A nurse aide training and competency evaluation program is a training program that a State has to approve, and 42 CFR 483.152 sets the minimum conditions it must meet, including no less than 75 clock hours of training, at least 16 hours of supervised practical training and qualified instructors. This page is for a nursing facility or school that plans to sponsor one. Integral Healthcare Solutions (IHS) drafts the application narrative, curriculum map and records plan, and your sponsor files it with the State.
Last updated: November 2026
What does 42 CFR 483.152 require of a nurse aide training program?
42 CFR 483.152, Requirements for approval of a nurse aide training and competency evaluation program, sets the federal minimums. IHS reads these as a floor a State may raise. Sources: sections 483.152, 483.150, 483.151 and 483.154; page opened November 5, 2026, using current GPO eCFR text built November 4, 2026 (Title 42 last amended October 8, 2026).
| Paragraph | What it asks, in IHS's words |
|---|---|
| (a)(1), (a)(2) | No less than 75 clock hours of training, including at least the subjects specified in paragraph (b). |
| (a)(3) | At least 16 hours of supervised practical training: training in a laboratory or other setting where the trainee demonstrates knowledge while performing tasks on an individual under the direct supervision of a registered nurse or a licensed practical nurse. |
| (a)(4) | Students do not perform any services for which they have not trained and been found proficient by the instructor, and students who are providing services to residents are under the general supervision of a licensed nurse or a registered nurse. |
| (a)(5)(i) | Training is performed by, or under the general supervision of, a registered nurse with a minimum of 2 years of nursing experience, at least 1 year of which is in the provision of long term care facility services. |
| (a)(5)(ii) | Instructors have completed a course in teaching adults, or have experience in teaching adults or supervising nurse aides. |
| (a)(5)(iii) | In a facility-based program, training may be performed under the general supervision of the director of nursing, who is prohibited from performing the actual training. |
| (a)(5)(iv) | Other personnel from the health professions may supplement the instructor, and supplemental personnel must have at least 1 year of experience in their fields. |
| (a)(6) | The program contains the competency evaluation procedures specified in section 483.154. |
| (b)(1) | At least a total of 16 hours of training before any direct contact with a resident, in communication and interpersonal skills, infection control, safety and emergency procedures (including the Heimlich maneuver), promoting residents' independence, and respecting residents' rights. |
Paragraph (b) also requires basic nursing skills, personal care skills, mental health and social service needs, care of cognitively impaired residents, basic restorative services and residents' rights. The text sets no hour count for those areas.
How does State approval work under 42 CFR 483.151 and 483.154?
Before approval, the State checks the program against sections 483.152 and 483.154. Under 483.151(b)(1)(iii), it must also visit the provider in every review after the initial review.
- Who reviews: if a State does not offer its own program, it must review and approve or disapprove programs upon request (483.151(a)(2)).
- Timing: within 90 days of the date of a request or of receipt of additional information from the requester, the State must advise whether the program is approved or request additional information (483.151(d)).
- Duration: approval may not run longer than 2 years, and a program must notify the State, which must then review it, when substantive changes are made within that period (483.151(e)).
- Facility history: the State may not approve a program offered by or in a facility that, in the previous two years, operated under one of the waivers the paragraph lists, was subject to an extended or partial extended survey, was assessed a civil money penalty of not less than 5,000 dollars as adjusted annually under 45 CFR part 102, or was subject to another remedy it lists (483.151(b)(2)). Under 483.151(c), a facility assessed such a penalty may request a CMS waiver of disapproval if the penalty was unrelated to direct hands-on resident care and treatment by health professionals or direct care staff. The waiver does not waive payment of the penalty.
- Competency evaluation: section 483.154 requires the evaluation to address each course requirement in 483.152(b), and the competency examination must be administered and evaluated only by the State directly or by a State approved entity that is neither a skilled nursing facility participating in Medicare nor a nursing facility participating in Medicaid.
- Withdrawal: under 483.151(f), the State must withdraw approval for a program offered by or in a facility described in (b)(2), or if the provider refuses unannounced State visits. It may withdraw approval if it determines applicable requirements of 483.152 or 483.154 are unmet. It must give written reasons and allow students who have started to complete the course.
Who needs it and what triggers it?
A nursing facility or school that wants to offer a nurse aide training program needs State approval for it. These triggers are IHS's reading of the text, not a list from CMS.
- A facility or school plans a new program and must meet the approval and curriculum conditions.
- An approval nears the end of its term, since 483.151(e) caps approval at 2 years, or a program makes substantive changes during the term.
How IHS helps
IHS assesses gaps against sections 483.151, 483.152 and 483.154, maps evidence, and drafts the application narrative, curriculum and clinical content for your clinicians to approve. Deliverables include the curriculum map, instructor checklist, proficiency and supervision procedures, facility-history screen and records plan. IHS conducts a mock review and supports readiness. Founded in 2002 by Thomas G. Goddard, JD, PhD, former URAC Chief Operating Officer and General Counsel, IHS offers this work through Compliance Services.
Your sponsor supplies program details, survey and penalty history, instructor credentials, training sites, supervising nurses and applicable State materials. State-specific requirements have not been reviewed here. IHS does not teach, supervise students, file with the State or communicate with the State agency. The sponsor approves and submits the application.
What to have ready
Checklist references are to 42 CFR, current eCFR text reviewed November 5, 2026.
- Facility history covering the prior two years of listed waivers, surveys, penalties and remedies (483.151(b)(2)).
- A curriculum of at least 75 clock hours covering each required subject (483.152(a)(1)–(2), (b)).
- At least 16 practical hours under direct RN or LPN supervision (483.152(a)(3)).
- At least 16 hours across all five required areas before any direct resident contact (483.152(b)(1)).
- Instructor qualification files and any facility-based director-of-nursing arrangement (483.152(a)(5)).
- Student proficiency and supervision procedures (483.152(a)(4)).
- Charge-prohibition and reimbursement procedures reflecting the conditions below (483.152(c)).
- Competency evaluation procedures (483.152(a)(6); 483.154).
If these do not exist yet, book the free introductory call and bring what you have.
How does outside drafting support compare with other routes?
A sponsor can use State guidance and prepare its application internally, or add outside drafting support. Internal preparation uses the sponsor's education and nursing staff; IHS adds document drafting, curriculum mapping and gap assessment. The sponsor supplies State materials and remains responsible for filing in either route. For a different program, see our NHSC site approval page.
What does it cost?
The four federal sections reviewed do not set an application fee; State fees have not been verified. Under 483.152(c)(1), an aide employed by, or holding an employment offer from, a facility when the program begins cannot be charged for any portion, including textbooks and other required materials. Under 483.152(c)(2), if an individual not employed, or without an offer to be employed, as a nurse aide becomes employed by, or receives an offer from, a facility within 12 months after completion, the State must provide reimbursement of program-completion costs pro rata during employment as a nurse aide.
IHS scopes each engagement after a free introductory call. Scope depends on training sites, instructors and gaps in the existing files. Sponsors also plan for their own staff time.
What this is not
This is not legal advice. IHS is a consulting firm, not a law firm, and your counsel confirms State law. It is not a guarantee that a State approves the program. IHS does not file with the State; the sponsor does.
Frequently asked questions
What does 42 CFR 483.152 require for an approved nurse aide training program?
Federal minimums include 75 clock hours, at least 16 hours of supervised practical training, qualified instructors and the subjects in 42 CFR 483.152(b). The program must also meet the student proficiency and supervision safeguards in 483.152(a)(4) and include competency evaluation procedures under 483.154.
How many hours must a nurse aide training program include?
The program must consist of no less than 75 clock hours of training and include at least 16 hours of supervised practical training. The curriculum must also include at least a total of 16 hours of training in listed areas before any direct contact with a resident.
What qualifications must nurse aide instructors have?
Training must be performed by, or under the general supervision of, a registered nurse with a minimum of 2 years of nursing experience, at least 1 year of which is in long term care facility services. Instructors must have completed a course in teaching adults or have experience teaching adults or supervising nurse aides.
Can a facility run its own nurse aide training program?
Yes, subject to State approval and the facility-history restrictions in 483.151(b)(2). Under 483.152(a)(5)(iii), the facility's director of nursing may provide general supervision but cannot perform the actual training. Section 483.151(c) permits a facility to request a CMS waiver of disapproval for a qualifying civil money penalty unrelated to direct hands-on resident care and treatment by health professionals or direct care staff. A waiver does not remove the obligation to pay the penalty.
What subjects must be covered before students have contact with residents?
Under 483.152(b)(1), students need at least 16 total training hours before any direct resident contact. The five areas are communication and interpersonal skills; infection control; safety and emergency procedures, including the Heimlich maneuver; promoting residents' independence; and respecting residents' rights.
How does a program get State approval, and what does the application contain?
If a State does not offer its own program, 483.151(a)(2) requires review and approval or disapproval upon request. Under 483.151(d), within 90 days of a request or receipt of additional information, the State must report whether approval was granted or request additional information. State application contents have not been verified here; the sponsor supplies the applicable materials for IHS to map against the federal requirements.
What supervision must students have when they work with residents?
Students do not perform any service for which they have not trained and been found proficient by the instructor, and students providing services to residents are under the general supervision of a licensed nurse or a registered nurse (paragraph (a)(4)). Supervised practical training takes place under the direct supervision of a registered nurse or a licensed practical nurse.
Can a sponsor charge trainees for the program?
An aide employed by, or holding an employment offer from, a facility when the program begins cannot be charged for any portion, including textbooks and other required materials (483.152(c)(1)). Section 483.152(c)(2) separately governs reimbursement after later facility employment or an offer, subject to the eligibility, 12-month and pro rata employment-period conditions described above.