BCHS Nurse Aide Program Instructions and …

1 Michigan Department of Licensing and Regulatory AffairsBureau of Community and Health SystemsHealth Facility Licensing, Permits and Support DivisionNurse Aide training Box 30664 Lansing, Michigan 48909 Phone: (517) 896-0511 Fax: (517) 241-3354 Nurse AIDE training Program Instructions AND APPLICATIONO mnibus Budget Reconciliation Act (OBRA) of 1987, as amendedELIGIBLE APPLICANTS:An applicant for a Nurse Aide training Program can be a skilled nursing facility ( , state licensedlong term care facility) or a non-nursing facility. Long-term care facilities must be in compliancewith specified State licensing and certification requirements at the time of application (asdetermined by the Department) and federal certification requirements.

2 Most privately operatedorganizations that offer non-degree occupational training for a fee or other consideration arelegally required to be licensed as a proprietary school by the Michigan Department of Licensingand Regulatory Affairs (LARA), Corporations, Securities & Commercial Licensing Bureau (CSCL),Licensing Division; therefore, non-nursing facilities that are public, private, or proprietary mustalso have their individual programs approved by the Department of Licensing and RegulatoryAffairs. For further information go to The fee is $ for anysecondary education institution or skilled nursing facility. The fee is $ for all proprietaryschools or the Nurse Aide training Program application including all signatures attesting thatthe Nurse aide training Program is following the State of Michigan Nurse Aide TrainingProgram Curriculum receipt of the application, a letter of acknowledgement will be sent within 30 to starting the Program , an onsite announced in-depth review will take place within 60days of the acknowledgement letter.

3 At this time all materials must be readily available forreview in order to demonstrate that the Program is in compliance with the State of MichiganNurse Aide training Program Curriculum the application form. Please note that this application form can be used for initial,renewal, and changes to the Program . Please check the appropriate box on the additional instructors, regardless of type, can be added on extra pages attached with copies of the formal collaborative relationship contracts with other agencies, healthcare facilities, or educational institutions, App-Rev. 02/26 the applicable fee for a Nurse Aide training Program Permit made payable to the State of Michigan.

4 Form and fee to the address listed at the top of the application REVIEW:Once reviewed, the Program will receive letter requesting additional information conditional approval notification. This does not allow the Program to start teachingstudents as it is not a full approval, which can occur after an on-site a Program has submitted all required documents and an on-site review has beenconducted to the satisfaction of the Bureau, a Program will be approved. A letter will be sentto the Program notifying them as well as an assignment of a Nurse Aide training TO THE training programs ubstantive changes to the training Program must be reported on a new applicationform.

5 These changes consist of the change (requires an on-site review) site change (must provide newcontract) Instructor- A registered Nurse that holds a Nurse aide trainer certificate from Instructor- An individual from the health professions that may supplement theprimary instructor. Supplemental instructors must have at least one year of experience intheir fields. The supplemental instructor is not a primary instructor and may not lead as aprimary CURRICULUM:The Program curriculum is a course of study necessary to achieve learner objectives. Thisincludes: Program goals/objectives; behavioral/learner objectives for lecture, laboratory, andclinical skills training ; teaching methods; evaluation measurements; student policies; programschedule; and instructor Nurse aide training Program must follow the State of Michigan Nurse Aide TrainingCurriculum Model of 2006.

6 This model provides examples of Program objectives andbehavioral/learner objectives for lecture, laboratory and clinical skills App-Rev. 02/26/2018 APPROVAL OF CLINICAL PRACTICE SITES:Requirements for approval will include the following (not all inclusive) space conducive to training with noise and interruptions kept to aminimum, maintained at a comfortable temperature, and in a clean and safeenvironment with adequate and supplies are available for use by and in good standing as a provider in the Medicare and/or Medicaidprogram(s)with no termination action in process while participating as a clinical staff on duty as specified by State and Federal requirements to provideadequateand appropriate care to residents while participating as a clinical practice training supervision is provided in accordance with the occupational RegulationSections of the Michigan Public Health Code (Articles 1 and 14 of Act 368 of 1978); Part 172,Nursing , Sections 17201(1) (a), (b) and(c).

7 RENEWAL approval to provide a Nurse Aide training Program is good for renew your Program , please send in a renewal application 30 days prior to its , please provide a copy of your most recent clinical :Appeals are to be directed to the Manager, LARA, Bureau of Community and HealthSystems, Health Facility Professional and Nurse Aide Section, Box 30664, Lansing,Michigan App-Rev. 02/26/2018 FOR CASHIER USE ONLY Nurse AIDE training Program APPLICATIONC ashier code: 100901 or 101001 Michigan Department of Licensing and Regulatory AffairsBureau of Community and Health SystemsHealth Facility Licensing Permits, and Support Division611 W. Ottawa Street, Box 30664 Lansing, MI 48909 Secondary Education Institution/Skilled Nursing Facility, $ Fee (code 101001).

8 Permit # if renewal: _____Proprietary School/Other, $ Fee (code 100901) . Permit # if renewal: _____Initial Use OnlyDate:Renewal (addendum)Permit # InformationProgram / Facility Name (NATP#) Program AddressClassroom Address if Different from Program Address(City)Contact PersonContact Number and E-mail AddressType of Program (please check the appropriate box):Long Term Care Facility (State Licensed Long Term Care Skilled Nursing Facility)Proprietary EducationAdult Basic / Community EducationCommunity CollegeVocational EducationOther (please specify):BCHS-HFLPSD-NAP Program APPLICATION (Rev. 02/26/2018) Page 1 of 2(State)(ZIP Code) Coordinator / Contact Person Add DeleteFull NameTrainer Certificate Number and Date Issued4704-Michigan RN License Number and Expiration Instructor Add DeleteFull NameTrainer Certificate Number and Date Issued4704-Michigan RN License Number and Expiration Instructor (please indicate) Add DeleteName of InstructorList field of instruction and dates for one year of experience in fieldList any professional license held and numberBCHS-HFLPSD-NAP Program APPLICATION (Rev.)

9 02/26/2018) Page 2 of 2 Our Program follows the State of Michigan Nurse Aide training Curriculum to NATP:Facility / Program Name:Contact PersonStreet Address(City)(State)(ZIP Code)Contact NumberFax Collaborative Relationship - PLEASE ATTACH WITH THIS APPLICATIONThis is an agreement between two programs to coordinate or share teaching responsibilities or sitesor Program and a longterm care facility for clinical training . This relationship requires a contract, which outlines the roles and responsibilities of each party involved and is signed by both Name Entering Into Contract WithContact PersonStreet Address(City)(State)(ZIP Code)Contact NumberFax certify that the following is true:A)B)C)D)E)There is sufficient space available for training and is environmentally and supplies are available to ensure that each student has the ability to meet course Program is in compliance with Federal and State information included in this application is complete and SignatureDateApplication packet submitted by Mail: Michigan Dept.

10 OfLicensing and Regulatory Affairs, Bureau of Community andHealth SystemsHealth Facility Licensing, Permits and Support DivisionP. O. Box 30664, Lansing, MI 48909 All applications and Renewals must be mailed to theDepartment.