Agency #016.06
Rules for the
Arkansas Long Term Care Facility
Nursing Assistant Training Program
Arkansas Department of Human Services
Division of Provider Services and
Quality Assurance
1992
(Revised January 1, 2023)
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Table of Contents
SECTION I - AUTHORITY............................................................................................................................................................................................ 3
SECTION II - PURPOSE .............................................................................................................................................................................................. 4
SECTION III - DEFINITIONS ........................................................................................................................................................................................ 5
SECTION IV - NURSING ASSISTANT TRAINING ......................................................................................................................................................... 8
A. Training ........................................................................................................................................................................................................... 8
B. Implementation Requirements ...................................................................................................................................................................... 9
C. Nursing Assistant Trainee Activities ............................................................................................................................................................. 10
D. Classroom Facilities & Resources ................................................................................................................................................................. 10
E. Orientation Program ..................................................................................................................................................................................... 11
SECTION V - APPROVAL OF PROGRAMS ................................................................................................................................................................ 12
A. Location .................................................................................................................................................................................................. 12
B. Restrictions ............................................................................................................................................................................................ 12
C. Application ............................................................................................................................................................................................. 13
D. Changes in Programs .............................................................................................................................................................................. 14
E. Withdrawal of Approval ........................................................................................................................................................................... 14
SECTION VI - QUALIFICATIONS OF INSTRUCTORS .................................................................................................................................................. 15
A. Primary Instructor (PI) ........................................................................................................................................................................... 15
B. Primary Instructor Responsibilities ....................................................................................................................................................... 15
C. Additional Instructor/Guest Speaker .................................................................................................................................................... 16
SECTION VII - REQUIREMENTS FOR TESTING AND CERTIFICATION ....................................................................................................................... 17
A. Transition ............................................................................................................................................................................................... 17
B. Examination ........................................................................................................................................................................................... 18
C. Test Dates, Locations, and Fees ............................................................................................................................................................. 19
D. Candidate Qualifications ........................................................................................................................................................................ 20
ARKANSAS CODE §17-4-106 CERTIFIED NURSING ASSISTANT LICENSURES OF UNIFORMED SERVICE MEMBERS, VETERANS, AND SPOUSES ... 21
SECTION VIII - CNA DIRECTORY .............................................................................................................................................................................. 23
A. Function and Content ............................................................................................................................................................................ 23
B. Inter-state (Reciprocity) Transfer .......................................................................................................................................................... 23
SECTION IX - METHODOLOGY FOR REVIEW OF COMPLIANCE WITH PROGRAM REQUIREMENTS ....................................................................... 24
A. Monitoring ............................................................................................................................................................................................. 24
B. Minimum Program Standards................................................................................................................................................................ 24
SECTION X - REIMBURSEMENTS ............................................................................................................................................................................. 26
A. General Provisions ................................................................................................................................................................................. 26
B. Allowable Costs ...................................................................................................................................................................................... 27
C. Claims Submission ................................................................................................................................................................................. 28
D. Maximum Cost Limit .............................................................................................................................................................................. 29
E. Cost Reporting and Record Retention ................................................................................................................................................... 29
F. Nursing Assistant Training Cost Reimbursement Claim Form ............................................................................................................... 29
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Section I AUTHORITY
1.
The following rules for the Long-Term Care Facility Nursing Assistant
Training Program are duly adopted and promulgated by the Department of Human
Services pursuant to Arkansas Code 20-10-701 et seq.
2.
This initiative is pursuant to the Federal mandates of Public Law 100-203 (the
Nursing Home Reform Act, Subtitle C of the Omnibus Budget and Reconciliation Act of
1987 and technical amendments of OBRA 1989 and 1990) concerning the training and
competency examination of nursing assistants employed in long term care facilities and
the registry of certified nursing assistants.
3.
The Federal Omnibus Budget Reconciliation Act of 1987, 1989, 1990, and
1993(OBRA) and regulations issued by the U.S. Department of Health and Human
Services – Centers for Medicare and Medicaid Services (formerly Health Care
Financing Administration, or HCFA) established the minimum requirements for nursing
assistant training and competency evaluation programs in Section 1819(a) - (f) and
1919(a) - (f) of the Social Security Act.
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Section II PURPOSE
1.
To develop and approve training and competency evaluation programs for
individuals who provide nursing or nursing-related services to residents in long term care
facilities and who are not licensed health professionals or volunteers who provide
services without monetary compensations.
2.
These requirements are designed to assist long term care facilities and other
educational institutions with training and competency programs for nursing assistants.
The objective of the Nursing Assistant Training Program is the provision of quality
services to residents by nursing assistants who are able to:
(a)
Perform Certified nursing-aide skills and to assist licensed practical nurses or
registered nurses in direct resident care;
(b)
Form a relationship, communicate and interact competently on a one-to-one
basis with the residents as part of the team implementing resident care objectives;
(c)
Demonstrate sensitivity to residents' emotional, social, and mental health
needs through skillful, directed interactions;
(d)
Assist residents in attaining and maintaining functional independence;
(e)
Exhibit behavior in support and promotion of residents' rights;
(f)
Demonstrate observational and documenting skills needed in support of
the assessment of residents' health, physical condition and well-being.
3.
The training program must teach skills to enhance knowledge in promoting
healthy functioning of residents both physically and emotionally and focus on the
restoration and maintenance of the resident. These attitudes and behaviors of staff
must be demonstrated in the facility on a day-to-day basis
.
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Section III DEFINITIONS
The following words and terms, when used in this section, shall have the following
meaning, unless the context clearly indicates otherwise.
−
Abuse - The willful, knowing, or reckless act of mistreatment of a resident
through words or physical action which results in physical, emotional, or mental
injury to a resident.
−
Act - Public Law 100-203 (the Federal Nursing Home Reform Act, Subtitle C of
the Omnibus Budget and Reconciliation Act) of 1987 and technical amendments
of OBRA 1989 and 1990. Also, may refer to Arkansas Code 20-10-701 et seq.
−
Additional Instructor - A RN or LPN who, under the general supervision
of the Primary Instructor, may provide classroom and skills training.
−
Centers for Medicare & Medicaid Services (CMS) - A federal agency that
oversees programs including Medicare, Medicaid, the Children's Health
Insurance Program (CHIP), and the state and federal health insurance
marketplaces.
−
Certified Nursing Assistant (CNA) - Individuals trained and certified to help
nurses by providing non-medical assistance to patients, such as help with bathing,
dressing, and using the bathroom.
−
Competency Examination - An examination that includes manual (skills)
and written (or oral component for those with limited literacy skills)
evaluations.
−
Department - The Arkansas Department of Human Services (DHS).
−
Division - The Division of Provider Services and Quality Assurance within
the Department of Human Services.
−
Educational Institution - An institution that is licensed by the Arkansas State
Board of Private Career Education within the Arkansas Division of Higher
Education as defined by Act 906 of 1989 (i.e., career colleges, proprietary
school).
−
Examination - A competency examination that includes manual (skills)
and written evaluations.
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Facility - A long term care facility/nursing facility (nursing home) licensed by the
Office of Long-Term Care. A nursing facility that provides nursing care and
supportive care on a twenty-four (24) hour basis to residents. Facility "premises"
include all structures and surrounding property.
−
Facility Based Program - A nursing assistant training program offered by or in a
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long-term care facility.
−
General Nursing Experience – Experience which may include, without
limitation, employment in a nursing assistant education program or employment
in or supervision of nursing students in a long-term care facility or unit, geriatrics
department excluding a geriatric psychiatry department, long-term acute care
hospital, home healthcare, hospice care, or other long-term care setting.
(Arkansas Code Ann. §20.10.702 (2)(C)(ii).
−
Guest Speaker – A registered nurse, licensed practical nurse, or other licensed
health professionals who conduct specific classroom lectures based upon an
expertise in a given subject area, under the direct supervision of the Primary
Instructor.
−
Instructor Training Program - A train-the-trainer program of instruction in
educational teaching techniques and methods for Primary Instructors and Team
Instructors approved by the Office of Long-Term Care.
−
Licensed Health Professional - A physician, physician assistant, nurse
practitioner, physical, speech, or occupational therapist, physical or occupational
assistant, registered professional nurse, licensed practical nurse, or certified social
worker.
−
Misappropriation of resident property - The taking, secretion, misapplication,
deprivation, transfer, or attempted transfer to any person not entitled to receive
any property, real or personal, or anything of value belonging to or under the
effective control of a resident or other appropriate legal authority, or the taking of
any action contrary to any duty imposed by law prescribing conduct relating to
the custody or disposition of property of a resident.
−
Neglect - An act of omission or an act without due care which causes physical or
emotional harm to a resident or adversely affects the resident's health, safety, or
welfare in any way.
−
Non-facility-based program - A nursing assistant training program not offered by
or in a facility (i.e., career college, community college, Vo-Tech school,
proprietary school, etc.)
−
Nursing Assistant - An unlicensed nursing staff member who assists with basic
patient care (such as giving baths, checking vital signs, bed-making, and
positioning) to residents in a long-term care facility who has successfully
completed a training and/or competency evaluation program and is competent to
provide such services but not an individual who is a licensed health professional
or who volunteers to provide such services without monetary compensation.
−
Orientation Program - A program which provides the nursing assistant with
explanations of facility structure, policies, procedures, philosophy of care,
description of the resident population and employee rules. This orientation phase
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is not included as part of the Nursing Assistant Training Program.
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Task Performance Record - A list of the major duties/skills to be learned in the
program and the trainee's performance of each.
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Petitioner - A person who appeals a finding that such person has, while acting as a
nursing assistant in a facility or while being used by a facility in providing
services to a resident, abused or neglected a resident, or has misappropriated a
resident's property.
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Primary Instructor (PI) - An individual who is a registered nurse licensed in
this state to practice if the registered nurse moves from a state that has joined
the Interstate Nurse Licensure Compact, §17-87-601 et seq., to Arkansas and
meets all requirements for licensure in Arkansas does not have any
disciplinary action regarding his or her license by the licensing entity or
authority; and possesses a minimum of two (2) years' general nursing
experience as a registered nurse including at least one (1) year of long-term
care nursing services in a long-term care facility setting within the last five
(5) years. (Arkansas Code Ann. §20-10-702).
−
−
Office - Nursing Assistant Training Program within the Division of Provider Services and
Quality Assurance.
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Resident - Individuals who reside in long-term care facilities that receive a range of services,
including medical and personal care.
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Skills training - Training composed of both skills demonstration in the classroom
lab and skills performance in the clinical area with residents in a long-term care
facility.
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Supervised Practical Training - Pursuant to 42 CFR 483.152, supervised
practical training means training in a laboratory or other setting in which the
trainee demonstrates knowledge while performing tasks on an individual under
the direct supervision of a registered nurse or a licensed practical nurse.
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Trainee - An individual who is enrolled in a nursing assistant training program
and who is not permitted to perform nursing services for residents during the
training period for which they have not been trained and found to be competent.
−
Virtual Instruction/Training - a method of teaching that is taught either entirely
online or when elements of face-to-face courses are taught online through
learning management systems and other educational tools and platforms.
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Section IV NURSING ASSISTANT TRAINING
GENERAL RULE: A facility must not use any individual working in the facility as a
nursing assistant for more than four (4) months (120 calendar days) unless that individual
has successfully completed a training program and competency examination approved
by the Department as required by CMS.
A.
Training
1.
Nursing assistant training programs must include materials that provide a
basic level of both knowledge and demonstrable skills for each individual
completing the program.
2.
Each course must be prepared and administered in accordance with the
training course guidelines prescribed in the "Arkansas LTCF Nursing
Assistant Training Curriculum". This curriculum is to be used as a guide for
conducting in-person or virtual training in both facility and non-facility
programs.
3.
These guidelines essentially provide the outline for in-person and virtual
training programs and can be enhanced by the inclusion of current information
to keep training relevant to changing needs. The content provides fundamental
information and leaves open the opportunity for an instructor to function as
necessary in response to perceived student requirements. It is important to
recognize that the curriculum guidelines identify the limitations (i.e., scope
of practice) of the LTCF nursing assistants' direct care responsibilities.
4.
Each in-person/virtual training program must use the behavioral stated
objectives in the "Arkansas LTCF Nursing Assistant Training Curriculum"
for each unit of instruction. These objectives state the measurable performance
criteria that serve as the basis for the state competency examination. The
instructor shall conduct a review of each unit objective with trainees at the
beginning of each unit so that each trainee knows what is expected of them in
each part of the training program.
5.
Upon successful completion of the required in-person/virtual training, the
trainee must pass the state competency examination administered by the
Department (see Section VII). An individual must complete the state competency
examination within twelve (12) months of graduation from a training program or
retraining will be required.
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B.
Implementation Requirements
1. Pursuant to 42 CFR § 483.152, a nurse aide training and competency
examination program must include, at a minimum, a combination of classroom
(in-person/virtual) and clinical instruction. The requirement for state certification
shall include a minimum of ninety (90) hours of training which consist of no less
than seventy-four (74) clock hours of training, including sixteen (16) hours of
supervised practical training, for a total of ninety (90) hours.
2. The clinical site must be a long-term care facility, skilled nursing unit or
rehabilitation unit located in an acute care facility or inpatient hospice unit which
has not been disqualified by restrictions as described in Section V (B).
3. A minimum of sixteen (16) hours initial classroom (in-person/virtual)
instruction is required in Part I. This will include both theory instruction and skills
demonstration in the classroom lab. During Part I, the trainee is not allowed on
the floor as part of a facility's staffing pattern. After completion of Part I, a
trainee may be used in a facility's staffing pattern but only assigned to duties for
which they have demonstrated competency. Documentation of acceptable
performance of all skills and duties shall be on file with the Primary Instructor
(see item C – Nursing Assistant Trainee Activities).
4. Parts II and III require the completion of the remaining seventy-four (74)
clock hours of training consisting of theory, classroom lab and clinical skills
training. Clinical skills training must include at least sixteen (16) hours of
supervised practical training in a facility performing tasks on an individual under
the direct supervision of the instructor. Clinical skills training assignment or
supervision by another nursing assistant is prohibited.
5. The ratio of trainees to instructors in the in-person/virtual classroom must
not exceed twenty-four (24) trainees to one (1) instructor (primary or
additional instructor) and the ratio for skills training must not exceed twelve
(12) trainees to one instructor.
6. . Staff in training can be employed after completing lessons one (1) – eleven
(11) (sixteen (16) hours of course work) and may continue to work on the floor
while they are actively progressing through a NATP; however, they cannot be
included in staffing ratio if they are actively participating in class instruction.
7. Each program shall issue a written statement to each trainee, upon successful
completion of the program in the form of a certificate of completion, which shall
include the program's name, NATP license number, the student's name and a
numerical identifier such as a driver’s license number or identification number
from a valid government issued document that contains a current photo (such as
state or national ID card, alien registration card, military identification or
passport); the begin date and end date; and the signature of the Primary
Instructor upon successful completion of the program. Such certificate, or
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copies thereof, shall serve as evidence of successful completion of a training
program to be eligible to take the state competency examination.
C.
Nursing Assistant Trainee Activities
1.
Each trainee shall wear identification during all skills training portions
that identifies them as a trainee. Identification must be visible to residents,
family members, visitors, and staff.
2.
A nursing assistant who has begun a training program and has not
completed the program may be hired by a facility to provide care for which they
have received training and demonstrated competence. Nursing assistants are not
permitted to perform services for residents during the training period for which
they have not been trained and found by the training program to be competent.
3.
Documentation of each trainee's acceptable performance of each
skill/procedure must be maintained by the Primary Instructor on the Task
Performance Record (DMS-741 form) provided by the Department This record
consists of the following:
• Tasks performed which includes duties and skills completed
• Satisfactory performance date; and
• The instructor’s signature supervising the performance.
4.
A program must terminate a trainee when provided with substantial
evidence or a determination that the trainee is guilty of resident neglect or abuse
or misappropriation of resident property. The program shall establish procedures
for a review of the allegations when requested by the trainee. The program shall
inform the Department of any trainees terminated under these circumstances.
D.
In person/Virtual Classroom Facilities & Resources
1.
In Person:
a. The nursing assistant training program shall require the provision of
physical facilities as follows:
−
Temperatures conducive to the weather;
−
Clean and safe conditions;
−
Adequate Lighting;
−
Space to accommodate all students; and
All Equipment for simulating resident care and classroom/lecture (See
Instructional Equipment under Section X). b. The physical facilities including
classrooms, laboratories, conference space, library, and educational materials
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shall be adequate to meet the needs of the program, the number of trainees, and
the instructional staff.
2.
Virtual:
See the virtual methodology section.
Suggested training material/resources may include, but is not limited to a
blackboard, flipchart, projector/screen, DVD, anatomical chart, mannequin, bed,
lavatory/sink, etc.
3.
The Department will not require or endorse any one textbook or other
material such as videotapes, films, etc. There are several resources on the market
and each facility or school will have the choice in selecting their materials. The
curriculum guide is to be used so each program will know the objectives and
procedures expected to be communicated to the nursing assistant trainee for
them to pass the state competency examination.
E.
Orientation Program
1.
All nursing assistants must receive an orientation program that includes,
but is not limited to, an explanation of:
−
The organizational structure of the facility;
−
Policies and procedures (including fire/disaster plans, etc.)
−
The philosophy of care of the facility;
−
The description of the resident population; and
−
Employee rules.
2.
This facility orientation training program is not included in the required
ninety (90) hours of nursing assistant training.
F.
Ongoing In-Service Training
1.
All facilities will continue to provide ongoing in-service training on a
routine basis both in groups and as necessary in specific situations on a one-to-
one basis. Each nursing assistant must receive one (1) hour of in-service training
per month.
2.
The facility must complete a performance review of each nursing assistant
at least once per year and provide regular in-service training based on the
outcome of these reviews. The in-service training should address areas of
weakness and be sufficient to ensure the continuing competence of the nursing
assistants.
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3.
In addition to training needs identified by performance reviews, in-service
training should also address the special needs of residents as determined by each
facility. Training can be received on the unit as long as it is directed toward skills
improvement, provided by appropriately trained staff, and documented (for
example, skills demonstration with return demonstration recorded on a check list).
4.
Effective July 1, 2006, facilities are strongly encouraged to offer in-
service training for nursing-home-employed CNAs who were certified in
Arkansas prior to July 1, 2006, that covers the Barbara Broyles Alzheimer and
Dementia Training that is included in Arkansas LTCF Nursing Assistant Training
Curriculum. Facilities should maintain records that verify each employed CNA,
who was certified in Arkansas prior to July 1, 2006, has received this training.
After July 1, 2006, and ongoing, the new Alzheimer’s training is strongly
encouraged for CNAs registered in Arkansas through reciprocity from other states
and test candidates that are allowed to challenge the State competency test based
on exemptions found in Section VII (D) (three (3) through six (6)).
G.
Non-Permanent Employees
1.
Nursing assistants who are employed/leased through a temporary hiring
service must have completed an approved training program and passed the state
competency evaluation test prior to employment and use by a facility.
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Section V APPROVAL OF PROGRAMS
A.
Location
1.
Nursing assistant training programs may be offered by or in nursing
facilities, as well as outside facilities. The clinical portion of the training must be
conducted in all cases and must utilize a nursing facility and its residents.
Nursing facilities may offer a complete training program and/or may contract
with another organization to provide the training unless they are sanctioned.
Sanctioned nursing facilities cannot offer the training.
2.
Other groups and/or institutions such as employee organizations,
vocational/technical schools, community colleges, and private institutions may
conduct programs, upon the Department’s approval.
3.
Programs offered to the public and charging a tuition fee must submit an
application and be approved by the Department before they can be licensed
through the State Board of Private Career Education. This provision would not
apply to the state schools (Vo-Tech, community colleges, etc.) or programs
offered by long-term care facilities who train their own employees (or potential
"on-call" employees).
B.
Restrictions
1.
The Department shall not approve a program offered by or in a nursing
facility which, in the previous two years, has done the following:
(A)
Operated under a waiver of the nurse staffing requirements in excess of
forty-eight (48) hours during the week;
(B)
Been subjected to an extended survey*or partially extended survey*; or
(C)
Been subjected to a civil money penalty of no less than $5,000, denial of
payment for new admissions, appointment of temporary management, closure, or
transfer of residents.
* Extended survey is defined for this provision as a survey which includes
a review of facility policy and procedures pertinent to Level A
deficiencies in Resident Rights, Resident Behavior and Facility
Practices, Quality of Life, or Quality of Care.
* Partial extended survey is defined as a survey conducted as a result of a
deficiency in Level A requirements other than those listed above in the
extended survey definition.
2.
Facility-based training programs are prohibited from charging
tuitions/training fees to their nursing assistant employees or those who have
received an offer of employment for any portion of the program including any
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fees for textbooks or other required course materials) (See Reimbursements under
Section X).
C.
Application
1.
Each facility or entity that desires to offer a program shall file an
Application for Program Approval form prescribed by the Department (Form
DMS-724). Application forms are available on the DHS DPSQA website or
you can request an application by emailing:
2.
An outline must be attached to the application showing the lesson plans
and teaching modules utilized to cover the curriculum contents. This should
specify the elements covered in each module, hours of classroom theory, hours
of lab (return demonstrations), and hours in the clinical area in a nursing home.
Each facility’s application must also include the following:
a. PI Resumes/work history to establish LTC experience;
b. AI resume/work history to establish LTC experience;
c. Waiver letter from the Department if utilizing a sanctioned
LTCF;
d. Professional license verification; and
e. Additional information, as requested by the Department.
3.
When applicable for renewals, verification of school licensure by the
Arkansas State Board of Private Career Education within the Arkansas Division
of Higher Education (ADHE) will be required (See item A of this section). A
notarized copy of the school licensure must be included with applications for
new programs and for renewal of programs. Notification to the ADHE verifying
additional instructors and/or changes in instructors will be required with each
application.
4.
Application must be submitted to the Department and approved by the
Department prior to the start of the first course.
5.
An application must be completed and signed by the Primary Instructor.
6.
Applications that are received incomplete may cause postponement of the
program starting date. A notice of deficiency in the application will be mailed to
an applicant within fifteen (15) business days of the date of filing. The applicant
will be given an opportunity to correct any deficiencies.
7.
Notice of approval or disapproval of the application will be given to the
entity within fifteen (15) business days of the receipt of a complete application.
If the application is to be disapproved, the reasons for disapproval shall be given
in the notice.
8.
An applicant may request a review on a disapproval in writing within ten
15
(10) business days of receipt of the notice of the proposed disapproval to the
Division Director. If no request is made, the entity is deemed to have waived the
opportunity for a hearing.
D.
Changes in Programs
1.
Prior to major changes in the course, an application must be resubmitted
for approval
2.
Major changes include, but are not limited to:
−
Change in training provider
−
Change in delivery site (i.e., classroom to virtual);
−
Change in clinical site
−
Change in instructor; and
−
Complete revision of course structure, including change in hours allotted to one (1) or
more modules.
3.
Major changes do NOT include:
−
Change in materials (handouts, textbooks, videos, etc.)
−
Change in order in which modules are taught
−
Addition of modules/tasks not required by rules or guidelines
E.
Withdrawal of Approval
1.
Provisions for monitoring and review of compliance with program
requirements are specified in these rules. The Department shall withdraw
approval of a training program when;
(a)
The program has one (1) or more restrictions;
(b)
The entity offering the program refuses to permit visits by the Department,
whether announced or unannounced. (Any facility that refuses to permit
unannounced visits is subject to having its provider agreement terminated;
(c)
The program’s curriculum and implementation requirements
specified in these rules are not met by the program;
(d)
The program has an excessive failure rate for trainees on the state
competency evaluation test over a three (3) year period and after
opportunities to address the failure rate through enhanced monitoring.;
(e)
Renewal is not completed prior to renewal date. NATP approval will be suspended until
renewal is completed and approved;
(f)
The program makes or causes to be made any false statement or
representation of a material fact used in determining rights or any
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application for payment by any entity for reimbursement of training
costs as allowed in Section X of these rules;
(g)
The program makes or causes to be made any false statement or
representation that training was provided when training was not provided;
(h)
The program makes or causes to be made, or induces or seeks to induce
the making of, any false statement or representation of a material fact with
respect to the conditions or operation of the program in order for the
program to qualify either upon initial approval or re-approval;
(i)
The program makes or causes to be made any false statement or
representation that the amount of training costs are greater than the
actual cost of the training to obtain Medicaid reimbursement, as
allowed in Section X of these rules, that exceeds the actual cost of
training;
(j)
The program makes or causes to be made any false statement or
representation of a material fact in violation of these rules; or
(k) The State determines that any of the applicable requirements of
§483.152 or §483.154 are not met by the program.
2. When the State withdraws approval of a nurse aide training and
competency evaluation program or competency evaluation program:
(a) The State must notify the program in writing, indicating the
reason(s) for withdrawal of approval of the program; and
(b) Students who have started a training and competency evaluation program from which
approval has been withdrawn must be allowed to complete the course.
3. The program may file for a reconsideration of the withdrawal of approval of a nurse aide
training and competency evaluation program within ten (10) business days of the notification.
The reconsideration shall be forwarded to the Director of the division.
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Section VI QUALIFICATIONS OF INSTRUCTORS
A.
Primary Instructor (PI)
1.
The Primary Instructor shall:
(a) Be a Registered Nurse currently licensed in Arkansas or licensed under a
compact license; or holding a multistate privilege to practice if the registered
nurse moves from a state that has joined the Interstate Nurse Licensure
Compact, § 17-87-601 et seq., to Arkansas and meets all requirements for
licensure in Arkansas; (b) Not be under any current disciplinary action by the
Arkansas State Board of Nursing. Disciplinary action includes, but is not
limited to: probation, suspension, revocation or voluntary surrender of license
due to disciplinary action;
(b) Possess a minimum of two (2) years’ general nursing experience as a
registered nurse including at least one (1) year of long-term care nursing
services in a nursing facility setting within the last five (5) years. (Ark. Code
Ann. § 20-10-702).
Nursing experience may include, but is not limited to, employment in:
(a) a Nursing Assistant Education Program;
(b) a long-term care facility, or the supervisor of nursing students in a
long-term care facility or unit;
(c) a geriatrics department (excluding geriatric psychiatry); or
(d) a long-term acute care hospital (recuperative care), home care,
hospice care, or other long-term care setting.
2.
In a facility-based program, the training of nursing assistants may be
performed under the general supervision of the Director of Nursing (DON), who
is prohibited from performing the actual training (unless replacement DON
coverage is provided).
3.
An individual who will be the Primary Instructor and meets the above
criteria must submit the Application for Program Approval (Form DMS-724) to
identify their teaching qualifications. This must include nursing experience,
supervisory experience, teaching experience and/or certificate of attendance in an
instructor workshop.
B.
Primary Instructor Responsibilities
1.
There must be one (1) and only Primary Instructor (PI). A Primary
Instructor may oversee a maximum of four sites. All questions and
correspondence pertaining to the site will be directed to the PI. The PI shall
participate in the planning of each lesson/teaching module including clinical
instruction whether or not the PI teaches the lesson.
https://codes.findlaw.com/ar/title-20-public-health-and-welfare/ar-code-sect-20-
10-705.html
2.
The PI of a nursing assistant training program shall be responsible for
supervision of the program and ensuring that the following requirements are
18
met:
(a)
Course objectives are accomplished.
(b)
Each trainee exhibits the appropriate skills and knowledge to conduct any
part of the training.
(c)
That Each instructor is monitored and evaluated in the classroom, learning
laboratory and clinical training whenever they are teaching an assignment or
introducing material for the first time and at periodic intervals. Performance
reviews of instructors must be documented and maintained.
(d)
The provision of direct individual care to assigned residents by a trainee is
limited to appropriately supervised clinical experience. Instructors shall serve as
supervisor of trainees while in clinical areas and providing resident care.
(e)
Each trainee shall demonstrate competence in clinical skills and
fundamental principles of resident care. The task performance record must be
approved and signed or initialed by the PI.
(f)
Records are kept to verify the participation and performance of each
trainee in each phase of the training program. Satisfactory completion of the
training program shall be attested on each trainee's record.
(g)
Each trainee is issued a certificate of completion within ten (10) calendar
days of course completion and as described in Section IV (B) (6) of these rules.
Additional Instructor Guest Speaker
Instructors may use other qualified resource personnel from the health field as
guest instructors or speakers in the program to meet the objectives for a specific
unit. Examples are pharmacists, dietitians, social workers, sanitarians,
advocates, gerontologists, nursing home administrators, nurse aid program staff,
etc. Guest instructors must have a minimum of one (1) year of experience in
their respective fields and must not have current disciplinary action by their
respective regulatory board.
Additional Instructors such as Registered Nurse (RN) or Licensed Practical
Nurse (LPN) may be used to provide instruction, skills training and/or
supervision. They must be under the general supervision of the Primary
Instructor, currently licensed in Arkansas and shall not be subject to any current
disciplinary action by the Arkansas State Board of Nursing. Disciplinary action
includes, but is not limited to probation, suspension, revocation or voluntary
surrender of license due to disciplinary action and have a minimum of one (1)
year of long-term care experience. All final skills check-off reviews must be
approved by the Primary Instructor.
3.
The Application of Program Approval (Form DMS-724) shall be
used to identify each additional instructor/guest speaker and their
qualifications to teach.
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Section VII REQUIREMENTS FOR EXAMINATION AND CERTIFICATION
A.
Transition
The initial implementation of these training and examination
requirements have covered three basic phases:
1.
Deemed Equivalence Waivers -
A nursing assistant shall be deemed to have satisfied the requirement of
completing a training and competency examination program approved
by the State if the nursing assistant:
a.
Completed a program that offered a minimum of sixty (60)
hours of nursing assistant training before July 1, 1989, and if
such received before July 1, 1989, up to fifteen (15) hours of
supervised and practical nursing assistant training or regular in-
service nursing assistant education (initial training must be at
least seventy-four (74) hours of classroom instruction, as well as
sixteen (16) hours of supervised practical training; a total of
ninety (90) hours);
b.
Completed a course of at least one hundred (100) hours of
nursing assistant training and was found competent (whether
by the State or not) before January 1, 1989; or
c.
Has served as a nursing assistant at one (1) or more facilities
of the same employer in the State for at least twenty-four (24)
consecutive months before December 19, 1989.
Individuals will not qualify for these waivers if they have not provided
nursing or nursing-related services for a period of twenty-four (24)
months or longer since completing training. They will be required to
complete a new training program and state examination to obtain
current certification.
Facilities who wish to obtain certification for the above-described
individuals should submit to the Department Interstate Transfer Form
(DMS-798), with attached copies of documents and/or certificates
verifying course completion, and the number of hours in a course.
2.
Employment Status as of July 1, 1989 -
All individuals working as nursing assistants in Arkansas nursing facilities
as of July 1, 1989, were allowed to become certified by passing the state
examination but were not required to complete the "formal" seventy-four
(74) hours classroom training course, as well as sixteen (16) hours of
supervised practical training; a total of ninety (90) hours.
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This phase was completed by October 1, 1990 and does not apply
thereafter. Therefore, all individuals must now complete the ninety (90)
hour training requirements to qualify to take the state examination
regardless of past employment status on July 1, 1989.
3.
July 1, 1989 - Ongoing -
Effective July 1, 1989, a facility must not use any individual working in
the facility as a nursing assistant for more than four (4) months (one
hundred twenty (120) calendar days) unless they have successfully
completed a training program and competency examination, approved by
the Department, as described in these rules.
B.
Examination
1.
The Department or its appointed agency shall be responsible for
administering the competency examination. The exam shall be based upon
the training curriculum requirements specified in the LTCF Nursing
Assistant Training Curriculum Guide.
2.
The examination will be in English. Translation of this examination
will be offered, if needed. Additional accommodations can be made by the
Department or contractor based on a documented need; however, an additional
fee may be required.
3.
The competency examination shall consist of two (2) components, a
written (or oral) exam and a skills demonstration. Each examination candidate
will be allowed to choose between a written or oral exam. The oral examination
will be read from a prepared text in a neutral manner.
4.
Foreign language translation dictionaries must be shown to the RN Test
Observer at check-in and to the Knowledge Test Proctor when entering the
knowledge test room. No electronic dictionaries are allowed. No definitions
or writing is allowed in the translation dictionary. If there is any writing or
definitions, the translation dictionary will not be permitted to be used during
testing.
5.
The written or oral component shall be developed from a pool of
examination questions. Only a portion will be used in the exam. The skills
demonstration shall consist of five (5) randomly selected questions drawn
from a pool of tasks ranked based on the level of difficulty.
6.
The skills demonstration component will be performed in a facility (not
disqualified by criteria specified in Section V, item B.) or laboratory setting.
7.
The skills demonstration will be administered and evaluated by a
registered nurse (RN) with at least one (1) year experience in providing care
21
for the elderly or chronically ill.
8.
The skills demonstration component may be proctored by facility or
training site personnel (RNs as described above) if secure, standardized, and scored
by the contractor approved by the Department. "Proctoring" will not be approved
in facilities prohibited as specified in Section V item B.
9.
To complete the competency examination successfully, an individual
must pass both the written or oral examination and the skills demonstration. If an
individual does not complete the examination satisfactorily, they will be advised
of areas which they did not pass and their right to take the examination two (2)
more times.
10.
All candidates will be allowed up to three (3) attempts, within in a
twelve (12) month period, to successfully complete all portions of the
competency examination. Failure after three (3) attempts will require retraining
to qualify to sit for the competency examination. An individual has twelve (12)
months to successfully pass the test after retraining.
11.
Any trainee who is employed by any long-term care facility and fails
any portion of the competency examination after three (3) attempts is
prohibited from providing nursing services to residents in a long-term
care facility.
Based on the program rules, these individuals may maintain their employment
status if they re-enroll in a new training program. They would be required to
follow the program implementation requirements of completing the first
sixteen (16) hours (Part I) of training prior to direct resident contact and can
only be assigned job duties thereafter in which they have been deemed
competent to perform as they complete the remainder of the full ninety (90)
hours of training. Upon successful completion of their training, they should be
scheduled for the next available competency examination.
12.
All individuals who successfully complete the examination shall be
placed on the CNA registry and issued a state certificate. Information on the
registry shall be made available for public inquiry (see Section VIII).
C.
Examination Fees, Dates, and Locations
1.
The Department does not require an initial fee for this occupational
license; however, there is a fee to take the state examination. The
amount of the examination fee will be announced in a timely manner
by the Department or designated contractor.
2.
If there were to be an initial fee, per Arkansas Code Ann §17-5-104, the
following individuals are not required to pay an initial fee for this
license:
a.
An individual receiving assistance through the Arkansas
Medicaid Program, the Supplemental Nutrition Assistance
22
Program, the Special Supplemental Nutrition Program for
Women, Infants, and Children, Temporary Assistance for Needy
Families Program, or the Lifeline Assistance Program;
b.
An individual who was approved for unemployment within the
last twelve (12) months; or
c.
An individual who has an income that does not exceed two
hundred percent (200%) of the federal poverty income
guidelines.
3.
The waiver of the initial fee does not include fees for:
a.
A criminal background check;
b.
An examination or a test; or
c.
A medical or drug test.
4.
The examination will be given at multiple sites geographically dispersed
throughout the state. Schedules of times, locations, and registration
requirements will be announced in a timely manner by the Department
or designated contractor.
5.
The competency examination (both written, oral, and skills components)
may be administered in the facility of the candidate’s employment
unless the facility is disqualified by the Department under criteria
specified in Section V, item B.
6.
Each candidate must have appropriate verification of the training
requirements. (see item D of this section and Section IV of these rules).
7.
The Department will be responsible for paying the examination fee one
(1) time for individuals who are employed by a Medicaid certified long-
term nursing facility or those individuals that have a commitment ("letter
of intent" as defined in Section X (A) (2) of these rules) to be employed
in a Medicaid certified nursing facility. Letters of intent to hire from
Medicaid certified nursing facilities must be dated within twelve (12)
months immediately preceding the date of the application to take the
examination. Independent examination candidates who are taking the
competency examination without an employment connection to a long-
term care facility will be responsible to pay their own examination fee. In
accordance with 42 CFR § 483.154, no nurse aide who is employed by,
or who has received an offer of employment from, a facility on the date
on which the aide begins a nurse aide competency examination program
may be charged for any portion of the program.
8.
If an individual who is not employed, or does not have an offer to be
employed, as a nurse aide becomes employed by, or receives an offer of
employment from, a facility not later than twelve (12) months after
completing a nurse aide training and competency examination program,
the State must provide for the reimbursement of costs incurred in
completing the program on a pro rata basis during the period in which the
23
individual is employed as a nurse aide.
D.
Candidate Qualifications
The following is a list of qualifications for the state competency exam.
Note: Individuals listed on the LTCF Employment Clearance Registry, with a
disqualification status due to a substantiated administrative finding of abuse,
neglect, misappropriation of resident property or a disqualifying criminal record
in accordance with Ark. Code Ann. § 20-38-101 et seq, shall not be eligible to
take the competency examination.
1.
Nursing assistants who were trained in approved non-facility programs
(for example: career colleges, Vo-Tech schools, or proprietary schools)
after January1, 1989.
2.
Nursing assistants who were trained in approved facility (nursing homes)
programs after July 1, 1989.
3.
Registered Nurses or students who have finished the basic nursing
course (for example: Introduction to Nursing, or Fundamentals of
Nursing). The individual must provide a copy of their school
transcript, or documentation showing successful completion of the
basic nursing course, to qualify for the state competency examination.
4.
Registered nurses or licensed practical nurses that have had disciplinary
action resulting in suspension, revocation, or voluntary surrender of
license due to disciplinary action, shall not be allowed an exemption to
training or be allowed to challenge the state examination.
5.
Home health aides who have met appropriate federal training or
examination requirements for HHA certification. Verification must
show completion of a minimum of seventy-four (74) hours classroom
training, and sixteen (16) hours of supervised practical training, or
federal testing requirements as a home health aide. This provision does
not apply to "personal care aides" as their training requirements of forty
(40) hours does not meet the ninety (90) hour requirement for the LTCF
Nursing Assistant Training Program's.
6.
Individuals from other states who can verify completion of a state
approved geriatric nursing assistant training program but were not
tested and registered. If registered in the other state, see Section VIII
for reciprocity transfers without further examination. Verification of
course completion rests with the individual and must be submitted to
the DHS designated contractor for approval to take the Arkansas
competency examination.
7.
Nursing assistants whose certification has become inactive based on the
24
recertification requirements (see Section VIII, item C). These individuals
shall be required to be retested for recertification. Permission for retesting
shall require an "admission slip" obtained from the examination agency
prior to the specified examination date.
All other individuals trained in programs that have not received approval from
the Department as a training provider shall not qualify and shall not be allowed
to take the examination. Such programs may include hospitals, emergency
medical technicians, medical assistant programs, personal care aides,
correspondence courses, independent study, on-the-job training, or in-service
training, as they are not acceptable in lieu of the approved training program.
Arkansas Code §17-4-106 Certified Nursing Assistant Licensures of Uniformed Service
Members, Veterans, and Spouses
To comply with Arkansas Occupational Licensing of Uniformed Service Members, Veterans, and
Spouses Act of 2021, the following rules apply to uniformed service members, uniformed service
veterans, and their spouses for licensure as defined below:
1. A uniformed service member stationed in the State of Arkansas;
2. A uniformed service veteran who resides in or establishes residency in the State of
Arkansas and makes an application within one (1) year of his or her discharge from
uniformed service; and
3. The spouse of:
a. A uniformed service member stationed in the State of Arkansas;
b. A uniformed service veteran who resides in or establishes residency in the State
of Arkansas;
c. A uniformed service member who is assigned a tour of duty that excludes the
uniformed service member's spouse from accompanying the uniformed service
member and the spouse relocates to this state; and
d. A uniformed service member who is killed or succumbs to his or her injuries or
illness in the line of duty if the spouse establishes residency in the state.
It is the intent of the Department to prevent removal of occupational licensure barriers for CNA
licensures that may impede the launch and sustainability of civilian occupational careers and
employment faced by uniformed service members, uniformed service veterans, and their spouses
due to frequent uniformed service assignment by providing;
1. Automatic Certified Nursing Assistant (CNA) Licensures. Automatic CNA licensures will
be provided to current license holders in order to expedite their entry into the workforce of
this state by means of reciprocity. Reciprocity may be granted without further training or
testing.
a. The process of reciprocity includes completion of the following with the state
Vendor:
i. Form 9110AR- Out of State Employment Verification for AR Registry Renewal
ii. Form DD214-DD 214/Separation Documents
iii. Form DMS-798- Interstate Transfer Form/CNA Reg. Exemption/Reciprocity
Request.
iv. Image/copy of individuals social security card
v. Image/copy of valid US government issued photo identification; and
25
vi. Proof of service education, training, experience, and service-issued credentials
by means of a Joint Service Transcript (JST).
b. Reciprocity is granted to those who meet the following criteria:
i. Completion of a training and competency evaluation program to become
registered as a nursing assistant in another state, territory, or district of the
United States that meets federal guidelines.
ii. A holder in good standings with CNA licensure within a similar scope of
practice by another state, territory, or district of the United States.
2. Temporary or Provisional Certified Nursing Assistant (CNA) Licensures. Temporary or
provisional CNA licensures to initial CNA licensures candidates will be provided while
expediting full licensure by recognizing uniformed service education, training, experience,
and service issued credentials of uniformed service members and uniformed service
veterans applying for initial CNA licensure. The following criteria will be classified as
meeting service education, training, experience, and credentials;
a. Ninety (90) hours of approved education, training, or experience in healthcare.
b. Sixteen (16) hours of supervised practical skills training in an Arkansas facility;
and
c. passing the Arkansas Nurse Aide Testing with three (3) given attempts in one
hundred eighty (180) days post application.
3. Extension of License Expiration and Continuing Education Requirements. Extension of
license expiration and any continuing education requirements for CNA licensure renewal
for a deployed uniformed service member or their spouse will be granted the following:
a. An extension of the expiration date of a CNA licensure for one hundred eighty
(180) days following the date of the uniformed service member’s return from
deployment.
b. An extension from continuing education requirements for one hundred eighty
(180) days following the date of the uniformed service member or from the
uniformed service member’s return from deployment.
The Department may require evidence of completion of continuing education before granting a
subsequent CNA licensure or authorizing the renewal of a CNA licensure to allow full or partial
exemption from continuing education requirements.
Uniformed service members, veterans and spouses who successfully meet the criteria and standards within the
provisions shall be placed on the CNA registry and issued a state certificate. Information regarding Military Member
Licensure can be found on the DHS-Division of Provider Services and Quality Assurance website at:
http://humanservices.arkansas.gov/about-dhs/dms/office-of-long-term-care.
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Section VIII CNA REGISTRY
A.
Function and Content
1.
The Department shall establish and maintain a registry of all individuals
who have satisfactorily completed the training and competency examination
program requirements. The nursing assistant registry shall be incorporated into
the Long-Term Care Facility Employment Clearance Registry (ECR), which
shall include substantiated administrative findings of abuse, neglect, or
misappropriation of resident property for CNAs.
2.
The information in the registry shall be made available to the public and
open for inquiries twenty-four (24) hours per day, seven (7) days per week (except
for scheduled maintenance or at times of technical problems), by computer
through an online website system (see Subsection B of this section).
3.
The Certified Nursing Assistant registry record, for each individual
who has successfully obtained certification as a LTCF nursing assistant shall
contain the following information:
• Individual’s full name;
• Date of birth;
• Name and date of the State approved training program successfully completed;
• Certification number and date of issuance;
• Current active or inactive status; and
• Most recent re-certification date.
4.
The Department shall review and investigate allegations of neglect, abuse,
or misappropriation of resident property by a nursing assistant. A nursing
assistant shall be given written notice by the Department of a finding on an
allegation and must request, in writing, a formal hearing within thirty (30) days of
receipt of the notice or the right to a hearing shall be waived. Following any
appeal, the registry and the nursing assistant shall be notified of the findings. If
the finding is substantiated either by the individual’s failure to appeal or by
issuance of a final administrative order, the registry shall include the documented
findings involving an individual listed in the registry, as well as any brief
statement of the individual disputing the findings. (See Subsection E of this
Section for the process to petition to remove findings of neglect.)
27
5.
The Department, in the case of inquiries to the registry, shall verify if the
individual is listed in the registry and shall disclose any information concerning a
finding of resident neglect, resident abuse, or misappropriation of resident
property involving an individual listed in the registry. It shall also disclose any
statement by the individual related to the finding or a clear and accurate summary
of such a statement.
B.
Inquiry Process
1.
A facility must inquire of the registry as to information in the registry
concerning any individual to be used as a nursing assistant. A facility may not
use an individual as a nursing assistant until registry inquiry and clearance is
obtained. Registry inquiries shall be performed within five calendar days of the
offer of employment and prior to any resident contact. A facility must document
all inquiries and must include such documentation in the personnel file of each
nursing assistant used by the facility.
2.
Registry clearance shall be obtained by computer access to the online
website system. The URL address to the online website system shall be issued by
the Department, or its designated agent, and may be subject to change. If
needed, facilities should contact the Department for the latest contact
information for the system.
3.
The online website system will maintain an internal log of each inquiry
made by Arkansas nursing facilities using a numeric code (Registry Identification
Number) assigned to each facility. The internal log shall be monitored by the
Department to verify each facility’s compliance with inquiry requirements.
4.
The online website system is capable of providing a printable registry
clearance verification report document for the nursing facility’s use in record
keeping. The facility shall be required to print the registry clearance report and
maintain this report in the employee’s personnel file.
5.
Registry clearances accessed through the online system require the nursing
assistant’s Social Security Number (SSN) and date of birth. Facilities are
required to access by using the SSN or certification number in order to assure an
accurate inquiry.
NAME SEARCHES ARE POSSIBLE ON THE ONLINE SYSTEM BUT
ACCURACY IS NOT ASSURED. NAME SEARCHES MAY ALSO BE
OBTAINED BY CALLING THE DEPARTMENT. PLEASE NOTE,
HOWEVER, THAT NAME SEARCHES BY CALLING THE
DEPARTMENT DO NOT GENERATE A VERIFICATION LOG OF THE
CLEARANCE. THEREFORE, FACILITIES SHALL AVOID THE USE
OF NAME SEARCHES WHEN THE NEED FOR DOCUMENTATION
AND ACCURACY OF THE REGISTRY CHECK IS REQUIRED.
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C.
Inter-state (Reciprocity) Transfer
1.
If an individual has completed a training and competency examination
program and become certified as a nursing assistant in other state(s) that meet
federal guidelines, reciprocity may be granted without further training or testing.
The DMS-798, Interstate Transfer Form, must be submitted to the DHS
designated contractor with a copy of each state's certificate or registration
document. The DHS designated contractor will contact the other state to clear
the individual's status for the transfer of their certification through reciprocity.
The facility may not use the individual until each other state's registry is cleared.
Once that information is received, the CNA may be added to the CNA registry.
Some of these individuals may qualify for registration under certain criteria;
some may be required to take the Arkansas state test, and some may be required
to complete both training and testing.
D.
Certification Renewal
The initial certification period is valid for twenty-four (24) months. Each
certificate contains an expiration date. The Department will develop a plan and
procedure to renew each nursing assistant certification listed in the registry on a
biennial basis (every two years). The renewal process will require the nursing
assistant to document having worked as a nursing assistant for monetary
compensation during the prior two years. This provision shall be defined by at
least one documented day (e.g., eight (8) hours) of employment providing
nursing or nursing-related services for monetary compensation in any setting.
CNAs who provide services for private pay clients must include a check stub and
a notarized letter from the employer, which should include CNA duties
performed within the twenty-four (24) month period, to verify current
employment or employment within the last twenty-four (24) month period.
1.
Employing facilities and/or individuals shall be required to submit
updated information to the registry to establish ongoing eligibility for active
status. The registry shall make "inactive" those individuals who cannot
document having worked in an aide capacity within a twenty-four (24) month
period. Nursing assistants who are currently employed as a nursing assistant at
the time of their renewal will be renewed for twenty-four (24) months. Nursing
assistants who are not currently employed will be renewed for twenty-four (24)
months beginning with the last day employed as a nursing assistant. A
certification that has been expired for a period longer than twenty-four (24)
months cannot be renewed and the individual shall retest and complete sixteen
(16) hours of clinical to re-certify to an active status.
2.
An individual will be required to successfully complete a new competency
evaluation test to become recertified (see Section VII, item D-7) if documentation
of having worked in an aide capacity within the previous twenty-four (24) month
period cannot be provided or for any certification that has been expired for over
twenty-four (24) months.
29
3.
The process to renew a nursing assistant certification shall be overseen by
the Department or its agent. Each certified nursing assistant shall be responsible
for renewing their certification online approximately sixty (60) calendar days
before the expiration of their certification.
4.
Individuals listed on the LTCF Employment Clearance Registry with a
disqualification status due to a substantiated administrative finding of abuse,
neglect, misappropriation of resident property or a disqualifying criminal record
in accordance with Ark. Code Ann. § 20-38-101 et seq shall not be eligible to
renew their certification. Individuals approved for removal of a neglect finding
pursuant to Subsection VIII (E) shall be eligible to renew their certification.
5.
Nursing assistant certifications may not be renewed more than sixty (60)
calendar days prior to the expiration date.
6.
Renewals may be completed through the online website. The Department
or its designated agent shall provide instructions for the online renewal process.
7.
The Arkansas Nursing Assistant Registry renewal must be fully
completed by the CNA, and the information must be accurate to the best of their
knowledge. Failure to fully complete the renewal or provide false or inaccurate
information, , shall constitute the basis for denial of certification renewal.
8.
When a nursing assistant renewal is processed and the nursing assistant is
determined to be eligible for renewal, a new certificate showing the new
expiration date will be available online for the CNA to print and their registry
record shall be updated to reflect the new certification period.
E.
Petition to Remove Neglect Findings
Pursuant to federal law 42 U.S.C. § 1395i-3(g)(1)(D), in the case of a finding of
neglect under Subsection A of Section VIII of these rules, the Department shall
establish a procedure that permits a certified nursing assistant to petition for the
removal of a substantiated finding of neglect.
1.
Factors that must be met are:
a.
The certified nursing assistant must have a substantiated finding of
neglect. There shall not be a Petition process available for
substantiated findings of physical abuse, verbal abuse or
misappropriation of resident property.
b.
The Department makes a determination that the Petitioner’s
employment and personal record does not reflect a pattern of abusive
behavior or neglect. Factors to be considered shall include, but shall not
be limited to:
• The neglect that resulted in a finding was a singular
30
occurrence as identified in the incident investigation file.
• The Petitioner does not have a criminal conviction related
to neglect, abusive behavior, or physical violence.
• The Petitioner’s name does not appear on the Adult and
Long-Term Care Facility Resident Maltreatment Central
Registry or the DHS/Division of Children and Family
Services’ Child Abuse Registry.
• Whether a pattern of abusive behavior or neglect is
discovered through reference checks with prior employers or
other parties.
• Character references as provided by the Petitioner.
c.
At least one year has passed since the Petitioner’s
substantiated finding of neglect was placed on the Registry.
2.
The procedure to file for a Petition to remove a neglect finding shall
include the following:
a.
Petitioner shall submit a letter requesting the removal of the
neglect finding. The letter shall be addressed to:
Division of Provider Services
and Quality Assurance
Nursing Assistant Training
Program
Mail Slot S-405, P.O. Box 8059
Little Rock, AR 72203-8059
b.
The Petitioner must provide the following information with their
request letter:
• Full name and current mailing address;
• Day-time phone number;
• Social Security Number;
• Date of birth;
• Name and day-time phone number of at least two (2)
personal character references;
• Letters of reference from any employment within the
previous year from the date of the Petition. This letter
must include a statement attesting to the Petitioner’s work
performance in relation to the lack of any incidents
involving abusive or negligent behavior;
• A current criminal record report from the Arkansas State
Police. If the Petitioner is currently or has recently (within
the previous twelve (12) months) lived in another state, a
criminal record report must be provided from that state.
All criminal record reports must be an original document
and copies will not be accepted.
31
3.
The Department shall review each Petition for consideration for
removal of the neglect finding. The review shall be conducted by an
administrative review panel consisting of at least three (3) members
appointed by the Division Director. The panel shall meet within thirty
(30) days of any Petition. The review panel shall consider all
information submitted by the Petitioner and may conduct additional
research as needed.
4.
The review panel shall render a decision within thirty (30) calendar days
of the panel’s review, and the Petitioner shall be notified in writing within
ten (10) business days of the review committee’s final determination.
5.
If the Petition to remove the neglect finding is approved, the Registry shall
be updated within ten (10) business days to show the Petitioner no longer
has the neglect record and shall be eligible for employment in Arkansas
long term care facilities. Note that any CNA whose certification has been
expired for over twenty-four (24) months must successfully complete the
state competency test to re-establish employment eligibility as a certified
nursing assistant.
6.
Any applicant whose Petition has been denied may not re-apply for a
subsequent Petition request for a period of at least twelve (12) months from
the date of the previous denial.
7.
If the Petition to remove the neglect finding is denied by the review panel,
any further appeals of the committee’s determination shall be based on the
appeals procedures as listed below:
a.
Administrative hearings are available to persons, herein referred to
as Petitioners, who disagree with determinations to deny a Petition
to remove a neglect finding made by the Department as described in
these rules.
b.
If a Petitioner wishes to appeal, they may do so by mailing a
written notice of appeal to the Office of Appeals and Hearings
Arkansas Department of Human Services,
P.O. Box 1437-Slot N401, Little Rock, Arkansas 72203. The
notice shall be mailed by certified mail, return receipt requested.
The notice of appeal shall state the following:
1.
Name of the Petitioner;
2.
Address of the Petitioner;
3.
Date of birth of the Petitioner;
4.
Phone number, if any, of the Petitioner;
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5.
The Petitioner's place of employment;
6.
A short statement explaining why the Petitioner believes
the determination/decision is in error.
c.
The notice of appeal must be postmarked by the Appeals and
Hearing Office within thirty (30) calendar days from the receipt
of the notification of denial of the petition. No appeal shall be
accepted after thirty (30) calendar days of receipt of the
determination/decision.
d.
A hearing shall be conducted by the Office of Appeals and
Hearings, Department of Human Services. The procedures to
conduct the hearing are as follows:
1.
The hearing record will contain all documents, exhibits and
testimony admitted into evidence by the hearing officer. Within
twenty (20) calendar days of receipt of notice that a Petitioner has
requested a hearing, the Petitioner and the Department will
prepare a file to be submitted to the Office of Appeals and Hearings
and mail a copy of the file by certified mail, return receipt
requested, to the other party. The file will contain only
documentary evidence supporting or tending to support each
party's allegations. The Department will also submit an
Administrative Hearing Statement summarizing the
determination/decision. This statement is not evidence. Only such
portions of each file as determined by the hearing officer to be
relevant shall be included in the Administrative Hearing Record.
2.
Both parties will be advised by the Office of Appeals and
Hearings via certified mail, return receipt requested, that they
have ten (10) calendar days from the date the certified mail
receipt was signed to review the hearing file and submit a request
to subpoena witnesses. The request shall include the name,
address and telephone number of all witnesses not employed by
DHS. DHS employees will be expected to attend hearings and
present testimony without the benefit of a subpoena and will be
notified by the Office of Appeals and Hearings of their required
presence at the hearing. Each party will be notified of any
witnesses requested and will have five
(5) business days from the receipt of this notice to request
subpoenas for rebuttal witnesses.
The Department of Human Services, Office of Chief Counsel, will
issue the subpoenas, pursuant to the terms and authority of Ark.
Code Ann. § 20-76-103.
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3.
After the time frame has expired for subpoenaing
witnesses, the hearing officer will schedule the hearing to afford
the Petitioner, the Department, and their attorneys, if any, at least
ten (10) calendar days’ notice of the date, place and time of the
hearing. The scheduling letter, sent via certified mail with return
receipt requested, shall also contain the name of the hearing
officer who will conduct the hearing. In the event the Petitioner,
the Department representative, or an attorney representing the
Petitioner suffers from illness or cannot attend the hearing due to
scheduling conflicts, that party may request the hearing be
continued. The hearing will be rescheduled by the hearing officer
upon a showing of good cause. A request for continuance made
by the Petitioner or the Petitioner's attorney will constitute a
waiver of any objection as to timeliness of the hearing. In each
case, the hearing and hearing record must be completed within
one hundred twenty (120) calendar days of receipt of the request
for a hearing.
4.
The hearing will take place at a place, time, and manner
determined by the Office of Appeals and Hearing. Hearings may
be conducted by telephone, by personal appearance of the parties,
or by record review by the Office of Appeals and Hearings.
5.
If the Petitioner fails to appear for the hearing when
conducted by telephone or by personal appearance of the parties
and does not contact the Office of Appeals and Hearings prior to
the date of the hearing of their inability to attend, the appeal will
be deemed abandoned. The Petitioner will be advised of this fact
in the scheduling letter.
6.
It is the responsibility of the Department to designate a
representative prior to the time of the hearing. The representative
should be familiar with the circumstances of the
determination/decision and be able to summarize the pertinent
aspects of the situation and present the documentation to support
the basis for the determination/decision. The representative should
also be able to answer questions posed by the Petitioner or the
hearing officer relative to the issues and should be prepared to
cross examine adverse witnesses. The representative may request
the services of an Office of Chief Counsel attorney for
representation at the hearing.
7.
If any party is to be represented by an attorney, notice shall
be given to all parties and to the Office of Appeals and Hearings
at least ten (10) calendar days prior to the hearing. Failure to
furnish notice shall entitle other parties to a continuance to obtain
counsel. Petitioner's failure to furnish notice shall constitute a
waiver of objection as to timeliness of the hearing.
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8.
The hearing will be conducted by a hearing officer from the
Office of Appeals and Hearings who had no part in the
determination/decision upon which the hearing is being conducted.
9.
The Petitioner may be accompanied by friends or other
persons and may be represented by a friend, legal counsel, or other
designated representative.
10.
The hearing officer may not review the case record or other
material either prior to or during the hearing unless such material is
made available to the Petitioner or their representative.
11.
The hearing will be conducted in an informal but orderly
manner. The hearing officer will explain the hearing procedure to
the Petitioner. The administrative hearing statement will be read
by the Department representative. The Department shall then
present its case. After completion of the Department's case, the
Petitioner's case will be presented. The parties shall have the
opportunity to present witnesses, advance arguments, offer
additional evidence, and to confront and cross examine adverse
witnesses. If the Petitioner is unable to present their evidence in
a logical manner, the hearing officer will assist the Petitioner.
Questioning of all parties will be confined to the issue(s)
involved.
12.
The hearing officer will prepare a comprehensive report of
the proceedings. The report will consist of an introduction,
findings of fact, conclusions of law and decision. The report shall
constitute the final agency determination. The determination shall
be mailed to the Petitioner and the Department.
e.
Any further review must be pursued in accordance with the
Administrative Procedure Act, Arkansas Code Annotated
§ 25-15-101 et seq.
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Section IX METHODOLOGY FOR REVIEW OF COMPLIANCE
WITH PROGRAM REQUIREMENTS
A.
Monitoring
1.
A program is subject to inspection at any reasonable time by personnel
authorized by the Department. After initial approval of a training program, the
Department has the right to do an onsite or virtual visit review to determine the
program's implementation of and compliance with the requirements. To ensure
ongoing compliance, the Department has the right to complete unannounced,
onsite, or virtual visits at a minimum of once every two (2) years.
2.
Program reviews may be comprehensive or partial. Based on the findings
of the most current review, or overall test scores, a program may be reviewed
more often and in depth.
3.
The inspector will generate a report that will specify strengths and
deficiencies of the program The Department will terminate programs that do not
meeting minimum requirements and that do not provide an acceptable plan for
correcting deficiencies within the specified timeframe as established by the
Department.
4.
The program will be able to re-apply for in-person or virtual instruction
after the one (1) year suspension.
5.
If a training program is deficient, a corrective action plan must be
submitted to the Department within ten (10) business days of receiving the
notification. The corrective action plan may be returned to the program for
further clarification, if the plan does not accurately describe a plan that corrects
the deficient practice. The Department will send notification to the program upon
approval of the corrective action plan. The corrective action plan must include, at
a minimum, the following:
• Activities to correct deficiencies;
• Person responsible for correcting the deficiencies;
• Implementation date; and
• Signature of the primary instructor.
Failure to respond or inadequate corrective actions may cause suspension of the Department's
approval of the program.
B.
Items Subject to Monitoring
1. Maintenance of Secure Records - Each training program shall provide for
secure maintenance of records. Records to be maintained and protected shall
include at a minimum, the following:
36
−
Names of enrollees;
−
Names of those who successfully complete the program
−
Begin and end dates of each class; Curriculum and/or revisions of curriculum, with
approval from the Department;
−
Tests, grades, course documents, skills checklist;
−
Credentials of instructors;
−
Documentation of all state approvals; and
−
Record of complaints (i.e., nature of complaint, date of complaint, investigation summary
and outcome).
2. Compliance with the following program related curriculum content,
(a)
Program length;
(b)
Ratio of classroom to skills training;
(c)
Qualifications of instructors;
(d)
Quality of skills training supervision;
(e)
Access for clinical training in a nursing facility that was not disqualified
based on criteria specified in Section V (B);
(f)
Physical (classroom and lab) facilities; and
(g)
Virtual classroom capabilities.
2.
Quality of Care - The quality of care provided by individual nursing assistants
monitored during a licensure and/or survey and certification survey
Success Rate - The graduates' success rate of both virtual and in-person trainees
on the state competency examination will be monitored by the Department and
shall be utilized as a criterion for revoking program approval.
4.
Any other requirements included in this manual.
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Section X REIMBURSEMENTS
A.
General Provisions
1.
This section sets forth policy for direct reimbursement for allowable
nursing assistant training costs incurred by Medicaid certified nursing facilities.
Allowable training costs will be separately tracked, documented, and
submitted monthly as described herein. All reimbursements shall be made
directly to the Medicaid certified nursing facility.
2.
Based on Federal regulations, nursing assistants who are employed by (or
who have a “letter of intent” to be employed by) a Medicaid certified nursing
facility may not be charged for any portion of the program (including any fees for
textbooks or other required course material). The Department shall be responsible
to pay for the training costs one (1) time for individuals who are employed by or
have a “letter of intent” to be employed, by a Medicaid certified nursing facility
as set forth in this Section.
The criteria required for reimbursements under the “letter of intent” arrangement
must meet the following:
a.
Letters of intent must be on the facility letterhead, dated within twelve
(12) months immediately preceding the training and signed by the facility
Administrator. Copies of the Administrator’s signature are not allowed;
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 Ark. Code Ann. § 20-38-101 et seq; and
d.
The facility must retain copies of documents to verify compliance with
these provisions as specified in Subsection E of this section.
3.
Allowable costs for nursing assistant training reimbursement may include
the costs for operation of an approved nursing assistant training program, the
costs associated with a cooperative training effort with a neighboring approved
training program (not claimed by that program) and the costs of having nursing
assistants trained in an approved non-facility-based training program (paid by the
facility). Nursing Assistant salaries and fringe benefits, including amounts
paid while in training, and in-service/continuing education costs are not
directly reimbursable but are included on the facility's annual cost report
and reimbursed through the per diem rates.
4.
Reimbursement of nursing facility costs for training of nursing assistants
must be allocated between Medicaid, Medicare, and private pay patients.
Medicaid may not be charged for that portion of these costs that are properly
38
charged to Medicare or private pay activities. Therefore, the Department will pay
only the percentage of the total billed or maximum limit (see item D) for nursing
assistant training based on the percentage of Medicaid recipients indicated on the
billing. Facilities should continue to bill for the total amount of expenses
incurred. The recipient information should reflect the midnight census for the last
day of the month.
B.
Allowable Costs
The following costs are allowable for nursing assistant training:
1.
Nursing Assistant Transportation Expenses. The dollar amount of
transportation expenses paid directly to or reimbursed for the NA to attend
training or to travel to a NA competency evaluation site.
2.
Books. The dollar amount spent for books purchased specifically for use
in the NA training program.
3.
Instructional Equipment. The dollar amount spent for equipment such as
SMARTBoards, iPads and Apple TV, Chromebooks, multi-media
projectors, DVDs, etc. purchased specifically for use in the NA training
program.
4.
Instructional Videos. The dollar amount spent for instructional videos, ,
etc. purchased specifically for use in the NA training program.
5.
Other Training Materials. The dollar amount spent for other
approved training materials purchased specifically for use in the NA
training program.
6.
Training Space. The dollar amount spent for the rent of classroom space
(outside the facility), lab equipment, etc. specifically for the NA training
program. Construction costs for training facilities will not be authorized.
7.
Instructor Wages. The dollar amount of wages paid to the NA Instructor
for training time, only while the NA Instructor is not included in the NF's
staffing pattern providing nursing services.
Facilities should not include the time spent proctoring the skills test as a
training activity for reimbursement. Information reported to DHS on the
DMS-755 is strictly for training, not testing activity.
8.
Instructor Fringe Benefits. The dollar amount paid for fringe benefits for
the NA Instructor while training, only while the NA Instructor is not
included in the NF's staffing pattern providing nursing services.
9.
Nursing Assistant Consultant Training Fees. The dollar amount paid to a
consultant trainer for NA training.
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10.
Consultant Reimbursable Expenses. The dollar amount paid to a
consultant trainer for reimbursable expenses such as travel and lodging.
11.
Instructor Workshop Fees. The amount of tuition and registration fees
paid for NA training program instructors to attend instructor workshops.
Instructor workshops must meet requirements established by the Office of
Long-Term Care to qualify for reimbursement and participants must be
approved for attendance by the Office of Long-Term Care.
12.
Instructor Workshop Travel Expenses. Travel expenses and lodging paid
directly or reimbursed for NA training program instructors to attend
instructor workshops.
13.
Nursing Assistant Training Tuition. The dollar amount spent on tuition
for employees (and potential employees given a "letter of intent", dated
within twelve (12) months immediately preceding the date of the
completion of training) to attend NA training in an approved non-
facility training program. The actual amount of tuition paid for a
student, up to a maximum of $480.00 per student, will be reimbursed
as allowable cost. This amount is based on the provision of the minimum
ninety (90) hours training required by the Department.
C.
Claims Submission
1.
Claims for reimbursement of expenses incurred for NA training costs shall
be submitted to the Department monthly on form DMS- 755. Claims for the
expense month can be submitted no earlier than the first day of the month or the
last day of the month following the expense month. The report forms will be
designed to capture the above cost categories by use area in either formal
"approved" or combined/cooperative training. Therefore, documentation of these
costs should be accounted for in a manner consistent with these categories.
2.
Claims must be submitted to the Department within thirty (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 submitted within fifteen
(15) calendar days of the date returned.
3.
A claim for reimbursement may not be submitted for any month in which
no students completed training. Unclaimed costs in this circumstance may be
carried over to the month when students complete training and will still be subject
to the $480.00 maximum cost limit per student (see item D - Maximum Cost
Limit).
4.
All submitted claims must include a copy of each trainee’s Certificate of
Completion from the training program and a copy of the DHS issued CRC
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Determination Letter. In accordance with Section 203.1 of the Rules for
Conducting Criminal Record Checks for Employees of Long-Term Care
Facilities, the facility must complete the criminal record check for each trainee
prior to conducting the nursing assistant training or prior to sponsoring the
trainee through the “letter for intent to employ” provisions as specified in item
A (2) and B (13) of this section.
5.
Reimbursements are not allowed and shall be denied to facilities for
the following:
a.
Individuals listed on the LTCF Employment Clearance Registry with
a disqualification status due to a substantiated administrative finding of
abuse, neglect, misappropriation of resident property or a disqualifying
criminal record in accordance with Ark. Code Ann. § 20-38-101 et seq.
b.
Individuals listed on the LTCF Employment Clearance Registry with
an expired certification. These individuals are not required to be retrained
and may retest in accordance with Section VII (D) (6) of these rules.
c.
Individuals who, prior to training, did not complete a criminal record
check in accordance with Ark. Code Ann. § 20-38-101 et seq.
6.
All claim forms (DMS-755) must be submitted with original signatures of
the nursing facility Administrator. Copies will not be accepted.
D.
Maximum Cost Limit
1.
In an effort to establish proper and efficient administration of training
costs reimbursements, a reasonable maximum cost limit shall be imposed. Based
on analysis of nursing assistant training costs, $480.00 per student will be the
maximum paid to facilities on their claims. This limit shall be imposed based on
the number of students who finish the training program. Claims must show actual
costs incurred and reimbursements will be made for actual costs but not to exceed
the maximum limit of $480.00 per student who complete the training.
2.
Example: Claim form shows actual costs is $1250.00 with four students
completing the course. As $1250.00 is less than $1920.00 (four (4) students x
$480 = $ 1920 maximum) the actual costs will be reimbursed. If this example had
only two students completing, the maximum would be $960.00 (2 students x
$480) and the reimbursement would be capped at $960.00 rather than paying the
full $1250.00 actual expenses.
E.
Cost Reporting and Record Retention
1.
NA training costs directly reimbursed by the Department of Human
Services shall be included in the nursing facility's annual Financial and Statistical
Cost Report (FSR) and shall be reported as revenue offsets to NA training costs.
Facilities must retain receipts/documentation of NA training costs submitted to
41
the Department for reimbursement for a period of no less than five (5) years or
until all audit findings are final. Any facility claiming reimbursement for costs
not actually incurred or not properly documented will be required to provide
restitution to the Department of Human Services and will be subject to fines
and/or prosecution as authorized by State and/or Federal statutes.
METHODOLOGY FOR REVIEW OF COMPLIANCE WITH
VIRTUAL TRAINING
VIRTUAL INSTRUCTION ONLY APPLIES TO LECTURE PORTION OF TRAINING
All content taught to students remains the same whether the program offers in-person or virtual instruction. If
the program chooses to offer virtual instruction, the expectation of delivery of information remains the same
as in-person. Virtual instruction must be indicated on the application and a virtual plan must be submitted to
the Department for approval. If the program fails to meet the guidelines, it will result in temporary
suspension and/or a deficiency. In addition to complying with rules, the following requirements must be met.
A. Requirements
1. A program is subject to inspection of virtual instruction at any time by Department personnel. A program
who provides virtual instruction must have practical capabilities and set forth expectations including, but not
limited to, the following:
a) Internet capabilities for the program and the participants;
b) Requirements of logging into the virtual site at least fifteen (15) minutes prior to the beginning of class
and staying connected virtually until class ends;
c) A camera that is turned on during instruction.
d) Individual logins must be tracked and maintained for auditing purposes by the Department;
2. Virtual programs are responsible for ensuring that the Department has the virtual link to audit compliance
with these rules. The link must be functional and active at all times.
3. All participants must be able to have visible access to observe all curriculum activities (i.e., hands-on
demonstration, notes on board, and all instruction provided by the program).
4. All videos to be viewed must be included in the curriculum for in-person and virtual training.
5. All skills labs must be in-person.
6. The programs must provide training materials prior to class, including but not limited, web access to
materials.
Nursing Assistant Training Cost Reimbursement Claim Form
The Nursing Assistant Training Cost Reimbursement Claim Form (DMS-755) is specific
to each facility.
To obtain a form DMS-755, or email natpcertification@dhs.arkansas.gov or visit Arkansas Department of Human Services -
DPSQA.
