Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO:
KRS
205.520, 42 C.F.R. 438.75, 438.150 -438.158,
42 U.S.C.
1395i-3 and
1396r
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health
and Family Services, Department for Medicaid Services, has responsibility to
administer the Medicaid Program.
KRS
205.520(3) authorizes the
cabinet, by administrative regulation, to comply with any requirement that may
be imposed or opportunity presented by federal law for the provision of medical
assistance to Kentucky's indigent citizenry. This administrative regulation
establishes requirements for the nurse aide training and competency evaluation
program and specifies the establishment and function of the nurse aide
registry.
Section 1. Definitions.
(1) "Cabinet" means the Cabinet for Health
and Family Services.
(2)
"Competency examination" means a written or oral examination that is:
(a) Described by
42 C.F.R.
483.154; and
(b) Used as a standard for determining
satisfactory completion of a nurse aide training and competency evaluation
program.
(3) "Department"
means the Department for Medicaid Services or its designee.
(4) "Licensed health professional" means a:
(a) Physician;
(b) Physician assistant;
(c) Nurse practitioner;
(d) Physical, speech, or occupational
therapist;
(e) Registered
nurse;
(f) Licensed practical
nurse;
(g) Registered dietician;
or
(h) Licensed or certified social
worker.
(5) "Nurse aide"
means an individual who has successfully completed the nurse aide training and
competency evaluation program and may include a nursing student, medication
aide, or a person employed through a nursing pool who provides nursing or
nursing-related services to a resident in a nursing facility, excluding:
(a) An individual who is a licensed health
professional;
(b) A volunteer who
provides the nursing or nursing-related services without monetary compensation;
or
(c) A person who is hired by the
resident or family to sit with the resident and who does not perform nursing or
nursing-related services.
(6) "Nurse aide training and competency
evaluation program" means a competency evaluation program that meets the
requirements of
42
C.F.R. 483.152.
(7) "Supervised practical training" means
training in a laboratory or other setting in which the trainee demonstrates
knowledge while performing tasks on an individual under the direct supervision
of a registered nurse or a licensed practical nurse.
Section 2. General Requirements.
(1) A nursing facility shall not use an
individual working in the facility as a nurse aide for more than four (4)
months, on a full-time basis, unless the individual:
(a) Is competent to provide nursing and
nursing-related services; and
(b)
1. Has satisfactorily completed a nurse aide
training and competency evaluation program; or
2. Has been deemed or determined competent in
accordance with
42 C.F.R.
483.150(a) and
(b).
(2) If an employee is used on a temporary,
per diem, leased, or other nonpermanent basis, a nursing facility shall not use
the employee as a nursing aide unless the employee meets the requirements of
subsection (1) of this section.
(3)
A nursing facility shall not use an individual who has worked less than four
(4) months as a nurse aide in that facility unless the individual:
(a) Is a full-time employee participating in
a department-approved nurse aide training and competency evaluation
program;
(b) Has demonstrated
competence through satisfactory participation in a department-approved nurse
aide training and competency evaluation program; or
(c) Has been deemed or determined competent
in accordance with
42 C.F.R.
483.150(a) and
(b).
Section 3. Course Requirements for the Nurse
Aide Training and Competency Evaluation Programs and Instructor Qualifications.
In accordance with
42
C.F.R. 483.152 and the Medicaid Services
Manual for Nurse Aide Training and Competency Evaluation Program, a nurse aide
training and competency evaluation program shall:
(1) Consist of a minimum of seventy-five (75)
clock hours of nurse aide instructional training;
(2) Include at least sixteen (16) hours of
supervised practical training; and
(3) Require that the program's instructor:
(a) Demonstrate completion of a course in
teaching adults or have experience teaching adults; and
(b) Be a registered nurse who possesses a
minimum of two (2) years of nursing experience, at least one (1) year of which
shall be in the provision of long-term care services; or
(c) Be a licensed practical nurse who:
1. Has at least one (1) year of experience;
and
2. Provides instruction as a
supplement to the registered nurse instructor.
Section 4. Regular In-service
Education and Ongoing Staff Development. A nursing facility shall provide and
document that at least twelve (12) hours of ongoing staff development training
is given annually to each nurse aide who:
(1)
Is employed by the facility; and
(2) Has satisfactorily completed the nurse
aide training and competency evaluation program.
Section 5. Approval, Initial Postapproval
Review, and Ongoing Review of Nurse Aide Training Programs.
(1) The following may request approval from
the department to provide a nurse aide training and competency evaluation
program:
(a) The Kentucky Community and
Technical College System (KCTCS);
(b) The Office of Career and Technical
Education, Department for Workforce Investment, Education Cabinet;
(c) A nursing facility;
(d) A community college;
(e) A university program;
(f) A licensed proprietary education
program;
(g) A health care facility
that is licensed in accordance with
KRS
216B.015(12) and offers a
nurse aide training and competency evaluation program to its own employees;
or
(h) A nonprofit, church-related
or tax-supported program that is not identified in paragraphs (a) through (g)
of this subsection.
(2)
In order to provide a nurse aide training and competency evaluation program, an
entity identified in subsection (1) of this section shall be approved by the
department in accordance with Section XI of the Medicaid Services Manual for
Nurse Aide Training and Competency Evaluation Program.
(3) In accordance with
42
C.F.R. 483.151(c), the
department shall, within ninety (90) days of receipt of a request for approval
or receipt of additional information:
(a)
Advise a requesting entity if its nurse aide training and competency evaluation
program has been approved or denied; or
(b) Request additional information from the
requesting entity.
(4)
The department shall conduct an on-site review of each nurse aide training and
competence evaluation program that is approved:
(a) Within one (1) year of initial approval;
and
(b) Annually
thereafter.
Section
6. Withdrawal of Approval.
(1)
The department shall withdraw approval of a nurse aide training and competency
evaluation program, if the entity providing the program does not:
(a) Meet the minimum requirements of
42
C.F.R. 483.152 or
483.154;
(b) Permit an unannounced visit by the
department; or
(c) Submit an
acceptable plan of correction if requested by the department upon completion of
an on-site review.
(2)
The department shall not approve a nurse aide training and competency
evaluation program offered by, or in a nursing facility that, within the
previous two (2) years,:
(a) Operated under a
waiver in accordance with section 1819(b)(4)(C)(ii)(ll) of the Social Security
Act,
42 U.S.C.
1395i-3(b)(4)(C)(ii)(II), by which the
facility was not required to engage the services of a registered professional
nurse for more than forty (40) hours per week;
(b) Operated under a waiver in accordance
with section 1919(b)(4)(C)(ii) of the Social Security Act,
42 U.S.C.
1396r(b)(4)(C)(ii), that was
granted on the basis of a demonstration by the facility of its inability to
provide nursing care for more than forty-eight (48) hours per week;
(c) Has been subject to an extended, or
partial extended, survey conducted by the cabinet under sections
1819(g)(2)(B)(i) or 1919(g)(2)(B)(i) of the Social Security Act,
42 U.S.C.
1395i-3(g)(2)(B)(ii) or
1396r(g)(2)(B)(ii);
(d) Has been assessed a civil money penalty
described in section 1819(h)(2)(B)(ii) or 1919(h)(2)(A)(ii) of the Social
Security Act,
42 U.S.C.
1395i-3(h)(2)(B)(ii) or
1396r(g)(2)(A)(ii),
of no less than $5,000; or
(e) Has
been subject to one (1) of the following actions:
1. Denial of payment in accordance with
section 1819(h)(2)(B)(i) of the Social Security Act,
42 U.S.C.
1395i-3(h)(2)(B)(i), for individuals entitled
to benefits under Title XIII of the Act,
42 U.S.C.
1395 to
1395hh h;
2. Appointment of temporary management to
oversee operation of the facility in accordance with section 1819(h)(2)(B)(iii)
or 1919(h)(2)(A)(iii) of the Social Security Act,
42 U.S.C.
1395i-3(h)(2)(B)(iii) or
1396r(h)(2)(A)(iii);
3. Termination of the facility's
participation:
a. In accordance with section
1819(h)(4) of the Social Security Act,
42 U.S.C.
1395i-3(h)(4); or
b. In the Medicaid Program in accordance with
section 1919(h)(1)(B)(i) of the Social Security Act,
42 U.S.C.
1396r(h)(1)(B)(i);
4. Denial of payment under Medicaid's Title
XIX State plan in accordance with section 1919(h)(1)(B)(i) of the Social
Security Act,
42 U.S.C.
1396r(h)(1)(B)(i), for any
individual admitted to the nursing facility after notice of the denial has been
made to the public and the facility; or
5. Closure of the facility or transfer of
residents to other facilities in accordance with section 1919(h)(2)(A)(iv) of
the Social Security Act,
42 U.S.C.
1396r(h)(2)(A)(iv).
(3) If the department withdraws
approval of a nurse aide training and competency evaluation program, the
department shall, in accordance with
42
C.F.R. 483.151(e)(4):
(a) Notify the nurse aide training and
competency evaluation program in writing;
(b) Indicate the reason for withdrawal of
approval; and
(c) Allow each
student who has started a nurse aide training and competency evaluation program
for which approval has been withdrawn to complete the course.
(4) In accordance with section
1919(f)(2)(C) of the Social Security Act,
42 U.S.C.
1396r(f)(2)(C) the
department may allow a nurse aide training and competency evaluation program to
be provided in, but not by, a nursing facility that meets one (1) of the
conditions of subsection (2) of this section if the department:
(a) Determines that there is not another
training and competency evaluation program offered within a reasonable distance
of the facility;
(b) Assures,
through an effort to oversee operation of the facility, that an adequate
environment exists for operating the training and competency evaluation program
in the facility; and
(c) Provides
notice to the cabinet's long-term care ombudsman of the determination required
by paragraph (a) of this subsection and assurance required by paragraph (b) of
this subsection.
Section
7. Competency Examination and Competency Evaluation.
(1) KCTCS or another department-approved
entity that is not a nursing facility shall administer and evaluate the final
examination, including the skills demonstration portion of the nurse aide
training and competency evaluation.
(2) In accordance with
42 C.F.R.
483.154(b)(1):
(a) An individual who obtains nurse aide
training from an entity identified in Section 5(1) of this administrative
regulation shall be permitted to choose between a final written or oral
competency examination; and
(b) The
competency examination shall:
1. Address each
course requirement:
a. As specified in
42
C.F.R. 483.152(b); and
b. Identified in the Medicaid
Services Manual for Nurse Aide Training and Competency Evaluation
Program;
2. Be developed
from a pool of test questions, only a portion of which shall be used in any one
(1) competency examination;
3. Use
a system that prevents disclosure of both the pool of questions and the
individual competency examinations; and
4. If oral, be read from a prepared text in a
neutral manner.
(3) In accordance with
42 C.F.R.
483.154(c)(4), the skills
demonstration portion of the nurse aide training and competency evaluation
shall be:
(a) Performed in a facility or
laboratory setting comparable to the setting in which the individual shall
function as a nurse aide; and
(b)
Administered by a registered nurse with at least one (1) year's experience in
providing care for the elderly or chronically ill of any
age.
(4) A competency
examination candidate shall submit the following to the nurse aide training and
competency evaluation program proctor:
(a) An
unexpired state or federally-issued photo identification; and
(b) A Social Security card that has not been
laminated.
(5) If a
competency examination candidate's Social Security card states, "Not valid for
employment without Immigration and Customs enforcement authorization", or
contains a similar statement, the candidate shall present an employment
authorization document issued by the Department of Homeland Security.
(6) A competency examination candidate's full
name and middle initial shall be the same on each personal document presented
to the nurse aide training and competency evaluation program proctor.
(7) In accordance with
42 C.F.R.
483.154(e):
(a) An individual shall pass the written or
oral competency examination and the skills demonstration for satisfactory
completion of the nurse aide training and competency evaluation program;
and
(b) A record of successful
completion of the nurse aide training and competency evaluation program shall
be included in the nurse aide registry within thirty (30) days of the date of
completion.
(8) In
accordance with
42 C.F.R.
483.154(f), an agency that
administers the competency examination shall advise each individual who does
not complete the examination satisfactorily:
(a) Of the areas which the individual did not
pass; and
(b) That the individual
has at two (2) additional opportunities to take the
examination.
Section
8. State Nurse Aide Registry.
(1)
The department, through an interagency agreement with the Kentucky Board of
Nursing, shall be responsible for establishing and maintaining a registry of
all nurse aides who have:
(a) Satisfactorily
completed a nurse aide training and competency evaluation program upon
successful completion of the competency examination; or
(b) Been granted an exception pursuant to
42 C.F.R.
483.150(c).
(2) A finding of resident or patient neglect,
abuse, or misappropriation of resident or patient property by a nurse aide
shall be maintained on an abuse registry pursuant to
906
KAR 1:100.
Section 9. Reciprocity.
(1) The department shall grant reciprocity
for a nurse aide who is on another state's nurse aide registry if:
(a) The other state provides documentation
that the individual is on its registry;
(b) An employment record provided to the
department's nurse aide registry verifies that twenty-four (24) months have not
elapsed since the individual worked for pay as a nurse aide; and
(c) The individual is not listed on the other
state's registry of resident abuse, neglect, or misappropriation of resident
property.
(2) The
department shall not grant reciprocity for an individual whose name appears on
any state's abuse registry.
Section
10. Reimbursement for Costs Incurred in Administering a Nurse Aide
Training and Competency Evaluation Program.
(1) Reimbursement to a nursing facility for
costs associated with a nurse aide training and competency evaluation program
shall be available:
(a) In an amount specified
in subsection (2) of this section; and
(b) For a nurse aide who:
1. Is employed by the facility; or
2. Receives an offer of employment from the
facility within twelve (12) months of completing a nurse aide training and
competency evaluation program.
(2) The maximum amount of reimbursement
available to a nursing facility for costs incurred by an individual who
completes the nurse aide training and competency evaluation program shall be
forty-five (45) cents per Medicaid patient day.
(3) To receive reimbursement, a nursing
facility shall report:
(a) The number of
Medicaid patient days on the Nursing Facility Supplemental Medicaid Schedule
NF-7 (included in the Medicaid Services Manual for Nurse Aide Training and
Competency Evaluation Program) for the twelve (12) month period preceding
October 1 of the current fiscal year; and
(b) The costs incurred for an aide to
complete the nurse aide training and competency evaluation program on the
MAP-576, Nurse Aide Training Expense Report and Authorization for Payment Form
included in the Medicaid Services Manual for Nurse Aide Training and Competency
Evaluation Program.
(4)
The department shall not reimburse a nursing facility for a nurse aide if the
nurse aide has been employed by another facility that received reimbursement
for the aide's nurse aide training and competency evaluation program
costs.
Section 11.
Incorporation by Reference.
(1) The "Medicaid
Services Manual for Nurse Aide Training and Competency Evaluation Program,
March 2005 edition"; is incorporated by reference.
(2) This material may be inspected, copied,
or obtained, subject to applicable copyright law, at the Department for
Medicaid Services, 275 East Main Street, Frankfort, Kentucky 40621, Monday
through Friday, 8 a.m. to 4:30 p.m.
STATUTORY AUTHORITY:
KRS
194A.030(2),
194A.050(1),
205.520(3),
42 U.S.C.
1396r