Approval of NATCEPs and CEPs

4132.1 - Approval of NATCEPs and CEPs (Rev. 1, 05-21-04) If the State does not offer a NATCEP or CEP, the State should review and approve or disapprove all NATCEPs, upon request. The State should approve NATCEPs and CEPs offered by any entity as long as the requirements for approval are met. 4132.1A - Requirements for Program Approval (Rev. 1, 05-21-04) Before approving a NATCEP or CEP, the State should: • For NATCEPs, determine whether the requirements of §4132.2 are met; • For CEPs, determine whether the requirements of §4132.3 are met; and • In all reviews other than the initial review, visit the entity providing the program. 4132.1B - Time Frames for Review (Rev. 1, 05-21-04) Within 90 days of a request to review a program or receipt of additional information from a requester, the State must: • Advise the requestor whether the program has been approved; or • Request additional information. The State may not grant approval of a program for more than 2 years. The State should require programs to notify the State when there are substantive changes to the program within the two-year period, and the State should review programs to which substantive changes are made. 4132.1C - Prohibition of Program Approval (Rev. 1, 05-21-04) Unless program disapproval is waived in accordance with subsection E below, the State must not approve a NATCEP or nurse aide CEP offered by or in a nursing home if, in the 2 years prior to the State’s review, that facility: • In the case of a skilled nursing facility, has operated under a waiver under §1819(b)(4)(C)(ii)(II) of the Act; • In the case of a nursing facility, has operated under a waiver under §1919(b)(4)(C)(ii) of the Act that was granted on the basis of a demonstration that the NF is unable to provide nursing care required under §1919(b)(4)(C)(i) of the Act for a period in excess of 48 hours a week; • Has been subject to an extended (or partial extended) survey under §§1819(g)(2)(B)(i) or 1919(g)(2)(B)(i) of the Act; Has been assessed a civil money penalty described in §§1819(h)(2)(B)(ii) or 1919(h)(2)(A)(ii) of the Act of not less than $5,000. This requirement applies to civil money penalties for Federal citations only after the facility has had an opportunity to a hearing as specified in §1128A of the Act and the penalty is determined due and payable; or • Has been subject to a remedy described in §§1819(h)(2)(B)(i) or (iii), 1819(h)(4), 1919(h)(1)(B)(i), or 1919(h)(2)(A)(i), or (iii), or (iv) of the Act. 4132.1D - Withdrawal of Program Approval (Rev. 1, 05-21-04) Unless the State waives program disapproval in accordance with subsection E below, the State must withdraw approval from: • Any NATCEP or CEP described in subsection C; and • Any NATCEP or CEP if the entity offering the program refuses to permit unannounced State visits. (Also, any facility that refuses to permit unannounced State visits is subject to having its provider agreement terminated, and being excluded from the program by the Office of the Inspector General.) The State may withdraw approval of a NATCEP or CEP if the State determines that any of the requirements described in §§4132.2 and 4132.3 are not met by the program. The State may also withdraw approval from any program that does not meet any requirements the State may have in excess of the minimum Federal requirements, or that otherwise fails to meet State standards. When withdrawing approval from a NATCEP or a CEP, the State should: • Notify the program in writing, indicating the reason(s) for withdrawal of approval; and • In the case of a NATCEP, permit students who have already started the program to finish it. 4132.1E - Waiver of Program Prohibition (Rev. 126, Issued: 11-21-14, Effective: 11-21-14, Implementation: 11-21-14) A facility may request that CMS waive the disapproval of its nurse aide training program when the facility has been assessed a civil money penalty of no less than $5,000 if the civil money penalty was not related to the quality of care furnished to residents in the facility. While the waivers should be submitted to the State, CMS will make the final determination on a case by case basis after considering the recommendation and facts of the case as provided by the State. Duration of Waiver - A waiver may not exceed 2 years, but must be withdrawn earlier if the facility is subsequently found to no longer meet the waiver criteria. If 2-year disapproval periods overlap, any non-waived disapproval in the earlier period will control waiver rights in the second until the two periods no longer overlap. Below are examples describing the effect of a series of survey findings on a facility’s ability to have a waiver. EXAMPLE: Year 1: A survey conducted at Facility X identifies substandard quality of care. The finding of substandard quality of care results in nurse aide training and competency evaluation program disapproval for 2 years. The facility requests and is granted a waiver after the State has confirmed that the facility has removed the substandard quality of care. The waiver may not exceed 2 years. Year 2: The survey of Facility X identifies substandard quality of care. Based on this current finding of substandard quality of care, the facility loses its existing waiver. This nurse aide training and competency evaluation program disapproval, based on this survey, is effective for 2 years. Additionally, the facility forfeits the waiver granted in year 1 due to its inability to continue to meet waiver criteria at E.1.b. (i.e., to be free of deficiencies which constitute substandard quality of care. Year 3: The survey of Facility X identifies deficiencies that do not constitute substandard quality of care, but result in the imposition of denial of payment for new admissions. The imposition of this remedy results in nurse aide training and competency evaluation program disapproval for 2 years. The facility requests and is granted a waiver. The waiver may not exceed 2 years. However, since the facility is currently operating under a nurse aide training and competency evaluation program disapproval for 2 years, based on its year two survey, the waiver resulting from this current survey will not apply until the remainder of the disapproval period (which overlaps with part of the waiver period) is satisfied. 4132.1F - Conflicts of Interest (Rev. 1, 05-21-04) States are governed by their respective conflict of interest laws and are free to develop their own policies or rules about what may or may not constitute a conflict of interest relative to nurse aide training and competency evaluation programs. This gives States the ability to define their programs so that they can meet their needs relative to NATCEPs while meeting the intent of the law. Factors States may consider in making conflict of interest determinations may include, but are not limited to, the following: • Whether the training program being offered is owned and operated independently of the ownership and operation of the nursing home that has lost its ability to train; • Whether facility staff, who are also employees of an approved outside training program, should be permitted to train in the facility (as employees of the outside training program) if the facility loses its ability to train; and • Any other factors the State believes to be relevant in making conflict of interest determinations.