DAR File No. 43964

Health, Family Health and Preparedness, Licensing

Rule R432-45

Nurse Aide Training and Competency Evaluation Program

Notice of Proposed Rule

(Amendment)

DAR File No.: 43964
Filed: 08/07/2019 03:49:25 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of these amendments is to modify the rules regulating the nurse aide training and competency evaluation program to allow the Direct Access Clearance System (DACS) to be used for background screening of instructors for the program, and to amend testing requirements. The Health Facility Committee reviewed and approved these rule amendments on 05/15/2019.

Summary of the rule or change:

These amendments add language for instructors in the Nurse Aide Training and Competency Evaluation Program (NATCEP) to be entered into the Direct Access Clearance System (DACS) to initiate a background clearance. These amendments also allow for CNAs with expired certificates in good standing to have three attempts to re-test. Due to multiple clinical sites, these amendments also remove the requirement for a two-hour orientation for CNAs at the clinical site.

Statutory or constitutional authorization for this rule:

• Title 26 Chapter 21

Anticipated cost or savings to:

the state budget:

State government licensing of health care facilities and agencies was thoroughly reviewed. These proposed rule amendments would not likely impact licensing deficiencies.

local governments:

Local government city business licensing requirements were considered. These proposed rule amendments should not impact local governments' revenues or expenditures.

small businesses:

After conducting a thorough analysis, it was determined that these rule amendments should not impact costs for small business health care facilities or agencies. There are approximately 35 NATCEPs in Utah. No financial impact will result for the training programs, as the individual instructors will incur the cost of their own background screening.

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

After conducting a thorough analysis, it was determined that these rule amendments will affect individual instructors for the NATCEP. There were 58 instructors engaged in the past 12 months. Each instructor will incur an additional background screening monitoring fee of $18 to utilize the Direct Access Clearance System and a storage fee of $5. The total impact per person is $23. The total impact for all persons affected is $1,334.

Compliance costs for affected persons:

After conducting a thorough analysis, it was determined that these proposed rule amendments will result in a fiscal impact to NATCEP instructors. Each instructor will incur an additional background screening monitoring fee of $18 to utilize the Direct Access Clearance System and a storage fee of $5. The total impact per person is $23. The total impact for all persons affected is $1,334.

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

There is no fiscal impact to businesses other than an additional $23 fee for each instruction for background screenings and storage.

Joseph K. Miner, MD, Executive Director

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

Health
Family Health and Preparedness, Licensing
3760 S HIGHLAND DR
SALT LAKE CITY, UT 84106

Direct questions regarding this rule to:

• Kristi Grimes at the above address, by phone at 801-273-2821, by FAX at , or by Internet E-mail at kristigrimes@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:

10/01/2019

This rule may become effective on:

10/08/2019

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2020	FY 2021	FY 2022
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Person	$1,334	$1,334	$1,334
Total Fiscal Costs:	$1 , 334	$1 , 334	$1 , 334
Fiscal Benefits
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Persons	$0	$0	$0
Total Fiscal Benefits:	$0	$0	$0
Net Fiscal Benefits:	$0	$0	$0

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described in the narrative. Inestimable impacts for Non - Small Businesses are described in Appendix 2.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

These rule amendments will only affect individual instructors for the Nurse Aide Training and Competency Evaluation Program (NATCEP). Since there were already rules in place for background screening of instructors, there will be no regulatory impact to non-small businesses.

 

 

R432. Health, Family Health and Preparedness, Licensing.

R432-45. Nurse Aide Training and Competency Evaluation Program.

R432-45-3. Program Access Requirements.

(1) A nurse aide is required to complete a NATCEP and become certified within 120 days of the first date of employment.

(2) An individual who was certified as a nurse aide on or before July 1, 1989, meets 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 with a passing grade[and to a current nursing student]. An official transcript of a nursing fundamentals class must accompany the Application for Certification Testing. If the candidate does not pass either the skills or written portion of the CNA examination after three attempts, the candidate must complete a NATCEP;

(b) a[n expired licensed] nurse with an expired license who can show proof of previous licensure in any state and who was in good standing with that state's professional board. UNAR shall grant the candidate 3[one] attempts to pass both the skills and written portion of the examination. If the candidate does not pass either portion, the candidate must complete a NATCEP[.];

(c) a[n expired Utah] CNA with an expired certificate from Utah who is in good standing with UNAR. UNAR shall grant the candidate 3[one] attempt s to pass both the skills and written portion of the examination within two[one] years of the certification expiration date. If the candidate does not pass either portion, the candidate must retrain; or

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

(4) An out-of-state [expired ]CNA with an expired certificate must complete a NATCEP in the state of Utah.

 

R432-45-5. Nurse Aide Training Requirements Under UNAR.

(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 NATCEP and all new NATCEP instructors must successfully complete a background clearance[be fingerprinted and have their records checked in state and national bureaus].[Before receiving NATCEP approval, a]

(a) A NATCEP must submit required information to UNAR to initiate a background clearance for each applicant and instructor.[send a background check and fingerprinting to UNAR to be placed in the file of the proposed new training program.]

(b) UNAR shall ensure:

(i) required information is entered into the Direct Access Clearance System to initiate a clearance for each applicant and instructor;

(ii) each applicant and instructor signs a criminal background screening authorization form which must be available for review by the department;

(iii) each applicant and instructor submits fingerprints; and

(iv) the Direct Access Clearance System reflects the current status of the applicant and instructor.

(c) If the Department determines an applicant or instructor are not eligible, based on information obtained through the Direct Access Clearance System, the Department shall send a Notice of Agency Action to UNAR and the individual explaining the action and the individual's right of appeal as defined in R432-30.

(4) In accordance with this section, UNAR shall review and render a determination of approval or disapproval of any NATCEP 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 NATCEP.

(5) UNAR must, within 90 days of the date of an application, either advise the requestor of UNAR's 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 NATCEP that meets the criteria specified in OBRA, the Centers for Medicare and Medicaid Service's guidelines, guidelines designated by the Department of Health, and all UNAR requirements.

(a) UNAR shall admit a student who is at least 16 years old on or before the first day the student begins class; and

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

(7) The nurse aide training program must meet certain content requirements to be UNAR-approved.

(a) NATCEP must consist of at least 100 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 resident independence;

(v) respecting resident rights; and

(vi) basic nursing skills.

(c) The trainee must complete at least 24 hours of supervised practical training in a long-term care facility, and complete all skill curriculum and skill competencies before training in any facility. The skills training must ensure that each nurse aide 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 one's 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 the 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 NATCEP 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 at least 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 NATCEP, the program coordinator and primary instructor must successfully complete a UNAR-approved "Train-the-Trainer" program or demonstrate competence to teach a CNA candidate who is at least 16 years old. All high school instructors must be certified to teach in the classroom by completing a "Train the Trainer" program or be certified to teach as defined by the Utah State Office of Education before providing instruction in the classroom.

(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 and 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 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 NATCEP 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 NATCEP 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 NATCEP, 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 nurse aide 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 nurse aides with at least 12 hours of staff development training each 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 nurse aide training that UNAR requires, each program shall provide a two-hour orientation of the clinical site for that student before beginning the clinical rotation. The orientation hours are not included in the required 24 hours of clinical training. This orientation phase must include an explanation of:

(a) facility organizational structure;

(b) facility policies and procedures;

(c) facility philosophy of care;

(d) resident population; and

(e) employee rules.]

 

KEY: health care facilities

Date of Enactment or Last Substantive Amendment: [August 25, 2014]2019

Notice of Continuation: April 5, 2019

Authorizing, and Implemented or Interpreted Law: 26-21-5; 26-21-1