Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-7B

Nurse Aide Training and Competency Evaluation Program

Notice of Proposed Rule

(Repeal and Reenact)

DAR File No.: 33341
Filed: 01/27/2010 10:57:40 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to update and implement by rule the criteria and protocol for the Nursing Assistant Training and Competency Evaluation Program.

Summary of the rule or change:

All requirements of the repealed rule are reenacted in the proposed rule. In contrast to the old rule, this new rule clarifies and updates program definitions and certification requirements that are specific to a nursing student, an expired licensed nurse, a certified nursing assistant (CNA), an expired CNA, an out-of-state CNA, and an out-of-state expired CNA. It also includes requirements for an entity that proctors competency evaluations and specifies Utah Nursing Assistant Registry (UNAR) requirements and procedures. It further specifies requirements and limitations for the Nursing Assistant Training and Competency Evaluation Program. The old rule, on the other hand, is more general in its outline of the aforementioned requirements, procedures and limitations as they applied at the inception of this program.

State statutory or constitutional authorization for this rule:

• Section 26-18-3

This rule or change incorporates by reference the following material:

• Adds: Omnibus Budget Reconciliation Act of 1987, Pub. L. No. 100 203, 101 Stat. 1330, Sec. 4211,(b)(5)(A)(B)(C)(D)(E)(F)(G), (e)(1)(2), f(2)(A)(B), 12/22/1987

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because only federal dollars pay for the Nursing Assistant Training and Competency Evaluation Program.

local governments:

There is no impact to local governments because they do not fund or provide the Nursing Assistant Training and Competency Evaluation Program for nursing assistants.

small businesses:

These changes only increase the number of personnel who may certify for the Nursing Assistant Training and Competency Evaluation Program and work within a nursing facility-based program. While smaller nursing facilities or providers may benefit from the work that a CNA performs, they do not necessarily increase their profits or revenues.

persons other than small businesses, businesses, or local governmental entities:

These changes only increase the number of personnel who may certify for the Nursing Assistant Training and Competency Evaluation Program and work within a nursing facility-based program. While nursing facilities or providers may benefit from the work that a CNA performs, they do not necessarily increase their profits or revenues. CNAs may also increase their employment opportunities through this program but do not necessarily increase their ability to earn more in revenue or salary.

Compliance costs for affected persons:

There are no compliance costs because these changes only increase the number of personnel who may certify for the Nursing Assistant Training and Competency Evaluation Program and work within a nursing facility-based program. While a single nursing facility or provider may benefit from the work that a CNA performs, it does not necessarily increase its profits or revenues. A CNA may also increase her employment opportunities through this program but does not necessarily increase her ability to earn more in revenue or salary.

Comments by the department head on the fiscal impact the rule may have on businesses:

This proposed change repeals and reenacts all of the previous rules requirements, while allowing for more persons to certify as certified nurses aides.

David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

03/17/2010

This rule may become effective on:

03/24/2010

Authorized by:

David Sundwall, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

[R414-7B. Nurse Aide Training and Competency Evaluation Program.

R414-7B-0. Authority and Purpose.

A. Authority

The nurse aide training and competency evaluation program is authorized by the Omnibus Budget Reconciliation Act (OBRA) of 1987, P.L. 100-203, Section 4211(b)(5)(A-G),(e)(2)(1-2),(f)(2)(A-B), which is hereby adopted and incorporated by reference.

B. The purpose of the nurse aide training and competency evaluation program is to provide quality services to residents of nursing facilities by nurse aides who are able to assist residents in maintaining independence, demonstrate sensitivity to residents' needs, and demonstrate observational and documenting skills that are needed in the assessment of residents' health, physical condition, and well-being.

 

R414-7B-1. Definitions as used in this chapter:

A. "Nurse aide" means any individual providing nursing or nursing-related services to residents in a nursing facility, but does not include an individual who is a licensed health professional or who volunteers to provide such services without monetary consideration.

B. "Licensed health professional" means a physician; physician assistant; nurse practitioner; physical, speech, or occupational therapist; registered professional nurse; licensed practical nurse; or licensed or certified social worker.

C. "Nursing facility" means an institution licensed and certified to provide long-term care, and includes those facilities previously or currently licensed and Medicaid-certified as an Intermediate Care Facility (ICF) or a Skilled Nursing Facility. An intermediate care facility for the mentally retarded (ICF/MR) is not included in this definition.

D. "Resident" means an individual residing in and receiving medical long-term nursing services in a Medicaid-certified nursing facility.

E. "Train-the-trainer program" means a state-approved program which consists of formal instructions to potential instructors on how to train adults through demonstrations and lectures.

F. "Retraining" means required training for those nurse aides who have not performed paid services for a continuous period of 24 months since the most recent completion of a training and competency evaluation program.

G. "Competency evaluation" means a written or oral examination which addresses each requirement of OBRA 1987 for nurse aides, and a demonstration of the tasks the aide will be expected to perform as part of his function as a nurse aide.

H. "Testing out or challenging the test" means that those individuals acting as nurse aides in nursing facilities as of July 1, 1989, may be determined competent by taking the competency evaluation without enrolling in the approved nurse aide training course.

I. "Deemed competency" means that those individuals who, prior to January 1, 1989, completed a nurse aide training program that met the State's requirements at the time it was offered, may be determined to have completed a training and competency evaluation program and be certified as competent.

J. "State survey agency" means the Bureau of Facility Review in the Division of Health Care Financing, which is responsible for certification of nursing facilities and for conducting surveys to determine compliance with Medicaid requirements.

 

R414-7B-2. Procedures for Achieving Certification.

A. All nurse aides employed by a nursing facility after July 1, 1989, shall complete the nurse aide training approved by the State Office of Vocational Education, and pass the nurse aide competency evaluation or be enrolled in the nurse aide training program by January 1, 1990.

B. A nursing facility must make the necessary provision for the individual to participate in and complete the competency evaluation by January 1, 1990.

C. Deemed competency

1. Individuals who were certified as nurse aides by the State Office of Vocational Education before January 1, 1989, shall be deemed to have met the OBRA requirement upon completion of the approved in-service training on mental retardation and mental illness.

2. It shall be the responsibility of the nursing facility to provide this in-service training on mental retardation and mental illness and to notify the State Office of Vocational Education when it is completed.

D. Testing out

Those aides employed by a nursing facility on or before July 1, 1989, who have not been deemed certified, if they elect to test out, shall be determined competent by:

1. successfully testing out on the competency evaluation, including the written and skills components of the evaluation, provided by the State Office of Vocational Education or a State Office of Vocational Education-approved program which meets federal requirements; and

2. presenting proof of employment at a nursing facility.

E. Nurse aides certified in other states

Nurse aides certified in other states before July 1, 1989, may be deemed as certified nurse aides in Utah if they complete the approved in-service training on mental retardation and mental illness provided by the nursing facility. After July 1, 1989, they may be deemed as certified nurse aides in Utah if they have documentation of certification in another state.

 

R414-7B-3. Competency Evaluation.

A. Administration of the competency evaluation

1. Vocational centers and community colleges are approved by the State Office of Vocational Education to provide competency evaluations to nurse aides, using both written or oral examinations and demonstration of skills.

a. The written examination shall be administered by the vocational centers and community colleges approved by the State Office of Vocational Education with the following exception. Nursing facility personnel may proctor the written examination when the State Office of Vocational Education is confident that the competency evaluation program is secure from tampering, is standardized and scored by a testing, education or other organization approved by the State Office of Vocational Education, and requires no actual administration or scoring by facility personnel.

b. The skills demonstration component shall be performed in a facility or laboratory setting comparable to the setting in which the individual will function as a nurse aide, and must be administered and evaluated by a registered nurse with at least one year's experience in providing care for the elderly or the chronically ill of any age. The skills demonstration shall be administered only by the State Office of Vocational Education.

2. If the individual fails to satisfactorily complete the evaluation, the individual must be advised of the areas in which he was inadequate, and that he may take the evaluation a maximum of three times.

3. Any individual who takes the competency evaluation must be advised in advance that a record of the successful completion of the evaluation shall be included in the nurse aide registry, and shall be required to sign a Release of Information form which indicates the nurse aide's understanding of information that is required to be entered into the nurse aide registry.

4. The State Office of Vocational Education shall periodically update and validate the competency evaluation.

B. Content of the Competency Evaluation

1. Written or oral examination

The State Office of Vocational Education shall establish a written or oral examination (in the case of individuals with limited literacy in English) that addresses each requirement as prescribed in OBRA 1987. The questions shall be developed from a pool of test questions, only a portion of which shall be used in any one evaluation, under a system which maintains the integrity of both the pool of questions and the individual evaluations.

2. Demonstration of skills

The competency evaluation must include demonstration of the tasks the aide will be expected to perform as part of his function as a nurse aide.

C. Requirements for the skills training component

1. For the skills training component of the evaluation, a performance record shall be developed for each nurse aide training program of major duties and skills taught which consist of, at a minimum:

a. a listing of the duties and skills expected to be learned in the program;

b. a record documenting when the aide performs this duty or skill;

c. documentation of satisfactory or unsatisfactory performance;

d. the date of the performance;

e. the instructor supervising the performance.

2. At the completion of the nurse aide training program, the nurse aide and his employer shall receive a copy of this record. If the individual did not successfully perform all the duties and skills on this performance record, he shall receive supervision for all duties and skills not satisfactorily performed until such satisfactory performance is confirmed.

3. The demonstration aspect of the skills training portion of the competency evaluation consists of a minimum performance of five tasks, all of which are included in the performance record. These five tasks are selected for each aide from a pool of evaluation items ranked according to degree of difficulty. A random selection of tasks shall be made with at least one task from each degree of difficulty.

 

R414-7B-4. Nurse Aide Training Program.

A. Administration

1. Training and competency evaluation programs shall be administered through the State Office of Vocational Education in accordance with a contract between the Division of Health Care Financing and the Department of Education.

2. All agencies conducting nurse aide training programs shall be approved by the State Office of Vocational Education.

3. Each area vocational center, community college, or nursing facility that conducts nurse aide training programs shall designate a qualified registered nurse to oversee training and instruction.

B. Training program approval and review

1. Process

a. The State Office of Vocational Education shall review and render a determination regarding approval or disapproval of any nurse aide training when requested to do so by a Medicare or Medicaid-participating nursing facility. The State Office of Vocational Education, at its option, may also agree to review and render approval or disapproval of any nurse aide training program when requested to do so by another entity.

b. The State Office of Vocational Education must, within 30 days of the date of an acceptable request, either advise the requestor of the State Office of Vocational Education's determination, or must seek additional information from the requesting entity with respect to the program for which it is seeking approval.

c. Nursing facilities may apply for approval of a nurse aide training program by completing an application provided by the State Office of Vocational Education.

2. Requirements

a. The State Office of Vocational Education shall approve any nurse aide training program which meets the criteria specified in OBRA 1987, the federal Health Care Financing Administration's guidelines, and guidelines designated by the State Division of Health Care Financing.

b. Minimal content requirements must be met for the nurse aide training program to be approved by the State Office of Vocational Education. The nurse aide training program must consist of no less than 80 hours of training. The curriculum of the nurse aide training program must include at least the following subjects:

1) at least 16 hours of training in the following areas prior to any direct contact with a resident:

a) communication and interpersonal skills;

b) infection control, including AIDS;

c) safety and emergency procedures;

d) promoting residents' independence;

e) respecting residents' rights;

f) basic nursing skills.

2) The skills training of at least 16 hours shall ensure that each nurse aide, at a minimum, demonstrates competencies in the following areas:

a) Basic nursing skills:

(1) caring for residents when death is imminent;

(2) taking and recording vital signs;

(3) measuring and recording height;

(4) caring for residents' environment;

(5) recognizing abnormal signs and symptoms of common diseases and conditions.

b) Personal care skills, including, but not limited to:

(1) bathing, including mouth care;

(2) grooming;

(3) dressing;

(4) toileting;

(5) assisting with eating and hydration;

(6) proper feeding techniques; and

(7) skin care.

c) Basic restorative services:

(1) use of assistive devices in ambulation, eating, and dressing;

(2) maintenance of range of motion;

(3) proper turning and positioning in bed and chair;

(4) bowel and bladder training;

(5) care and use of prosthetic and orthotic devices; and

(6) transfer techniques;

d) Mental health and social service skills:

(1) modifying his own behavior in response to the resident's behavior;

(2) identifying developmental tasks associated with the aging process;

(3) training the resident in self-care according to the resident's ability;

(4) behavior management by reinforcing appropriate resident behavior and reducing or eliminating inappropriate behavior;

(5) allowing the resident to make personal choices, providing and reinforcing other behavior consistent with resident's dignity; and

(6) using the resident's family as a source of emotional support.

e) Residents' rights:

(1) providing privacy and maintaining confidentiality;

(2) promoting the residents' rights to make personal choices to accommodate their needs;

(3) giving assistance in solving grievances;

(4) providing needed assistance in getting to, and participating in, resident and family groups and other activities;

(5) maintaining care and security of residents' personal possessions;

(6) providing care which maintains residents free from abuse, mistreatment, or neglect; reporting any instances of such poor care to appropriate facility staff; and

(7) maintaining the residents' environment and care through appropriate nurse aide behavior so as to minimize the need for physical and chemical restraints.

c. Qualifications of instructors:

1) Non-nursing facility-based programs:

Nurse aide training and competency evaluation programs must have a program coordinator or primary instructor who is a registered nurse with at least two years of experience in caring for the elderly or chronically ill of any age.

2) Nursing facility-based programs:

a) The program coordinator in a nursing facility-based program may be the director of nursing for the facility as long as the facility remains in full compliance with OBRA 1987, Section 4211, requirements.

b) The primary instructor must be a licensed nurse with at least one year of experience in a nursing facility.

3) The program coordinator or primary instructor must have successfully completed a "train-the-trainer" type program approved by the State Office of Vocational Education or have demonstrated competence to teach adult learners as defined by the State Office of Vocational Education.

4) Qualified personnel from the health professions may supplement the program coordinator or primary instructor in the case of non-facility programs, or the program instructor in the case of facility-based programs, and as program trainers in both facility-based and non-facility-based programs;

5) Program trainers may include: registered nurses, licensed practical or vocational nurses, pharmacists, dietitians, social workers, sanitarians, fire safety experts, nursing home administrators, gerontologists, psychologists, physical and occupational therapists, activities specialists, speech or language therapists, and any other appropriate and duly qualified personnel.

6) To function as program trainers, these health professionals must have a minimum of one year of current experience in the care of the elderly or chronically ill of any age, or have equivalent experience, and must be currently licensed, registered or certified in their field.

7) Licensed practical nurses, under the general supervision of the primary instructor, may provide classroom and skills training instruction and supervision if they have at least two years of experience in caring for the elderly or chronically ill of any age, or have equivalent experience.

8) Instructor-to-student ratio

A student-to-instructor ratio of 15:1 for clinical instruction and 30:1 for theory instruction shall not be exceeded.

9) Facilities

A classroom must be provided that has the following:

a) adequate space and furniture for the number of students;

b) adequate lighting and ventilation;

c) comfortable temperature;

d) appropriate audio-visual equipment;

e) skills lab equipment to simulate a resident's unit;

f) clean and safe environment;

g) appropriate textbooks and reference materials.

C. Compliance reviews

1. Initial post-approval and ongoing reviews

After the initial approval of a training and competency evaluation program, an initial one-year post-approval review shall be done by the State Office of Vocational Education to determine the program's compliance with the OBRA 1987 requirements.

2. After the one-year review, an on-site review shall be completed at least every two years by the State Office of Vocational Education.

3. A self-evaluation shall be submitted by the program provider to the State Office of Vocational Education each year that an on-site review is not scheduled.

4. Minimum program review standards

The training and evaluation program review must include:

a. skills training experience;

b. maintenance of qualified faculty members for both classroom and skills portions of the training and competency evaluation programs;

c. maintenance of the security of the competency evaluation examinations;

d. a record of complaints received about the program;

e. a record that each nursing facility has provided certified nurse aides with six hours of staff development training per quarter with compensation for the training;

f. curriculum content that meets federal and state requirements; and

g. classroom facilities that meet federal requirements for nurse aide training programs.

5. Division of Health Care Financing shall enforce the standards for nurse aide training and competency evaluation described in OBRA 1987, Section 4211, which are hereby adopted and incorporated by reference.

6. In addition to the required nurse aide training, all nurse aides shall receive an orientation program from the nursing facility where they are employed, which is not included in the required 80 hours of training. This orientation phase shall include, but is not limited to, an explanation of:

1) the organizational structure of the facility;

2) the facility policies and procedures;

3) the philosophy of care of the facility;

4) the description of the resident population; and

5) the employee rules.

 

R414-7B-5. Nurse Aide Registry.

A. A central nurse aide registry has been developed and shall be maintained under the direction of the State Office of Vocational Education. This registry must include identification of individuals who have successfully completed and passed the nurse aide training and competency evaluation program with a passing score of 75 percent or above.

B. Any organization responsible for the nurse aide competency evaluation program must report to the nurse aide registry within 30 days the names of all individuals who have satisfactorily completed the nurse aide training and competency evaluation program.

C. The registry shall also document substantiated allegations of resident neglect, abuse, or misappropriation of resident property by a nurse aide in a nursing facility, including an accurate summary of the findings. If the nurse aide disputes the findings, this information shall also be entered into the registry.

D. The Division of Health Care Financing's Bureau of Facility Review shall investigate such complaints. A nurse aide shall be entitled to a hearing, to be conducted through the Division of Health Care Financing, before a substantiated claim can be entered against the nurse aide.

E. The Division of Health Care Financing shall enforce the standards for the nurse aide registry described in OBRA 1987, Sections 4211 and 4212, which are hereby adopted and incorporated by reference.

 

R414-7B-6. Limitations.

A. The State Office of Vocational Education may not approve a facility-based nurse aide training program if, in the prior two years, the facility's participation in the Medicare and Medicaid programs has been terminated.

B. Nurse aide training programs must be reviewed and reapproved at least every two years.

C. The competency evaluation, both written and skills components, may not be administered by a skilled nursing facility which participates in Medicare nor a nursing facility which participates in Medicaid.

D. After January 1, 1990, nursing facilities may not use nurse aides for more than four months unless they have completed the nurse aide training and competency evaluation program.

E. After January 1, 1990, a nursing facility may not permit an individual to work as a nurse aide for monetary compensation unless the facility has checked the credentials of the nurse aide through the nurse aide registry.

F. Upon review of program performance standards, those programs not meeting minimum requirements and which do not provide an acceptable plan for correcting deficiencies shall be terminated from the program.

G. Retraining

Nurse aides who have not performed paid services for a continuous period of 24 months since the most recent completion of a training and competency evaluation program shall be required to undergo necessary retraining.]

R414-7B. Nursing Assistant Training and Competency Evaluation Program.

R414-7B-1. Introduction and Authority.

The Nursing Assistant Training and Competency Evaluation Program is authorized by the Omnibus Budget Reconciliation Act of 1987 (OBRA), Pub. L. No. 100 203, 101 Stat. 1330, Sec. 4211,(b)(5)(A)(B)(C)(D)(E)(F)(G), (e)(1)(2), f(2)(A)(B), which the Department adopts and incorporates by reference. The purpose of this program is to allow a certified nursing assistant (CNA) to provide quality nursing services to nursing facility residents.

 

R414-7B-2. Definitions.

(a) "Certified Nursing Assistant" means any person who completes a UNAR-approved nursing assistant training program and passes the state certification examination.

(b) "Competency evaluation" means a written or oral examination that addresses each requirement of OBRA for a nursing assistant and a demonstration of the tasks the nursing assistant is expected to perform as part of the assistant's function.

(c) "Deemed competency" means that an individual is deemed to be competent if the individual completed a state-approved nursing assistant training program on or before July 1, 1989.

(d) "Nursing assistant" means any individual who provides nursing or nursing-related services to residents in a nursing facility, but does not include an individual who is a licensed professional or who volunteers to provide these services without monetary consideration.

(e) "Nursing Assistant Training and Competency Evaluation Program" (NATCEP) means any program that the Utah Nursing Assistant Registry (UNAR) approves to offer training to an individual who is interested in becoming a certified nursing assistant in the state of Utah.

(f) "Nursing facility" means any institution that is licensed and Medicare or Medicaid-certified to provide long-term care.

(g) "Resident" means an individual who resides in and receives medical long-term nursing services in a Medicare or Medicaid-certified nursing facility.

(h) "Retraining" means training for a CNA who has not performed paid services for a total of 200 hours of nursing or nursing-related services under the direction of a licensed nurse during the 24 months following the completion date of the state-approved nursing assistant training or certification renewal.

(i) "State survey agency" means the Bureau of Health Facility Licensing, Certification and Resident Assessment, within the Department of Health, which is responsible for nursing facility certification and for conducting surveys to determine compliance with Medicare and Medicaid requirements.

(j) "Supervised practical training" means training in a nursing facility in which the trainee demonstrates knowledge while performing tasks on an individual under the direct supervision of a licensed nurse, who is a UNAR-approved instructor.

(k) "Train-the-trainer program" means a UNAR-approved program that consists of formal instructions to potential instructors on how to train adults through demonstrations and lectures.

(l) "Waiver of CNA Training Program" means a waiver that allows a qualified nursing professional and qualified in-state expired CNA to challenge the state written and skill examination.

(m) "Utah Nursing Assistant Registry" means the state agency that approves nursing assistant training programs, monitors all UNAR test sites, maintains an abuse registry for all substantiated allegations of resident neglect, abuse or misappropriation of resident property by a CNA in a nursing facility or Medicare and Medicaid facility, certifies nursing assistants who have completed a nursing assistant training program, and renews certifications of qualified CNAs.

 

R414-7B-3. Program Access Requirements.

(1) A nursing assistant is required to complete a UNAR-approved nursing assistant training program and become certified within 120 days of the first date of employment.

(2) An individual who was certified as a nursing assistant on or before July 1, 1989, is deemed to be competent and to have met the OBRA requirement upon completion of the approved in-service training on mental retardation and mental illness.

(3) If specific requirements are met in the following cases, the UNAR office may grant a waiver to:

(a) a nursing student who has completed the first semester of nursing school within the past two years and to a current nursing student. An official transcript of a nursing fundamentals class must accompany the waiver request. If the candidate does not pass either the skills or written portion of the CNA examination after three attempts, she must complete a UNAR-approved nursing assistant training program;

(b) an expired licensed nurse who can show proof of previous licensure and who was in good standing with her professional board. UNAR shall grant the candidate one attempt to pass both the skills and written portion of the examination. If the candidate does not pass either portion, she must complete a UNAR-approved nursing assistant training program.

(c) an expired Utah CNA who is in good standing with UNAR. UNAR shall grant the candidate one attempt to pass both the skills and written portion of the examination. If the candidate does not pass either portion, the candidate must complete a UNAR-approved nursing assistant training program;

(d) any out-of-state CNA deemed certified and in good standing with another state's survey agency. UNAR grants reciprocity upon the CNA providing proof of certification in her state.

(4) An out-of-state expired CNA must complete a UNAR-approved nursing assistant training program.

 

R414-7B-4. Competency Evaluation.

(1) An entity that proctors competency evaluations using both written or oral examinations and demonstrations of skills to nursing assistants must be UNAR-approved.

(a) An individual shall perform the skills demonstration component in a facility or laboratory setting comparable to the setting in which the individual will function as a nursing assistant, and a UNAR-approved representative must administer and evaluate the demonstration. (b) The examiner must be a registered nurse (RN) with a current active license to practice nursing as an RN, who is in good standing with the Division of Occupational and Professional Licensing (DOPL) in the state of Utah, with at least one year of experience in providing care for the elderly or chronically ill of any age;

(c) If the individual fails to satisfactorily complete the skills or written examination after three attempts at either, the candidate must be advised of the areas in which the candidate is inadequate and must retrain at an approved nursing assistant training program;

(d) UNAR must advise an individual who takes the competency evaluation that a record of the outcome of the evaluation shall be included in the nursing assistant registry. Further, UNAR shall require the individual to sign a Release of Information form that indicates the nursing assistant's understanding of information that UNAR requires to be entered into the registry;

(e) UNAR shall periodically update and validate the competency evaluations;

(f) UNAR shall establish a written and oral examination that addresses each requirement as prescribed in OBRA. The questions shall be developed from a pool of test questions, only a portion of which shall be used in any one evaluation, under a system that maintains the integrity of both the pool of questions and individual evaluations;

(f) The competency evaluation must include a demonstration of the tasks the nursing assistant is expected to perform as part of the assistant's function as a CNA;

(g) For the skills training component of the evaluation, UNAR shall establish a performance record for each nursing assistant training program of major duties and skills taught that include:

(i) a listing of the duties and skills that UNAR expects a CNA to learn in the program in accordance with Section R414-7B-4;

(ii) a record that documents when the nursing assistant performs this duty or skill;

(iii) documentation of satisfactory or unsatisfactory performance;

(iv) the date of the performance; and

(v) the instructor supervising the performance.

(2) At the completion of the nursing assistant training program, the nursing assistant shall receive a copy of this record.

(3) The demonstration aspect of the skills training portion of the competency evaluation consists of a minimum performance of five tasks, all of which are included in the performance record. UNAR shall select five tasks for each nursing assistant from a pool of evaluation items ranked according to degree of difficulty. UNAR shall make a random selection of tasks with at least one task from each degree of difficulty.

 

R414-7B-5. Nurse Assistant Training Program.

(1) UNAR shall administer a NATCEP through a contract with the Department of Health.

(2) An agency that conducts a NATCEP must be UNAR-approved.

(3) Applicants for approval of a nursing assistant training program must be fingerprinted and have their records checked in state and national bureaus. Before receiving NATCEP approval, a nursing assistant training program must send a background check and fingerprinting to UNAR to be placed in the file of the proposed new training program.

(4) In accordance with Section R414-7B-5, UNAR shall review and render a determination regarding approval or disapproval of any nursing assistant training program when a Medicare or Medicaid participating nursing facility requests the determination. UNAR at its option, may also agree to review and render approval or disapproval of any private nursing assistant training program.

(5) UNAR must, within 90 days of the date of an application, either advise the requestor of UNARs determination, or must seek additional information from the requesting entity with respect to the program for which it is seeking approval.

(6) UNAR shall approve a nursing assistant training program that meets the criteria specified in OBRA, the Centers for Medicare and Medicaid Service's guidelines, guidelines desginated by the Department of Health, and all UNAR requirements.

(a) UNAR shall admit a student who is 16 years of age and older on or before the first day that the student begins class; and

(b) shall include an orientation to the training program.

(7) The nursing assistant training program must meet minimal content requirements to be UNAR-approved.

(a) NATCEP must consist of no less than 80 hours of supervised and documented training by a licensed nurse.

(b) The curriculum of the training program must include the following subjects:

(i) communication and interpersonal skills;

(ii) infection control;

(iii) safety and emergency procedures;

(iv) promoting residents' independence;

(v) respecting residents' rights; and

(vi) basic nursing skills.

(c) The trainee must complete at least 16 hours of supervised practical training in a long-term care facility, and complete all skill curriculum and skill competencies prior to training in any facility. The skills training must ensure that each nursing assistant demonstrates competencies in the following areas:

(i) Basic nursing skills:

(A) taking and recording vital signs;

(B) measuring and recording height;

(C) caring for residents' environment; and

(D) recognizing abnormal signs and symptoms of common diseases and conditions.

(ii) Personal care skills:

(A) bathing that includes mouth care;

(B) grooming;

(C) dressing;

(D) using the toilet;

(E) assisting with eating and hydration;

(F) proper feeding techniques; and

(G) skin care.

(iii) Basic restorative services:

(A) use of assistive devices in ambulation, eating, and dressing;

(B) maintenance of range of motion;

(C) proper turning and positioning in bed and chair;

(D) bowel and bladder training;

(E) care and use of prosthetic and orthotic devices; and

(F) transfer techniques.

(iv) Mental Health and Social Service Skills:

(A) modifying her own behavior in response to the resident's behavior;

(B) identifying developmental tasks associated with the aging process;

(C) training the resident in self-care according to the resident's ability;

(D) behavior management by reinforcing appropriate resident behavior and reducing or eliminating inappropriate behavior;

(E) allowing the resident to make personal choices, providing and reinforcing other behavior consistent with resident's dignity; and

(F) using the resident's family as a source of emotional support.

(v) Resident's rights:

(a) providing privacy and maintaining confidentiality;

(b) promoting the resident's right to make personal choices to accommodate the resident's needs;

(c) giving assistance in solving grievances;

(d) providing needed assistance in getting to and participating in resident and family groups and other activities;

(e) maintaining care and security of resident's personal possessions;

(f) providing care that keeps a resident free from abuse, mistreatment, or neglect, and reporting any instances of poor care to appropriate facility staff; and

(g) maintaining the resident's environment and care through appropriate nurse aide behavior to minimize the need for physical and chemical restraints.

(8) Qualification of Instructors:

(a) a nursing assistant training program must have a program coordinator who is a registered nurse with a current and active Utah license to practice;

(b) who is in good standing with DOPL;

(c) with two years of nursing experience, at least one of which is the provision of long-term care facility services or caring for the elderly or chronically ill of any age; and

(d) must have three hours of documented consulting time per month with the respective program.

(9) Nursing facility-based programs:

(a) the program coordinator in a nursing facility-based program may be the director of nursing for the facility as long as the facility remains in full compliance with OBRA requirements.

(b) the primary instructor must be a licensed nurse with a current and active Utah license to practice and must be in good standing with DOPL; and

(c) must have two years of nursing experience, at least one of which is the provision of long-term care facility services or caring for the elderly or chronically ill of any age.

(10) Before approval of a nursing assistant training program, the program coordinator and primary instructor must successfully complete a UNAR-approved "Train-the-Trainer" program or demonstrate competence to teach adult learners as defined by UNAR.

(11) Students who provide services to residents must be under the direct supervision of a licensed nurse who is a UNAR-approved clinical instructor and whose clinical time is separate from her facility employment.

(12) Qualified personnel from the health professions may supplement the program coordinator or primary instructor. The program coordinator or primary instructor must be present during all provided supplemental training.

(13) Qualified personnel include registered nurses, licensed practical or vocational nurses, pharmacists, dietitians, social workers, sanitarians, fire safety experts, nursing home administrators, gerontologists, psychologists, physical and occupational therapists, activities specialists, speech or language therapists, and any other appropriate and duly qualified personnel.

(14) UNAR requires qualified personnel to have at least one year of current experience in the care of the elderly or chronically ill of any age, or to have equivalent experience. Qualified personnel must also meet current licensure requirements, whether they are registered or certified in their field.

(15) A nursing assistant training program must have a student-to-instructor ratio of 12:1 for clinical instruction and shall not exceed a 30:1 ratio for theory instruction. UNAR requires an instructor assistant when the program has more than 20 students.

(16) A nursing assistant training program must provide a classroom with the following:

(a) adequate space and furniture for the number of students;

(b) adequate lighting and ventilation;

(c) comfortable temperature;

(d) appropriate audio-visual equipment;

(e) skills lab equipment to simulate a resident's unit;

(f) clean and safe environment; and

(g) appropriate textbooks and reference materials.

(17) Initial post-approval and ongoing reviews:

(a) After the initial approval of a nursing assistant training program, UNAR grants a one-year probationary period;

(b) During the probationary period, UNAR may withdraw program approval if there is a violation of OBRA, state, federal, or UNAR requirements;

(c) After the probationary period, UNAR shall complete an on-site review and then complete subsequent on-site reviews at least every two years;

(d) The CNA training program shall submit a self-evaluation to UNAR during the interim year that UNAR does not complete an on-site review;

(e) In the event that UNAR does not complete an on-site review within two years, the CNA training program is responsible to send a self-evaluation to UNAR for the applicable two-year period;

(f) If UNAR does not make an on-site visit within two years and the CNA training program sends in a self-evaluation, UNAR must make an on-site visit within one year of the self-evaluation.

(18) The training and evaluation program review must include:

(a) skills training experience;

(b) maintenance of qualified faculty members for both classroom and skills portions of the nursing assistant training program;

(c) maintenance of the security of the competency evaluation examinations;

(d) a record of complaints received about the program;

(e) a record that each nursing facility has provided certified nursing assistants with 12 hours of staff development training per year with the compensation for the training;

(f) curriculum content that meets state and federal requirements; and

(g) classroom facilities and required equipment that meet state, federal and UNAR requirements.

(19) In addition to the nursing assistant training that UNAR requires, all nursing assistants shall receive an orientation program from the nursing facility where they are employed, which is not included in the required 80 hours of training. This orientation phase shall include an explanation of:

(a) the organizational structure of the facility;

(b) the facility policies and procedures;

(c) the philosophy of care of the facility;

(d) the description of the resident population; and

(e) the employee rules.

 

R414-7B-6. Nurse Aide Registry.

(1) UNAR is the central registry for all certified nursing assistants. This registry must include identification of individuals who have successfully completed and passed a nursing assistant training program with a passing score of 75.

(2) A nursing assistant training program must report to UNAR, within five days of the completion date of the program, the names of all individuals who have satisfactorily completed the certified nursing assistant training program.

(3) The state survey agency shall enforce the standards of UNAR described in OBRA, Secs. 4211 and 4212.

(4) The state survey agency shall investigate all complaints of resident neglect, abuse or misappropriation of resident property by a CNA. A CNA is entitled to a hearing through the Division of Medicaid and Health Financing before a substantiated claim can be entered into the registry.

(5) After notification from the health facility licensing, certification and resident assessment agency of a substantiated claim of abuse, neglect or misappropriation of property of a vulnerable adult by a CNA, the name of the CNA and an accurate summary of the findings are placed in the abuse registry in accordance with UNAR protocol.

 

R414-7B-7. Limitations.

(1) UNAR may approve a facility-based NATCEP only if the facility's participation in the Medicare and Medicaid programs has not been terminated within the last two years.

(2) UNAR must review and reapprove a nursing assistant training program at least every two years.

(3) A skilled nursing facility that participates in a Medicare or Medicaid facility may not administer the written and skills components of the competency evaluation.

(4) A nursing facility may employ a nursing assistant for more than 120 days only if the assistant has completed a nursing assistant training program.

(5) Upon review of program performance standards, UNAR shall terminate a program that does not provide an acceptable plan to correct deficiencies.

(6) A nursing assistant who does not perform paid services that total at least 200 hours of nursing or nursing-related services under the direction of a licensed nurse during the 24 months that follow the completion date of the state-approved nursing assistant training program or certification renewal, must retrain and repeat the skills and written examination.

(7) A candidate has one attempt to pass both the skills and written portion of the examination. If the candidate fails either portion of the examination, the candidate must complete a UNAR-approved nursing assistant training program.

 

KEY: [m]Medicaid

Date of Enactment or Last Substantive Amendment: [1989]2010

Notice of Continuation: October 20, 2009

Authorizing, and Implemented or Interpreted Law: 26-1-4.1; 26-1-5; 26-18-3