Missouri has one of the nation's fastest-growing senior populations. It is currently experiencing huge demands for certified nursing assistants (CNAs) at long-term care facilities, hospitals, and home health agencies. CNAs are responsible for providing direct, hands-on care for patients and assisting licensed practical nurses (LPNs) and registered nurses (RNs) in direct patient care. CNAs must complete medical training before they can practice, but they also must possess patience and compassion to care for vulnerable patients. It's not a glamourous job—duties can include dressing wounds and helping frail patients with personal needs. But it is one that is critical to the healthcare industry.
Obtaining the credentials to become a CNA sets you on a journey for a long-term career in the medical field with opportunities to advance your training and climb the ladder to roles with more patient-care responsibilities. But when someone accuses you of wrongdoing, your certification and your livelihood are at risk. Don't gamble with your future. Protect your rights and your career. Contact the professional license defense team at the Lento Law Firm today.
Missouri Department of Health and Senior Services' Rules and Standards
The Omnibus Nursing Home Act, the Missouri State Department of Health and Senior Services (DHSS), and Section 198.082, RSMo, 1994, requires all CNAs to undergo a training program that involves completing 75 hours of classroom training and 100 hours of on-the-job training, followed by the successful completion of a two-part, 75-question (total) final exam. The exam includes a written (or oral) test and a practicum examination. Topics usually covered include basic nursing skills, fire safety, disaster training, long-term care resident safety and rights, social and psychological problems of residents, and methods for caring for residents with cognitive issues. Some candidates may be allowed to challenge and just take the final two-part exam without completing the entire course if they meet special circumstances and have the approval of the state agency. Other requirements include:
- At least 18 years of age
- In good physical health
- Up-to-date immunization record
- Clean criminal background check
CNAs must also have graduated from a Certified Nursing Assistant School in Missouri. Most of these programs are available at community colleges, trade schools, and the American Red Cross. Students can complete the program in 6-15 weeks; however, some accelerated programs offer 4-week CNA classes. Students are under direct supervision during their training, and their program instructors must be licensed for nursing in Missouri, have a minimum of one year of nursing experience, and have either completed a course on how to teach adults or have verifiable experience teaching adults or supervising nurse aides. Once a CNA passes the final exam, DHSS places their name on Missouri's active Certified Nurse Assistant Registry.
Becoming a CNA is an investment of both time and money toward your future. The cost of CNA training programs in Missouri can vary from school to school and ranges from about $500 to $2,000. For example, St. Charles Community College charges $375 for classroom instruction and $310 for the clinical internship. The CNA exam in Missouri costs $125, which includes $95 for the Knowledge Exam and $30 for the Skills exam. CNAs in training who struggle with reading have the option to have the test read to them for an additional $10.
Issues with License Renewal
CNAs are required to renew their certification every 24 months. To remain active, CNAs must submit documentation, such as pay stubs, W-2s, or a letter from the employer, of their work in nursing or nursing-related services for at least one day (8 hours) within a 24 consecutive month time period. A third-party test administrator approves the documentation and assesses a fee for each renewal. If a CNA in Missouri does not provide this documentation every two years, DHSS assumes they have a two-year gap in their employment of nursing services, and their status in the registry becomes inactive.
CNA certificates are expired if the registry shows a five-year break in employment in providing nursing care. If your certificate is expired, you may be required to retake the CNA course to obtain active status, which means paying for the course, going through the weeks of training, and taking the two-part test. You also have the option to challenge the CNA, which means to take the test for certification without taking the course, if you meet the following criteria:
- Your Missouri CNA is inactive, and you have not been working
- You have completed an Unlicensed Assistive Personnel (UAP) program
- You have successfully completed at least four months of a nursing program, including the Fundamentals of Nursing, with a clinical rotation within the last five years
- You completed the Nursing program but failed the NCLEX exam
If you challenge the CNA and fail the NCLEX exam, you must take the full CNA course in Missouri before you can have your CNA reinstated.
Certified Nursing Assistants in Missouri
The Missouri State Department of Health and Senior Services also maintains the Certified Nurse Assistant Registry. The registry is a compilation of all nursing assistants certified to practice within the state, along with the training they have received. It allows employers and states to quickly verify credentials for employment and provides a level of safety for the public. Any charges such as neglect, abuse, or practicing outside the scope of their training are flagged in the registry. To be admitted into the registry, all CNAs must also undergo a background check and be fingerprinted. Those who have committed felonies may be barred from practicing. Additionally, CNAs who have not practiced in the past two years are removed from the registry. Federal law requires all CNAs to complete 12 hours of continuing education each year to stay current in their field.
If you work in a nursing home or other long-term care facility, to remain on active status, the facility is required by Missouri regulation to provide 12 hours of in-service to nursing personnel, and, likewise, you are required to attend. If you do not work in a long-term care facility, you are not required to have 12 hours of in-service in order to remain active.
Bottom line, there can be a lot of hoops to jump through in order to maintain active CNA credentials or to have credentials reinstated after they have become inactive or expired.
CNAs and the Employee Disqualification List (EDL)
If Missouri DHSS places you on the Employee Disqualification List (EDL), your career in healthcare is essentially over. DHSS maintains the EDL. It's a listing of individuals DHSS has determined to have committed at least one of the following:
- Abuse a resident, patient, client, or consumer;
- Neglect a resident, patient, client, or consumer;
- Misappropriate funds or property belonging to a resident, patient, client, or consumer; or
- Falsify documentation verifying delivery of services to an in-home services client or consumer.
These acts must have happened while the CNA was employed or because of their employment by a long-term care facility, in-home services provider agency, hospital, home health agency, hospice, ambulatory surgical center, consumer, or vendor.
The department notifies a CNA that an investigation has indicated that they have committed one of the aforementioned offenses, and DHSS gives them an opportunity to appeal before being placed on the EDL. Once on the EDL for one of the offenses mentioned above, a permanent "federal indicator" or "federal marker" is also placed on the Missouri Certified Nurse Assistant Registry under the CNA's name.
Long-term care facilities, in-home services provider agencies, hospitals, home-health agencies, hospices, and ambulatory surgical centers are required to check the EDL before hiring any CNA, and they must ensure that none of their CNAs have been placed on the list. DHSS also prohibits these facilities from employing a CNA, in any capacity if their name appears on the EDL. The department further prohibits the authorization or expenditure of any state or financial assistance to pay for personal care assistance services provided by a CNA who is listed on any of the background checklists in the Family Care Safety Registry under the Revised Statutes of Missouri (RSMo), Sections 210.900 to 2010.933, unless a Good Cause Waiver is obtained, in accordance to Section 660.317, RSMo. However, Good Cause Waivers cannot be obtained by anyone whose name is on the EDL.
Section 639.170, RSMo, also disqualifies any person whose name appears on the EDL from holding any position in any public or private facility or day program operated, funded, or licensed by the Department of Mental Health or in any mental health facility or mental health program in which people are admitted on a voluntary or involuntary basis or are civilly detained.
A Closer Look at Conduct That Could Lead to EDL Placement
Chapter 192 RSMo states that a CNA can be placed on the EDL for the following behavior toward a resident, patient, client, or consumer:
A CNA may be accused of neglect if they fail to provide a patient with basic needs, such as hygiene, water, shelter, food, and basic medical care. This may include failing to respond to a patient in need in a timely manner; failing to call a medical professional for assistance when needed; failing to feed a patient; or failing to turn them, as needed, to prevent bedsores. CNAs and nursing facilities may be at risk of neglect if the facility is inadequately staffed or understaffed, if employees are stressed or overworked, or if staff is not properly trained. Accidental neglect can also lead to patient harm, such as accidentally giving a patient the wrong dose of medication.
Abuse can come in many forms, including physical (punching, kicking, restraining, or pushing a patient), emotional (yelling, making fun of, or threatening patients), financial (stealing a patient's money or property, overcharging for services, coercing residents to turn over assets, etc.), or sexual (any form of non-consensual sexual contact with a patient, as well as failing to protect patients from sexual abuse by others). In fact, neglect is considered a form of abuse.
Misappropriation of funds or property belonging to a resident, patient, client, or consumer
Misappropriation is the deliberate misplacement, misuse, or exploitation of a resident's belongings or money without the resident's consent. For example, threatening or coercing a resident to give money in order to receive care or services; stealing a resident's money or personal property, such as jewelry or even medication; or using a resident's personal property, such as their car, phone, or clothing.
Falsifying documentation verifying delivery of services to an in-home services client or consumer
Examples of falsifying documentation include submitting fake applications for home health services or exaggerating a patient's needs for home health services that they have no medical need for; overbilling the amount of time spent with the patient; offering, receiving, or soliciting kickbacks to providers who will sign off on a patient needed home health care services.
The EDL Disciplinary Process
The disciplinary process for CNAs begins when someone makes an allegation of misconduct about a CNA to the Missouri Department of Health and Senior Services. Healthcare employers usually make complaints because they are required to report suspected abuse and neglect to the department. But a patient's family member, a co-worker, or anyone else may file a complaint against you to the DHSS as well. Once receiving the complaint, DHSS conducts an investigation and notifies the CNA of the allegation against them.
If DHSS determines to add your name to the EDL, the department will notify you in writing. You will have 30 days to apply for a state hearing to challenge the department's determination. If you fail to respond within this time limit, your name will go on the EDL, and DHSS will bar you from seeking employment in a healthcare setting in Missouri.
If you do respond, DHSS will schedule a hearing. A hearing officer from another Missouri department in your county oversees these hearings. The hearing will run similar to a courtroom hearing, with the hearing officer serving as the "judge." Both sides can make an opening statement, call witnesses, bring evidence, cross-examine witnesses, and make closing statements. The hearing officer will weigh all the evidence and decide whether to place your name on the EDL. If the hearing officer decides to place your name on the EDL, you may appeal to the Missouri Court of Appeals.
If your name goes on the EDL, you will not be able to work in a healthcare setting ever again, except under very rare circumstances. To keep your CNA status, it is imperative that you hire a professional license defense attorney at the first notice of a complaint against you. Your lawyer can advise you every step of the way to ensure the best possible outcome in your case.
Removal from EDL Via a Good Cause Waiver
There is no opportunity for a CNA to have a federal marker for abuse removed. However, a CNA may request in writing for the removal of a federal marker for neglect. This is a one-time-only opportunity, and, to be successful, the request must meet the requirements at 42 USC 1395i-3(g)(1)(D), which states that, in a finding of neglect, the state must establish a procedure to permit a CNA to petition the State Department to have their name removed from the registry upon a determination by the state that:
- The employment and personal history of the nurse aide does not reflect a pattern of abusive behavior or neglect;
- The neglect involved in the original finding was a singular occurrence.
The determination of the state cannot be made less than one year from the date on which the CNA was placed on the EDL.
Increased Stakes of Missouri CNA Charges
There is no Nurse Licensure Compact agreement for certified nursing assistants as there is with LPNs and RNs. The compact license agreement enables nurses licensed in one of the 39 states participating in the Nurse Licensure Compact to take their license to another participating state for nurse practice without getting a new license in the other state. However, CNAs have reciprocity. As long as your CNA credentials are active and in good standing in one state, you can add your CNA to the Missouri Registry. To do this, you must contact each state you want to be certified in and ask about their regulations regarding reciprocity since each state has different regulations. Those who oversee the Missouri Registry will not fill out reciprocity verification forms for other states.
Understand that healthcare facilities in other states will have access to the Missouri Registry. If you have a federal marker on your CNA in the Missouri Registry, other state facilities will also see the marker, and it is highly unlikely you will be able to work as a nurse aide in another state because of it.
How a Nursing License Defense Attorney Helps in Missouri
Don't lose your opportunity to serve patients as a certified nurse assistant in Missouri. Hire an experienced professional License Team. You should call the Lento Law Firm's Professional License Defense Team for several reasons if your CNA credentials are at risk. First, retaining a lawyer as soon as DHSS notifies you of a complaint helps create a strong foundation for our team to build your defense. In many cases, we can work to convince the department to determine that the allegations do not warrant your name going on the Employee Disqualification List. If DHSS determines that it should, we will immediately apply for a hearing within the DHSS timeframe.
In the weeks leading up to the hearing, we will launch our own investigation into the complaint, gather evidence, and begin building a strong case in your defense. As an experienced Professional License Defense Team, we will guide you through the hearing process to ensure the best outcome possible.
If your name is already on the DSL and you want to return to health care, contact us. We can discuss the circumstances of your placement on the list and determine whether you may be eligible for a Good Cause Waiver. If so, we will build a strong case for reinstating you.
License Defense Team for Missouri CNAs
The Missouri Department of Health and Senior Services is committed to prioritizing the safety of vulnerable patients in the state. It holds the authority to conduct an investigation and determine whether you should be placed on the Employee Disqualification List, essentially barring you from working in the healthcare field ever again in Missouri—or any other state in the union. This sort of threat can ruin the career you invested your time and money in and damage your reputation. It is crucial that you seek guidance from a team of professional license defense lawyers. The Lento Law Firm's Professional License Defense Team is standing by to guide you through the Missouri disciplinary process and fight on your behalf for the best possible outcome.
Our attorneys have experience defending licensed professionals in Missouri like you. We can guide you through the disciplinary process, provide you with a comprehensive understanding of the legal intricacies affecting the healthcare landscape in Missouri, and investigate all allegations against you. We will build a robust defense strategy from the onset, thereby increasing the odds of a favorable resolution. If your case goes to a hearing, we will prepare you thoroughly and represent you proudly.
Your CNA credentials are your badge of honor. Don't let an allegation of misconduct put your career and livelihood at risk. Call attorney-advisor Joseph D. Lento and his Professional License Defense Team today. They have assisted CNAs just like you in Missouri and across the United States in defending their credentials and careers in health care. Contact the Lento Law Firm today at (888) 535-3686 or use our online form to discuss your case.