[Code of Federal Regulations] [Title 42, Volume 3] [Revised as of October 1, 2005] From the U.S. Government Printing Office via GPO Access [CITE: 42CFR483.151] [Page 545-546] TITLE 42--PUBLIC HEALTH CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PART 483_REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES--Table of Contents Subpart D_Requirements That Must Be Met by States and State Agencies: Nurse Aide Training and Competency Evaluation, and Paid Feeding Assistants Sec. 483.151 State review and approval of nurse aide training and competency evaluation programs and competency evaluation programs. (a) State review and administration. (1) The State-- (i) Must specify any nurse aide training and competency evaluation programs that the State approves as meeting the requirements of Sec. 483.152 and/or competency evaluations programs that the State approves as meeting the requirements of Sec. 483.154; and (ii) May choose to offer a nurse aide training and competency evaluation program that meets the requirements of Sec. 483.152 and/or a competency evaluation program that meets the requirements of Sec. 483.154. (2) If the State does not choose to offer a nurse aide training and competency evaluation program or competency evaluation program, the State must review and approve or disapprove nurse aide training and competency evaluation programs and nurse aide competency evaluation programs upon request. (3) The State survey agency must in the course of all surveys, determine whether the nurse aide training and competency evaluation requirements of Sec. 483.75(e) are met. (b) Requirements for approval of programs. (1) Before the State approves a nurse aide training and competency evaluation program or competency evaluation program, the State must-- (i) Determine whether the nurse aide training and competency evaluation program meets the course requirements of Sec. Sec. 483.152: (ii) Determine whether the nurse aide competency evaluation program meets the requirements of Sec. 483.154; and (iii) In all reviews other than the initial review, visit the entity providing the program. (2) The State may not approve a nurse aide training and competency evaluation program or competency evaluation program offered by or in a facility which, in the previous two years-- (i) In the case of a skilled nursing facility, has operated under a waiver under section 1819(b)(4)(C)(ii)(II) of the Act; (ii) In the case of a nursing facility, has operated under a waiver under section 1919(b)(4)(C)(ii) of the Act that was granted on the basis of a demonstration that the facility is unable to provide nursing care required under section 1919(b)(4)(C)(i) of the Act for a period in excess of 48 hours per week; (iii) Has been subject to an extended (or partial extended) survey under sections 1819(g)(2)(B)(i) or 1919(g)(2)(B)(i) of the Act; (iv) Has been assessed a civil money penalty described in section 1819(h)(2)(B)(ii) of 1919(h)(2)(A)(ii) of the Act of not less than $5,000; or (v) Has been subject to a remedy described in sections 1819(h)(2)(B) (i) or (iii), 1819(h)(4), 1919(h)(1)(B)(i), or 1919(h)(2)(A) (i), (iii) or (iv) of the Act. (3) A State may not, until two years since the assessment of the penalty (or penalties) has elapsed, approve a nurse aide training and competency evaluation program or competency evaluation program offered by or in a facility that, within the two-year period beginning October 1, 1988-- (i) Had its participation terminated under title XVIII of the Act or under the State plan under title XIX of the Act; (ii) Was subject to a denial of payment under title XVIII or title XIX; (iii) Was assessed a civil money penalty of not less than $5,000 for deficiencies in nursing facility standards; [[Page 546]] (iv) Operated under temporary management appointed to oversee the operation of the facility and to ensure the health and safety of its residents; or (v) Pursuant to State action, was closed or had its residents transferred. (c) Time frame for acting on a request for approval. The State must, within 90 days of the date of a request under paragraph (a)(3) of this section or receipt of additional information from the requester-- (1) Advise the requester whether or not the program has been approved; or (2) Request additional information form the requesting entity. (d) Duration of approval. The State may not grant approval of a nurse aide training and competency evaluation program for a period longer than 2 years. A program must notify the State and the State must review that program when there are substantive changes made to that program within the 2-year period. (e) Withdrawal of approval. (1) The State must withdraw approval of a nurse aide training and competency evaluation program or nurse aide competency evaluation program offered by or in a facility described in paragraph (b)(2) of this section. (2) The State may withdraw approval of a nurse aide training and competency evaluation program or nurse aide competency evaluation program if the State determines that any of the applicable requirements of Sec. Sec. 483.152 or 483.154 are not met by the program. (3) The State must withdraw approval of a nurse aide training and competency evaluation program or a nurse aide competency evaluation program if the entity providing the program refuses to permit unannounced visits by the State. (4) If a State withdraws approval of a nurse aide training and competency evaluation program or competency evaluation program-- (i) The State must notify the program in writing, indicating the reason(s) for withdrawal of approval of the program. (ii) Students who have started a training and competency evaluation program from which approval has been withdrawn must be allowed to complete the course.