201 Ky. Admin. Regs. 20:700

Current through Register Vol. 51, No. 5, November 1, 2024

Section 201 KAR 20:700 - Medication aide training programs and credentialing of medication aides

RELATES TO: KRS 194A.705(2)(c), 216.510(1), 216.590, 314.011, 314.133

NECESSITY, FUNCTION, AND CONFORMITY: KRS 314.131(1) and 314.133 require the board to promulgate administrative regulations to establish requirements for the credentialing of medication aides, including educational requirements, standards for training programs including delegation of the administration of oral or topical medications and preloaded insulin injection, credentialing requirements, and fees for initial, renewal, and reinstatement of credentials, and any other necessary fees. This administrative regulation establishes requirements for board approval of medication aide training programs and requirements for the credentialing of medication aides.

Section 1. Definitions.

(1) "Board" is defined by KRS 314.011(1).

(2) "Didactic" means the component of a medication aide training program that includes lecture, verbal instruction, or other means of exchanging theoretical information between the instructor and students, including a classroom setting or distance learning technology.

(3) "Long-term care facility" is defined by KRS 216.510(1).

(4) "Mentor" means a didactic instructor with teaching experience.

(5) "Nursing facility" means a facility defined by 42 C.F.R. 483.5.

(6) "Training program" means formal specialized medication aide training provided by an individual, facility, third party vendor, college, or school.

Section 2. Certified Medication Aide Requirements.

(1) A Certified Medication Aide (CMA) I:

(a) Shall have met the requirements of Section 7(2), (3), (4), and (5) of this administrative regulation; and

(b) May administer oral or topical medications under the delegation of a nurse upon successful completion of a board approved examination that validates the competency of the topics covered by the CMA curriculum under Section 7(5) of this administrative regulation.

(2) A Certified Medication Aide (CMA) II:

(a) Shall have met the requirements of Section 7(6), (7), and (8) of this administrative regulation; and

(b) May administer only insulin via preloaded insulin pen upon successful completion of a board approved examination that validates the competency of administration of insulin via preloaded insulin pen and the topics covered by the CMA II curriculum under Section 7(7) of this administrative regulation.

(3) A Kentucky Medication Aide (KMA) shall:

(a) Be a State Registered Nurse Aide (SRNA);

(b) Successfully complete the medication aide examination administered by the Kentucky Community and Technical College System (KCTCS);

(c) Administer oral or topical medications under the delegation of a nurse to a resident of a long-term care facility; and

(d) Be accepted by the board as having a credential that shall be equivalent to a CMA I.

Section 3. Medication Aide Training Program Approval.

(1) A KMA medication aide training and testing program administered by a college within KCTCS shall:

(a) Be determined as compliant with the requirements of this administrative regulation; and

(b) Not be required to submit an application to the board unless the KMA program provides training to individuals seeking a CMA II credential.

(2) Unless exempt under subsection (1) of this section, a training program shall not admit an individual until the program has been approved by the board.

(3) A training program that may request approval from the board to provide medication aide training for an individual seeking a CMA I or CMA II credential shall be:

(a) A long-term care facility that has a license in good standing and offers medication aide training to:

1. Its own employees; or

2. Employees of a long-term care facility owned by the same company;

(b) A Kentucky university or college program; or

(c) Other proprietary education program located in Kentucky.

(4) In-state training programs.

(a) An in-state entity seeking board approval of its training program shall:

1. Submit a completed Application for Medication Aide Training Program (CMA I) or an Application for Medication Aide Training Program (CMA I or CMA II) via the portal at www.kbn.ky.gov accompanied by a fee of:

a. $200 for initial approval of a CMA I training program; or

b. $300 for initial approval of a CMA I and CMA II training program;

2. Prepare each candidate seeking a CMA I credential to pass:

a. The Medication Aide Competency Examination (MACE) administered by National Council of State Boards of Nursing; or

b. Other competency examination approved by the board; and

3. If the training program prepares a candidate seeking a CMA II credential, it shall prepare the candidate to pass a competency examination approved by the board.

(b) If the training program administers a proprietary competency examination to candidates seeking a CMA I or CMA II credential, the program shall submit a copy of the examination to the board for prior approval.

(5) Out-of-state training.

(a) An individual who completes a medication aide training program provided by an out-of-state training provider shall:

1. As a condition of obtaining the CMA I credential, pass the MACE or other competency examination approved by the board; or

2. As a condition of obtaining the CMA II credential:

a. Complete an out-of-state training program that meets the requirements of Section 7(7) and (8) of this administrative regulation; and

b. Pass a competency examination approved by the board.

(b) An out-of-state medication aide training program shall be exempt from the application requirements of subsection (4)1. of this section.

Section 4. Medication aide training program administration.

(1) The training program shall:

(a) Appoint a program administrator who shall be responsible for the administrative oversight of the program; and

(b) Submit the following in writing to the board:

1. Name of the program administrator;

2. Date the program administrator will assume responsibility for administrative oversight of the program; and

3. A copy of the program administrator's curriculum vitae.

(2)

(a) The training program shall notify the board in writing of a change of a program administrator within thirty (30) days of the personnel change; and

(b) Develop and implement a plan of organization and administration that clearly establishes the lines of authority, accountability, and responsibility for each training program location.

(3) The program administrator shall maintain a system of official records and reports essential to the operation of the training program according to the program's written policies that:

(a) Addresses how the program's records shall be maintained in a secure manner to protect from loss or unauthorized distribution or use;

(b) Ensures that all records shall be retained for at least five (5) years;

(c) Ensures that each trainee roster includes:

1. The nurse instructor's name and licensure information;

2. Each trainee's:

a. Name;

b. Date of birth;

c. Last four (4) digits of the trainee's Social Security number; and

d. Program activity and completion dates;

(d) Documents how the program will conduct a periodic and systematic plan of evaluation; and

(e) Ensures that a list of successful graduates of the training program is maintained.

Section 5. Program Administrator. The program administrator shall be:

(1) The facility administrator on record for each facility; or

(2) A registered nurse who has the following qualifications:

(a) An unencumbered Kentucky nursing license or multistate privilege to practice; or

(b) A temporary work permit as nurse in Kentucky.

Section 6. Instructors.

(1) The number of instructors shall be adequate to implement the training program as determined by:

(a) Program outcomes;

(b) Instruction objectives; and

(c) The educational technology utilized.

(2) The program administrator shall be responsible for approving the instructors.

(3) Didactic instructors.

(a) The training program's didactic instructor shall have the following qualifications:

1. An unencumbered Kentucky nursing license or multistate privilege to practice; or

2. A temporary work permit as nurse in Kentucky.

(b) If the didactic instructor does not have prior teaching experience, the program administrator shall assign a mentor to the didactic instructor for the purpose of assisting with implementation of an educational development plan.

(4) Clinical instructors and preceptors.

(a) A clinical instructor shall hold a current:

1. Unencumbered Kentucky nursing license or multistate privilege to practice; or

2. Temporary work permit as nurse in Kentucky.

(b) A preceptor shall:

1. Meet the clinical instructor requirements in paragraph (a) of this subsection; or

2.

a. Hold a current medication aide certification; and

b. Have a minimum of six (6) months experience administering medications.

(5) Each training program shall maintain records in accordance with Section 4 of this administrative regulation to document that each clinical instructor has been oriented to the:

(a) Course;

(b) Program outcomes;

(c) Student learning objectives;

(d) Evaluation methods used by the instructors; and

(e) Role expectations.

Section 7. Standards for Training Programs and Medication Aide Certification.

(1) A training program shall conduct an evaluation as required by Section 4(3)(d) of this administrative regulation to:

(a) Validate that identified program outcomes have been achieved; and

(b) Provide evidence of improvement based on an analysis of the results.

(2) As a condition of admission to a training program for a CMA I credential, the applicant shall:

(a) Be able to read, write, and speak English;

(b) Have basic math skills;

(c) Have a high school diploma or equivalent; and

(d)

1. Have at least six (6) months of continuous work experience as a State registered nurse aide (SRNA) in a nursing facility; or

2. Be a direct care staff member of a:

a. Long-term care facility that is not certified under 42 C.F.R. Part 483 ;

b. Facility operated by the Department of Juvenile Justice; or

c. Residential facility licensed by the Cabinet for Health and Family Services if authorized under the facility's scope of licensure.

(3) A training program that prepares an individual for a CMA I credential shall:

(a) Include at least:

1. Forty (40) clock hours of didactic course work;

2. Twenty (20) clock hours of skills laboratory; and

3. Forty (40) clock hours of direct patient contact with a clinical instructor;

(b) Ensure that the didactic course work and skills laboratory shall be completed in no shorter than a two (2) week course;

(c) Ensure that the candidate is precepted for a minimum of sixty (60) clock hours; and

(d) Maintain a log of clinical hours for each trainee in which the instructor and preceptor document completion of the clock hours required by paragraphs (a) through (c) of this subsection.

(4)

(a) Upon completion of CMA I training, a candidate shall complete the MACE or other board approved examination within sixty (60) days.

(b) If the candidate does not pass the examination after two (2) attempts or if more than sixty (60) days have elapsed since completion of the CMA I training, the candidate shall provide documentation of repeating the CMA I training to be eligible to retake the examination.

(5) The curriculum for a CMA I training program shall include the following topics:

(a) Medication orders, documentation, storage, and disposal;

(b) Mathematics, weights, and measures;

(c) Forms of medications;

(d) Medication basics, including terms, abbreviations, dosage, and actions;

(e) Safety and rights of medication administration;

(f) Preparation and actual medication administration;

(g) Prevention of medication errors;

(h) Causes and reporting of medication errors;

(i) Building of relationships;

(j) Reporting of symptoms or side effects;

(k) Reporting of changes from the resident's normal condition, status, or routine;

(l) Documentation of medication administration;

(m) Routes of administration;

(n) Factors affecting how the body uses medication;

(o) Classes of medications related to body systems and common actions;

(p) Location of resources and references;

(q) Rights of individuals;

(r) Specific legal and ethical issues;

(s) Knowledge of infection control related to medication administration;

(t) Roles of the supervising nurse;

(u) Role of the medication aide; and

(v) Responsibility of the medication aide when accepting delegated tasks.

(6) As a condition of admission to a training program for a CMA II credential, the applicant shall have successfully completed the CMA I training and passed the board approved CMA I examination.

(7) A training program that prepares an individual for a CMA II credential shall include:

(a) A minimum of sixteen (16) clock hours of didactic course work in insulin administration via a prefilled insulin pen;

(b) A minimum of eight (8) clock hours of clinical training with continuous, direct, on-site supervision by a nurse to be completed within sixty (60) days of completion of the didactic course work;

(c) A minimum of twenty (20) documented insulin injections via prefilled insulin pen that shall be:

1. Directly supervised by a nurse; and

2. Completed within sixty (60) days of completion of the didactic course work; and

(d) A board approved competency examination.

1. Upon completion of the CMA II training, a candidate shall complete a board approved examination within sixty (60) days.

2. If the candidate does not pass the examination after two (2) attempts or if more than sixty (60) days have elapsed since completion of the CMA II training, the candidate shall provide documentation of repeating the CMA II training to be eligible to retake the examination.

(8) The curriculum for a CMA II training program shall include the following topics:

(a) Pathophysiology of diabetes;

(b) Diabetes disease management;

(c) Blood glucose testing and use of equipment;

(d) Understanding the meaning of glucose levels;

(e) Insulin administration procedure;

(f) Potential complications and adverse reactions; and

(g) Role and responsibility.

(9) Implementation of the curriculum.

(a) A training program shall be developed to include outcomes, planned instruction, learning activities, and methods of evaluation.

(b) The instruction methods and activities of both instructor and trainee shall be specified. The activities shall be congruent with stated objectives, and content shall reflect adult learning principles.

(c) A copy of the training program's curriculum shall be on file and available to the board upon request.

(d) Didactic instruction may be offered through distance learning technologies. The instruction offered through the use of distance learning technologies shall be comparable to that offered in an in-person program.

(10) Substantive changes to the training program's standards for medication training or certification shall be:

(a) Submitted to the board portal at www.kbn.ky.gov with a completed Application for Medication Aide Training Program (CMA 1) and Application for Medication Aide Training Program (CMA I and II) within thirty (30) days of implementation; and

(b) Subject to a change of status fee of:

1. $200 for a CMA I training program; or

2. $300 for a CMA II training program.

(11) A training program shall respond to a written request from the board for documentation within thirty (30) days of the date of the board's request.

(12) The board may amend a program's standards for medication training or certification if it fails to comply with the requirements of the administrative regulation. Upon written notification, the training provider shall comply with the requirements within thirty (30) days.

(13) The board may deny, suspend, or revoke approval or the change of status of a medication aide training program, based upon the following:

(a) Failure to meet or maintain the requirements set forth in this administrative regulation; or

(b) Submitting false, misleading or deceptive statements, information, or documentation to the board or its designees.

(14) If approval of the training program is denied, suspended, or revoked, the board shall do so in writing stating the reasons for the adverse action.

Section 8. Program Completion Requirements and Recertification.

(1) Each individual who successfully completes a board approved medication aide training program and passes the medication aide training and competency evaluation shall register for certification via the board's nursing portal at www.kbn.ky.gov.

(2) The training program shall submit to the board:

(a) The name of the certified individual;

(b) Title of training program, date of completion, and location;

(c) A program code number issued by the board; and

(d) Name and signature of the program administrator;

(3) A training program shall:

(a) Maintain a record of graduates for at least five (5) years; and

(b) Provide a copy of the training program's graduate records to the board upon request.

(4) Recertification.

(a) The credential for a CMA I or CMA II shall expire one (1) year from the date of initial certification or recertification.

(b) To recertify as a CMA I or CMA II, the medication aide shall provide the board with:

1. Documentation of a yearly evaluation and validation of competency;

2. Proof of at least four (4) clock hours of medication-specific education; and

3. A minimum of forty (40) hours worked prior to expiration of certification.

(5) The fee for initial certification and recertification shall be twenty-five (25) dollars.

Section 9. Incorporation by Reference.

(1) The following material is incorporated by reference:

(a) "Application for Medication Aide Training Program (CMA I)", 09/23; and

(b) "Application for Medication Aide Training Program (CMA I and II)", 09/23.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Kentucky Board of Nursing, 312 Whittington Parkway, Suite 300, Louisville, Kentucky 40222-5172, Monday through Friday, 8 a.m. to 4:30 p.m. This material is also available on the board's Web site at: https://kbn.ky.gov/document-library/Pages/default.aspx.

201 KAR 20:700

49 Ky.R. 2424; 50 Ky.R. 826, 1658; eff. 3/21/2024.

STATUTORY AUTHORITY: KRS 314.131(1), 314.133