CMS SOM App. B, Tag G768

An individual may furnish home health services on behalf of an HHA only after that

individual has successfully completed a competency evaluation program as

described in this section.

Interpretive Guidelines §484.80(c)

The HHA may not allow an aide to provide services to patients independently until they

have successfully completed competency testing either at that HHA or at another training

facility and successful completion is verified through documentation provided by the

applicant or the training facility.

§484.80(c)(1) The competency evaluation must address each of the subjects listed in

paragraph (b)(3) of this section. Subject areas specified under paragraphs (b)(3)(i),

(iii), (ix), (x), and (xi) of this section must be evaluated by observing an aide’s

performance of the task with a patient or pseudo-patient. The remaining subject

areas may be evaluated through written examination, oral examination, or after

observation of a home health aide with a patient, or with a pseudo-patient as part of

a simulation.

§484.80(c)(2) A home health aide competency evaluation program may be offered by

any organization, except as specified in paragraph (f)

of this section.

§484.80(c)(3) The competency evaluation must be performed by a registered nurse

in consultation with other skilled professionals, as appropriate.

Interpretive Guidelines §484.80(c)(1)

The following skills must be evaluated by observing the aide’s performance while

carrying out the task with a patient or pseudo-patient.

(i) Communication skills, including the ability to read, write, and verbally report

clinical information to patients, representatives, and caregivers, as well as to

other HHA staff;

(iii) Reading and recording temperature, pulse, and respiration;

(ix) Appropriate and safe techniques in performing personal hygiene and grooming

tasks that include—

(A) Bed bath;

(B) Sponge, tub, and shower bath;

(C) Hair shampooing in sink, tub, and bed;

(D) Nail and skin care;

(E) Oral hygiene;

(F) Toileting and elimination;

(x) Safe transfer techniques and ambulation;

(xi) Normal range of motion and positioning.

In accordance with §484.80(c)(3), a registered nurse, in consultation with other skilled

professionals (as appropriate), must observe the HHA aide candidate perform each of the

tasks above in its entirety to confirm the competence of the candidate.

HHA aides who successfully completed a competency evaluation prior to January 13,

2018, do not need to repeat the portions of the competency evaluation required to be done

while providing services to a patient under §§484.80 (b) (i), (iii), (ix), (x), and (xi). For

all HHA aides who receive a competency evaluation after January 13, 2018, however,

these skills must be tested while the aide is providing care to a patient or pseudo-patient.

A pseudo-patient is a person who is trained to participate in a role-play situation, or a

computer-based mannequin device. A pseudo-patient must be capable of responding to

and interacting with the home health aide trainee, and must be similar in characteristics

to the primary patient population served by the HHA in key areas such as age, frailty,

functional status, and cognitive status.

When pseudo-patients are used to test home health aide competency, the simulated

environment must mimic the reality of the homecare environment, including

environmental distractions and constraints that evoke or replicate substantial aspects of

the real world in a fully interactive fashion, to assess proficiency in performing skills.