Current through Reg. 49, No. 38; September 20, 2024
(a)
To train nurse aides, a nursing facility must apply for and obtain approval
from HHSC to offer a NATCEP or contract with another entity offering a NATCEP.
The nursing facility must participate in Medicare, Medicaid, or both, to apply
for approval to be a NATCEP.
(b) A
person who wants to offer a NATCEP must file a complete NATCEP application with
HHSC through the online portal.
(c)
A person applying to offer a NATCEP must submit a separate NATCEP application
through the online portal for each location at which training is delivered or
administered.
(d) A NATCEP
application must identify one or more facilities that the NATCEP uses as a
clinical site. The clinical site must have all necessary equipment needed to
practice and perform skills training.
(e) A NATCEP may offer clinical training
hours in a laboratory setting under the following circumstances:
(1) no appropriate and qualified clinical
site is located within 20 miles of the location of the NATCEP; or
(2) HHSC has determined that clinical
training provided in a facility poses a risk to an individual's health or
safety based on the existence of a disaster declared at the federal or state
level. A NATCEP must request the ability to complete clinical training hours in
a laboratory setting under the circumstances described in subsection (e)(1) of
this section. HHSC will alert the public of the availability of laboratory
training under the circumstances described in subsection (e)(2) of this
section.
(f) HHSC does
not approve a NATCEP offered by or in a nursing facility if, within the
previous two years, the nursing facility:
(1)
has operated under a waiver concerning the services of a registered nurse under
§1819(b)(4)(C)(ii)(II) or §1919(b)(4)(C)(i) - (ii) of the
Act;
(2) has been subjected to an
extended or partially extended survey under §1819(g)(2)(B)(i) or
§1919(g)(2)(B)(i) of the Act;
(3) has been assessed a civil money penalty
of not less than $5,000 as adjusted annually under 45 Code of Federal
Regulations (CFR) Part 102 for deficiencies in nursing facility standards, as
described in §1819(h)(2)(B)(ii) or §1919(h)(2)(A)(ii) of the
Act;
(4) has been subjected to
denial of payment under Title XVIII or Title XIX of the Act;
(5) has operated under state-appointed
temporary management to oversee the operation of the facility under
§1819(h) or §1919(h) of the Act;
(6) had its participation agreement
terminated under §1819(h)(4) or §1919(h)(1)(B)(i) of the Act;
or
(7) pursuant to state action,
closed or had its residents transferred under §1919(h)(2) of the
Act.
(g) Clinical
training provided by a NATCEP in a facility other than a nursing facility must
be provided under the direct supervision of the NATCEP instructor and cannot be
delegated to any staff of the facility.
(h) A NATCEP using an assisted living
facility as a clinical site may provide clinical training only in those
services that are authorized to be provided to residents under Texas Health and
Safety Code, Chapter 247.
(i) A
NATCEP using an intermediate care facility for an individual with an
intellectual disability or related conditions as a clinical site may provide
clinical training only in those services that are authorized to be provided to
individuals under Texas Health and Safety Code, Chapter 252.
(j) A NATCEP using a hospice inpatient unit
as a clinical site may provide clinical training only in those services that
are authorized to be provided to clients under Texas Health and Safety Code,
Chapter 142.
(k) A NATCEP using a
general or special hospital as a clinical site may provide clinical training
only in those services that are authorized to be provided to patients under
Texas Health and Safety Code, Chapter 241.
(l) A nursing facility that is prohibited
from offering a NATCEP under subsection (f) of this section may contract with a
person to offer a NATCEP in accordance with §1819(f)(2)(C) and
§1919(f)(2)(C) of the Act so long as the person has not been employed by
the nursing facility or by the nursing facility's owner and:
(1) the NATCEP is offered to employees of the
nursing facility that is prohibited from training nurse aides under subsection
(e) of this section;
(2) the NATCEP
is offered in, but not by, the prohibited nursing facility;
(3) there is no other NATCEP offered within a
reasonable distance from the nursing facility; and
(4) an adequate environment exists for
operating a NATCEP in the nursing facility.
(m) A person who wants to contract with a
nursing facility in accordance with subsection (l) of this section must submit
a completed application to HHSC through the online portal in accordance with
§
556.4 of this chapter (relating to
Filing and Processing an Application for a Nurse Aide Training and Competency
Evaluation Program (NATCEP)) and include the name of the prohibited nursing
facility in the application. HHSC may withdraw the application within two years
of approving it if HHSC determines that the nursing facility is no longer
prohibited from offering a NATCEP.
(n) A nursing facility that is prohibited
from offering a NATCEP under subsection (f)(3) of this section may request a
Centers for Medicare and Medicaid Services waiver of the prohibition related to
the civil money penalty in accordance with §1819(f)(2)(D) and
§1919(f)(2)(D) of the Act and
42 CFR §
483.151(c) if:
(1) the civil money penalty was not related
to the quality of care furnished to residents;
(2) the NATCEP submits a request to HHSC for
the waiver; and
(3) the Centers for
Medicare and Medicaid Services approves the waiver.
(o) A NATCEP must ensure the trainee has
completed 100 hours of training. The 100 hours must include:
(1) 60 hours of classroom training:
(A) taught by the NATCEP either in-person or
virtually; or
(B) completed by the
trainee through HHSC's computer-based training (CBT) within the preceding 12
months; and
(2) 40 hours
of clinical training provided by the NATCEP with at least one program
instructor for every 10 trainees.
(p) A NATCEP that provides online training
must:
(1) maintain records in accordance with
subsection (z) of this section and otherwise comply with this
chapter;
(2) adopt, implement, and
enforce a policy and procedures for establishing that a trainee who registers
in an online training is the same trainee who participates in and completes the
course and that describe the procedures the NATCEP uses to:
(A) verify a trainee's identity;
(B) ensure protection of a trainee's privacy
and personal information; and
(C)
document the hours completed by each trainee; and
(3) verify on the NATCEP application that the
online course has the security features required under paragraph (2) of this
subsection.
(q) A NATCEP
must teach the curriculum established by HHSC and described in
42 CFR §
483.152. Except as provided in subsection (r)
of this section, the NATCEP must include at least 16 introductory hours of
classroom training in the following areas before a trainee has any direct
contact with a resident:
(1) communication and
interpersonal skills;
(2) infection
control;
(3) safety and emergency
procedures, including ways to assist someone who is choking, such as the
Heimlich maneuver;
(4) promoting a
resident's independence;
(5)
respecting a resident's rights;
(6)
basic nursing skills, including:
(A) taking
and recording vital signs;
(B)
measuring and recording height and weight;
(C) caring for a resident's
environment;
(D) recognizing
abnormal changes in body functioning and the importance of reporting such
changes to a supervisor; and
(E)
caring for a resident when death is imminent;
(7) personal care skills, including:
(A) bathing;
(B) grooming, including mouth care;
(C) dressing;
(D) toileting;
(E) assisting with eating and
hydration;
(F) proper feeding
techniques;
(G) skin care;
and
(H) transfers, positioning, and
turning;
(8) mental
health and social service needs, including:
(A) modifying the aide's behavior in response
to a resident's behavior;
(B)
awareness of developmental tasks associated with the aging process;
(C) how to respond to a resident's
behavior;
(D) allowing a resident
to make personal choices, providing and reinforcing other behavior consistent
with the resident's dignity; and
(E) using a resident's family as a source of
emotional support;
(9)
care of cognitively impaired residents, including:
(A) techniques for addressing the unique
needs and behaviors of a resident with a dementia disorder including
Alzheimer's disease;
(B)
communicating with a cognitively impaired resident;
(C) understanding the behavior of a
cognitively impaired resident;
(D)
appropriate responses to the behavior of a cognitively impaired resident;
and
(E) methods of reducing the
effects of cognitive impairments;
(10) basic restorative services, including:
(A) training a resident in self-care
according to the resident's abilities;
(B) use of assistive devices in transferring,
ambulation, eating, and dressing;
(C) maintenance of range of motion;
(D) proper turning and positioning in bed and
chair;
(E) bowel and bladder
training; and
(F) care and use of
prosthetic and orthotic devices; and
(11) a resident's rights, including:
(A) providing privacy and maintenance of
confidentiality;
(B) promoting the
resident's right to make personal choices to accommodate their needs;
(C) giving assistance in resolving grievances
and disputes;
(D) providing needed
assistance in getting to and participating in resident, family, group, and
other activities;
(E) maintaining
care and security of the resident's personal possessions;
(F) promoting the resident's right to be free
from abuse, mistreatment, and neglect and the need to report any instances of
such treatment to appropriate facility staff; and
(G) avoiding the need for restraints in
accordance with current professional standards.
(r) If a trainee completes HHSC's 60-hour
classroom training CBT, a NATCEP must accept proof of completion of the CBT in
lieu of the 16 introductory hours of classroom training in subsection (q) of
this section and the eight hours of infection control training in subsection
(u) of this section. The NATCEP must ensure that the trainee:
(1) only performs services for which the
trainee has been trained and has been found to be proficient by a program
instructor;
(2) is under the direct
supervision of a licensed nurse when performing skills as part of a NATCEP
until the trainee has been found competent by the program instructor to perform
that skill;
(3) is under the
general supervision of a licensed nurse when providing services to a resident
after a trainee has been found competent by the program instructor;
and
(4) is clearly identified as a
trainee during the clinical training portion of the NATCEP.
(s) A NATCEP that fails to accept proof of
completion of the classroom training in accordance with subsection (o)(1)(B) of
this chapter may be subject to §
556.8 of this chapter (relating to
Withdrawal of Approval of a NATCEP).
(t) A NATCEP must have a program director and
a program instructor when the NATCEP applies for initial approval by HHSC in
accordance with §
556.7 of this chapter (relating to
Review and Reapproval of a Nurse Aide Training and Competency Evaluation
Program (NATCEP)) and to maintain HHSC approval. The program director and
program instructor must meet the requirements of §556.5(b) - (d) of this
chapter (relating to Program Director, Program Instructor, Supplemental
Trainers, and Skills Examiner Requirements).
(u) Except as provided in subsection (r) of
this section, a NATCEP must teach eight hours of infection control that
includes the proper use of personal protective equipment (PPE) before a trainee
has any direct contact with a resident.
(v) A NATCEP must verify that a trainee:
(1) is not listed on the NAR in revoked
status;
(2) is not listed as
unemployable on the EMR; and
(3)
has not been convicted of a criminal offense listed in Texas Health and Safety
Code (THSC) §250.006(a) or convicted of a criminal offense listed in THSC
§250.006(b) within the five years immediately before participating in the
NATCEP.
(w) A NATCEP must
ensure that a trainee:
(1) completes the
first 16 introductory hours of training (Section I of the curriculum) before
having any direct contact with a resident;
(2) only performs services for which the
trainee has been trained and has been found to be proficient by a program
instructor;
(3) is under the direct
supervision of a licensed nurse when performing skills as part of the NATCEP
until the trainee has been found competent by the program instructor to perform
that skill;
(4) is under the
general supervision of a licensed nurse when providing services to a resident
after a trainee has been found competent by the program instructor;
and
(5) is clearly identified as a
trainee during the clinical training portion of the NATCEP.
(x) A NATCEP must submit a NATCEP application
through the online portal to HHSC if the information in an approved NATCEP
application changes. The NATCEP may not continue training or start new training
until HHSC approves the change. HHSC conducts a review of the NATCEP
information if HHSC determines the changes are substantive.
(y) A NATCEP must use HHSC Form 5497-NATCEP,
Texas Nurse Aide Performance Record, to document major duties or skills taught,
trainee performance of a duty or skill, satisfactory or unsatisfactory
performance, and the name of the instructor supervising the performance. At the
completion of the NATCEP, the trainee and the employer, if applicable, will
receive a copy of the performance record. The NATCEP must maintain a copy of
the performance record.
(z) A
NATCEP must maintain records for each session of classroom training, whether
offered in person or online, and of clinical training, and must make these
records available to HHSC or its designees at any reasonable time.
(1) The classroom and clinical training
records must include:
(A) dates and times of
all classroom and clinical training;
(B) the full name and social security number
of each trainee;
(C) a record of
the date and time of each classroom and clinical training session a trainee
attends;
(D) a final course grade
that indicates pass or fail for each trainee; and
(E) a physical or electronic sign-in record
for each classroom and clinical training session. An electronic sign-in must
include a form of identity verification for the trainee conducted in compliance
with the requirements of subsection (p)(2) of this section.
(2) If a trainee completes the
classroom training by successfully completing HHSC's CBT, a NATCEP must retain
records that include a copy of the trainee's certification of completion for
the CBT. The certificate of completion must be issued by HHSC and include the
date the trainee completed the CBT.
(3) A NATCEP must provide to HHSC, on the
NATCEP application through the online portal, the physical address where all
records are maintained and must notify HHSC of any change in the address
provided.
(aa) A nursing
facility must not charge a nurse aide for any portion of a NATCEP, including
any fees for textbooks or other required course materials, if the nurse aide is
employed by or has received an offer of employment from a facility on the date
the nurse aide begins the NATCEP.
(bb) HHSC reimburses a nurse aide for a
portion of the costs incurred by the nurse aide to complete a NATCEP if the
nurse aide is employed by or has received an offer of employment from a nursing
facility within 12 months of completing the NATCEP.
(cc) HHSC must approve a NATCEP before the
NATCEP solicits or enrolls trainees.
(dd) HHSC approval of a NATCEP only applies
to the required curriculum and hours. HHSC does not approve additional content
or hours.
(ee) A new employee or
trainee orientation given by a nursing facility to a nurse aide employed by the
facility does not constitute a part of a NATCEP.
(ff) A NATCEP that provides training to renew
a nurse aide's listing on the NAR must include training in geriatrics and the
care of residents with a dementia disorder, including Alzheimer's
disease.
