(a) To train nurse aides, a nursing facility must apply for and obtain approval from HHSC to offer a NATCEP or contract with another entity offering a NATCEP. The nursing facility must participate in Medicare, Medicaid, or both, to apply for approval to be a NATCEP.
(b) A person who wants to offer a NATCEP must file a complete NATCEP application with HHSC.
(c) A person applying to offer a NATCEP must submit a separate NATCEP application for each location at which training is delivered or administered.
(d) A NATCEP application must identify one or more facilities that the NATCEP uses as a clinical site. The clinical site must have all necessary equipment needed to practice and perform skills training.
(e) A NATCEP may offer clinical training hours in a laboratory setting under the following circumstances:
  (1) no appropriate and qualified clinical site is located within 20 miles of the location of the NATCEP; or
  (2) HHSC has determined that clinical training provided in a facility poses a risk to an individual's health or safety based on the existence of a disaster declared at the federal or state level. A NATCEP must request the ability to complete clinical training hours in a laboratory setting under the circumstances described in subsection (e)(1) of this section. HHSC will alert the public of the availability of laboratory training under the circumstances described in subsection (e)(2) of this section.
(f) HHSC does not approve a NATCEP offered by or in a nursing facility if, within the previous two years, the nursing 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 adjusted annually under 45 Code of Federal Regulations (CFR) part 102 for deficiencies in nursing facility standards, 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.
(g) Clinical training provided by a NATCEP in a facility other than a nursing facility must be provided under the direct supervision of the NATCEP instructor and cannot be delegated to any staff of the facility.
(h) A NATCEP using an assisted living facility as a clinical site may provide clinical training only in those services that are authorized to be provided to residents under Texas Health and Safety Code, Chapter 247.
(i) A NATCEP using an intermediate care facility for an individual with an intellectual disability or related conditions as a clinical site may provide clinical training only in those services that are authorized to be provided to individuals under Texas Health and Safety Code, Chapter 252.
(j) A NATCEP using a hospice inpatient unit as a clinical site may provide clinical training only in those services that are authorized to be provided to clients under Texas Health and Safety Code, Chapter 142.
(k) A nursing facility that is prohibited from offering a NATCEP under subsection (e) of this section may contract with a person to offer a NATCEP in accordance with §1819(f)(2)(C) and §1919(f)(2)(C) of the Act so long as the person has not been employed by the nursing facility or by the nursing facility's owner and:
  (1) the NATCEP is offered to employees of the nursing 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 nursing facility;
  (3) there is no other NATCEP offered within a reasonable distance from the nursing facility; and
  (4) an adequate environment exists for operating a NATCEP in the nursing facility.
(l) A person who wants to contract with a nursing facility in accordance with subsection (k) of this section must submit a completed application to HHSC in accordance with §556.4 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 nursing facility in the application. HHSC may withdraw the application within two years of approving it if HHSC determines that the nursing facility is no longer prohibited from offering a NATCEP.
(m) A nursing facility that is prohibited from offering a NATCEP under subsection (e)(3) of this section may request a Centers for Medicare and Medicaid Services waiver of the prohibition related to the civil money penalty in accordance with §1819(f)(2)(D) and §1919(f)(2)(D) of the Act and 42 CFR §483.151(c) if:
  (1) the civil money penalty was not related to the quality of care furnished to residents;
  (2) the NATCEP submits a request to HHSC for the waiver; and
  (3) the Centers for Medicare and Medicaid Services approves the waiver.
(n) A NATCEP must ensure the trainee has completed 100 hours of training. The 100 hours must include:
  (1) 60 hours of classroom training:
    (A) taught by the NATCEP either in-person or virtually; or
    (B) completed by the trainee through HHSC's computer-based training (CBT) within the preceding 12 months; and
  (2) 40 hours of clinical training provided by the NATCEP with at least one program instructor for every 10 trainees.
(o) A NATCEP that provides online training must:
  (1) maintain records in accordance with subsection (y) of this section and otherwise comply with this chapter;
  (2) adopt, implement, and enforce a policy and procedures for establishing that a trainee who registers in an online training is the same trainee who participates in and completes the course. This policy and associated procedures must describe the procedures the NATCEP uses to:
    (A) verify a trainee's identity;
    (B) ensure protection of a trainee's privacy and personal information; and
    (C) document the hours completed by each trainee; and
  (3) verify on the NATCEP application that the online course has the security features required under paragraph (2) of this subsection.
(p) A NATCEP must teach the curriculum established by HHSC and described in 42 CFR §483.152. Except as provided in subsection (q) of this section, 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
Cont'd...