1. Advance Personal Care Aide 13 CSR 70-91.010(5)(E)
Personal care providers are required to provide training to advanced personal care aides (APC)
In addition to the aide training previously mentioned:
8 hours classroom training
Task training
The next area of required training is for Advanced Personal Care Aides. If a person meets all of the hiring requirements to be an advanced personal care aide that were discussed earlier, they must receive additional advanced personal care training prior to providing any advanced personal care services.
The training must include 8 hours of classroom training. Refer to the code of state regulations for a complete listing of topics that must be included in the training.
In addition to the classroom training, the advanced personal care aide must demonstrate successful execution of the advanced personal care tasks prior to providing the service. The execution of the tasks must be observed by the RN supervisor. Some of the tasks can be observed in a classroom setting but there are other tasks that must be observed in a client’s home. Refer to the code of state regulations for a complete listing of the tasks required to be observed and where each task must be observed.

2. Waiver of APC Training 13 CSR 70-91.010(5)
Advanced personal care training can be waived under the following circumstances.
Licensed nurse: no additional training.
CNA: 8 hours classroom training can be waived. Task training cannot be waived.
Previously completed APC training and worked as an APC aide within the prior 6 months: waive 8 hours classroom. Task training cannot be waived.
All advanced personal care training, including demonstration of the tasks, can be waived for nurses licensed to practice in Missouri.
For certified nurse assistants, the 8 hours of classroom training can be waived. However, successful completion of the task training CANNOT be waived. They must still demonstrate the successful completion of the tasks for the RN supervisor.
If a person previously completed advanced personal care training AND worked as an advanced personal care aide within the prior six months, the 8 hours of classroom training can be waived. The successful completion of the task training CANNOT be waived. The prior training must have been with a contracted in-home services provider and the aide had to have been employed at least half time as an Advanced Personal Care aide

3. In-Service Training 19 CSR 15-7. 021(22); 13 CSR 70-91. 010(3); 660
In-Service Training 19 CSR (22); 13 CSR (3); , RSMo
An additional ten hours of in-service training annually after the first 12 months of employment. At least six of the required 10 hours shall be classroom instruction. The additional four hours may be via any appropriate training method.
And, the last required training is annual in-service training. After being employed for one year, 10 hours of in-service training per year are required. At least six of the ten hours must be classroom training. The remaining four hours can be whatever method the provider chooses such as reading material, online training, etc. An update of Alzheimer’s disease and related dementia must be included in the training. Refer to the Medicaid Provider Manual for additional training topics.

4. Waiver of In-Service Training 19 CSR 15-7. 021(22); 13 CSR 70-91
Waiver of In-Service Training 19 CSR (22); 13 CSR (3)(E)
The provider may waive the required annual 10 hours of in-service training and require only two hours of refresher training annually, when the aide has been employed for three years and has completed 30 hours of in-service training.
The 10 hours of in-service training per year can be waived after a person has been employed for three years and received the 10 hours of in-service training each year.
After that, they are only required to receive 2 hours of training per year. The training must continue to include updates on Alzheimer’s disease and related dementia.

5. Adequate Documentation
It is very important for the agency to maintain adequate documentation of all training provided and all training waived.

6. Training Documentation 19 CSR 15-7.021(18)(23); 13 CSR 70-91.010(3)(E)
Training documentation must be maintained:
A report in each employee’s personnel record
A record or folder
Documentation of training provided must be maintained in two places. A training report must be maintained in each employee’s personnel record. The report must include the dates of all classroom or on-the-job training, trainer’s name, topics, number of hours and location of the training, the date of the first client contact and the aide’s signature.
The second location the training documentation must be maintained is a training record or folder. It must contain a list of all training sessions held by the provider, a copy of all agendas showing date, time and duration of the training sessions and the qualifications of the trainer if the trainer is not the agency’s RN.
It is the RNs responsibility to oversee all training and ensure all training requirements are met. However, training can also be provided by an LPN, supervisor or an experienced aide who has been employed by the provider agency for at least six months. A list of designated trainers must be maintained.

7. Waiver Documentation Medicaid Provider Manual Section 13
Written and phone verification
Name, address and phone number of the employer from whom the training was received;
The date or dates of the training;
A summary of the content and number of hours of the training;
For phone verification, the date of the phone contact and the name of the person verifying the information.
Providers are not required to waive training. They should use their judgment to determine if training should be waived. However, if any training is waived, proper verification and documentation must be maintained.
If a waiver is granted based on prior employment or prior training received, documentation must include the name, address and phone number of the employer from whom the training was received; the date or dates of the training received and a summary of the content and number of hours of training. This information can be received in written form or over the phone. If it is received over the phone, the date of the phone contact and the name of the person verifying the information must documented.
All documentation of waived training must be maintained in the employee’s personnel file.
As you can imagine, after investing the time of training an aide, some providers aren’t willing to verify the training. If the training cannot be verified, the training CANNOT be waived.

8. Certificate/License Verification 13 CSR 70.91-010(3)(E);
CNA Registry
State Board of Nursing
If any training is waived because the person is a certified nurses aide, a licensed practical nurse or a registered nurse, the person’s certificate or license must be verified. The certificate or license number and proof of verification must be maintained. These agencies can be contacted by telephone or their website for verification. Additionally, certificates and licenses must be verified on an ongoing basis to verify continued compliance.