1     
CERTIFIED NURSING ASSISTANT AMENDMENTS

2     
2024 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: A. Cory Maloy

5     
Senate Sponsor: ____________

6     

7     LONG TITLE
8     General Description:
9          This bill modifies provisions related to certified nursing assistants.
10     Highlighted Provisions:
11          This bill:
12          ▸     allows an individual seeking a certified nursing assistant certification to complete
13     the training requirement at certain health care facilities; and
14          ▸     makes technical changes.
15     Money Appropriated in this Bill:
16          None
17     Other Special Clauses:
18          None
19     Utah Code Sections Affected:
20     AMENDS:
21          26B-2-202, as renumbered and amended by Laws of Utah 2023, Chapter 305
22          58-31b-102, as last amended by Laws of Utah 2023, Chapters 223, 329
23          58-31b-302, as last amended by Laws of Utah 2023, Chapters 223, 284
24     

25     Be it enacted by the Legislature of the state of Utah:
26          Section 1. Section 26B-2-202 is amended to read:
27          26B-2-202. Duties of department.

28          (1) The department shall:
29          (a) enforce rules established pursuant to this part;
30          (b) authorize an agent of the department to conduct inspections of health care facilities
31     pursuant to this part;
32          (c) collect information authorized by the committee that may be necessary to ensure
33     that adequate health care facilities are available to the public;
34          (d) collect and credit fees for licenses as free revenue;
35          (e) collect and credit fees for conducting plan reviews as dedicated credits;
36          (f) (i) collect and credit fees for conducting clearance under Sections 26B-2-239 and
37     26B-2-240; and
38          (ii) beginning July 1, 2012:
39          (A) up to $105,000 of the fees collected under Subsection (1)(f)(i) are dedicated
40     credits; and
41          (B) the fees collected for background checks under Subsection 26B-2-240(6) and
42     Subsection 26B-2-241(4) shall be transferred to the Department of Public Safety to reimburse
43     the Department of Public Safety for its costs in conducting the federal background checks;
44          (g) designate an executive secretary from within the department to assist the committee
45     in carrying out its powers and responsibilities;
46          (h) establish reasonable standards for criminal background checks by public and
47     private entities;
48          (i) recognize those public and private entities that meet the standards established
49     pursuant to Subsection (1)(h); [and]
50          (j) establish and maintain a certification for certified nursing assistants that:
51          (i) complies with the Omnibus Budget Reconciliation Act of 1987, Pub. L. No.
52     100-203; and
53          (ii) allows an individual to fulfill the supervised training requirement while working in:
54          (A) a nursing care facility;
55          (B) a general acute hospital; or
56          (C) any other health care facility the department determines would not violate the
57     Omnibus Budget Reconciliation Act of 1987, Pub. L. No. 100-203; and
58          [(j)] (k) provide necessary administrative and staff support to the committee.

59          (2) The department may:
60          (a) exercise all incidental powers necessary to carry out the purposes of this part;
61          (b) review architectural plans and specifications of proposed health care facilities or
62     renovations of health care facilities to ensure that the plans and specifications conform to rules
63     established by the committee; and
64          (c) in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act,
65     make rules as necessary to implement the provisions of this part.
66          Section 2. Section 58-31b-102 is amended to read:
67          58-31b-102. Definitions.
68          In addition to the definitions in Section 58-1-102, as used in this chapter:
69          (1) "Administrative penalty" means a monetary fine or citation imposed by the division
70     for acts or omissions determined to be unprofessional or unlawful conduct in accordance with a
71     fine schedule established by division rule made in accordance with Title 63G, Chapter 3, Utah
72     Administrative Rulemaking Act, and as a result of an adjudicative proceeding conducted in
73     accordance with Title 63G, Chapter 4, Administrative Procedures Act.
74          (2) "Applicant" means an individual who applies for licensure or certification under
75     this chapter by submitting a completed application for licensure or certification and the
76     required fees to the department.
77          (3) "Approved education program" means a nursing education program that is
78     accredited by an accrediting body for nursing education that is approved by the United States
79     Department of Education.
80          (4) "Board" means the Board of Nursing created in Section 58-31b-201.
81          (5) "Diagnosis" means the identification of and discrimination between physical and
82     psychosocial signs and symptoms essential to the effective execution and management of
83     health care.
84          (6) "Examinee" means an individual who applies to take or does take any examination
85     required under this chapter for licensure.
86          (7) "Licensee" means an individual who is licensed or certified under this chapter.
87          (8) "Long-term care facility" means any of the following facilities licensed by the
88     Department of Health and Human Services pursuant to Title 26B, Chapter 2, Part 2, Health
89     Care Facility Licensing and Inspection:

90          (a) a nursing care facility;
91          (b) a small health care facility;
92          (c) an intermediate care facility for people with an intellectual disability;
93          (d) an assisted living facility Type I or II; or
94          (e) a designated swing bed unit in a general hospital.
95          (9) "Medication aide certified" means a certified [nurse aide] nursing assistant who:
96          (a) has a minimum of 2,000 hours experience working as a certified [nurse aide]
97     nursing assistant;
98          (b) has received a minimum of 60 hours of classroom and 40 hours of practical training
99     that is approved by the division in collaboration with the board, in administering routine
100     medications to patients or residents of long-term care facilities; and
101          (c) is certified by the division as a medication aide certified.
102          (10) (a) "Practice as a medication aide certified" means the limited practice of nursing
103     under the supervision, as defined by the division by rule made in accordance with Title 63G,
104     Chapter 3, Utah Administrative Rulemaking Act, of a licensed nurse, involving routine patient
105     care that requires minimal or limited specialized or general knowledge, judgment, and skill, to
106     an individual who:
107          (i) is ill, injured, infirm, has a physical, mental, developmental, or intellectual
108     disability; and
109          (ii) is in a regulated long-term care facility.
110          (b) "Practice as a medication aide certified":
111          (i) includes:
112          (A) providing direct personal assistance or care; and
113          (B) administering routine medications to patients in accordance with a formulary and
114     protocols to be defined by the division by rule made in accordance with Title 63G, Chapter 3,
115     Utah Administrative Rulemaking Act; and
116          (ii) does not include assisting a resident of an assisted living facility, a long term care
117     facility, or an intermediate care facility for people with an intellectual disability to self
118     administer a medication, as regulated by the Department of Health and Human Services by rule
119     made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
120          (11) "Practice of advanced practice registered nursing" means the practice of nursing

121     within the generally recognized scope and standards of advanced practice registered nursing as
122     defined by rule and consistent with professionally recognized preparation and education
123     standards of an advanced practice registered nurse by a person licensed under this chapter as an
124     advanced practice registered nurse. "Practice of advanced practice registered nursing" includes:
125          (a) maintenance and promotion of health and prevention of disease;
126          (b) diagnosis, treatment, correction, consultation, and referral;
127          (c) prescription or administration of prescription drugs or devices including:
128          (i) local anesthesia;
129          (ii) Schedule III-V controlled substances; and
130          (iii) Schedule II controlled substances; or
131          (d) the provision of preoperative, intraoperative, and postoperative anesthesia care and
132     related services upon the request of a licensed health care professional by an advanced practice
133     registered nurse specializing as a certified registered nurse anesthetist, including:
134          (i) preanesthesia preparation and evaluation including:
135          (A) performing a preanesthetic assessment of the patient;
136          (B) ordering and evaluating appropriate lab and other studies to determine the health of
137     the patient; and
138          (C) selecting, ordering, or administering appropriate medications;
139          (ii) anesthesia induction, maintenance, and emergence, including:
140          (A) selecting and initiating the planned anesthetic technique;
141          (B) selecting and administering anesthetics and adjunct drugs and fluids; and
142          (C) administering general, regional, and local anesthesia;
143          (iii) postanesthesia follow-up care, including:
144          (A) evaluating the patient's response to anesthesia and implementing corrective
145     actions; and
146          (B) selecting, ordering, or administering the medications and studies listed in this
147     Subsection (11)(d);
148          (iv) other related services within the scope of practice of a certified registered nurse
149     anesthetist, including:
150          (A) emergency airway management;
151          (B) advanced cardiac life support; and

152          (C) the establishment of peripheral, central, and arterial invasive lines; and
153          (v) for purposes of this Subsection (11)(d), "upon the request of a licensed health care
154     professional":
155          (A) means a health care professional practicing within the scope of the health care
156     professional's license, requests anesthesia services for a specific patient; and
157          (B) does not require an advanced practice registered nurse specializing as a certified
158     registered nurse anesthetist to obtain additional authority to select, administer, or provide
159     preoperative, intraoperative, or postoperative anesthesia care and services.
160          (12) "Practice of nursing" means assisting individuals or groups to maintain or attain
161     optimal health, implementing a strategy of care to accomplish defined goals and evaluating
162     responses to care and treatment, and requires substantial specialized or general knowledge,
163     judgment, and skill based upon principles of the biological, physical, behavioral, and social
164     sciences. "Practice of nursing" includes:
165          (a) initiating and maintaining comfort measures;
166          (b) promoting and supporting human functions and responses;
167          (c) establishing an environment conducive to well-being;
168          (d) providing health counseling and teaching;
169          (e) collaborating with health care professionals on aspects of the health care regimen;
170          (f) performing delegated procedures only within the education, knowledge, judgment,
171     and skill of the licensee;
172          (g) delegating nursing tasks that may be performed by others, including an unlicensed
173     assistive personnel; and
174          (h) supervising an individual to whom a task is delegated under Subsection (12)(g) as
175     the individual performs the task.
176          (13) "Practice of practical nursing" means the performance of nursing acts in the
177     generally recognized scope of practice of licensed practical nurses as defined by division rule
178     made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, and as
179     provided in this Subsection (13) by an individual licensed under this chapter as a licensed
180     practical nurse and under the direction of a registered nurse, licensed physician, or other
181     specified health care professional as defined by division rule made in accordance with Title
182     63G, Chapter 3, Utah Administrative Rulemaking Act. Practical nursing acts include:

183          (a) contributing to the assessment of the health status of individuals and groups;
184          (b) participating in the development and modification of the strategy of care;
185          (c) implementing appropriate aspects of the strategy of care;
186          (d) maintaining safe and effective nursing care rendered to a patient directly or
187     indirectly; and
188          (e) participating in the evaluation of responses to interventions.
189          (14) "Practice of registered nursing" means performing acts of nursing as provided in
190     this Subsection (14) by an individual licensed under this chapter as a registered nurse within
191     the generally recognized scope of practice of registered nurses as defined by division rule made
192     in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act. Registered
193     nursing acts include:
194          (a) assessing the health status of individuals and groups;
195          (b) identifying health care needs;
196          (c) establishing goals to meet identified health care needs;
197          (d) planning a strategy of care;
198          (e) prescribing nursing interventions to implement the strategy of care;
199          (f) implementing the strategy of care;
200          (g) maintaining safe and effective nursing care that is rendered to a patient directly or
201     indirectly;
202          (h) evaluating responses to interventions;
203          (i) teaching the theory and practice of nursing; and
204          (j) managing and supervising the practice of nursing.
205          (15) "Registered nurse apprentice" means an individual licensed under Subsection
206     58-31b-301(2)(b) who is learning and engaging in the practice of registered nursing under the
207     indirect supervision of an individual licensed under:
208          (a) Subsection 58-31b-301(2)(c), (e), or (f);
209          (b) Chapter 67, Utah Medical Practice Act; or
210          (c) Chapter 68, Utah Osteopathic Medical Practice Act.
211          (16) "Routine medications":
212          (a) means established medications administered to a medically stable individual as
213     determined by a licensed health care practitioner or in consultation with a licensed medical

214     practitioner; and
215          (b) is limited to medications that are administered by the following routes:
216          (i) oral;
217          (ii) sublingual;
218          (iii) buccal;
219          (iv) eye;
220          (v) ear;
221          (vi) nasal;
222          (vii) rectal;
223          (viii) vaginal;
224          (ix) skin ointments, topical including patches and transdermal;
225          (x) premeasured medication delivered by aerosol/nebulizer; and
226          (xi) medications delivered by metered hand-held inhalers.
227          (17) "Unlawful conduct" means the same as that term is defined in Sections 58-1-501
228     and 58-31b-501.
229          (18) "Unlicensed assistive personnel" means any unlicensed individual, regardless of
230     title, who is delegated a task by a licensed nurse as permitted by division rule made in
231     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, and the standards
232     of the profession.
233          (19) "Unprofessional conduct" means the same as that term is defined in Sections
234     58-1-501 and 58-31b-502 and as may be further defined by division rule made in accordance
235     with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
236          Section 3. Section 58-31b-302 is amended to read:
237          58-31b-302. Qualifications for licensure or certification -- Criminal background
238     checks.
239          (1) An applicant for certification as a medication aide shall:
240          (a) submit an application to the division on a form prescribed by the division;
241          (b) pay a fee to the division as determined under Section 63J-1-504;
242          (c) have a high school diploma or its equivalent;
243          (d) have a current certification as a [nurse aide] nursing assistant, in good standing,
244     from the Department of Health and Human Services;

245          (e) have a minimum of 2,000 hours of experience within the two years prior to
246     application, working as a certified [nurse aide] nursing assistant in a long-term care facility or
247     another health care facility that is designated by the division in collaboration with the board;
248          (f) obtain letters of recommendation from a health care facility administrator and one
249     licensed nurse familiar with the applicant's work practices as a certified [nurse aide] nursing
250     assistant;
251          (g) be in a condition of physical and mental health that will permit the applicant to
252     practice safely as a medication aide certified;
253          (h) have completed an approved education program or an equivalent as determined by
254     the division in collaboration with the board;
255          (i) have passed the examinations as required by division rule made in collaboration
256     with the board; and
257          (j) meet with the board, if requested, to determine the applicant's qualifications for
258     certification.
259          (2) An applicant for licensure as a licensed practical nurse shall:
260          (a) submit to the division an application in a form prescribed by the division;
261          (b) pay to the division a fee determined under Section 63J-1-504;
262          (c) have a high school diploma or its equivalent;
263          (d) be in a condition of physical and mental health that will permit the applicant to
264     practice safely as a licensed practical nurse;
265          (e) have completed an approved practical nursing education program or an equivalent
266     as determined by the board;
267          (f) have passed the examinations as required by division rule made in collaboration
268     with the board; and
269          (g) meet with the board, if requested, to determine the applicant's qualifications for
270     licensure.
271          (3) An applicant for a registered nurse apprentice license shall:
272          (a) submit to the division an application form prescribed by the division;
273          (b) pay to the division a fee determined under Section 63J-1-504;
274          (c) have a high school diploma or its equivalent;
275          (d) be in a condition of physical and mental health that will allow the applicant to

276     practice safely as a registered nurse apprentice;
277          (e) as determined by an approved registered nursing education program, be:
278          (i) in good standing with the program; and
279          (ii) in the last semester, quarter, or competency experience;
280          (f) have written permission from the program in which the applicant is enrolled; and
281          (g) meet with the board, if requested, to determine the applicant's qualifications for
282     licensure.
283          (4) An applicant for licensure as a registered nurse shall:
284          (a) submit to the division an application form prescribed by the division;
285          (b) pay to the division a fee determined under Section 63J-1-504;
286          (c) have a high school diploma or its equivalent;
287          (d) be in a condition of physical and mental health that will allow the applicant to
288     practice safely as a registered nurse;
289          (e) have completed an approved registered nursing education program;
290          (f) have passed the examinations as required by division rule made in collaboration
291     with the board; and
292          (g) meet with the board, if requested, to determine the applicant's qualifications for
293     licensure.
294          (5) Applicants for licensure as an advanced practice registered nurse shall:
295          (a) submit to the division an application on a form prescribed by the division;
296          (b) pay to the division a fee determined under Section 63J-1-504;
297          (c) be in a condition of physical and mental health which will allow the applicant to
298     practice safely as an advanced practice registered nurse;
299          (d) hold a current registered nurse license in good standing issued by the state or be
300     qualified at the time for licensure as a registered nurse;
301          (e) (i) have earned a graduate degree in:
302          (A) an advanced practice registered nurse nursing education program; or
303          (B) a related area of specialized knowledge as determined appropriate by the division
304     in collaboration with the board; or
305          (ii) have completed a nurse anesthesia program in accordance with Subsection
306     (5)(f)(ii);

307          (f) have completed:
308          (i) course work in patient assessment, diagnosis and treatment, and
309     pharmacotherapeutics from an education program approved by the division in collaboration
310     with the board; or
311          (ii) a nurse anesthesia program which is approved by the Council on Accreditation of
312     Nurse Anesthesia Educational Programs;
313          (g) to practice within the psychiatric mental health nursing specialty, demonstrate, as
314     described in division rule, that the applicant, after completion of a doctorate or master's degree
315     required for licensure, is in the process of completing the applicant's clinical practice
316     requirements in psychiatric mental health nursing, including in psychotherapy;
317          (h) have passed the examinations as required by division rule made in collaboration
318     with the board;
319          (i) be currently certified by a program approved by the division in collaboration with
320     the board and submit evidence satisfactory to the division of the certification; and
321          (j) meet with the board, if requested, to determine the applicant's qualifications for
322     licensure.
323          (6) For each applicant for licensure or certification under this chapter except an
324     applicant under Subsection 58-31b-301(2)(b):
325          (a) the applicant shall:
326          (i) submit fingerprint cards in a form acceptable to the division at the time the
327     application is filed; and
328          (ii) consent to a fingerprint background check conducted by the Bureau of Criminal
329     Identification and the Federal Bureau of Investigation regarding the application;
330          (b) the division shall:
331          (i) in addition to other fees authorized by this chapter, collect from each applicant
332     submitting fingerprints in accordance with this section the fee that the Bureau of Criminal
333     Identification is authorized to collect for the services provided under Section 53-10-108 and the
334     fee charged by the Federal Bureau of Investigation for fingerprint processing for the purpose of
335     obtaining federal criminal history record information;
336          (ii) submit from each applicant the fingerprint card and the fees described in this
337     Subsection (6)(b) to the Bureau of Criminal Identification; and

338          (iii) obtain and retain in division records a signed waiver approved by the Bureau of
339     Criminal Identification in accordance with Section 53-10-108 for each applicant; and
340          (c) the Bureau of Criminal Identification shall, in accordance with the requirements of
341     Section 53-10-108:
342          (i) check the fingerprints submitted under Subsection (6)(b) against the applicable state
343     and regional criminal records databases;
344          (ii) forward the fingerprints to the Federal Bureau of Investigation for a national
345     criminal history background check; and
346          (iii) provide the results from the state, regional, and nationwide criminal history
347     background checks to the division.
348          (7) For purposes of conducting the criminal background checks required in Subsection
349     (6), the division shall have direct access to criminal background information maintained
350     pursuant to Title 53, Chapter 10, Part 2, Bureau of Criminal Identification.
351          (8) (a) (i) Any new nurse license or certification issued under this section shall be
352     conditional, pending completion of the criminal background check.
353          (ii) Notwithstanding Title 63G, Chapter 4, Administrative Procedures Act, if the
354     criminal background check discloses the applicant has failed to accurately disclose a criminal
355     history, the license or certification shall be immediately and automatically revoked upon notice
356     to the licensee by the division.
357          (b) (i) An individual whose conditional license or certification has been revoked under
358     Subsection (8)(a) is entitled to a postrevocation hearing to challenge the revocation.
359          (ii) A postrevocation hearing shall be conducted in accordance with Title 63G, Chapter
360     4, Administrative Procedures Act.
361          (9) If an individual has been charged with a violent felony, as defined in Subsection
362     76-3-203.5(1)(c), and, as a result, the individual has been convicted, entered a plea of guilty or
363     nolo contendere, or entered a plea of guilty or nolo contendere held in abeyance pending the
364     successful completion of probation, the division shall act upon the license as required under
365     Section 58-1-401.
366          (10) If an individual has been charged with a felony other than a violent felony, as
367     defined in Subsection 76-3-203.5(1)(c), and, as a result, the individual has been convicted,
368     entered a plea of guilty or nolo contendere, or entered a plea of guilty or nolo contendere held

369     in abeyance pending the successful completion of probation, the division shall determine
370     whether the felony disqualifies the individual for licensure under this chapter and act upon the
371     license, as required, in accordance with Section 58-1-401.
372          (11) The division may not disseminate outside of the division any criminal history
373     record information that the division obtains from the Bureau of Criminal Identification or the
374     Federal Bureau of Investigation under the criminal background check requirements of this
375     section.
376          Section 4. Effective date.
377          This bill takes effect on May 1, 2024.