The Centers for Medicare & Medicaid Services (CMS) on April 8, 2026, clarified federal requirements for nurse aide training and competency evaluation programs (NATCEPs) and competency evaluation programs (CEPs).

While CMS’ memo does not announce any policy changes, it will be useful for sharing with states that may be considering changes to their NATCEPs and CEPs. Recall that while CMS sets forth federal requirements for NATCEPs and CEPs, each individual state is responsible for approving or denying NATCEPs/CEPs according to state laws and requirements.

Memo highlights:

Fees: NATCEPs and CEPs are provided free of charge to nurse aides who are employed at the time of training. Nurse aides who become employed within 12 months of completing training are eligible for reimbursement of training costs by the state. No fees may be charged for listing in the state’s nurse aide registry either.

Training Hours Requirements: NATCEPs must, by federal law, include a minimum of 75 clock hours of training. These 75 hours must include at least 16 hours of supervised practical training in which nurse aide trainees demonstrate knowledge and skills by performing tasks on an individual. Training settings may include long-term care settings, acute care settings, and vocational education centers. Supervision must be direct supervision by a registered nurse (RN) or licensed practical nurse (LPN) but does not have to be the course instructor.

Supervision: General supervision means providing necessary guidance for the program and ultimate responsibility for the course. It does not mean direct observation of the trainee or being physically present in the immediate training area. Nurse aides who have been trained and found to be proficient by the instructor may practice under the general supervision of an RN or LPN.

Instructor Qualifications: Nurse aide training must be conducted under the general supervision of an RN who has at least two years’ nursing experience, at least one year of which is in the provision of long-term care. RNs and LPNs may provide training under the general supervision of an RN who meets the instructor qualifications. The RNs and LPNs providing training under the general supervision of a qualified RN instructor are not required to meet the instructor qualifications but must have completed a course in teaching adults or must have experience teaching adults or supervising nurse aides. Any personnel supplementing the instructor must have at least one year of experience in their fields.

Competency Evaluations and Remote Technologies: Due to ongoing challenges in states regarding testing site limitations and staff availability for administering evaluations, CMS is allowing states to utilize remote technologies for written exams. Remote technologies can also be used for the skills demonstration portion of the competency evaluation; however, the remote technology must allow the observer to clearly see all parts of the skills being demonstrated by the trainee as would occur during in-person observation. The skills portion of competency evaluations must be administered and evaluated by an RN with at least one year’s experience in providing care for the elderly or chronically ill of any age. Consent must be obtained from the resident to be observed through remote technologies.

Waivers of Disapproval: Nursing homes may be locked out of providing a NATCEP/CEP based on certain conditions. In some circumstances, the state or the CMS location (regional office) has the authority to waive this disapproval if certain criteria are met. States and providers can be reminded of this waiver authority and eligibility criteria in this memo from 2017.