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 examination 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, 1990, and
1993(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 Certified nursing-aide skills
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
skills to enhance knowledge in promoting healthy functioning of residents both
physically and emotionally and focus on the restoration and maintenance of the
resident. These attitudes and behaviors of staff must be demonstrated in the
facility on a day-to-day basis.
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.
- Additional Instructor - A RN or LPN who, under the general
supervision of the Primary Instructor, may provide classroom and skills
training.
- Centers for Medicare & Medicaid Services (CMS) - A
federal agency that oversees programs including Medicare, Medicaid, the
Children's Health Insurance Program (CHIP), and the state and federal health
insurance marketplaces.
- Certified Nursing Assistant (CNA) - Individuals trained and
certified to help nurses by providing non-medical assistance to patients, such
as help with bathing, dressing, and using the bathroom.
- Competency Examination - 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
(DHS).
- Division - The Division of Provider Services and Quality
Assurance within the Department of Human Services.
- Educational Institution - An institution that is licensed by
the Arkansas State Board of Private Career Education within the Arkansas
Division of Higher Education as defined by Act 906 of 1989 (i.e., career
colleges, proprietary school).
- Examination - A competency examination 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 twenty-four (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.
- General Nursing Experience - Experience which may include,
without limitation, employment in a nursing assistant education program or
employment in or supervision of nursing students in a long-term care facility
or unit, geriatrics department excluding a geriatric psychiatry department,
long-term acute care hospital, home healthcare, hospice care, or other
long-term care setting. (Arkansas Code Ann. §20.10.702 (2)(C)(ii).
- Guest Speaker - 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.
- 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 unlicensed nursing staff member who
assists with basic patient care (such as giving baths, checking vital signs,
bed-making, and positioning) 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.
- Task 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 who is a registered
nurse licensed in this state to practice if the registered nurse moves from a
state that has joined the Interstate Nurse Licensure Compact, §
17-87-601 et seq., to Arkansas and
meets all requirements for licensure in Arkansas does not have any disciplinary
action regarding his or her license by the licensing entity or authority; and
possesses a minimum of two (2) years' general nursing experience as a
registered nurse including at least one (1) year of long-term care nursing
services in a long-term care facility setting within the last five (5) years.
(Arkansas Code Ann. §
20-10-702). -
- Office - Nursing Assistant Training Program within the
Division of Provider Services and Quality Assurance.
- Resident - Individuals who reside in long-term care
facilities that receive a range of services, including medical and personal
care.
- 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.
- Supervised Practical Training - Pursuant to
42 CFR
483.152, supervised practical training means
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 nurse or a licensed practical nurse.
- 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 they have not been trained
and found to be competent.
- Virtual Instruction/Training - a method of teaching that is
taught either entirely online or when elements of face-to-face courses are
taught online through learning management systems and other educational tools
and platforms.
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 examination approved by the Department as required by CMS.
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 in-person or virtual
training in both facility and non-facility programs.
3. These guidelines essentially provide the
outline for in-person and virtual training programs 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 in-person/virtual 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 examination. 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 them in each part of the training
program.
5. Upon successful
completion of the required in-person/virtual training, the trainee must pass
the state competency examination administered by the Department (see Section
VII). An individual must complete the state competency examination within
twelve (12) months of graduation from a training program or retraining will be
required.
B.
Implementation Requirements
1. Pursuant to
42 CFR §
483.152, a nurse aide training and competency
examination program must include, at a minimum, a combination of classroom
(in-person/virtual) and clinical instruction. The requirement for state
certification shall include a minimum of ninety (90) hours of training which
consist of no less than seventy-four (74) clock hours of training, including
sixteen (16) hours of supervised practical training, for a total of ninety (90)
hours.
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 sixteen (16) hours initial
classroom (in-person/virtual) 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
- Nursing Assistant Trainee Activities).
4. Parts II and III require the completion of
the remaining seventy-four (74) clock hours of training consisting of theory,
classroom lab and clinical skills training. Clinical skills training must
include at least sixteen (16) hours of supervised practical training in a
facility performing tasks on an individual under the direct supervision of the
instructor. Clinical skills training assignment or supervision by another
nursing assistant is prohibited.
5.
The ratio of trainees to instructors in the in-person/virtual classroom must
not exceed twenty-four (24) trainees to one (1) instructor (primary or
additional instructor) and the ratio for skills training must not exceed twelve
(12) trainees to one instructor.
6.
Staff in training can be employed after completing lessons one (1) - eleven
(11) (sixteen (16) hours of course work) and may continue to work on the floor
while they are actively progressing through a NATP; however, they cannot be
included in staffing ratio if they are actively participating in class
instruction.
7. Each program shall
issue a written statement to each trainee, upon successful completion of the
program in the form of a certificate of completion, which shall include the
program's name, NATP license number, 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 ID card, alien registration card, military identification or
passport); the begin date and end date; and the signature of the Primary
Instructor upon successful completion of the program. Such certificate, or
copies thereof, shall serve as evidence of successful completion of a training
program to be eligible to take the state competency examination.
C.
Nursing Assistant
Trainee Activities1. Each
trainee shall wear identification during all skills training portions that
identifies them as a trainee. Identification must be visible to residents,
family members, visitors, and staff.
2. A nursing assistant who has begun a
training program and has not completed the program may be hired by a facility
to provide care for which they have received training and demonstrated
competence. 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 (DMS-741 form) provided by the
Department This record consists of the following:
* Tasks performed which includes duties and skills
completed
* Satisfactory performance date; and
* The instructor's signature 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.
In person/Virtual Classroom Facilities & Resources
1. In Person:
a. The nursing assistant training program
shall require the provision of physical facilities as follows:
- Temperatures conducive to the weather;
- Clean and safe conditions;
- Adequate Lighting;
- Space to accommodate all students; and
All Equipment for simulating resident care and
classroom/lecture (See Instructional Equipment under Section
X).
b. 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.
2. Virtual:
See the virtual methodology section.
Suggested training material/resources may include, but is not
limited to a blackboard, flipchart, projector/screen, DVD, anatomical chart,
mannequin, bed, lavatory/sink, etc.
3. The Department will not require or endorse
any one textbook or other material such as videotapes, films, etc. There are
several resources on the market and each facility or school will have the
choice in selecting their materials. The curriculum guide is to be used so each
program will know the objectives and procedures expected to be communicated to
the nursing assistant trainee for them to pass the state competency
examination.
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 ninety (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 inservice 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) (three (3) through six (6)).
G.
Non-Permanent
Employees1. 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.
Location1. Nursing
assistant training programs may be offered by or in nursing facilities, as well
as outside facilities. The clinical portion of the training must be conducted
in all cases and must utilize a nursing facility and its residents.
Nursing facilities may offer a complete training program and/or
may contract with another organization to provide the training unless they are
sanctioned. Sanctioned nursing facilities cannot offer the training.
2. Other groups and/or
institutions such as employee organizations, vocational/technical schools,
community colleges, and private institutions may conduct programs, upon the
Department's approval.
3. Programs
offered to the public and charging a tuition fee must submit an application and
be approved by the Department before they can 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 long-term
care 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, has done the following:
(A) Operated under a waiver of the nurse
staffing requirements in excess of forty-eight (48) hours during the
week;
(B) Been subjected to an
extended survey*or partially extended survey*; or
(C) Been subjected to a civil money penalty
of no 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 Reimbursements under Section X).
C.
Application
1. 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 the DHS
DPSQA website or you can request an application by emailing:
natpcertification@dhs.arkansas.gov
2. An outline must be attached to the
application showing the lesson plans and teaching modules utilized 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. Each facility's application must also
include the following:
a. PI Resumes/work
history to establish LTC experience;
b. AI resume/work history to establish LTC
experience;
c. Waiver letter from
the Department if utilizing a sanctioned LTCF;
d. Professional license verification;
and
e. Additional information, as
requested by the Department.
3. When applicable for renewals, verification
of school licensure by the Arkansas State Board of Private Career Education
within the Arkansas Division of Higher Education (ADHE) will be required (See
item A of this section). A notarized copy of the school licensure must be
included with applications for new programs and for renewal of programs.
Notification to the ADHE verifying additional instructors and/or changes in
instructors will be required with each application.
4. Application must be submitted to the
Department and approved by the Department prior to the start of the first
course.
5. An application must be
completed and signed by the Primary Instructor.
6. 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 fifteen (15) business
days of the date of filing. The applicant will be given an opportunity to
correct any deficiencies.
7. Notice
of approval or disapproval of the application will be given to the entity
within fifteen (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.
8. An
applicant may request a review on a disapproval in writing within ten (10)
business days of receipt of the notice of the proposed disapproval to the
Division Director. 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,
but are not limited to:
- Change in training provider
- Change in delivery site (i.e., classroom to virtual);
- Change in clinical site
- Change in instructor; and
- Complete revision of course structure, including change in
hours allotted to one (1) or more modules.
3. Major changes do NOT include:
- Change in materials (handouts, textbooks, videos,
etc.)
- 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 these rules. The
Department shall withdraw approval of a training program when;
(a) The program has one (1) or more
restrictions;
(b) The entity
offering the program refuses to permit visits by the Department, whether
announced or unannounced. (Any facility that refuses to permit unannounced
visits is subject to having its provider agreement terminated;
(c) The program's curriculum and
implementation requirements specified in these rules are not met by the
program;
(d) The program has an
excessive failure rate for trainees on the state competency evaluation test
over a three (3) year period and after opportunities to address the failure
rate through enhanced monitoring.;
(e) Renewal is not completed prior to renewal
date. NATP approval will be suspended until renewal is completed and
approved;
(f) The program makes or
causes to be made any false statement or representation of a material fact used
in determining rights or any application for payment by any entity for
reimbursement of training costs as allowed in Section X of these
rules;
(g) The program makes or
causes to be made any false statement or representation that training was
provided when training was not provided;
(h) The program 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 for the program to qualify either upon initial approval
or re-approval;
(i) The program
makes or causes to be made any false statement or representation that the
amount of training costs are 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;
(j) The program makes or causes to be made
any false statement or representation of a material fact in violation of these
rules; or
(k) The State determines
that any of the applicable requirements of §483.152 or §483.154 are
not met by the program.
2. When the State withdraws approval of a
nurse aide training and competency evaluation program or competency evaluation
program:
(a) The State must notify the program
in writing, indicating the reason(s) for withdrawal of approval of the program;
and
(b) Students who have started a
training and competency evaluation program from which approval has been
withdrawn must be allowed to complete the course.
3. The program may file for a reconsideration
of the withdrawal of approval of a nurse aide training and competency
evaluation program within ten (10) business days of the notification. The
reconsideration shall be forwarded to the Director of the division.
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 inservice nursing assistant
education (initial training must be at least seventy-four (74) hours of
classroom instruction, as well as sixteen (16) hours of supervised practical
training; a total of ninety (90) 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 Interstate Transfer
Form (DMS-798), with attached copies of documents and/or certificates verifying
course completion, and the number of hours in a 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"
seventy-four (74) hours classroom training course, as well as sixteen (16)
hours of supervised practical training; a total of ninety (90) hours.
This phase was completed by October 1, 1990 and does not apply
thereafter. Therefore, all individuals must now complete the ninety (90) 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 they have 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. Foreign language
translation dictionaries must be shown to the RN Test Observer at check-in and
to the Knowledge Test Proctor when entering the knowledge test room. No
electronic dictionaries are allowed. No definitions or writing is allowed in
the translation dictionary. If there is any writing or definitions, the
translation dictionary will not be permitted to be used during
testing.
5. The written or oral
component shall be developed from a pool of examination questions. Only a
portion will be used in the exam. The skills demonstration shall consist of
five (5) randomly selected questions drawn from a pool of tasks ranked based on
the level of difficulty.
6. The
skills demonstration component will be performed in a facility (not
disqualified by criteria specified in Section V, item B.) or laboratory
setting.
7. 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.
8. 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
prohibited as specified in Section V item B.
9. 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 two (2) more times.
10. All candidates will be allowed up to
three (3) attempts, within in a twelve (12) month period, to successfully
complete all portions of the competency examination. Failure after three (3)
attempts will require retraining to qualify to sit for the competency
examination. An individual has twelve (12) months to successfully pass the test
after retraining.
11. Any trainee
who is employed by any long-term care facility and fails any portion of the
competency examination after three (3) attempts is prohibited from providing
nursing services to residents in a long-term care facility.
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) of training prior to direct resident contact
and can only be assigned job duties thereafter in which they have been deemed
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.
12. 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. The competency examination (both written,
oral, and skills components) may be administered in the facility of the
candidate's employment unless the facility is disqualified by the Department
under criteria specified in Section V, item B.
6. Each candidate must have appropriate
verification of the training requirements. (see item D of this section and
Section IV of these rules).
7. The
Department will be responsible for paying the examination fee one (1) time for
individuals who are employed by a Medicaid certified longterm 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 longterm 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 is a list of qualifications 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 on-facility programs (for example: career colleges,
Vo-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. Registered Nurses or
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 for 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. Verification must show completion of a
minimum of seventy-four (74) hours classroom training, and sixteen (16) hours
of supervised practical 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 ninety (90) hour
requirement for the LTCF Nursing Assistant Training Program's.
6. Individuals from other states who can
verify completion of a state approved geriatric nursing assistant training
program but were not tested and registered. If registered in the other state,
see Section VIII for reciprocity transfers without further examination.
Verification 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 C). 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 individuals 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.
Arkansas Code §
17-4-106 Certified Nursing
Assistant Licensures of Uniformed Service Members, Veterans, and
Spouses
To comply with Arkansas Occupational Licensing of Uniformed
Service Members, Veterans, and Spouses Act of 2021, the following rules apply
to uniformed service members, uniformed service veterans, and their spouses for
licensure as defined below:
1. A
uniformed service member stationed in the State of Arkansas;
2. A uniformed service veteran who resides in
or establishes residency in the State of Arkansas and makes an application
within one (1) year of his or her discharge from uniformed service;
and
3. The spouse of:
a. A uniformed service member stationed in
the State of Arkansas;
b. A
uniformed service veteran who resides in or establishes residency in the State
of Arkansas;
c. A uniformed service
member who is assigned a tour of duty that excludes the uniformed service
member's spouse from accompanying the uniformed service member and the spouse
relocates to this state; and
d. A
uniformed service member who is killed or succumbs to his or her injuries or
illness in the line of duty if the spouse establishes residency in the
state.
It is the intent of the Department to prevent removal of
occupational licensure barriers for CNA licensures that may impede the launch
and sustainability of civilian occupational careers and employment faced by
uniformed service members, uniformed service veterans, and their spouses due to
frequent uniformed service assignment by providing;
1. Automatic Certified Nursing Assistant
(CNA) Licensures. Automatic CNA licensures will be provided to current license
holders in order to expedite their entry into the workforce of this state by
means of reciprocity. Reciprocity may be granted without further training or
testing.
a. The process of reciprocity
includes completion of the following with the state Vendor:
i. Form 9110AR- Out of State Employment
Verification for AR Registry Renewal
ii. Form DD214-DD 214/Separation
Document
iii. Form DMS-798-
Interstate Transfer Form/CNA Reg. Exemption/Reciprocity Request.
iv. Image/copy of individuals social security
card
v. Image/copy of valid US
government issued photo identification; and
vi. Proof of service education, training,
experience, and service-issued credentials by means of a Joint Service
Transcript (JST).
b.
Reciprocity is granted to those who meet the following criteria:
i. Completion of a training and competency
evaluation program to become registered as a nursing assistant in another
state, territory, or district of the United States that meets federal
guidelines.
ii. A holder in good
standings with CNA licensure within a similar scope of practice by another
state, territory, or district of the United States.
2. Temporary or Provisional
Certified Nursing Assistant (CNA) Licensures. Temporary or provisional CNA
licensures to initial CNA licensures candidates will be provided while
expediting full licensure by recognizing uniformed service education, training,
experience, and service issued credentials of uniformed service members and
uniformed service veterans applying for initial CNA licensure. The following
criteria will be classified as meeting service education, training, experience,
and credentials;
a. Ninety (90) hours of
approved education, training, or experience in healthcare.
b. Sixteen (16) hours of supervised practical
skills training in an Arkansas facility; and
c. passing the Arkansas Nurse Aide Testing
with three (3) given attempts in one hundred eighty (180) days post
application.
3. Extension
of License Expiration and Continuing Education Requirements. Extension of
license expiration and any continuing education requirements for CNA licensure
renewal for a deployed uniformed service member or their spouse will be granted
the following:
a. An extension of the
expiration date of a CNA licensure for one hundred eighty (180) days following
the date of the uniformed service member's return from deployment.
b. An extension from continuing education
requirements for one hundred eighty (180) days following the date of the
uniformed service member or from the uniformed service member's return from
deployment.
The Department may require evidence of completion of continuing
education before granting a subsequent CNA licensure or authorizing the renewal
of a CNA licensure to allow full or partial exemption from continuing education
requirements.
Uniformed service members, veterans and spouses who
successfully meet the criteria and standards within the provisions shall be
placed on the CNA registry and issued a state certificate. Information
regarding Military Member Licensure can be found on the DHS-Division of
Provider Services and Quality Assurance website at:
http://humanservices.arkansas.gov/about-dhs/dms/office-of-long-term-care.
Section
VIII
CNA REGISTRY
A.
Function and
Content1. The Department shall
establish and maintain a registry of all individuals who have satisfactorily
completed the training and competency examination program requirements. The
nursing assistant registry shall be incorporated into the Long-Term Care
Facility Employment Clearance Registry (ECR), which shall include substantiated
administrative findings of abuse, neglect, or misappropriation of resident
property for CNAs.
2. The
information in the registry shall be made available to the public and open for
inquiries twenty-four (24) hours per day, seven (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 Certified 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;
* Name and date of the State approved training program
successfully completed;
* Certification number and date of issuance;
* Current active or inactive status; and
* Most recent re-certification date.
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 thirty (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 Process1. 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 Department, or its designated agent, and
may be subject to change. If needed, facilities should contact the Department
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 the Department 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
DEPARTMENT. PLEASE NOTE, HOWEVER, THAT NAME SEARCHES BY CALLING THE DEPARTMENT
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 examination program and become certified 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 the DHS designated contractor with a copy
of each state's certificate or registration document. The DHS designated
contractor will contact the other state to clear the individual's status for
the transfer of their certification through reciprocity. The facility may not
use the individual until each other state's registry is cleared. Once that
information is received, the CNA may be added to the CNA registry.
Some of these individuals may qualify for registration under
certain criteria; some may be required to take the Arkansas state test, and
some may be required to complete both training and testing.
D.
Certification
Renewal
The initial certification period is valid for twenty-four (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.
CNAs who provide services for private pay clients must include
a check stub and a notarized letter from the employer, which should include CNA
duties performed within the twenty-four (24) month period, to verify current
employment or employment within the last twenty-four (24) month period.
1. Employing facilities and/or individuals
shall be required to submit updated 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
twenty-four (24) month period. Nursing assistants who are currently employed as
a nursing assistant at the time of their renewal will be renewed for
twenty-four (24) months. Nursing assistants who are not currently employed will
be renewed for twenty-four (24) months beginning with the last day employed as
a nursing assistant. A certification that has been expired for a period longer
than twenty-four (24) months cannot be renewed and the individual shall retest
and complete sixteen (16) hours of clinical to re-certify to an active
status.
2. 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 twenty-four (24) month period cannot be
provided or for any certification that has been expired for over twenty-four
(24) months.
3. The process to
renew a nursing assistant certification shall be overseen by the Department or
its agent. Each certified nursing assistant shall be responsible for renewing
their certification online approximately sixty (60) calendar days before the
expiration of their certification.
4. 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.
5. Nursing
assistant certifications may not be renewed more than sixty (60) calendar days
prior to the expiration date.
6.
Renewals may be completed through the online website. The Department or its
designated agent shall provide instructions for the online renewal
process.
7. The Arkansas Nursing
Assistant Registry renewal must be fully completed by the CNA, and the
information must be accurate to the best of their knowledge. Failure to fully
complete the renewal or provide false or inaccurate information, shall
constitute the basis for denial of certification renewal.
8. When a nursing assistant renewal is
processed and the nursing assistant is determined to be eligible for renewal, a
new certificate showing the new expiration date will be available online for
the CNA to print 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 Department shall establish a procedure that permits a certified
nursing assistant to petition for the removal of a substantiated finding of
neglect.
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 Department makes a determination that
the Petitioner'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 Petitioner does not have a criminal conviction related to
neglect, abusive behavior, or physical violence.
* The Petitioner's name does not appear on the Adult and
Long-Term Care Facility Resident Maltreatment Central 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 Petitioner.
c. At least one year has passed
since the Petitioner'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. Petitioner shall submit a letter
requesting the removal of the neglect finding. The letter shall be addressed
to:
Division of Provider Services and Quality Assurance Nursing
Assistant Training
Program
Mail Slot S-405, P.O. Box 8059
Little Rock, AR 72203-8059
b. The Petitioner 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 (2) personal
character references;
* Letters of reference from any employment within the previous
year from the date of the Petition. This letter must include a statement
attesting to the Petitioner'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 Petitioner is currently or has recently (within the previous
twelve (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 Department shall review each Petition
for consideration for removal of the neglect finding. The review shall be
conducted by an administrative review panel consisting of at least three (3)
members appointed by the Division Director. The panel shall meet within thirty
(30) days of any Petition. The review panel shall consider all information
submitted by the Petitioner 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 Petitioner shall be notified in writing within ten (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 ten (10) business
days to show the Petitioner 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 twenty-four (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 twelve (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 Department as described
in these rules.
b. If a Petitioner
wishes to appeal, they may do so by mailing a written notice of appeal to the
Office of Appeals and Hearings Arkansas Department of Human Services, P.O. Box
1437-Slot N401, 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
postmarked by the Appeals and Hearing Office within thirty (30) calendar days
from the receipt of the notification of denial of the petition. No appeal shall
be accepted after thirty (30) calendar days of receipt of the
determination/decision.
d. A
hearing shall be conducted by the Office of Appeals and Hearings, 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 twenty (20) calendar days of receipt of notice that a
Petitioner has requested a hearing, the Petitioner and the Department will
prepare a file to be submitted to the Office of Appeals and Hearings 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 Department will also submit an
Administrative Hearing Statement summarizing the determination/decision. This
statement is not evidence. Only such portions of each file as determined by the
hearing officer to be relevant shall be included in the Administrative Hearing
Record.
2. Both parties will be
advised by the Office of Appeals and Hearings 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 DHS. DHS employees will be
expected to attend hearings and present testimony without the benefit of a
subpoena and will be notified by the Office of Appeals and Hearings 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 Department, 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 Department 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 Office of Appeals and
Hearing. Hearings may be conducted by telephone, by personal appearance of the
parties, or by record review by the Office of Appeals and Hearings.
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 Office of Appeals and Hearings prior to the date of
the hearing of their 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 Department
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 Office of Appeals and Hearings 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 Office of Appeals and Hearings 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 their 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 Department representative. The Department shall then present its case.
After completion of the Department'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 their 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 Department.
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.
Monitoring
1. 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
has the right to do an onsite or virtual visit review to determine the
program's implementation of and compliance with the requirements. To ensure
ongoing compliance, the Department has the right to complete unannounced,
onsite, or virtual visits at a minimum of once every two (2) years.
2. Program reviews may be comprehensive or
partial. Based on the findings of the most current review, or overall test
scores, a program may be reviewed more often and in depth.
3. The inspector will generate a report that
will specify strengths and deficiencies of the program The Department will
terminate programs that do not meeting minimum requirements and that do not
provide an acceptable plan for correcting deficiencies within the specified
timeframe as established by the Department.
4. The program will be able to re-apply for
in-person or virtual instruction after the one (1) year suspension.
5. If a training program is deficient, a
corrective action plan must be submitted to the Department within ten (10)
business days of receiving the notification. The corrective action plan may be
returned to the program for further clarification, if the plan does not
accurately describe a plan that corrects the deficient practice. The Department
will send notification to the program upon approval of the corrective action
plan. The corrective action plan must include, at a minimum, the following:
* Activities to correct deficiencies;
* Person responsible for correcting the deficiencies;
* Implementation date; and
* Signature of the primary instructor.
Failure to respond or inadequate corrective actions may cause
suspension of the Department's approval of the program.
B.
Items Subject to
Monitoring1. Maintenance of
Secure Records - Each training program shall provide for secure maintenance of
records. Records to be maintained and protected shall include at a minimum, the
following:
- Names of enrollees;
- Names of those who successfully complete the program
- Begin and end dates of each class; Curriculum and/or
revisions of curriculum, with approval from the Department;
- Tests, grades, course documents, skills checklist;
- Credentials of instructors;
- Documentation of all state approvals; and
- Record of complaints (i.e., nature of complaint, date of
complaint, investigation summary and outcome).
2. Compliance with the following program
related curriculum content,
(a) Program
length;
(b) Ratio of classroom to
skills training;
(c) Qualifications
of instructors;
(d) Quality of
skills training supervision;
(e)
Access for clinical training in a nursing facility that was not disqualified
based on criteria specified in Section V (B);
(f) Physical (classroom and lab) facilities;
and
(g) Virtual classroom
capabilities.
2. Quality
of Care - The quality of care provided by individual nursing assistants
monitored during a licensure and/or survey and certification survey
Success Rate - The graduates' success rate of both virtual and
in-person trainees on the state competency examination will be monitored by the
Department and shall be utilized as a criterion for revoking program
approval.
4. Any other
requirements included in this manual.
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
one (1) time 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 Department 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 SMART Boards, iPads and Apple TV, Chromebooks, multi-media
projectors, DVDs, etc. purchased specifically for use in the NA training
program.
4.
Instructional Videos. The dollar amount spent for
instructional videos, etc. purchased specifically for use in the NA training
program.
5.
Other
Training Materials. The dollar amount spent for other approved
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 a training activity for reimbursement. Information reported to
DHS 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 twelve (12) months immediately preceding the date of the
completion of training) to attend NA training in an approved nonfacility
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 ninety (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 Department monthly on
form DMS- 755. Claims for the expense month can be submitted no earlier than
the first day of the month or the last 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 Department
within thirty (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 fifteen (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 submitted claims must include a copy
of each trainee's Certificate of Completion from the training program and a
copy of the DHS 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. Copies will not be accepted.
D.
Maximum Cost
Limit1.I n an effort 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 (four (4) students x $480 = $ 1920 maximum) the actual costs will be
reimbursed.
I f 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 Retention
1. 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 Department for
reimbursement for a period of no 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.
METHODOLOGY FOR REVI EW OF COMPLIANCE WITH
V IRTUAL TRAINING
VI RTUAL INSTRUCTION ONLY APPLIES
TO LECTURE PORTION OF TRAINING
All content taught to students remains the same whether the
program offers in-person or virtual instruction. If the program chooses to
offer virtual instruction, the expectation of delivery of information remains
the same as in-person.
V irtual instruction must be
indicated on the application and a virtual plan must be submitted to the
Department for approval. If the program fails to meet the guidelines, it will
result in temporary suspension and/or a deficiency. In addition to complying
with rules, the following requirements must be met.
A. Requirements
1. A program is subject to inspection of
virtual instruction at any time by Department personnel. A program who provides
virtual instruction must have practical capabilities and set forth expectations
including, but not limited to, the following:
a) Internet capabilities for the program and
the participants;
b) Requirements
of logging into the virtual site at least fifteen (15) minutes prior to the
beginning of class and staying connected virtually until class ends;
c) A camera that is turned on during
instruction.
d) Individual logins
must be tracked and maintained for auditing purposes by the
Department;
2. Virtual
programs are responsible for ensuring that the Department has the virtual link
to audit compliance with these rules. The link must be functional and active at
all times.
3. All participants must
be able to have visible access to observe all curriculum activities (i.e.,
hands-on demonstration, notes on board, and all instruction provided by the
program).
4. All videos to be
viewed must be included in the curriculum for in-person and virtual
training.
5. All skills labs must
be in-person.
6. The programs must
provide training materials prior to class, including but not limited, web
access to materials.
Nursing Assistant Training Cost Reimbursement Claim
Form
The Nursing Assistant Training Cost Reimbursement Claim Form
(DMS-755) is specific to each facility.
To obtain a form DMS-755, or email
natpcertification@dhs.arkansas.gov or visit Arkansas Department of Human
Services - DPSQA.
