File No. 34211
This rule was published in the November 15, 2010, issue (Vol. 2010, No. 22) of the Utah State Bulletin.
Health, Health Care Financing, Coverage and Reimbursement Policy
Nursing Assistant Training and Competency Evaluation Program
Notice of Proposed Rule
DAR File No.: 34211
Filed: 11/01/2010 05:53:34 PM
Purpose of the rule or reason for the change:
The purpose of this change is to clarify terminology in the rule text to match federal verbiage, and to clarify other requirements for certified nursing assistants (CNAs) in the Nurse Aide Training and Competency Evaluation Program.
Summary of the rule or change:
This amendment changes the term of "nursing assistant" to "nurse aide" to match verbiage in the federal statute. It also clarifies the renewal process and program access requirements for CNAs, the competency evaluation for CNAs, and training and orientation requirements for CNAs. This amendment further clarifies the limitations of a Nurse Aide Training and Competency Evaluation Program.
State statutory or constitutional authorization for this rule:
- Section 26-18-3
- Section 26-1-5
Anticipated cost or savings to:
the state budget:
The Department does not anticipate any impact to the state budget because this change only clarifies the requirements of a CNA in a Nurse Aide Training and Competency Evaluation Program.
There is no impact to local governments because they do not fund or provide Medicaid programs or services.
The Department does not anticipate any impact to small businesses because this change only clarifies the requirements of a CNA in a Nurse Aide Training and Competency Evaluation Program.
persons other than small businesses, businesses, or local governmental entities:
The Department does not anticipate any fiscal impact to Medicaid providers, Medicaid clients, nursing facilities, and CNAs because this change only clarifies the requirements of a CNA in a Nurse Aide Training and Competency Evaluation Program.
Compliance costs for affected persons:
There are no compliance costs to a single Medicaid provider, Medicaid client, nursing facility, or CNA because this change only clarifies the requirements of a CNA in a Nurse Aide Training and Competency Evaluation Program.
Comments by the department head on the fiscal impact the rule may have on businesses:
The changes imposed by this rule are technical and not expected to have a fiscal impact.
David N. Sundwall, MD, Executive Director
The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:Health
Health Care Financing, Coverage and Reimbursement Policy
288 N 1460 W
SALT LAKE CITY, UT 84116-3231
Direct questions regarding this rule to:
- Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at firstname.lastname@example.org
Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:
This rule may become effective on:
David Sundwall, Executive Director
R414. Health, Health Care Financing, Coverage and Reimbursement Policy.
Training and Competency Evaluation Program.
R414-7B-1. Introduction and Authority.
Nursing Assistant] Training and Competency Evaluation Program is
authorized by the Omnibus Budget Reconciliation Act of 1987 (OBRA),
Pub. L. No. 100 203, 101 Stat. 1330, Sec.
4211,(b)(5)(A)(B)(C)(D)(E)(F)(G), (e)(1)(2), f(2)(A)(B), which the
Department adopts and incorporates by reference. The purpose of
this program is to allow a certified [ nursing assistant] (CNA) to provide quality nursing services to
nursing facility residents.
a]) "Certified [ Nursing Assistant]" means any person who completes a [ UNAR-approved nursing assistant] training
and passes the state certification examination.
b]) "Competency evaluation" means a written or oral
examination that addresses each requirement of OBRA for a [ nursing assistant] and a demonstration of the tasks the [ nursing assistant] is expected to perform as part of the [
(c) "Deemed competency" means that an individual
is deemed to be competent if the individual completed a
state-approved nursing assistant training program on or before July
d]) "[ Nursing assistant]" means any individual who provides nursing
or nursing-related services to residents in a nursing facility, but
does not include an individual who is a licensed professional or
who volunteers to provide these services without monetary
e]) "[ Nursing Assistant] Training and Competency Evaluation
Program" (NATCEP) means any program that the Utah Nursing
Assistant Registry (UNAR) approves to offer training to an
individual who is interested in becoming a certified [ nursing assistant in the state of Utah].
f]) "Nursing facility" means any institution that
is licensed and Medicare or Medicaid-certified to provide long-term
g]) "Resident" means an individual who resides in
and receives medical long-term nursing services in a Medicare or
Medicaid-certified nursing facility.
h]) "Retraining" means training for a CNA who has
not performed paid services for a total of 200 hours of nursing or
nursing-related services under the direction of a licensed nurse
during the 24 months following the completion date of the
state-approved nursing assistant training or certification
i]) "State survey agency" means the Bureau of
Health Facility Licensing, Certification and Resident Assessment,
within the Department of Health, which is responsible for nursing
facility certification and for conducting surveys to determine
compliance with Medicare and Medicaid requirements.
j]) "Supervised practical training" means training
in a nursing facility in which the trainee demonstrates knowledge
while performing tasks on an individual under the direct
supervision of a licensed nurse, who is a UNAR-approved
k]) "Train-the-[ t]rainer program" means a UNAR-approved program that
consists of formal instructions to potential instructors on how to
train adults through demonstrations and lectures.
l]) "Waiver of CNA Training Program" means a
waiver that allows a qualified nursing professional and qualified
in-state expired CNA to challenge the state written and skill
m]) "Utah Nursing Assistant Registry" means the
state agency that approves [ nursing assistant] training programs, monitors all UNAR test sites,
maintains an abuse registry for all substantiated allegations of
resident neglect, abuse or misappropriation of resident property by
a CNA in a nursing
[ facility or] Medicare [ and] Medicaid facility, certifies [ nursing assistants] who have completed a [ nursing assistant training program], and renews certifications of qualified CNAs.
R414-7B-3. Program Access Requirements.
(1) A [
nursing assistant] is required to complete a [ UNAR-approved nursing assistant training program] and become certified within 120 days of the first
date of employment.
(2) An individual who was certified as a [
nursing assistant] on or before July 1, 1989, [ is deemed to be competent and to have met] the OBRA requirement upon completion of the approved
in-service training on mental retardation and mental illness.
(3) If specific requirements are met in the following cases, the UNAR office may grant a waiver to:
(a) a nursing student who has completed
the first semester of nursing school within the past two years and
to a current nursing student. An official transcript of a nursing
fundamentals class must accompany the [
waiver request]. If the candidate does
not pass either the skills or written portion of the CNA
examination after three attempts, [ she] must complete a [ UNAR-approved nursing assistant training program];
(b) an expired licensed nurse who can show
proof of previous licensure
and who was in good standing with [
her] professional board. UNAR shall grant the
candidate one attempt to pass both the skills and written portion
of the examination. If the candidate does not pass either portion,
[ she] must complete a [ UNAR-approved nursing assistant training program].
(c) an expired Utah CNA who is in good
standing with UNAR. UNAR shall grant the candidate one attempt to
pass both the skills and written portion of the examination
. If the
candidate does not pass either portion, the candidate must [
complete a UNAR-approved nursing assistant training
(d) any out-of-state CNA [
deemed] certified and in good standing with another
state's survey agency. UNAR grants reciprocity upon the CNA
providing proof of certification in [ her]
(4) An out-of-state expired CNA must
complete a [
UNAR-approved nursing assistant training program].
R414-7B-4. Competency Evaluation.
(1) An entity that proctors competency
evaluations using both written or oral examinations and
demonstrations of skills to [
nursing assistants] must be UNAR-approved.
(a) An individual shall perform the skills
demonstration component in a facility or laboratory setting
comparable to the setting in which the individual will function as
nursing assistant], and a UNAR-approved representative must
administer and evaluate the demonstration.
(b) The examiner must be a registered nurse (RN) with a current active license to practice nursing as an RN, who is in good standing with the Division of Occupational and Professional Licensing (DOPL) in the state of Utah, with at least one year of experience in providing care for the elderly or chronically ill of any age;
(c) If the individual fails to
satisfactorily complete the skills or written examination after
three attempts at either, the candidate must be advised of the
areas in which the candidate is inadequate and must retrain at an
nursing assistant training program];
(d) UNAR [
must] advise an individual who takes the competency
evaluation that a record of the outcome of the evaluation [ shall] be included in the nursing assistant registry. Further,
UNAR shall require the individual to sign a Release of Information
form that indicates the [ nursing assistant's] understanding of information that UNAR
requires to be entered into the registry;
(e) UNAR shall periodically update and validate the competency evaluations;
(f) UNAR shall establish a written and
oral examination that addresses each requirement as prescribed in
The questions shall be developed] from a pool of test
questions, only a portion of which [ shall be used] in any one evaluation, under a system that maintains
the integrity of both the pool of questions and individual
f]) The competency evaluation must include a demonstration of
the tasks the [ nursing assistant] is expected to perform as part of the [ assistant's] function as a CNA;
g]) For the skills training component of the evaluation, UNAR
shall establish a performance record for each [ nursing assistant training program] of major duties and skills [ taught] that include:
(i) a list[
ing] of the duties and skills that UNAR expects a
CNA to learn in the program in accordance with [ Section R414-7B-4];
(ii) a record that documents when the [
nursing assistant] performs this duty or skill;
(iii) documentation of satisfactory or unsatisfactory performance;
(iv) the date of the performance; and
(v) the instructor supervising the performance.
(2) At the completion of the [
nursing assistant training program, the] [ nursing assistant] [ shall receive] a copy of this record.
(3) The demonstration aspect of the skills
training portion of the competency evaluation [
consists of a minimum performance of] five
tasks, all of which are included in the
performance record. UNAR shall select five tasks for each [ nursing assistant] from a pool of evaluation items ranked according
to degree of difficulty. UNAR shall make a random selection of
tasks with at least one task from each degree of difficulty.
Nurse Assistant Training Program].
(1) UNAR shall administer a NATCEP through a contract with the Department of Health.
(2) An agency that conducts a NATCEP must be UNAR-approved.
(3) Applicants for approval of a [
nursing assistant training program] must be fingerprinted and
have their records checked in state and national bureaus. Before
receiving NATCEP approval, a [ nursing assistant training program] must send a background check and fingerprinting to
UNAR to be placed in the file of the proposed new training
(4) In accordance with [
Section R414-7B-5], UNAR shall review and render a determination [ regarding] approval or disapproval of any [ nursing assistant training program] when a Medicare or Medicaid participating nursing
facility requests the determination. UNAR at its option, may also
agree to review and render approval or disapproval of any private [ nursing assistant training program].
(5) UNAR must, within 90 days of the date of an application, either advise the requestor of UNAR s determination, or must seek additional information from the requesting entity with respect to the program for which it is seeking approval.
(6) UNAR shall approve a [
nursing assistant training program] that meets the criteria specified in OBRA, the
Centers for Medicare and Medicaid Service's guidelines,
guidelines [ desginated] by the Department of Health, and all UNAR
(a) UNAR shall admit a student who is 16 years of age and older on or before the first day that the student begins class; and
(b) shall include an orientation to the training program.
(7) The [
nursing assistant] training program must meet [ minimal] content requirements to be UNAR-approved.
(a) NATCEP must consist of [
no less than] 80 hours of supervised and documented training by a
(b) The curriculum of the training program must include the following subjects:
(i) communication and interpersonal skills;
(ii) infection control;
(iii) safety and emergency procedures;
(iv) promoting resident[
(v) respecting resident[
s'] rights; and
(vi) basic nursing skills.
(c) The trainee must complete at least 16
hours of supervised practical training in a long-term care
facility, and complete all skill curriculum and skill competencies
prior to] training in any facility. The skills training must
ensure that each [ nursing assistant] demonstrates competencies in the following
(i) Basic nursing skills:
(A) taking and recording vital signs;
(B) measuring and recording height;
(C) caring for residents' environment; and
(D) recognizing abnormal signs and symptoms of common diseases and conditions.
(ii) Personal care skills:
(A) bathing that includes mouth care;
(D) using the toilet;
(E) assisting with eating and hydration;
(F) proper feeding techniques; and
(G) skin care.
(iii) Basic restorative services:
(A) use of assistive devices in ambulation, eating, and dressing;
(B) maintenance of range of motion;
(C) proper turning and positioning in bed and chair;
(D) bowel and bladder training;
(E) care and use of prosthetic and orthotic devices; and
(F) transfer techniques.
(iv) Mental Health and Social Service Skills:
(A) modifying [
her own] behavior in response to the resident's
(B) identifying developmental tasks associated with the aging process;
(C) training the resident in self-care according to the resident's ability;
(D) behavior management by reinforcing appropriate resident behavior and reducing or eliminating inappropriate behavior;
(E) allowing the resident to make personal choices, providing and reinforcing other behavior consistent with resident's dignity; and
(F) using the resident's family as a source of emotional support.
(v) Resident's rights:
(a) providing privacy and maintaining confidentiality;
(b) promoting the resident's right to make personal choices to accommodate the resident's needs;
(c) giving assistance in solving grievances;
(d) providing needed assistance in getting to and participating in resident and family groups and other activities;
(e) maintaining care and security of resident's personal possessions;
(f) providing care that keeps a resident free from abuse, mistreatment, or neglect, and reporting any instances of poor care to appropriate facility staff; and
(g) maintaining the resident's environment and care through appropriate nurse aide behavior to minimize the need for physical and chemical restraints.
(8) Qualification of Instructors:
(a) a [
nursing assistant training program] must have a program coordinator who is a registered
nurse with a current and active Utah license to practice;
(b) who is in good standing with DOPL;
(c) with two years of nursing experience, at least one of which is the provision of long-term care facility services or caring for the elderly or chronically ill of any age; and
(d) must have three hours of documented consulting time per month with the respective program.
(9) Nursing facility-based programs:
(a) the program coordinator in a nursing
facility-based program may be the director of nursing for the
facility as long as the facility remains in full compliance with
(b) the primary instructor must be a licensed nurse with a current and active Utah license to practice and must be in good standing with DOPL; and
(c) must have two years of nursing experience, at least one of which is the provision of long-term care facility services or caring for the elderly or chronically ill of any age.
(10) Before approval of a [
nursing assistant training program], the program coordinator and primary instructor must
successfully complete a UNAR-approved "Train-the-Trainer"
program or demonstrate competence to teach adult learners as
defined by UNAR.
(11) Students who provide services to residents must be under the direct supervision of a licensed nurse who is a UNAR-approved clinical instructor and whose clinical time is separate from her facility employment.
(12) Qualified personnel from the health
professions may supplement the program coordinator [
or] primary instructor. The program coordinator or primary
instructor must be present during all provided supplemental
(13) Qualified personnel include
registered nurses, licensed practical or vocational nurses,
pharmacists, dietitians, social workers, sanitarians, fire safety
experts, nursing home administrators, gerontologists,
psychologists, physical and occupational therapists, activities
specialists, speech or language therapists, and any other [
appropriate and duly] qualified personnel.
(14) UNAR requires qualified personnel to have at least one year of current experience in the care of the elderly or chronically ill of any age, or to have equivalent experience. Qualified personnel must also meet current licensure requirements, whether they are registered or certified in their field.
(15) A [
nursing assistant training program] must have a student-to-instructor ratio of 12:1 for
clinical instruction and shall not exceed a 30:1 ratio for theory
instruction. UNAR requires an instructor assistant when the program
has more than 20 students.
(16) A [
nursing assistant training program] must provide a classroom with the following:
(a) adequate space and furniture for the number of students;
(b) adequate lighting and ventilation;
(c) comfortable temperature;
(d) appropriate audio-visual equipment;
(e) skills lab equipment to simulate a resident's unit;
(f) clean and safe environment; and
(g) appropriate textbooks and reference materials.
(17) Initial post-approval and ongoing reviews:
(a) After the initial approval of a [
nursing assistant training program], UNAR grants a one-year probationary period;
(b) During the probationary period, UNAR may withdraw program approval if there is a violation of OBRA, state, federal, or UNAR requirements;
(c) After the probationary period, UNAR shall complete an on-site review and then complete subsequent on-site reviews at least every two years;
(d) The CNA training program shall submit a self-evaluation to UNAR during the interim year that UNAR does not complete an on-site review;
(e) In the event that UNAR does not complete an on-site review within two years, the CNA training program is responsible to send a self-evaluation to UNAR for the applicable two-year period;
(f) If UNAR does not make an on-site visit within two years and the CNA training program sends in a self-evaluation, UNAR must make an on-site visit within one year of the self-evaluation.
(18) The training and evaluation program review must include:
(a) skills training experience;
(b) maintenance of qualified faculty
members for both classroom and skills portions of the [
nursing assistant] training program;
(c) maintenance of the security of the competency evaluation examinations;
(d) a record of complaints received about the program;
(e) a record that each nursing facility
has provided certified [
nursing assistants] with
12 hours of staff development training [ per] year with the compensation for the training;
(f) curriculum content that meets state and federal requirements; and
(g) classroom facilities and required equipment that meet state, federal and UNAR requirements.
(19) In addition to the [
nursing assistant] training that UNAR requires, [ all nursing assistants shall receive an orientation program
from the nursing facility where they are employed, which is not
included in the required 80 hours of training.] This orientation phase [ shall] include an explanation of:
(a) the organizational structure of the facility;
(b) the facility policies and procedures;
(c) the philosophy of care of the facility;
(d) the description of the resident population; and
(e) the employee rules.
R414-7B-6. Nurse Aide Registry.
(1) UNAR is the central registry for all
nursing assistants]. This registry must [ include identification of] individuals who have successfully completed [ and passed] a [ nursing assistant training program] with a passing score of 75.
(2) A [
nursing assistant training program] must report to UNAR, within five days [ of the completion date of] the program
, the names of all individuals who [ have] satisfactorily completed the [ certified nursing assistant training] program.
3]) The state survey agency shall enforce the standards of
UNAR described in OBRA, Secs. 4211 and 4212.
4]) The state survey agency shall investigate all complaints
of resident neglect, abuse or misappropriation of resident property
by a CNA. A CNA is entitled to a hearing through the Division of
Medicaid and Health Financing before a substantiated claim can be
entered into the registry.
5]) After notification from the health facility licensing,
certification and resident assessment agency of a substantiated
claim of abuse, neglect or misappropriation of property of a
vulnerable adult by a CNA, the name of the CNA and an accurate
summary of the findings are placed in the abuse registry in
accordance with UNAR protocol.
(1) UNAR may approve a facility-based NATCEP only if the facility's participation in the Medicare and Medicaid programs has not been terminated within the last two years.
(2) UNAR must review and reapprove a [
nursing assistant training program] at least every two years.
(3) A skilled nursing facility that participates in a Medicare or Medicaid facility may not administer the written and skills components of the competency evaluation.
(4) A nursing facility may employ a [
nursing assistant] for more than 120 days only if the [ assistant] has completed a [ nursing assistant training program].
(5) Upon review of program performance standards, UNAR shall terminate a program that does not provide an acceptable plan to correct deficiencies.[
(6) A nursing assistant who does not perform paid
services that total at least 200 hours of nursing or
nursing-related services under the direction of a licensed nurse
during the 24 months that follow the completion date of the
state-approved nursing assistant training program or
certification renewal, must retrain and repeat the skills and
(7) A candidate has one attempt to pass both the skills and
written portion of the examination. If the candidate fails either
portion of the examination, the candidate must complete a
UNAR-approved nursing assistant training program.]
Date of Enactment or Last Substantive Amendment: [
March 29], 2010
Notice of Continuation: October 20, 2009
Authorizing, and Implemented or Interpreted Law: [
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For questions regarding the content or application of this rule, please contact Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at email@example.com.