(a) To train nurse aides, a facility must apply for
and obtain approval from DADS to offer a NATCEP or the facility must
contract with another entity offering a NATCEP.
(b) A person that wants to offer a NATCEP must file
a complete NATCEP application with DADS.
(c) A person applying to offer a NATCEP must submit
a separate NATCEP application for each classroom location.
(d) A NATCEP application must identify one or more
facilities that the NATCEP uses as a clinical site.
(e) DADS does not approve a NATCEP offered by or in
a facility if, within the previous two years, the facility:
  (1) has operated under a waiver concerning the services
of a registered nurse under §1819(b)(4)(C)(ii)(II) or §1919(b)(4)(C)(i)-(ii)
of the Act;
  (2) has been subjected to an extended or partially
extended survey under §1819(g)(2)(B)(i) or §1919(g)(2)(B)(i)
of the Act;
  (3) has been assessed a civil money penalty of not
less than $5,000 as described in §1819(h)(2)(B)(ii) or §1919(h)(2)(A)(ii)
of the Act;
  (4) has been subjected to denial of payment under Title
XVIII or Title XIX of the Act;
  (5) has operated under state-appointed temporary management
to oversee the operation of the facility under §1819(h) or §1919(h)
of the Act;
  (6) had its participation agreement terminated under §1819(h)(4)
or §1919(h)(1)(B)(i) of the Act; or
  (7) pursuant to state action, closed or had its residents
transferred under §1919(h)(2) of the Act.
(f) A facility that is prohibited from offering a NATCEP
under subsection (e) of this section must contract with a person who
has not been employed by the facility or by the facility's owner to
offer NATCEP in accordance with §1819(f)(2) and §1919(f)(2)
of the Act if:
  (1) the NATCEP is offered to employees of the facility
that is prohibited from training nurse aides under subsection (e)
of this section;
  (2) the NATCEP is offered in, but not by, the prohibited
facility;
  (3) there is no other NATCEP offered within a reasonable
distance from the facility; and
  (4) an adequate environment exists for operating a
NATCEP in the facility.
(g) A person who wants to contract with a facility
in accordance with subsection (f) of this section must submit a completed
application to DADS in accordance with §94.4 of this chapter
(relating to Filing and Processing an Application for a Nurse Aide
Training and Competency Evaluation Program (NATCEP)) and include the
name of the prohibited facility in the application. DADS may withdraw
the application within two years of approving it if DADS determines
that the facility is no longer prohibited from offering a NATCEP.
(h) Before September 1, 2013, a NATCEP must provide
at least 75 hours of training to a trainee. The 75 hours must include:
  (1) 51 hours of classroom training; and
  (2) 24 hours of clinical training, which includes care
of residents and has at least one program instructor for every 10
trainees.
(i) Effective September 1, 2013, a NATCEP must provide
at least 100 hours of training to a trainee. The 100 hours must include:

  (1) 60 hours of classroom training; and
  (2) 40 hours of clinical training, which includes care
of residents and has at least one program instructor for every 10
trainees.
(j) A NATCEP must teach the curriculum established
by DADS and described in the Code of Federal Regulations, Title 42, §483.152.
The NATCEP must include at least 16 introductory hours of classroom
training in the following areas before a trainee has any direct contact
with a resident:
  (1) communication and interpersonal skills;
  (2) infection control;
  (3) safety and emergency procedures, including the
Heimlich maneuver;
  (4) promoting a resident's independence;
  (5) respecting a resident's rights;
  (6) basic nursing skills, including:
    (A) taking and recording vital signs;
    (B) measuring and recording height and weight;
    (C) caring for a resident's environment;
    (D) recognizing abnormal changes in body functioning
and the importance of reporting such changes to a supervisor; and
    (E) caring for a resident when death is imminent;
  (7) personal care skills, including:
    (A) bathing;
    (B) grooming, including mouth care;
    (C) dressing;
    (D) toileting;
    (E) assisting with eating and hydration;
    (F) proper feeding techniques;
    (G) skin care; and
    (H) transfers, positioning, and turning;
  (8) mental health and social service needs, including:
    (A) modifying the aide's behavior in response to a
resident's behavior;
    (B) awareness of developmental tasks associated with
the aging process;
    (C) how to respond to a resident's behavior;
    (D) allowing a resident to make personal choices, providing
and reinforcing other behavior consistent with the resident's dignity;
and
    (E) using a resident's family as a source of emotional
support;
  (9) care of cognitively impaired residents, including:
    (A) techniques for addressing the unique needs and
behaviors of a resident with a dementia disorder including Alzheimer's
disease;
    (B) communicating with a cognitively impaired resident;
    (C) understanding the behavior of a cognitively impaired
resident;
    (D) appropriate responses to the behavior of a cognitively
impaired resident; and
    (E) methods of reducing the effects of cognitive impairments;

  (10) basic restorative services, including:
    (A) training a resident in self care according to the
resident's abilities;
    (B) use of assistive devices in transferring, ambulation,
eating, and dressing;
    (C) maintenance of range of motion;
    (D) proper turning and positioning in bed and chair;
    (E) bowel and bladder training; and
    (F) care and use of prosthetic and orthotic devices;
and
  (11) a resident's rights, including:
    (A) providing privacy and maintenance of confidentiality;

    (B) promoting the resident's right to make personal
choices to accommodate their needs;
    (C) giving assistance in resolving grievances and disputes;

    (D) providing needed assistance in getting to and participating
in resident, family, group, and other activities;
    (E) maintaining care and security of the resident's
personal possessions;
    (F) promoting the resident's right to be free from
abuse, mistreatment, and neglect and the need to report any instances
of such treatment to appropriate facility staff; and
    (G) avoiding the need for restraints in accordance
with current professional standards.
(k) A NATCEP must have a program director and a program
instructor when the NATCEP applies for initial approval by DADS in
accordance with §94.7 of this chapter (relating to Review and
Reapproval of a Nurse Aide Training and Competency Evaluation Program
(NATCEP)) and to maintain DADS approval. The program director and
program instructor must meet the requirements of §94.5(a) and
(b) of this chapter (relating to Program Director, Program Instructor,
Supplemental Trainers, and Skills Examiner Requirements).
(l) A NATCEP must verify that a trainee:
  (1) is not listed on the NAR in revoked status;
  (2) is not listed as unemployable on the EMR;
  (3) has not been convicted of a criminal offense listed
in Texas Health and Safety Code (THSC), §250.006(a), or convicted
of a criminal offense listed in THSC, §250.006(b) within the
five years immediately before participating in the NATCEP.
(m) A NATCEP must ensure that a trainee:
  (1) completes the first 16 introductory hours of training
(Section I of the curriculum) before having any direct contact with
a resident;
  (2) only performs services for which the trainee has
been trained and has been found to be proficient by a program instructor;

  (3) is under the direct supervision of a licensed nurse
when performing skills as part of a NATCEP until the trainee has been
found competent by the program instructor to perform that skill;
  (4) is under the general supervision of a licensed
nurse when providing services to a resident after a trainee has been
found competent by the program instructor;
  (5) is clearly identified as a trainee during the clinical
training portion of the NATCEP.
(n) A NATCEP must submit a NATCEP application to DADS
if the information in an approved NATCEP application changes. A NATCEP
may not continue training or start new training until DADS approves
the change. DADS conducts a review of the NATCEP information if DADS
determines the changes are substantive.
(o) A NATCEP must use a DADS performance record to
document major duties or skills taught, trainee performance of a duty
or skill, satisfactory or unsatisfactory performance, and the name
of the instructor supervising the performance. At the completion of
the NATCEP, the trainee and the employer, if applicable, will receive
a copy of the performance record.
(p) A NATCEP must maintain records and make them available
to DADS or its designees at any reasonable time. The records must
include:
  (1) dates and times of all classroom and clinical training;

  (2) full name and social security number of a trainee;
  (3) attendance record of a trainee;
  (4) final course grade for the training portion of
the NATCEP that indicates pass or fail for a trainee; and
  (5) daily sign-in records for classroom and clinical
training.
(q) A facility must not charge a nurse aide for any
portion of the NATCEP, including any fees for textbooks or other required
course materials, if the nurse aide is employed by or has received
an offer of employment from a facility on the date the nurse aide
begins a NATCEP.
(r) DADS reimburses a nurse aide for a portion of the
costs incurred by the nurse aide to complete a NATCEP if the nurse
aide is employed by or has received an offer of employment from a
facility within 12 months after completing the NATCEP.
(s) DADS must approve a NATCEP before the NATCEP solicits
or enrolls trainees.
(t) DADS approval of a NATCEP only applies to the required
curriculum and hours. DADS does not approve additional content or
hours.
(u) A new employee or trainee orientation given by
a facility to a nurse aide employed by the facility does not constitute
a part of a NATCEP.
(v) A NATCEP that provides training to renew a nurse
aide's listing on the NAR must include training in geriatrics and
the care of residents with a dementia disorder, including Alzheimer's
disease.


Source Note: The provisions of this §94.3 adopted to be effective June 27, 2013, 38 TexReg 3999