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CMS Tells States to Stop Charging CNAs for Nurse Aide Registry Placement
March 13, 2006
The Centers for Medicare and Medicaid Services(CMS) is instructing states to stop charging nursing assistants for placement on their nurse aide registries, thanks to a report by the Office of Inspector General (OIG) in the U.S. Department of Health and Human Services.
The Nursing Home Reform Act of 1987 that required every state and the District of Columbia to establish its own registry for certified nursing assistants (CNAs) also forbade states to charge workers for joining or remaining on the list. However, as the OIG reports in State Fees for Nurse Aide Registration, nearly half the states (24) require CNAs to pay for placement on nurse aide registries. Some charge for initial placement, some for continued placement, and some for criminal background checks and/or fingerprinting required for initial placement. Some states charge more than one type of fee.
In addition, the report says, ''Four States imposed fees on nurse aides as a requirement to work in long-term care facilities. These four States did not explicitly charge for initial or continued placement on the registry, but required fees for a nurse aide to work in a long-term care facility. Failure to pay these fees could lead to nurse aides being removed from the registry.''
The report found that CMS failed to oversee the process, providing guidance only to states that requested it. The OIG recommends that CMS ensure that states stop imposing the fees, clarify prohibitions on the fees, and conduct ''appropriate,'' possibly ongoing oversight to prevent states from charging inappropriate fees.
CMS concurred with all three recommendations, pledging in a letter reproduced in the OIG report that CMS will ''notify the States found to be imposing fees in violation of Federal requirements that such practices must cease'' and ''ensure that all state Medicaid agencies receive a written reminder of the statutory and regulatory provisions that prohibit the imposition of any charges on nurse aides relating to the nurse aide registry.''
Elise Nakhnikian
Communications Specialist
Paraprofessional Healthcare Institute
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