This federal regulation (F-Tag F728) governs nursing facilities' hiring and use of nurse aides, requiring that no individual work as a nurse aide for more than four months on a full-time basis unless they have completed a state-approved nurse aide training and competency evaluation program (NATCEP) or competency evaluation program (CEP), or have been otherwise deemed competent. The rule applies equally to permanent, temporary, per diem, and leased staff. Facilities must ensure that aides in their first four months are enrolled as permanent employees in an approved NATCEP program.
View official sourceF728 (Rev. 229; Issued: 04-25-25; Effective: 04-25-25; Implementation: 04-28-25) §483.35(e) Requirement for facility hiring and use of nurse aides- §483.35(e)(1) General rule. A facility must not use any individual working in the facility as a nurse aide for more than 4 months, on a full-time basis, unless— (i) That individual is competent to provide nursing and nursing related services; and (ii) (A) That individual has completed a training and competency evaluation program, or a competency evaluation program approved by the State as meeting the requirements of §483.151 through §483.154; or (B) That individual has been deemed or determined competent as provided in §483.150(a) and (b). §483.35(e)(2) Non-permanent employees. A facility must not use on a temporary, per diem, leased, or any basis other than a permanent employee any individual who does not meet the requirements in paragraphs (e)(1)(i) and (ii) of this section. §483.35(e)(3) Minimum Competency A facility must not use any individual who has worked less than 4 months as a nurse aide in that facility unless the individual— (i) Is a full-time employee in a State-approved training and competency evaluation program; (ii) Has demonstrated competence through satisfactory participation in a State- approved nurse aide training and competency evaluation program or competency evaluation program; or (iii) Has been deemed or determined competent as provided in §483.150(a) and (b). DEFINITIONS A “permanent employee” is defined as any employee the facility expects to continue working on an ongoing basis. GUIDANCE Any individual who successfully completed either a nurse aide training or competency evaluation program (NATCEP) or a competency evaluation program (CEP) or has been deemed or determined competent as provided in §483.150(a) and (b) may be employed as a nurse aide. If an individual has not successfully completed a NATCEP program at the time of employment, that individual may only function as a nurse aide if the individual is currently in a NATCEP (not a competency evaluation program (CEP) alone) and is a permanent employee in his or her first four months of employment in the facility. PROCEDURES AND PROBES • If there are concerns with a nurse aide’s competency or qualification determine whether he/she successfully completed an approved NATCEP or a CEP. If not, are these individuals’ permanent employees who have worked in the facility for 4 months or less enrolled in a NATCEP? • Interview those aides to determine where they received their NATCEP training, how long the training was and how long they have worked in the facility as a nurse aide. If you identify deficient care practices by nurse aides who do not have evidence of having successfully completed a NATCEP/CEP, determine: • If the aide is currently receiving training in a State-approved NATCEP; and • If the aide has been trained, has demonstrated proficiency and determined to be proficient for the tasks to which he or she is assigned. See §483.152 for specific training that the aide is to receive. For specific procedures for NATCEP/CEP refer to the State Operations Manual (SOM), Chapters 4 and 7.