CMS Issues Guidance Related to Loss of Nurse Aide Training Program

The Centers for Medicare and Medicaid Services (CMS) has issued S&C letter 18-02 clarifying situations where a nursing home may regain its Nurse Aide Training and Competency Evaluation Program (NATCEP/CEP) prior to the end of the two-year ban. The two-year ban may be imposed as a result of survey findings where a Civil Money Penalty (CMP) has been levied or where an extended survey or partial extended survey has been conducted. In instances where this remedy has been imposed, many providers have experienced considerable difficulty in the recruitment of certified nurse aides, and the imposition of the penalty on top of other penalties has always been considered unusually harsh.

The attachment, provided with the letter, outlines the circumstances where ending the ban prior to the two-year requirement will be considered. The following situations are described:

State Authority to Waive NATCEP/CEP Disapproval, where the State:

(i) determines that there is no other such program offered within a reasonable distance of the facility;
(ii) assures, through an oversight effort, that an adequate environment exists for operating the program in the facility; and
(iii) provides notice of such determination and assurances to the State long-term care ombudsman.

CMS Regional Office authority to waive disapproval of NATCEP/CEP Due to Civil Money Penalties (CMPs):

Facilities may also request a waiver of NATCEP/CEP loss based on a CMP if the amount imposed is at least $10,483 as adjusted by 45 CFR 102 and the CMP was not related to the quality of care furnished to residents. “Quality of care furnished to residents” means the direct hands-on care and treatment that a health care professional or direct care staff furnished to a resident. This definition is not limited exclusively to Substandard Quality of Care (SQC) deficiencies.

Appeal Rights in Cases for NATCEP/CEP Disapproved Due to Extended/Partial Extended Survey:

When NATCEP/CEP is lost due to an extended or partial extended survey as a result of Substandard Quality of Care (SQC) findings, the facility has the right to request an appeal of these findings to the HHS Departmental Appeals Board (for SNFs and SNF/NFs) or the state (for NFs).

Other Considerations:

An Informal Dispute Resolution (IDR) or an Independent IDR (IIDR) that removes or reduces the findings that required the loss of NATCEP/CEP will result in a restoration of that facility’s program.

Contact: Elliott Frost, efrost@leadingageny.org, 518-867-8832