If you have any questions after this call, please feel free to contact me at

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1 JULY 8, 2008 AIPP CONFERENCE CALL NURSING ASSISTANT TRAINING PROGRAM Good morning, this is Renee Davison with the Office of Long Term Care Nursing Assistant Training Program. Today I will review the rules and regulations for nursing assistant training, reimbursement issues, continuing education for nursing assistants after certification, renewals and the online option for renewal, reciprocity and training exemption policies, establishing a new in-facility training program, nursing home sanctions and the waiver process and testing issues. If you have any questions after this call, please feel free to contact me at NURSING ASSISTANT TRAINING PROGRAM SPECIFIC 1. The Rules and Regulations for nursing assistant training were implemented in 1992 and are based on the Federal regulations 42CFR The State Operations Manual tags associated with nursing assistant training are F493-F In July 2006 the regulations were changed to accommodate the increased number of required training hours in order to include the 15 hour Barbara Broyles Alzheimer and Dementia training. Beginning July 1, 2006, all nursing assistant training programs were required to increase their training from the federally mandated 75 hours to 90 hours. This marked the first time the state mandated two specific videos, Bathing without a Battle and Look at Me. 3. Significant changes that were included in the updated regulations included requiring nursing assistant training instructors to have an unencumbered AR nursing license, expanded the reasons for revocation of program approval and prohibited a licensed nurse with an encumbered license to challenge the state competency evaluation. We also tightened down on reimbursements. 4. All nursing assistant training programs must be approved by the OLTC and State Board of Private Career Education, if applicable, prior to training. Facility based programs only require approval by the OLTC. 5. In order to request approval for a training program, the facility must select a Primary Instructor. The Primary Instructor (PI) must be a Registered Nurse (RN) with a minimum of 2 years experience with 1 year in long term care within the last 5 years. There can only be one PI per program. The Director of Nursing (DON) can be the PI, but, when the DON is teaching or supervising clinicals, they must have DON coverage; in other words, they cannot wear both hats it is one or the other. 6. In addition to the PI, the training program can have an unlimited amount of Additional Instructors (AI). The AI can be either a Licensed Practical Nurse (LPN) or RN that meets the same requirements as the PI must meet. 7. The training program must have classroom and skills lab space that is dedicated to the program. There must be adequate room for classroom instruction, skills demonstration and skills check-off. The skills lab must have all of the equipment required to perform each of the 48 skills required by the curriculum.

2 8. The PI has several mandated program responsibilities. These include the training and supervision of all additional instructors; ensuring trainees are minimally competent in the performance of all skills; participation in planning each lesson and clinical instruction; ensuring course objectives were met; makes certain the provision of direct care by trainees is adequately supervised by program staff, NOT unit staff; and provides trainees with a Certificate of Completion upon successful completion of the course. 9. Training programs must be a minimum of 90 hours. Training programs may elect to increase their training hours, but shall not go below the minimum. The time is split into two sections: classroom/skills lab and clinical. The classroom/skills lab time must be a minimum of 74 hours and the clinical time must be a minimum of 16 hours. 10. The Rules and Regulations and curriculum are available for downloading on the OLTC website. If you have any questions after reviewing the regulations or curriculum, please do not hesitate to contact me. TRAINING/TESTING PROHIBITON AND WAIVER PROCESS 1. Medicaid-certified long term care facilities shall go on training/testing prohibition for a period of 2 years if any of the following are found on any type of survey conducted by OLTC: A. Finding of immediate jeopardy or substandard quality of care; B. Has been subject to an extended or partial extended survey; C. Operated under a waiver of the nurse staffing requirements in excess of 48 hours during the week; D. Subject to a civil money penalty of not less than $5000, denial of payment, appointment of temporary management, closure or transfer of residents. 2. If a facility has an in-house program, the program approval is automatically withdrawn and the facility cannot provide further training, act as a clinical training site for an outside program or participate in in-facility testing. All training must be performed by an outside program and facilities that have offered employment or letter of intent to hire are prohibited from charging tuitions/training fees for any portion of the program. 3. Facilities may request a waiver of the nursing assistant training prohibition by writing a letter to Tommy Wingard. The waiver allows the facility to utilize outside programs to come into their facility and provide the training. The waiver does not allow the facility to conduct the training. Testing may occur in facilities that have been granted a waiver. 4. Waivers are granted based on availability of other training programs in the area based on either frequency of classes or within reasonable distance. The waiver is valid for as long as the testing/training prohibition is in effect. Waivers are automatically extended with any extensions of prohibitions and are automatically withdrawn at the end of the prohibition period. 5. Training programs that utilize facilities with training waivers are required to submit trainee rosters to OLTC one week prior to training.

3 REGISTRY VERIFICATION 1. Long term care facilities are required by state and federal law to check the nursing assistant registry for all nursing assistants or potential employees. In Arkansas, the employment clearance registry contains both certified and non-certified individuals. Non-certified individuals have been placed on the registry due to either criminal record check or an administrative finding of abuse, neglect or misappropriation of resident property. 2. Registry verification can be made one of two ways: telephone or online. To check the registry by telephone, call and enter the four-digit facility registry ID code and the individual s social security number. It is VERY important to listen to the recording in its entirety because if the person is disqualified, the system will not transfer your call until the end. To check online, go to and scroll to the bottom of the screen. Click on the LTCF Employment Clearance registry link. Enter your four-digit facility registry ID code, the person s social security number and date of birth. The date of birth must be entered in MM/DD/YYYY format. 3. Facilities are prohibited from performing registry verification by name only. Searching by name or certificate number is not valid registry verification and can result in deficient practice. 4. The benefit of performing online verification is that the person performing the verification can print the registry information. Then the person should sign, date and time the verification and place in the employee s file. Telephone verifications must also be documented for the file; documentation includes the result of the verification, signature of the person completing the verification, time and date. 5. The facility registry ID code is not your vendor number. This will be the same number used on criminal record requests. If you are unsure of your number, please contact our office to receive the code. CERTIFICATION RENEWAL 1. Prometric sends renewal notices 60 days before the CNA s expiration date to the last known address. Renewals can be done online or through the mail. Online renewals instantly update the registry. Renewals done through the mail can take several weeks to process. 2. CNA s with expired certifications cannot work as a CNA until their certification is current. There is no charge for the renewal. 3. CNA s are required by state and federal law to work for a minimum of 8 hours for pay performing CNA duties during their certification period in qualify for renewal. 4. Continuing education is not required for renewal. Continuing education is required to be performed through the facility and each nursing assistant must receive 1 hour of continuing education or in-service training per month.

4 RECIPROCITY 1. Reciprocity is given to any CNA from another state as long as they are current and in good standing in that state. 2. Facilities are mandated to check all applicable state nursing assistant registries for any individual that is certified in a state other than Arkansas. 3. Any certification number that ends with the letter R indicates reciprocity. 4. Reciprocity requests are processed by OLTC and all requests are sent to OLTC. Prometric does not process these requests. 5. CNA s with an out of state certification can work for 120 days on the other states certification as long as the facility verifies that the certificate is current and in good standing. The CNA must attain Arkansas certification within the 120 day window. TESTING 1. All testing is performed by Prometric through a state contract. The contract was awarded to Prometric for fiscal year 2008 in June The candidate bulletin has been updated and is available online at the Arkansas Prometric website. Fees have increased to $89 for the initial test. This includes the $10 eligibility screening fee. The fee for rescheduling due to no show or late cancellation is equivalent to the testing fee of $ Testing is conducted in regional test sites and in-facility. In-facility testing is a quicker option for testing since regional test sites are scheduled on a first-come first-serve method. All testing must be scheduled through Prometric. 4. If a CNA has been expired for more than 2 years or is not eligible to renew, they must retake the state competency exam and become current on the registry before they are eligible to work. 5. Nursing students that have been approved by OLTC to challenge the state exam are not eligible to work as a CNA until after placement on the registry. This also applies to individuals that trained in other states but did not take the exam and expired reciprocity applicants. REIMBURSEMENT 1. Facilities that conduct training or sponsor trainees are eligible to file for reimbursement of training expenses. These expenses have a cap of $480. All requests for reimbursement must be filed on the facility-specific forms provided by OLTC. 2. In order to qualify for reimbursement under the letter of intent arrangement must meet the following criteria: A. Letters of intent must be on facility letterhead, dated within 12 months immediately preceding the training with an original signature by the administrator;

5 B. The facility must have on file a job application completed and signed by the individual receiving the letter of intent; C. The facility must complete a criminal record check on the individual in accordance with ACA ; and D. The facility must maintain copies of documents to verify compliance with the regulation. 3. Individuals that are on the registry are not eligible for reimbursement. If a facility provides an individual a letter of intent to cover testing fees, the facility cannot file for reimbursement because that is a direct bill expense to the state from Prometric. 4. Individuals that have had reimbursement paid in the past are not eligible for a second reimbursement. An example of this would be if an individual went through training but did not successfully complete the state competency exam and requires re-training. You can contact Janet Loften at to verify if an individual is eligible for reimbursement. 5. Reimbursement is calculated based on the percentage of Medicaid residents in the facility at midnight on the last day of the month. The calculation is the number of students eligible multiplied by the cap amount divided by the percentage of Medicaid residents. 6. All requests for reimbursements must be received within 30 calendar days following the end of the expense month. Claims not submitted timely or claims that are incomplete will not be accepted for payment and shall be returned to the facility. Corrected claims must be re-submitted within 15 calendar days of the date returned. 7. Reimbursements are not allowed and shall be denied to facilities for the following: A. Individuals listed on the registry with a disqualification status due to substantiated administrative finding of abuse, neglect, misappropriation of resident property or a disqualifying criminal record; B. Individuals listed on the registry with an expired certification. These individuals are not required to retrain, only retest; C. Individuals who, prior to training, did not complete a criminal record check. 8. All records shall be retained for a minimum of 5 years.