Washington, D.C. — The federal government just handed nursing homes a potential lifeline for one of their most persistent problems: finding and training enough certified nursing assistants to meet demand.
The Centers for Medicare and Medicaid Services released guidance memo QSO-26-08-NH on April 8, clarifying and expanding flexibilities for Nurse Aide Training and Competency Evaluation Programs, known as NATCEP. The memo signals that CMS is actively trying to clear the bottlenecks operators have complained about for years — but it doesn’t let anyone off the hook for maintaining quality.
What’s Actually Changing
The memo is part of CMS’s broader push to grow the CNA workforce nationwide, and it touches several areas operators have flagged as barriers.
Training is no longer limited to long-term care settings. CNAs can now complete their required hours in hospitals, vocational schools, or other approved locations — not just nursing homes. That opens the door for more partnerships with community colleges and technical programs that many facilities have been trying to form.
Instructors also get more flexibility. Registered nurses and licensed practical nurses can deliver training under appropriate supervision, as long as they have experience teaching adults. Oversight doesn’t have to mean constant physical presence — CMS clarified that “general supervision” just requires accountability and availability, not hovering.
Remote technology gets a green light, too. States can allow written exams and even skills observation to happen off-site, using video or other tools, as long as visibility is clear and residents consent when training occurs in a facility.
One thing hasn’t changed: the 75-hour minimum. That includes 16 hours of supervised practical training, and CMS made clear there’s no flexibility there.
A Cost Note Operators Should Flag
The memo also reaffirmed a rule that sometimes gets overlooked: facilities cannot charge CNAs for training, materials, testing, or registry fees if those workers are employed — or have a job offer in hand. Workers may also be eligible for reimbursement within 12 months of completing their training. Operators should review their current practices to make sure they’re not out of compliance.
The Bigger Picture
The guidance arrives as nursing homes grapple with a workforce crisis that federal budget proposals have made worse. The proposed cuts to federal nursing education funding have left many facilities scrambling to build internal pipelines. More flexibility in how CNAs get trained could help — but only if states act quickly to update their programs and websites, which CMS specifically called out as an area needing improvement.
Facilities that aren’t already leveraging community training partnerships may want to revisit those conversations now. The rules just got more permissive. The staffing shortage hasn’t gone away.
