Current through Register Vol. 49, No. 9, September, 2024
Arkansas Department of Human Services Division of Medical
Services Office of Long Term Care
The following Rules for the Licensure of Nursing Home
Administrators are duly adopted and promulgated by the Arkansas Department of
Human Services, Office of Long Term Care, pursuant to the authority expressly
conferred by Title
20-10-203(b)
of the Arkansas Code.
These rules have been prepared for the purpose of establishing
nursing home administrator competency as well as criterion for the licensure of
nursing home administrators. There exists a relationship between the quality of
care and quality of life for residents in a nursing home and the knowledge,
skills, and abilities of the nursing home's administrator. This relationship
becomes increasingly apparent as nursing home administrators attempt to
implement new and often complex standards of resident care services so that the
facilities can participate in the full continuum of care.
The rules are subject to periodic revisions as new knowledge
becomes available that will more fully establish the level of competency
necessary for effective nursing home administration.
Rules are limited in their ability to set forth all the
attributes necessary for quality administration. Administrators of nursing
homes have a responsibility beyond the minimum standards detailed here to
continue to enhance their education, experience, and professional
growth.
The end result of such enhancement will be the achievement of
optimum nursing home resident care.
Section
III - Licensure
A.
LICENSURE REQUIREMENT
No person shall administer, manage, supervise, or be in general
administrative charge of a nursing home unless he or she is a licensed nursing
home administrator in active status. No nursing home within the State shall
operate except under the supervision of a licensed administrator. No
administrator shall manage more than one nursing home.
B.
APPLICATION FOR LICENSURE
Applicants for licensure shall file applications under oath
with the Department, upon forms prescribed by the Department (Form DMS-7790)
and shall pay the required licensure fee, as outlined in Ark. Code Ann. §
20-10-404.
The application and fee shall be mailed to the Department at the address
provided by the Department. If the application is approved, the applicant has
eighteen (18) months from the date of approval, to become licensed. Half of the
licensure fee shall be refunded to the applicant if the Department denies
licensure because (a) the application is not approved, (b) the applicant does
not pass the exams, or (c) any other reason deemed appropriate by the
Department.
Pursuant to Ark. Code Ann. §
17-5-104, individuals may be
granted a licensing waiver if they have been receiving assistance through the
Arkansas Medicaid Program, the Supplemental Nutrition Assistance Program, the
Special Supplemental Nutrition Program for Women, Infants, and Children, the
Temporary Assistance for Needy Families Program, or the Lifeline Assistance
Program; or they were approved for unemployment within the last twelve (12)
months; or they have an income that does not exceed two hundred percent (200%)
of the federal poverty income guidelines.
The waiver of the initial fee does not include fees for:
* A criminal background check;
* An examination or a test; or
* A medical or drug test.
A signed consent form from the applicant may be required for
verification of eligibility.
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Section
VII
REQUIREMENTS FOR EXAMINATION AND
CERTIFICATION
A.
Transition
The initial implementation of these training and examination
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 examination program
approved by the State if the nursing assistant:
a. Completed a program that offered a minimum
of sixty (60) hours of nursing assistant training before July 1, 1989 and if
such received before July 1, 1989 up to fifteen (15) hours of supervised and
practical nursing assistant training or regular in service nursing assistant
education (initial training must be at least seventy-five (75)
hours);
b. Completed a course of at
least one hundred (100) hours of nursing assistant training and was found
competent (whether by the State or not) before January 1, 1989; or
c. Has served as a nursing assistant at one
(1) or more facilities of the same employer in the State for at least
twenty-four (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 twenty-four (24)
months or longer since completing training. They will be required to complete a
new training program and state examination to obtain current
certification.
Facilities who wish to obtain certification for the
above-described individuals should submit to the Department Form DMS-798,
Interstate Transfer Form, with attached copies of documents or certificates
verifying course completion, and the number of hours in the course.
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 examination 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 ninety hour
training requirements to qualify to take the state examination 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
(one hundred twenty (120) calendar days) unless that individual has
successfully completed a training program and competency examination, approved
by the Department, as described in these rules.
B.
Examination
1. The Department or its appointed agency
shall be responsible for administering the competency 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.
Translation of this examination will be offered, if needed. Additional
accommodations can be made by the Department or contractor based on a
documented need; however, an additional fee may be required.
3. The competency examination shall consist
of two (2) components, a written (or oral) exam and a skills demonstration.
Each examination 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 or oral
component shall be developed from a pool of examination questions, only a
portion of which are used in each exam. The skills demonstration shall consist
of a demonstration of five (5) 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 or training site personnel (RNs as described above) if
secure, standardized, and scored by the contractor 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 examination successfully, an individual must pass
both the written (or oral) examination and the skills demonstration. If an
individual does not complete the examination satisfactorily, they will be
advised of areas which they did not pass and their right to take the
examination three (3) times.
9. All
candidates will be allowed up to three (3) opportunities to successfully
complete the examination. Failure after three (3) attempts will require
re-training to qualify for further examination opportunities. A maximum time
limit of twelve (12) months shall be imposed on an individual to complete the
examination. Verification of new re-training will be required after this
12-month limit, for further examination opportunities.
10. Effective upon notification of
examination results, any person who has failed the competency examination
(either the written, oral, or skills portion) after three (3) 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 sixteen (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 ninety
(90) hours of training. Upon successful completion of their training, they
should be scheduled for the next available competency examination.
11. All individuals who successfully complete
the 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.
Examination Fees, Dates, and
Locations1. The Department does
not require an initial fee for this occupational license; however, there is a
fee to take the state examination. The amount of the examination fee will be
announced in a timely manner by the Department or designated
contractor.
2. If there were to be
an initial fee, per Arkansas Code Ann §
17-5-104, the following
individuals are not required to pay an initial fee for this license:
a. An individual receiving assistance through
the Arkansas Medicaid Program, the Supplemental Nutrition Assistance Program,
the Special Supplemental Nutrition Program for Women, Infants, and Children,
Temporary Assistance for Needy Families Program, or the Lifeline Assistance
Program;
b. An individual who was
approved for unemployment within the last twelve (12) months; or
c. An individual who has an income that does
not exceed two hundred percent (200%) of the federal poverty income
guidelines.
3. The
waiver of the initial fee does not include fees for:
a. A criminal background check;
b. An examination or a test; or
c. A medical or drug test.
4. The examination will be given
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 contractor.
5. At the option of the NA, the competency
examination (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).
6. Each 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).
7. The
Department will be responsible to pay the examination 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
twelve (12) months immediately preceding the date of the application to take
the examination. Independent examination candidates who are taking the
competency examination without an employment connection to a long-term care
facility will be responsible to pay their own examination fee. In accordance
with
42 CFR §
483.154, no nurse aide who is employed by, or
who has received an offer of employment from, a facility on the date on which
the aide begins a nurse aide competency examination program may be charged for
any portion of the program.
8. If
an individual who is not employed, or does not have an offer to be employed, as
a nurse aide becomes employed by, or receives an offer of employment from, a
facility not later than twelve (12) months after completing a nurse aide
training and competency examination program, the State must provide for the
reimbursement of costs incurred in completing the program on a pro rata basis
during the period in which the individual is employed as a nurse
aide.
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 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 take the competency examination.
1. Nursing assistants who were trained in
approved non-facility programs (for example: career colleges, V
o-Tech schools, or proprietary schools) 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 (for example: Introduction to Nursing,
or Fundamentals of Nursing). The individual must provide a copy of their school
transcript, or documentation showing successful completion of the basic nursing
course, to qualify to take the state competency examination.
4. Registered 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
examination.
5. Home health aides
who have met appropriate federal training or examination requirements for HHA
certification. V erification must show completion of a minimum of seventy-five
(75) hours training or federal testing requirements as a home health aide. This
provision does not apply to "personal care aides" as their training
requirements of forty (40) hours does not meet the LTCF Nursing Assistant
Training Program's ninety (90) hours or curriculum content.
6.I ndividuals 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 examination.)
V erification of course completion rests with the individual and must be
submitted to the DHS designated contractor for approval to take the Arkansas
competency examination.
7. 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 examination agency prior to the specified
examination 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, on-the-job training, or in-service
training, as they are not acceptable in lieu of the approved training
program.
