) Assessment of civil
money penalty in excess of $5000;
(4) Denial of payment for new admissions for
Medicare/Medicaid;
(5) Appointment
of temporary management;
(6)
Transfer of residents;
(7)
Termination from Medicare/Medicaid;
(8) Closure of facility.
* Extended survey is defined for this provision as a survey
that 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.
*Nursing facilities that are prohibited due to one
of the actions above will not be approved as a clinical training or testing
site for any nursing assistant training program. Sanctioned nursing facilities
may apply for a training waiver by submitting a written request to this
office.
*Public training programs MUST contact the
Arkansas State Board of Private Career Education, 501 Woodlane, Suite 312S,
Little Rock, AR 72201, 501-683-8000, to apply for a license to operate a
proprietary educational program in Arkansas.
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