WHCA/WiCAL has sought additional guidance from Wisconsin’s Nurse Aide Training and Registry staff within the Division of Quality Assurance (DQA). Based on our conversations, WHCA/WiCAL has slightly new information for facilities who have fallen under the two-year prohibition from operating an in-house Nurse Aide Training and Competency Evaluation Program (NATCEP).

WHCA/WiCAL had previously reported that DQA has adopted a new approach to granting waivers from the two-year prohibition for nursing facilities operating Nurse Aide Training and Competency Evaluation Programs.

In general, DQA’s previous position was that DHS did not have the authority to grant waivers of any kind under certain circumstances related to survey/enforcement results, including for extended surveys and for imposition of CMPs above $10,483 (adjusted for inflation). However, DHS has changed its course, and will now make determinations for approval of waivers to the NATCEP two-year prohibition for waivers requesting the ability to provide nurse aide training in, but not by, the facility. Thus, the facility could serve as the site of the training, as long as there is a third-party trainer. Many providers already use this approach, for example working with a local technical college to provide the instruction.

Please see below for an update on considerations facilities should follow when considering pursuing an “in but not by” NATCEP, in which the facility is used as the site for all or some of the nurse aide training (i.e., classroom, lab/clinical).

For some facilities under the 2-year prohibition, you will have to submit a waiver request to DHS to have an “in but not by” nurse aide training program. Others won’t.

Considerations for facilities that, until the prohibition was imposed, operated a Wisconsin-approved in-house nurse aide training program:

Facilities under a two-year NATCEP prohibition which are seeking to establish an “in-but-not-by” training program, who previously operated their own approved training program, must obtain a waiver from DQA. Waiver requests must provide information to demonstrate 1) there is no other program offered within a reasonable distance of the facility; 2) the facility is an adequate environment for a training program; and 3) the reasons behind the facility’s NATCEP prohibition are not related to resident or nursing care.

Importantly, obtaining this waiver will not allow the facility to continue to operate its previous training program. The waiver would allow the facility to serve as the site for a third-party training program.

Please reach out to WHCA/WiCAL VP of Government Relations and Regulatory Affairs, Jim Stoa, jstoa@whcawical.org if you would like to receive a tried and tested waiver request.

Considerations for facilities which did not operate a Wisconsin-approved in-house nurse aide training program prior to imposition of the prohibition:

Facilities under a two-year NATCEP prohibition which are seeking to establish an “in-but-not-by” training program, who did not previously operate their own approved training program, do not need to obtain a waiver from DQA.

Rather, the approved third-party training program which the facility is partnering with to provide the actual training at the facility (i.e., a tech college, or a private program) must submit a Substantial Change Form indicating the facility as a training program site to DQA, along with the clinical agreement to add the facility as a training site. The documents can be emailed to DQA at DHSWIDQA_NATCEP@dhs.wisconsin.gov. The facility should keep copies of the documentation on-site as well.

If the facility already had a preexisting “in but not by” training program prior to the prohibition, the third party training program likely already has submitted the necessary paperwork to add the facility as classroom/lab and/or clinical site.