Current through Register Vol. 49, No. 9, September, 2024
The following Rules for the Licensure of Nursing Home
Administrators are duly adopted and promulgated by the Arkansas Department of
Human Services, Division of Provider Services and Quality Assurance, pursuant
to the authority expressly conferred by Arkansas Code §
20-10-203(b).
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 revision 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.
Such enhancement will support the achievement of optimal
nursing home resident care.
Section I
- Definitions
The following terms are defined for the purpose of these
rules:
A.
NURSING HOME
"Nursing home" shall mean a skilled nursing facility (SNF) or a
nursing facility (NF) which meets the requirements of 1819 or 1919 of the
Social Security Act or meets State licensure requirements for a long-term care
facility.
A nursing home usually provides skilled nursing care, medical
services, rehabilitation services, or health-related services (or both
rehabilitation and health related services) to frail elderly, injured,
disabled, or sick persons who require such services on an extended or
continuous basis.
B.
NURSING HOME ADMINISTRATOR
"Nursing home administrator" shall mean a person who
administers, manages, supervises, or is in general administrative charge of a
nursing home whether such individual has an ownership interest in such home and
whether their function and duties are shared with one (1) or more
individuals.
C.
LICENSE
For the purposes of these rules, "license" shall mean a nursing
home administrator's license issued to a qualified individual.
Section II - Applicant's
Qualifications
A.
CHARACTER
Applicant for licensure as a nursing home administrator shall
abide by the Code of Ethics adopted by the American College of Health Care
Administrators. The Division of Provider Services and Quality Assurance may
deny an applicant if they fail to comply with these rules or for any of the
reasons listed under Disciplinary Proceedings of these rules.
B.
AGE
An applicant for licensure as a nursing home administrator
shall be at least twenty-one (21) years of age.
C.
HEALTH
Applicant shall be physically and mentally capable of
performing the full-time duties of an administrator of a nursing home (Arkansas
Code §
20-10-403). If there are factors that indicate that an individual
may not be capable of performing such duties, a physician's certification of
health would be required.
D.
EDUCATION
1. A qualified
applicant for licensure as a nursing home administrator shall possess the
following education and experience in order to be eligible for testing:
a. For an applicant who holds a baccalaureate
degree (Bachelor of Science or Bachelor of Arts) or higher in health care
administration (HCA) or long-term care administration (LTCA) with an internship
in a nursing home: No additional experience required.
b. For an applicant who holds a baccalaureate
degree (Bachelor of Arts or Bachelor of Science) in HCA or LTCA without
internship: Three (3) months internship or experience in a nursing home is
required.
c. For an applicant who
holds a baccalaureate degree (Bachelor of Arts or Bachelor of Science) or
higher in nursing or business which included basic core requirements noted
under D.2: Three (3) months internship or experience in a nursing home is
required.
d. For an applicant who
holds a baccalaureate degree (Bachelor of Arts or Bachelor of Science) or
higher in other field which included basic core requirements noted under D.2:
Three (3) months internship or experience in a nursing home is
required.
e. For an applicant who
holds an Associate's degree in HCA or LTCA or a registered nurse with an
associate degree or diploma which included basic core requirements noted under
D.2: Six (6) months internship or experience in a nursing home is
required.
f. For an applicant who
holds an Associate's degree in other field which included basic core
requirements noted under D.2: One (1) year internship or experience in a
nursing home is required.
2. A minimum of fifteen equivalent semester
hours must be satisfied in these basic core requirement areas (three (3) hours
per topic): accounting, management, personnel, writing, and resident care.
Experience and continuing education credits will be accepted in lieu of
education as follows:
a. College or vocational
courses (per credit hour or equivalent);
b. Work experience (six (6) weeks of work
experience equals one (1) credit hour);
c. Credit by examination (CLEP) (credit
received);
d. Continuing education
credits (ten (10) contact hours equals one (1) credit hour); or
e. Any combination of the above.
E.
ADMINISTRATOR-IN-TRAINING PROGRAM QUALIFICATIONS
Applicants who do not meet the educational and experience
requirements noted in D.1. and D.2. must meet the qualifications for and
complete the requirements of the Administrator-In-Training Program as
administered by the Department of Human Services.
F.
EQUIVALENT QUALIFICATIONS
An administrator who holds a current active license on the
effective date of these rules shall be deemed to have met qualifications
equivalent to those required for new applicants for licensure.
An administrator who holds an inactive license on the effective
date of these rules must either a) activate their license by July 2, 1998, OR
b) meet the qualifications required for new applicants for licensure at the
time that active status is desired. Reexamination would not be required.
Applicants who are approved for testing prior to the effective
date of these rules shall be deemed to have met qualifications equivalent to
those for new applicants for licensure.
Section III - Licensure
A.
LICENSURE REQUIREMENT
No person shall administer, manage, supervise, or be in general
administrative charge of a nursing home unless they are 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 (1) nursing home.
B.
APPLICATION FOR LICENSURE
Applicants for licensure shall file applications under oath
with the Department of Human Services, upon forms prescribed by the Department
of Human Services and shall pay the required licensure fee, as outlined in
Arkansas Code Annotated §
20-10-404. The application and fee shall be
mailed to the Department of Human Services at the address provided by the
Department of Human Services or through the means provided by the Department of
Human Services. The application must be accompanied by the applicant's criminal
background check results; the applicant's criminal background must be completed
by the Arkansas State Police. The applicant is responsible for all costs
related to obtaining the criminal background check results. 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 of Human Services 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 of Human Services.
Pursuant to Arkansas Code §
17-5-104, individuals may be
granted a licensing fee 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 if 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.
Administrator applicants must submit proof of completing an
Administrator in Training program that is approved by the Department of Human
Services with their application.
C.
LICENSURE FOR MILITARY PERSONNEL,
VETERANS, AND THEIR SPOUSES1. Pursuant
to Arkansas Code §
17-4-101 et seq., this rule applies to licensure for
uniformed service members, uniformed service veterans, and their spouses as
defined below:
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; and
c. The spouse of:
i. A uniformed service member stationed in
the State of Arkansas;
ii. A
uniformed service veteran who resides in or establishes residency in the State
of Arkansas;
iii. 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
iv. A uniformed service member who is killed
or succumbs to their injuries or illness in the line of duty if the spouse
establishes residency in the state.
2. Automatic NHA licensure will be provided
to current license holders 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 the following:
i.
Completion of an application, prescribed by the Department of Human Services,
with all required forms;
ii.
Submission of DD214-DD 214 Separation Documents;
iii. Submission of DMS-7790 Application for
Nursing Home Administrators;
iv.
Submission of an image or copy of individual's social security card;
v. Submission of an image or 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 NHA in another state, territory,
or district of the United States that meets federal guidelines; and
ii. A holder in good standing with NHA
licensure within a similar scope of practice by another state, territory, or
district of the United States.
3. Temporary or Provisional Certified Nursing
Home Administrator (NHA) Licensure
a. A
temporary or provisional NHA license will be granted to a uniformed service
member, or uniformed service veteran, or their spouse while expediting full
licensure. The Department of Human Services will take into consideration the
education, training, national certification, experience, and service issued
credentials of uniformed service members and uniformed service veterans, or
their spouse that are applying for initial NHA licensure.
D.
EXTENSION OF LICENSE
EXPIRATION AND CONTINUING EDUCATION REQUIREMENTS FOR MILITARY PERSONNEL AND
THEIR SPOUSES.1. The Department of
Human Services will extend the expiration date and any continuing education
requirements for NHA licensure renewal for a deployed uniformed service member,
or their spouse, as follows:
a. An extension
of the expiration date of a NHA license 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's return from deployment.
2. The Department of Human
Services may require evidence of completion of continuing education before
granting a subsequent NHA licensure or authorizing the renewal of a NHA
licensure to allow full or partial exemption from continuing education
requirements.
3. Uniformed service
members, veterans, and their spouses who successfully meet the criteria and
standards within this provision shall be placed on the NHA registry and issued
a state certificate. Information regarding Military Member Licensure can be
found on the Department of Human Services - Division of Provider Services and
Quality Assurance - Office of Long Term Care - Nursing Home Administrator -
Occupational Licensing website.
E.
AUTOMATIC OCCUPATIONAL LICENSURE OF
OUT OF STATE INDIVIDUALS1. Pursuant to
Arkansas Code Annotated §
17-7-101 et. Seq., a Nursing Home Administrator
from another state may qualify as a nursing home administrator in Arkansas if
they meet the following criteria and provide documentation that reflects:
a. They do not have a disqualifying criminal
offense under Arkansas Code Annotated §
17-3-102 or any additional state
law relating to the occupational licensure;
b. They do not have a complaint, allegation,
or investigation pending for their occupational activity; and
c. They are in good standing for one (1) year
of an occupational licensure of similar scope of practice issued by another
state, territory, or district of the United States; or they have worked:
i. In another state, territory, or district
of the United States that does not use an occupational licensure to regulate an
occupation or profession but is regulated by occupational licensure in this
state; and
ii. At least three (3)
years in the occupation.
2. An individual who is granted automatic
occupational licensure under these Rules shall meet all other occupational
licensure requirements for a resident of this state and all renewal
requirements of the occupational licensure, including without limitation a
criminal background check and continuing education hours.
3. The Department of Human Services may
require an applicant to pass an examination.
4. The Department of Human Services shall
require an applicant to furnish a bond, financial statement, or proof of
insurance coverage if required by state law.
F.
EXAMINATION FOR LICENSURE
All initial applicants for nursing home administrator licensure
must pass a two-part written examination which shall be so designed and
administered as to prove competence in nursing home administration.
An applicant will be tested as to their knowledge of the
current Domains of Practice as published by the National Association of Boards
of Examiners of Long-Term Care Administrators through the use of a national
examination approved by the Office of Long-Term Care. A scaled score of one
hundred thirteen (113) will be required to pass the national
examination.
An applicant will also be tested on their knowledge of Arkansas
Rules for the operation of nursing homes through the use of an examination
developed by the Office of Long-Term Care. A score of seventy (70) will be
required to pass the state examination.
If an applicant is unsuccessful on either or both such
examinations, they will be entitled to be reexamined one (1) additional time at
their expense for such additional examination. After two (2) such successive
failures, an applicant must:
(a)
complete an approved training course in an area proven by test scores to be
deficient,
(b) be suspended for six
(6) months, and
(c) reapply before
reexamination.
G.
CONTINUING EDUCATION AND TRAINING
During each licensure year, active licensed administrators
must:
(a) participate in twenty (20)
clock hours of continuing education at approved workshops,
(b) complete six (6) semester hours at an
accredited college or university in courses covered by the National Association
of Boards of Examiners Domains of Practice, or
(c) complete an approved course in nursing
home administration as a prerequisite for annual license renewal. Continuing
education hours must be applied to the licensure year in which they were
obtained and cannot be carried over to the following year.
Workshops and seminars are approved by the Division of Provider
Services and Quality Assurance based on criteria established by the National
Continuing Education Review Service and the National Association of Boards of
Examiners of Long-Term Care Administrators.
An administrator initially licensed after July
2nd will not be required to complete continuing
education hours to renew their license during the renewal period immediately
following. Time spent preparing for the examinations will satisfy the education
requirements.
H.
LICENSURE RENEWAL
All nursing home administrator licenses expire on July 1 and
shall be renewable only by the submission of a renewal application and
appropriate fees.
* Active licensees who seek to continue in active status shall
pay the active license fee and submit verification of compliance with
continuing education requirements.
* Active licensees who seek to change to inactive status shall
pay the inactive license fee and submit verification of compliance with
continuing education requirements.
* Inactive licensees who seek to remain in inactive status
shall pay the inactive license fee. (See Section III "Licensure", Item I
"Inactive Administrators.")
* Inactive licensees who seek to change to active status must
contact the Office of Long-Term Care individually for guidance. (See Section
III "Licensure", Item I "Inactive Administrators.")
Applications for annual license renewal shall be post-marked no
later than July 1st. Should the renewal be
postmarked July 2nd or later, the licensee must pay
a designated late charge. Any license not renewed on or before September 1
shall expire effective September 2. The forms are located at the Department of
Human Services - Division of Provider Services and Quality Assurance - Office
of Long Term Care - Nursing Home Administrator - Occupational Licensing
website.
NOTE: Should either due date fall on a Saturday,
Sunday, State of Arkansas holiday or federal holiday, the due date shall be the
following business day.
A licensee must notify the Division of Provider Services and
Quality Assurance immediately of changes in address, in employment, or in any
other pertinent information to ensure that renewal forms and other
correspondence will reach the licensee in a timely manner. Non-receipt of
renewal forms by the licensee, regardless of the reason, may result in
non-renewal of an administrator's license. Responsibility for renewal rests
with the licensee and the Division of Provider Services and Quality Assurance
assumes no liability. An applicant who has not received renewal notification by
June 1 of each year should contact the Division of Provider Services and
Quality Assurance at: NHA.Licensure@dhs.arkansas.gov
I.
INACTIVE ADMINISTRATORS
A licensed administrator who is not administering or managing a
nursing home and who does not wish to maintain an active license may keep their
administrator's license current by completing the renewal application section
entitled, "Inactive Administrators", and by submission of the required inactive
license fee.
Effective July 1, 1998, an inactive license will be granted for
no more than two (2) consecutive licensure years during which time continuing
education hours will not be required. During the third inactive licensure year,
the administrator must either complete twenty (20) hours of continuing
education or complete an approved course of study on current federal
regulations governing the operation of nursing homes and submit documentation
with their renewal form. The license will automatically expire after three (3)
years of inactive status unless such training is completed.
If an inactive administrator chooses to reactivate their
license, they must notify the Division of Provider Services and Quality
Assurance. An administrator who holds an inactive license on the effective date
of these rules must either a) activate their license by July 2, 1998, OR b)
meet the qualifications required for new applicants for licensure at the time
that the active status is desired. Reexamination would not be required. The
required number of continuing education hours must be obtained prior to
reactivation. Failure to notify the Division of Provider Services and Quality
Assurance or to obtain the required continuing education could result in
disciplinary action.
J.
DISCIPLINARY PROCEEDINGS
The Division of Provider Services and Quality Assurance may
refuse to issue or renew an administrator's license or may take other
disciplinary action against a nursing home administrator who fails to perform
their duties adequately. Inadequate performance which may lead to the
imposition of disciplinary actions include, but are not limited to, the
following areas:
1. During the time
that the administrator was employed by the facility, the facility was subjected
to:
a. Involuntary closure and transfer of
residents;
b. Appointment of a
temporary manager or receiver;
c. A
determination of immediate jeopardy to the health and safety of any
resident;
d. Civil Money Penalties
based on annual or complaint surveys;
e. Termination from the Medicare or Medicaid
programs;
f. An extended or partial
extended survey resulting in a determination of substandard quality of care;
or
g. Denial of payments for new
admissions or denial of all payments.
2. Conviction or finding against the
administrator of the misconduct listed below. For purposes of this subsection,
a conviction or finding against the administrator concerning any facility or
resident, past or current, can form the basis of disciplinary action:
a. Fraud in the operation of any
facility;
b. Misappropriation or
embezzlement of funds from any facility or resident;
c. Abuse or neglect of any
resident;
d. Purposeful failure to
report abuse or neglect of any resident or misappropriation of any resident's
property;
e. Any criminal offense
conviction related to the abuse of endangered adults or children;
f. Failure to protect any resident's rights;
or
g. Any criminal offense under
Arkansas Code §
17-3-102 or any additional state law relating to the
occupational licensure.
3. Failure to meet licensure renewal
requirements or to participate in required continuing education.
Disciplinary action may include but is not limited to:
1. Letter of concern or reprimand;
2. Directed in-service training or plan of
correction;
3. Probation;
4. Suspension of license; or
5. Revocation of license.
K.
APPEALS
Disciplinary actions by the Division of Provider Services and
Quality Assurance which result in suspension or revocation of an
administrator's license may be appealed for hearing before the Department of
Human Services. Rules for appeals before the Board are available from the
following entity:
Office of Appeals and Hearings:
P.O. Box 1437 - Slot S101
Little Rock, AR 72203-1437
501-682-8622
Fax: 501-682-6605
Visit: Department of Human Services
L.
PENALTIES
It shall be unlawful for any person to act or serve in the
capacity of a nursing home administrator in this State unless such person has
been licensed to do so. Any person who violates this requirement shall be
guilty of a Class A misdemeanor and upon conviction thereof shall be subject to
a fine of not less than one hundred dollars ($100) nor more than one thousand
dollars ($1000) or imprisonment for not less than ten (10) days nor more than
ninety (90) days or both fine and imprisonment.
Section I
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 nor 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; and
(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 II
DEFINITIONS
The following words and terms, when used in this section, shall
have the following meaning, unless the context clearly indicates
otherwise.
- "Abuse" means 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" means the 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 Omnibus Budget and Reconciliation Act of 1989 and
1990. "Act" may also refer to the Long-Term Care Aide Training Act, Arkansas
Code §
20-10-701 et seq.;
- "Additional Instructor" means a registered nurse (RN) or
licensed practical nurse (LPN) who, under the general supervision of the
primary instructor, may provide classroom and skills training;
- "Centers for Medicare and Medicaid Services (CMS)" means a
federal agency that oversees programs including Medicare, Medicaid, the
Children's Health Insurance Program, and the state and federal health insurance
marketplaces;
- "Certified Nursing Assistant (CNA)" means individuals trained
and certified to help nurses by providing nonmedical assistance to patients,
such as help with bathing, dressing, and using the bathroom;
- "Competency Examination" means an examination that includes
manual (skills) and written (or oral component for those with limited literacy
skills) evaluations;
- "Educational Institution" means an institution that is
licensed by the Arkansas State Board of Private Career Education within the
Arkansas Division of Higher Education as defined by Acts 1989, No. 906
(examples include but are not limited to career colleges and proprietary
schools);
- "Examination" means a competency examination that includes
manual (skills) and written evaluations;
- "Facility" means a long term care facility or 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" means a nursing assistant training
program offered by or in a long-term care facility;
- "General nursing experience" means 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 §
20-10-702(2)(C)(ii));
- "Guest Speaker" means 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;
- "Licensed health professional" means 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" means 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" means 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" means a nursing assistant
training program not offered by or in a facility (examples include but are not
limited to career college, community college, vocational or technical school,
and proprietary schools);
- "Nursing assistant" means 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 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;
- "Office" means the Nursing Assistant Training Program within
the Division of Provider Services and Quality Assurance;
- "Orientation program" means 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;
- "Petitioner" is 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" means 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 their 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 §
20-10-702);
- "Resident" means individuals who reside in long-term care
facilities that receive a range of services, including medical and personal
care.
- "Skills training" means 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" means pursuant to 42 C.F.R. 483.152, 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;
- "Task performance record" means a list of the major duties
and skills to be learned in the program and the trainee's performance of
each;
- "Trainee" means 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 or training" means 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
III
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 (meaning one
hundred twenty (120) calendar days) unless that individual has successfully
completed a training program and competency examination approved by the
Department of Human Services as required by the Centers for Medicare and
Medicaid Services.
A.
Training1. 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 Long-Term Care Facility 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 (for example, limitations to the scope of practice) of
the long-term care facility nursing assistants' direct care
responsibilities.
4. Each
in-person or virtual training program must use the behavioral stated objectives
in the "Arkansas Long-Term Care Facility 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 or virtual training, the trainee must pass the state competency
examination administered by the Department of Human Services (see 20 CAR §
403-501 et seq.) 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 C.F.R. §
483.152, a
nurse aide training and competency examination program must include, at a
minimum, a combination of classroom (in-person or 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 IV (B).
3. A minimum of sixteen (16) hours initial
classroom (in-person or 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
of this section - 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 or 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 (1) instructor.
6. Staff in training can be employed after
completing lessons one through eleven (1-11) (for a total of sixteen (16) hours
of course work) and may continue to work on the floor while they are actively
progressing through a Nursing Assistant Training Program (NATP); however, they
cannot be included in the 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 or procedure must be maintained by the Primary
Instructor on the Task Performance Record (DMS-741 form) provided by the
Department of Human Services. This record consists of the following:
(a) Tasks performed (which includes duties
and skills completed);
(b)
Satisfactory performance date; and
(c) 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 establishes procedures for a
review of the allegations when requested by the trainee. The program shall
inform the Department of Human Services of any trainees terminated under these
circumstances.
D.
In-Person Facilities and Resources
1. The nursing assistant training program
shall require the provision of physical facilities as follows:
(a) Temperatures conducive to the
weather;
(b) Clean and safe
conditions;
(c) Adequate
lighting;
(d) Space to accommodate
all students; and
(e) All Equipment
for simulating resident care in a classroom or lecture (See Instructional
Equipment under Section X).
2. The physical facilities including
classrooms, laboratories, conference space, library, and educational materials
shall be adequate to meet the needs of the program, the number of trainees, and
the instructional staff.
3.
Suggested training materials or resources may include, but are not limited to,
a blackboard, flipchart, projector or screen, DVD, anatomical chart, mannequin,
bed, and a lavatory or sink.
4. The
Department of Human Services will not require or endorse any single textbook or
other material (examples include but are not limited to videotape or film).
(a) There are several resources on the market
and each facility or school will have the choice in selecting their textbooks
or other training materials.
(b)
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.
Virtual Training: See Virtual
Methodology - Section X.
F.
Orientation
Program1. All nursing assistants
must receive an orientation program that includes, but is not limited to, an
explanation of:
(a) The organizational
structure of the facility;
(b)
Policies and procedures (including but not limited to disaster plans for
example fire, earthquake, flood, tornado);
(c) The philosophy of care of the
facility;
(d) The description of
the resident population; and
(e)
Employee rules.
2. This
facility orientation training program is not included in the required ninety
(90) hours of nursing assistant training.
G.
Ongoing In-Service
Training1. All facilities will
continue to provide ongoing in-service training on a routine basis both in
groups and as necessary in specific situations on a one-to-one basis. Each
nursing assistant must receive one (1) hour of in-service training per
month.
2. The facility must
complete a performance review of each nursing assistant at least once per year
and provide regular in-service training based on the outcome of these reviews.
The in-service training should address areas of weakness and be sufficient to
ensure the continuing competence of the nursing assistants.
3. In addition to training needs identified
by performance reviews, in-service training should also address the special
needs of residents as determined by each facility. Training can be received on
the unit, as long as it is directed toward skills improvement, provided by
appropriately trained staff, and documented (for example, skills demonstration
with return demonstration recorded on a check list).
4. Effective July 1, 2006, facilities are
strongly encouraged to offer in-service training for nursing-home-employed
Certified Nursing Assistants 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 employee, 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 Certified
Nursing Assistants 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 VI (D).
H.
Non-Permanent
Employees
Nursing assistants who are employed or leased through a
temporary hiring service must have completed an approved training program and
passed the state competency evaluation test prior to employment and utilization
by a facility.
Section
IV
APPROVAL OF PROGRAMS
A.
Location
1. Nursing assistant training programs may be
offered by or in nursing facilities, as well as outside facilities. The
clinical portion of the training must be conducted in all cases and must
utilize a nursing facility and its residents. Nursing facilities may offer a
complete training program or may contract with another organization (or both)
to provide the training unless they are sanctioned. Sanctioned nursing
facilities cannot offer the training.
2. Other groups or institutions (examples
include but are not limited to employee organizations, vocational or technical
schools, community colleges, and private institutions) may conduct programs
upon the Department of Human Services' approval.
3. Programs offered to the public and
charging a tuition fee must submit an application and be approved by the
Department of Human Services before they can be licensed through the State
Board of Private Career Education. This provision would not apply to the state
schools (such as a vocational, technical, or community college) or programs
offered by long-term care facilities who train their own employees (or
potential "on-call" employees).
B.
Restrictions
1. The Department of Human Services 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 to another facility.
* "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 or 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 of Human Services (Form DMS-724). Application forms are
available on the Department of Human Services - Division for Provider Services
and Quality Assurance website or you can request an application by emailing:
natpcertification@dhs.arkansas.gov
2. An outline, showing the lesson plans and
teaching modules utilized to cover the curriculum contents, must be attached to
the application. 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 or work history
to establish long-term care experience;
(b) AI resume or work history to establish
long-term care experience;
(c)
Waiver letter from the Department of Human Services if utilizing a sanctioned
long-term care facility;
(d)
Professional license verification; and
(e) Additional information, as requested by
the Department of Human Services.
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. A
notarized copy of the school licensure must be included with applications for
new programs and for renewal of programs. Notification to the division,
verifying additional instructors and any changes in instructors, will be
required with each application.
4.
Application must be submitted to the Department of Human Services and approved
by the Department of Human Services 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
Director of the Division of Higher Education. 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:
(a) Change in training
provider;
(b) Change in delivery
site (such as, from classroom to virtual);
(c) Change in clinical site;
(d) Change in instructor; and
(e) Complete revision of course structure,
including change in hours allotted to one (1) or more modules.
3. Major changes do not include:
(a) Change in materials (such as, handouts,
textbooks, or videos);
(b) Change
in order in which modules are taught; or
(c) Addition of modules or tasks not required
by rules or guidelines.
E.
Withdrawal of
Approval1. Provisions for
monitoring and review of compliance with program requirements are specified in
this part. The Department of Human Services 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 of Human
Services, 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 is greater than the actual cost of the training to
obtain Medicaid reimbursement, as allowed in Section X of these rules, that
exceeds the actual cost of training;
(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 if 42 C.F.R. §
483.152 or 42 C.F.R. §
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 from 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 Division of Higher
Education.
Section
V
QUALIFICATIONS OF INSTRUCTORS
A.
Primary
Instructor1. The primary
instructor shall:
(a) Be a registered nurse
currently licensed in Arkansas or licensed under a compact license, or holding
a multistate privilege to practice if the registered nurse moves from a state
that has joined the Interstate Nurse Licensure Compact, Arkansas Code §
17-87-601 et seq., to Arkansas and meets all requirements for licensure in
Arkansas;
(b) Not be under any
current disciplinary action by the Arkansas State Board of Nursing.
Disciplinary action includes, but is not limited to, probation, suspension,
revocation, or voluntary surrender of license due to disciplinary action;
and
(c) Possess 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 nursing facility setting
within the last five (5) years. (Arkansas Code §
20-10-702).
2. Nursing experience may include,
but is not limited to, employment in:
(a) A
Nursing assistant education program;
(b) A long-term care facility, or the
supervisor of nursing students in a long-term care facility or unit;
(c) A geriatrics department (excluding
geriatric psychiatry); or
(d) A
long-term acute care hospital (recuperative care), home care, hospice care, or
other long-term care setting.
3. In a facility-based program, the training
of nursing assistants may be performed under the general supervision of the
director of nursing (DON), who is prohibited from performing the actual
training (unless replacement DON coverage is provided).
4. An individual who will be the Primary
Instructor and meets the above criteria must submit the Application for Program
Approval (Form DMS-724) to identify their teaching qualifications. This must
include nursing experience, supervisory experience, and either teaching
experience or certificate of attendance in an instructor workshop.
B.
Primary Instructor
Responsibilities1. There must be
only one (1) Primary Instructor (PI). A Primary Instructor may oversee a
maximum of four (4) sites. All questions and correspondence pertaining to the
site will be directed to the PI. The PI shall participate in the planning of
each lesson or teaching module, including clinical instruction, whether or not
the PI teaches the lesson.
2. The
primary instructor of a nursing assistant training program shall be responsible
for supervision of the program and ensuring that the following requirements are
met:
(a) Course objectives are
accomplished;
(b) Each trainee
exhibits the appropriate skills and knowledge to conduct any part of the
training;
(c) That each instructor
is monitored and evaluated in the classroom, learning laboratory and clinical
training whenever they are teaching an assignment or introducing material for
the first time, and at periodic intervals. Performance reviews of instructors
must be documented and maintained.
(d) The provision of direct individual care
to assigned residents by a trainee is limited to appropriately supervised
clinical experience. Instructors shall serve as supervisor of trainees while in
clinical areas and providing resident care.
(e) Each trainee shall demonstrate competence
in clinical skills and fundamental principles of resident care. The task
performance record must be approved and signed or initialed by the primary
instructor.
(f) Records are kept in
order to verify the participation and performance of each trainee in each phase
of the training program. Satisfactory completion of the training program shall
be attested on each trainee's record.
(g) Each trainee is issued a certificate of
completion within ten (10) calendar days of course completion and as described
in Section IV (B) (6) of these rules.
C.
Additional Instructor or Guest
Speaker1. Instructors may use
other qualified resource personnel from the health field as guest instructors
or speakers in the program to meet the objectives for a specific unit. Examples
include but are not limited to pharmacists, dietitians, social workers,
sanitarians, advocates, gerontologists, nursing home administrators, and nurse
aid program staff. Guest instructors must have a minimum of one (1) year of
experience in their respective fields and must not have current disciplinary
action by their respective regulatory board.
2. Additional Instructors such as registered
nurses or licensed practical nurses may be used to provide instruction, skills
training, or supervision. They must be under the general supervision of the
primary instructor, currently licensed in Arkansas and shall not be subject to
any current disciplinary action by the Arkansas State Board of Nursing.
Disciplinary action includes, but is not limited to, probation, suspension,
revocation, or voluntary surrender of license due to disciplinary action, and
have a minimum of one (1) year of long-term care experience. All final skills
check-off reviews must be approved by the primary instructor.
3. The Application of Program Approval (Form
DMS-724) shall be used to identify each additional instructor or guest speaker
and their qualifications to teach.
Section VI
REQUIREMENTS FOR
EXAMINATION AND CERTIFICATION
A.
Transition
The initial implementation of these training and examination
requirements has 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-four (74) hours of
classroom instruction, as well as sixteen (16) hours of supervised practical
training, a total of ninety (90) hours); or
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 the Department Interstate Transfer
Form (DMS-798), with attached copies of documents 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. These individuals were not required to complete
the ninety (90) total hours of training. These ninety (90) hours consisted of
seventy-four (74) hours of "formal" classroom training course, as well as
sixteen (16) hours of supervised practical training.
After October 1, 1990. nursing assistants 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 of Human Services, as described in these rules.
B.
Examination1. The
Department of Human Services or its appointed agency shall be responsible for
administering the competency examination. The examination shall be based upon
the training curriculum requirements specified in the Long-Term Care Facility
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 of Human Services 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)
examination and a skills demonstration. Each examination candidate will be
allowed to choose between a written or oral examination. The oral examination
will be read from a prepared text in a neutral manner.
4. Foreign language translation dictionaries
must be shown to the registered nurse 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 instances of writing are allowed in
the translation dictionary. If there are any definitions or instances of
writing, 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 of Human Services. 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 a twelve month period, to successfully complete all
portions of the competency examination. Failure after three (3) attempts will
require retraining in order 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 of
Human Services 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 of Human
Services or designated contractor.
2. If there were to be an initial fee, per
Arkansas Code Annotated §
17-5-104, the following individuals would not be
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 of Human Services or designated contractor.
5. The competency examination (including
written, oral, and skills components) may be administered in the facility of
the candidate's employment unless the facility is disqualified by the
Department of Human Services 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 of Human Services will be
responsible for paying the examination fee one (1) time for individuals who are
employed by a Medicaid certified long-term 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 C.F.R. §
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.
1. Nursing assistants
who were trained in approved non-facility programs (for example:
career colleges, vocational or technical 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 home health aide
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 do not meet the ninety-hour requirement for the Long-Term Care
Facility Nursing Assistant Training Program.
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.
Note: Individuals listed on the long-term care facility
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
Arkansas Code §
20-38-101 et seq, shall not be eligible to take the
competency examination.
All other individuals trained in programs that have not
received approval from the Department of Human Services 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.
E.
Certified Nursing Assistant
Licensure of Uniformed Service Members, Veterans, and Spouses
1. Pursuant to Arkansas Code §
17-4-101
et. seq., the following rules apply to licensure for uniformed service members,
uniformed service veterans, and their spouses for licensure as defined below:
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; and
c. The spouse of:
i. A uniformed service member stationed in
the State of Arkansas;
ii. A
uniformed service veteran who resides in or establishes residency in the State
of Arkansas;
iii. 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
iv. A uniformed service member who is killed
or succumbs to their injuries or illness in the line of duty if the spouse
establishes residency in the state.
2. Automatic Certified Nursing Assistant
Licensure:
Automatic Certified Nursing Assistant licensure will be
provided to current license holders 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 the following:
i. Completion of an application with all
required forms;
ii. Submission of
DD 214-DD 214/Separation Documents;
iii. Submission of DMS-798-Interstate
Transfer Form/CNA Reg. Exemption/Reciprocity Request;
iv. Submission of an image or copy of
individuals social security card;
v. Submission of an image or copy of valid
United States government issued photo identification; and
vi. Proof of service education, training,
experience, and service-issued credentials by means of a Joint Service
Transcript.
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; and
ii. A holder in
good standings with Certified Nursing Assistant licensure within a similar
scope of practice by another state, territory, or district of the United
States.
3.
Temporary or Provisional Certified Nursing Assistant Licensure:
A temporary or provisional Certified Nursing Assistant
licensure will be granted to a uniformed service member, or their spouse, or a
uniformed service veteran, or their spouse, while expediting full licensure,
when considering an application for initial licensure. The Department of Human
Services will consider education, training, national certification, experience,
and service issued credentials of uniformed service members and uniformed
service veterans that are applying for initial certified nursing assistant
licensure. The following criteria will be classified as meeting service
education, training, national certification, experience, and
credentials;
a. Ninety (90) hours of
approved education, training, or experience in healthcare; or
b. Passing the Arkansas nurse aide testing
with three (3) given attempts within one hundred eighty (180) days post
application.
4. Extension
of License Expiration and Continuing Education Requirements Uniformed Service
Members, Uniformed Service Veterans, and Their Spouses:
The Department of Human Services will extend the expiration
date and any continuing education requirements for Certified Nursing Assistant
licensure renewal for a deployed uniformed service member or their spouse as
follows:
a. An extension of the
expiration date of a Certified Nursing Assistant 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 of Human Services may require evidence of
completion of continuing education before granting a subsequent Certified
Nursing Assistant licensure or authorizing the renewal of a Certified Nursing
Assistant licensure to allow full or partial exemption from continuing
education requirements.
5. Uniformed service members, veterans and
spouses who successfully meet the criteria and standards within the provisions
shall be placed on the Certified Nursing Assistant registry and issued a state
certificate. Information regarding military member licensure can be found on
the Department of Human Services-Division of Provider Services and Quality
Assurance website.
F.
Automatic Occupational Licensure of Out of State
Individuals1. Pursuant to
Arkansas Code Annotated §
17-7-101 et seq., a Nursing Assistant from
another state may qualify as a Nursing Assistant in Arkansas if they meet the
following criteria and provide documentation that reflects this:
a. They do not have a disqualifying criminal
offense under Arkansas Code Annotated §
17-3-102 or any additional state
law relating to the occupational licensure;
b. They do not have a complaint, allegation,
or investigation pending for their occupational activity; or
c. They are in good standing for one (1) year
with an occupational licensure of similar scope of practice issued by another
state, territory, or district of the United States; or they have worked:
i. In another state, territory, or district
of the United States that does not use an occupational licensure to regulate an
occupation or profession but is regulated by occupational licensure in this
state; and
ii. At least three (3)
years in the occupation.
2. An individual who is granted automatic
occupational licensure under these Rules shall meet all other occupational
licensure requirements for a resident of this state and all renewal
requirements of the occupational licensure, including without limitation a
criminal background check and continuing education hours.
3. The Department of Human Services may
require an applicant to pass an examination.
4. The Department of Human Services shall
require an applicant to furnish a bond, financial statement, or proof of
insurance coverage, if required by state law.
Section VII
CERTIFIED NURSING
ASSISTANT (CNA) REGISTRY
A.
Function and Content
1. The Department of Human Services 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 which shall include substantiated
administrative findings of abuse, neglect, or misappropriation of resident
property for Certified Nursing Assistants.
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 long-term care facility nursing
assistant shall contain the following information:
(a) Individual's full name;
(b) Date of birth;
(c) Name and date of the successfully
completed state-approved training program;
(d) Certification number and date of
issuance;
(e) Current active or
inactive status; and
(f) Most
recent recertification date.
4. The Department of Human Services 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 Human Services 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 item D of this section for the process to petition to remove
findings of neglect.)
5. The
Department of Human Services, 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 of Human Services, or its
designated agent, and may be subject to change. If needed, facilities should
contact the Department of Human Services for the latest website
information.
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 of Human
Services 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 and date
of birth. Facilities must have the social security number or certification
number in order to ensure 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 of Human Services. Please note, however, that name searches by
calling the Department of Human Services 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.
Certification
Renewal
The initial certification period is valid for twenty-four (24)
months. Each certificate contains an expiration date. The Department of Human
Services 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 (2) years.
This provision shall be defined by at least one (1) documented day (meaning,
eight (8) hours) of employment providing nursing or nursing-related services
for monetary compensation in any setting.
Certified Nursing Assistants who provide services for private
pay clients must include a check stub and a notarized letter from the employer,
which should include Certified Nursing Assistant duties performed within the
twenty-four-month period, to verify current employment or employment within the
last twenty-four-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 training 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 VI, item D, number 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 of
Human Services 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 long-term care
facility 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
Arkansas Code §
20-38-101 et seq. shall not be eligible to renew their
certification. Individuals approved for removal of a neglect finding pursuant
to Section VII, Item D, 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 Certified Nursing Assistants, 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 Certified Nursing Assistant to print and their registry record shall be
updated to reflect the new certification period.
D.
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 VII of these
rules, the Department of Human Services 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 of Human Services 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:
i.
The neglect that resulted in a finding was a singular occurrence as identified
in the incident investigation file;
ii. The petitioner does not have a criminal
conviction related to neglect, abusive behavior, or physical
violence;
iii. The petitioner's
name does not appear on the Adult and Long-Term Care Facility Resident
Maltreatment Central Registry or the department or the Division of Children and
Family Services' Child Maltreatment Central Registry;
iv. Whether a pattern of abusive behavior or
neglect is discovered through reference checks with prior employers or other
parties; and
v. Character
references as provided by the petitioner.
c. At least one (1) 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:
i. Full
name and current mailing address;
ii. Daytime phone number;
iii. Social Security Number;
iv. Date of birth;
v. Name and daytime phone number of at least
two (2) personal character references;
vi. 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;
and
vii. 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 of
Human Services 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 Director of the
Division of Provider Services and Quality Assurance. 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
Certified Nursing Assistant 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 of Human
Services as described in these rules.
b. If a petitioner wishes to appeal, they may
do so by mailing a written notice of appeal to:
Office of Appeals and Hearings
Arkansas Department of Human Services
P.O. Box 1437-Slot S101
Little Rock, Arkansas 72203
The notice shall be mailed by certified mail, with return
receipt requested. The notice of appeal shall state the following:
i. Name of the petitioner;
ii. Address of the petitioner;
iii. Date of birth of the
petitioner;
iv. Phone number, if
any, of the petitioner;
v. The
petitioner's place of employment; and
vi. A short statement explaining why the
petitioner believes the determination or decision is in error.
c. The notice of appeal must be
postmarked by the Office of Appeals and Hearings 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 or decision.
d. A
hearing shall be conducted by the Department of Human Services Office of
Appeals and Hearings. The procedures to conduct the hearing are as follows:
i. 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 of Human
Services 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 of
Human Services will also submit an administrative hearing statement summarizing
the determination or 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.
ii. 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 in order to review the hearing file and submit a request to subpoena
witnesses. The request shall include the name, address, and telephone number of
all witnesses not employed by the Department of Human Services. Department of
Human Services 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 Arkansas Code
§
20-76-103.
iii. After the
time frame has expired for subpoenaing witnesses, the hearing officer will
schedule the hearing to afford the petitioner, the Department of Human
Services, 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 that the
petitioner, the Department of Human Services 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.
iv. 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.
v. 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.
vi. It is the responsibility of the
Department of Human Services to designate a representative prior to the time of
the hearing. The representative should be familiar with the circumstances of
the determination or decision and be able to summarize the pertinent aspects of
the situation and present the documentation to support the basis for the
determination or 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.
vii.
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.
viii. The hearing will be
conducted by a hearing officer from the Office of Appeals and Hearings who had
no part in the determination or decision upon which the hearing is being
conducted.
ix. The petitioner may
be accompanied by friends or other persons and may be represented by a friend,
legal counsel, or other designated representative.
x. 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.
xi. 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 of Human Services representative. The Department of Human
Services shall then present its case. After completion of the Department of
Human Services' 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.
xii. 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 of Human Services.
xiii. Any further review must be pursued in
accordance with the Administrative Procedure Act, Arkansas Code §
25-15-101 et seq.
Section VIII
METHODOLOGY FOR
REVIEW OF COMPLIANCE WITH PROGRAM REQUIREMENTS
A.
Monitoring
1. A program is subject to inspection at any
reasonable time by personnel that are authorized by the Department of Human
Services. After initial approval of a training program, the Department of Human
Services 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 of Human Services 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 of Human Services will terminate programs that do not meet
minimum requirements and that do not provide an acceptable plan for correcting
deficiencies within the specified timeframe as established by the department of
Human Services.
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 of Human Services 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 of Human Services will send
notification to the program upon approval of the corrective action plan. The
corrective action plan must include, at a minimum, the following:
(a) Activities to correct
deficiencies;
(b) Person
responsible for correcting the deficiencies;
(c) Implementation date; and
(d) Signature of the primary instructor.
Failure to respond or inadequate corrective actions may cause
suspension of the Department of Human Services' approval of the program.
B.
Items Subject to Monitoring
1. 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:
(a) Names of enrollees;
(b) Names of those who successfully complete
the program
(c) Begin and end dates
of each class; Curriculum and any revisions of curriculum, with approval from
the Department of Human Services;
(d) Tests, grades, course documents, skills
checklist;
(e) Credentials of
instructors;
(f) Documentation of
all state approvals; and
(g) Record
of complaints (for example, 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.
3. Quality
of care - The quality of care provided by individual nursing assistants
monitored during a licensing survey or certification survey.
4. Success rate - The graduates' success rate
of both virtual and in-person trainees on the state competency examination will
be monitored by the Department of Human Services and shall be utilized as a
criterion for revoking program approval.
5. Any other requirements included in this
manual.
Section
IX
METHODOLOGY FOR REVIEW OF COMPLIANCE WITH VIRTUAL
TRAINING VIRTUAL 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. Virtual 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,
deficiency, or both. In addition to complying with rules, the following
requirements must be met:
A.
Requirements1. A
program is subject to inspection of virtual instruction at any time by
Department of Human Services personnel. A program that 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; and
d. Individual
logins that must be tracked and maintained for auditing purposes by the
Department.
2. Virtual
programs are responsible for ensuring that the Department of Human Services 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 (examples include, but are
not limited to, 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.
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 of Human Services 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.
3. The
criteria required for reimbursements under the "letter of intent" arrangement
must meet the following:
(a) The facility must
have on file a job application completed and signed by the individual receiving
the letter of intent;
(b) The
facility must complete a criminal record check on the individual in accordance
with Arkansas Code §
20-38-101 et seq; and
(c) The facility must retain copies of
documents to verify compliance with these provisions as specified in Subsection
E of this section.
4.
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 or continuing education costs
are not directly reimbursable but are included on the facility's annual cost
report and reimbursed through the per diem rates.
5. 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 of Human Services 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 nursing
assistant to attend training or to travel to a nursing assistant competency
evaluation site.
2.
Books: The dollar amount spent for books purchased
specifically for use in the Nursing Assistant training program.
3.
Instructional
equipment: The dollar amount spent for equipment. Examples
include, but are not limited to, SMARTBoards, iPads, Apple TV, Chromebooks,
multi-media projectors, and DVDs, purchased specifically for use in the nursing
assistant training program.
4.
Instructional videos: The dollar amount spent for
things such as instructional videos, purchased specifically for use in the
nursing assistant training program.
5.
Other training
materials: The dollar amount spent for other approved training
materials purchased specifically for use in the nursing assistant training
program.
6.
Training
space: The dollar amount spent for the rent of classroom space
(outside the facility), and things such as lab equipment, specifically for the
nursing assistant training program. Construction costs for training facilities
will not be authorized.
7.
Instructor wages: The dollar amount of wages paid to
the Nursing Assistant Instructor for training time, only while the Nursing
Assistant Instructor is not included in the Nursing Facility'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
the Department of Human Services on the DMS-755 is strictly for training,
not testing activity.
8.
Instructor fringe
benefits: The dollar amount paid for fringe benefits to the
nursing assistant instructor is for their training services only. The nursing
assistant instructor is not to be included in the nursing facility's staffing
pattern for providing nursing services.
9.
Nursing assistant consultant
training fees: The dollar amount paid to a consultant trainer for
Nursing Assistant 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 Nursing Assistant 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 Nursing Assistant 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 Nursing Assistant training in an approved non- facility
training program. The actual amount of tuition paid for a student, up to a
maximum of four hundred eighty dollars ($480) 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 of Human
Services.
C.
Claims submission1.
Claims for reimbursement of expenses incurred for nursing assistant training
costs shall be submitted to the Department of Human Services 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
of Human Services 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 four
hundred eighty dollars ($480) maximum cost limit per student (see item D of
this section - 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 Department of Human Services issued criminal records check.
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 Long-Term Care Facility 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 Arkansas Code §
20-38-101 et seq.
(b) Individuals listed on the Long-Term Care
Facility Employment Clearance Registry with an expired certification. These
individuals are not required to be retrained and may retest in accordance with
Section VII (C) (1) of these rules.
(c) Individuals who, prior to training, did
not complete a criminal record check in accordance with Arkansas Code §
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. In 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, four hundred eighty dollars ($480) 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 four hundred eighty dollars ($480) per
student who complete the training.
Example: Claim form shows actual costs is $1250.00 with four
(4) 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. If this
example had only two (2) students completing, the maximum would be $960.00 (two
(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
Nursing assistant 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 nursing assistant training costs. Facilities must retain receipts
and documentation of nursing assistant training costs submitted to the
Department of Human Services 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 that were 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, prosecution, or both, as authorized by
state and federal statutes.
F.
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, email
natpcertification@dhs.arkansas.gov or visit: Department of Human Services -
Division of Provider Services & Quality Assurance
Section XI
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.
