Chapter 4723-26 Community Health Workers

For the purpose of this chapter, the following definitions apply:

(A) “Administrator” means the individual who is responsible for assuring that a community health worker training program establishes and implements appropriate standards and policies as set forth in rule 4723-26-12 of the Administrative Code.

(B) “Board” means the Ohio board of nursing.

(C) “Certificate to practice” means the certificate issued by the board in accordance with section 4723.85 of the Revised Code.

(D) “Client” means the recipient of a nursing task or activity delegated by a registered nurse and may include an individual, group, or community.

(E) “Clinical experience” means a task or activity planned to meet course objectives or outcomes and to provide community health worker students with the opportunity to practice cognitive, psychomotor, and affective skills related to the delivery of care by community health workers. This experience may take place in a community setting or other appropriate site.

(F) “Community health worker” and “certified community health worker” mean an individual who satisfies both of the following:

(1) As a community representative, advocates for clients in the community by assisting them in accessing community health and supportive resources through the provision of such services as education, role modeling, outreach, home visits, or referrals; and

(2) Holds a certificate to practice issued or renewed by the board under section 4723.85 of the Revised Code.

(G) “Continuing education” means a planned learning activity that builds upon a community health worker’s precertification education program and enables a community health worker to acquire or improve skills, knowledge or behavior that promotes professional or technical development or the enhancement of career goals and is approved by the board under Chapter 4723-14 of the Administrative Code.

(H) “Curriculum” means the standard minimum curriculum to be used in a board-approved training program for community health workers as provided in rule 4723-26-13 of the Administrative Code.

(I) “Delegation” means the transfer of responsibility for the performance of selected nursing tasks or activities from a registered nurse to a community health worker.

(J) “Didactic” means the component of an educational program that includes lecture, verbal instruction, or other means of exchanging theoretical information between instructor and students, typically in a classroom setting.

(K) “Endorsement” means the process by which a certificate to practice as a community health worker is issued by the board following verification that the applicant holds or has held a valid certificate, license, or other authorization to practice that is or was in good standing in every jurisdiction in which the applicant is authorized to practice as a community health worker.

(L) “Laboratory experience” means an activity planned to meet course objectives or outcomes and to provide a community health worker student with the opportunity to practice cognitive, psychomotor, and affective skills in the delivery of care, that takes place in a learning resource center or other appropriate location.

(M) “Professional boundaries” means the limits of the professional relationship that allow for a safe therapeutic relationship between the client and the community health care worker.

(N) “Registered nurse” means an individual who holds a current, valid license that authorizes the practice of nursing as defined in divisions (A) to (D) of section 4723.01 of the Revised Code.

(O) “Representative of the board” means an employee of the board or an individual designated by the board to act on its behalf.

(P) “Site visit” means an announced or unannounced visit to a community health worker training program by a representative of the board to determine whether the program meets or maintains the minimum standards require by the board.

(Q) “Supervise” and “supervision” mean initial and ongoing direction, procedural guidance, observation, and evaluation by a registered nurse who is continually available in person, or by some form of telecommunication, of the nursing tasks or activities provided by a community health worker.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Statutory Authority: 4723.88

Rule Amplifies: 4723.81 through 4723.88

R.C. 119.032 review dates: 02/01/2010

(A) To obtain a certificate to practice as a community health worker, an applicant who meets the qualifications set forth in division (A) of section 4723.84 of the Revised Code shall:

(1) Submit a completed application on a form specified by the board that includes the requirements set forth in division (A) of section 4723.84 of the Revised Code;

(2) Submit an application fee of thirty-five dollars; and

(3) In accordance with division (B) of section 4723.83 of the Revised Code, submit a request to the bureau of criminal identification and investigation for a criminal records check. The results of the criminal records check shall:

(a) Be received by the board before issuance of a certificate; and

(b) Indicate that the individual has not been convicted of, pleaded guilty to, or had a judicial finding of guilt for any violation set forth in division (A)(4) of section 4723.84 of the Revised Code.

(B) Except as provided in paragraph (D) of this rule, the board shall issue a certificate to practice as a community health worker to applicants who satisfy the requirements of paragraph (A) of this rule, after receipt of both of the following:

(1) Notice that the applicant has successfully completed a community health worker training program from a program approved by the board; and

(2) Attestation from the board-approved training program that the applicant is competent to provide care as a community health worker.

(C) If through no fault of the board, an applicant for a certificate to practice as a community health worker is not determined eligible for a certificate within one year from the time the board receives the application, the application shall be considered void and the fee shall be forfeited. The application shall state the circumstances under which this forfeiture may occur.

(D) For the period of one year following the effective date of this chapter, an individual desiring to be issued a certificate to practice as a community health worker may be issued a certificate to practice by the board providing that all of the following are satisfied:

(1) The individual can document that he or she has worked in a capacity that is substantially similar to a community health worker at some point within the three years immediately prior to February 1, 2005;

(2) A representative of the program at which the individual worked will attest to the fact that:

(a) The individual worked in a program that is substantially similar to a community health worker program approved by the board, within the three years immediately prior to February 1, 2005; and

(b) The individual worked in a capacity that is substantially similar to a community health worker certified by the board in accordance with section 4723.81 of the Revised Code and this chapter;

(3) A notarized written statement is provided to the board attesting to the competency of the individual applying for certification in accordance with this paragraph to provide community health worker services. Such statement shall be provided by either of the following:

(a) An employer or representative of an employer of community health workers certified in accordance with section 4723.81 of the Revised Code and this chapter; or

(b) A former employer or representative of a former employer of the individual as provided in paragraph (D)(2) of this rule.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Statutory Authority: 4723.88

Rule Amplifies: 4723.81, 4723.83, 4723.84

R.C. 119.032 review dates: 02/01/2010

(A) To obtain a certificate to practice as a community health worker by endorsement, an applicant shall:

(1) Hold a current valid certificate, license, or other authorization to practice as a community health worker issued by another jurisdiction that has standards for issuing a certificate, license, or other authorization to practice that are substantially similar to the board’s standards;

(2) Submit a completed application on a form specified by the board;

(3) Submit an application fee of thirty-five dollars; and

(4) In accordance with division (A)(4) of section 4723.84 of the Revised Code, submit a request to the bureau of criminal identification and investigation for a criminal records check. The results of the criminal records check shall:

(a) Be received by the board before issuance of a certificate; and

(b) Indicate that the individual has not been convicted of, pleaded guilty to, or had a judicial finding of guilt for any violation set forth in division (A)(4) of section 4723.84 of the Revised Code.

(B) Prior to issuing a certificate to practice as a community health worker by endorsement the board shall have received directly from each jurisdiction in which the applicant holds a certificate, license, or other authorization to practice as a community health worker, verification that the applicant holds a certificate, license, or other authorization to practice in good standing in each jurisdiction.

(C) The board shall issue a certificate to practice as a community health worker by endorsement to an applicant who satisfies both of the following:

(1) Has provided the information and fees required in paragraph (A) of this rule; and

(2) The board has received evidence that the applicant holds a certificate, license, or other authorization to practice as a community health worker in good standing from another jurisdiction whose standards for issuing a certificate, license or other authorization to practice are substantially similar to standards of the board.

(D) The board may condition issuance of the certificate on proof of the applicant’s successful completion of board-approved course content covering Chapter 4723. of the Revised Code and the rules of this chapter with respect to the role, accountability, and responsibility of a community health worker certified to practice in Ohio.

(E) If through no fault of the board, an applicant for a certificate to practice as a community health worker by endorsement is not determined eligible for a certificate within one year from receipt of the application, the application shall be considered void and the fee forfeited. The application shall state the circumstances under which this forfeiture may occur.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Statutory Authority: 4723.88

Rule Amplifies: 4723.83, 4723.84

R.C. 119.032 review dates: 02/01/2010

(A) To renew a certificate to practice as a community health worker a holder of a current valid certificate shall, on a schedule specified by the board, satisfy all of the following:

(1) Submit a completed renewal application on a form specified by the board;

(2) Submit a renewal fee of thirty-five dollars; and

(3) Meet the continuing education requirements set forth in rule 4723-26-05 of the Administrative Code.

(B) If a completed renewal application is not submitted to the board on or before March first of each odd numbered year, the application shall be considered late and a late fee of fifty dollars shall be imposed in addition to the thirty-five dollar renewal fee set forth in paragraph (A)(2) of this rule.

(C) A certificate holder who, at any time, does not wish to renew his or her certificate to practice as a certified community health worker in Ohio may request that his or her certificate be placed on inactive status by either of the following:

(1) Submitting to the board, the certificate holder’s current certificate together with a written statement requesting that the certificate be placed on inactive status; or

(2) At certificate renewal time, checking the appropriate box on the renewal form provided by the board that indicates the certificate holder wants to initiate inactive status.

(D) The board may reactivate an inactive certificate to practice as a community health worker if an individual submits to the board all of the following:

(1) Written notice requesting reactivation of the inactive certificate on a form prescribed by the board;

(2) A reactivation fee in the amount of thirty-five dollars; and

(3) Documentation satisfactory to the board of having completed the continuing education requirements for renewal of a community health worker certificate as provided in rule 4723-26-05 of the Administrative Code.

(E) If a certificate to practice as a community health worker is not renewed by April first of each odd number year and the certificate holder has failed by that time to request that the certificate be placed on inactive status, the board shall place the certificate on lapsed status.

(F) The board may restore to active status a lapsed certificate to practice as a community health worker if the individual submits to the board all of the following:

(1) A written request for restoration on a form prescribed by the board;

(2) Payment of the thirty-five dollar renewal fee plus a lapsed fee of one hundred dollars; and

(3) Documentation satisfactory to the board of having completed the continuing education requirements for renewal as provided in rule 4723-26-05 of the Administrative Code.

(G) When a certificate to practice as a community health worker is on inactive or lapsed status, the individual shall not represent or imply to the public that he or she is certified by the board to practice as a community health worker.

(H) An individual who continues to represent to the public that he or she is a certified community health worker during the time that his or her certificate is on inactive or lapsed status, may be subject to disciplinary action by the board in accordance with section 4723.28 of the Revised Code.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Statutory Authority: 4723.88

Rule Amplifies: 4723.85

R.C. 119.032 review dates: 02/01/2010

(A) Except in the case of the first renewal of an active certificate to practice as a community health worker, to be eligible to renew an active certificate, a community health worker shall obtain fifteen contact hours of continuing education during each renewal period. For each reporting period, at least one of the required hours of continuing education must be directly related to Chapter 4723. of the Revised Code and the rules of the board in Chapters 4723-1 to 4723-23 of the Administrative Code. For each reporting period, at least one of the required hours of continuing education must be directly related to establishing and maintaining professional boundaries. This requirement applies to the reporting period set forth in paragraph (C) of this rule.

(B) A community health worker from another jurisdiction who applies for a certificate to practice as a community health worker by endorsement shall not be required to meet the continuing education requirement to obtain an initial certificate to practice as a community health worker.

(C) A community health worker who requests that the certificate to practice as a community health worker be placed on inactive status shall not be required to meet the continuing education requirement for the period of time the certificate is on inactive status. To return to active status the community health worker shall complete fifteen hours of continuing education that meet the requirements as set forth in paragraph (A) of this rule during the twenty-four months immediately preceding application for reactivating the certificate.

(D) When a certificate to practice as a community health worker is allowed to lapse the holder of the certificate shall complete fifteen hours of continuing education that meet the requirements of paragraph (A) of this rule during the twenty-four months immediately preceding application to restore the certificate.

(E) A community health worker shall verify completion of the continuing education required by this rule on the application for certificate renewal provided by the board, and at the discretion of the board, may be required to show proof of completion of the approved continuing education. Failure to so verify or provide such proof shall result in ineligibility to renew or restore a certificate to practice as a community health worker until the continuing education requirements are met.

(F) A community health worker who earns in excess of the number of contact hours of continuing education required for a single reporting period shall not apply the excess hours to satisfy future continuing education requirements.

(G) A community health worker who is ineligible to renew or restore a certificate to practice as a community health worker in Ohio due to failure to meet the continuing education requirements, may be required to show completion of up to thirty contact hours of continuing education, that meets the requirements of this rule, before being issued a current certificate by the board. The continuing education shall be obtained within the forty-eight months immediately preceding renewal or restoration of the certificate.

(H) A community health worker may use a waiver to satisfy the continuing education requirement only one time, and the community health worker shall notify the board in writing requesting the waiver. Once the community health worker notifies the board of the intent to use the waiver, the waiver shall not be rescinded and use of the waiver shall be documented on the community health worker’s certificate.

(I) The calculation of contact hours based on credit hours earned in an academic institution shall be made in accordance with paragraph (B) of rule 4723-14-04 of the Administrative Code.

(J) Educational activities that satisfy the requirements of this rule are the same as those set forth in rule 4723-14-05 of the Administrative Code.

(K) The board may conduct a retrospective audit of any holder of a certificate to practice as a community health worker to determine compliance with this rule. The audit shall be conducted in accordance with rule 4723-14-07 of the Administrative Code. A community health worker shall retain proof of completion of approved continuing education for a period of six years.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Statutory Authority: 4723.88

Rule Amplifies: 4723.85

R.C. 119.032 review dates: 02/01/2010

(A) This chapter sets forth standards for the delegation and supervision of nursing tasks and activities performed by a community health worker at the delegation of a registered nurse.

(B) Nothing in this chapter shall be construed to prevent any person registered, certified, licensed, or otherwise legally authorized under any law in this state from engaging in the practice for which such person is registered, certified, licensed, or authorized.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Statutory Authority: 4723.88

Rule Amplifies: 4723.82

R.C. 119.032 review dates: 02/01/2010

(A) Pursuant to division (B) of section 4723.82 of the Revised Code, a registered nurse shall not delegate to a community health worker the administration of medications.

(B) No community health worker to whom a nursing task or activity is delegated shall delegate the nursing task or activity to any other person.

(C) Employing a community health worker to engage in the unauthorized practice of nursing is prohibited by section 4723.03 of the Revised Code.

(D) If a community health worker delegates a nursing task or activity, the community health worker shall be engaging in the unauthorized practice of nursing, which is prohibited by section 4723.03 of the Revised Code.

(E) If a community health worker performs a nursing task or activity and does not comply with all the provisions set forth in this chapter, the community health worker shall be engaging in the unauthorized practice of nursing, in violation of section 4723.03 of the Revised Code.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Statutory Authority: 4723.88

Rule Amplifies: 4723.82

R.C. 119.032 review dates: 02/01/2010

(A) A registered nurse may delegate a nursing task or activity to a community health worker if all the conditions for delegation set forth in this chapter are met.

(B) When delegating a nursing task or activity to a community health worker, the delegating registered nurse shall determine that the following conditions are met:

(1) The nursing task or activity is within the scope of practice of a registered nurse as set forth in section 4723.01 of the Revised Code;

(2) The nursing task or activity is within the knowledge, skill, and ability of the registered nurse delegating the nursing task or activity;

(3) The nursing task or activity is within the training, skill, and ability of the community health worker who will be performing the delegated nursing task or activity;

(4) The nursing task or activity is delegable as specified in this rule;

(5) Appropriate resources and support are available for the performance of the nursing task or activity, and for management of the outcome;

(6) Adequate and appropriate supervision by the registered nurse of the performance of the nursing task or activity is available in accordance with this rule; and

(7) The community health worker shall perform the delegated task or activity only as specified by the registered nurse.

(C) Prior to the delegation of any nursing task or activity to a community health worker, a registered nurse shall:

(1) Identify:

(a) The individual on whom the nursing task or activity may be performed; and

(b) A specific time frame during which the delegated nursing task or activity may be performed.

(2) Complete an evaluation of the conditions that relate to the delegation of the nursing task or activity to be performed, including:

(a) An evaluation of the individual who needs nursing care;

(b) The types of nursing care the individual requires;

(c) The complexity and frequency of the nursing care needed;

(d) The stability of the individual who needs nursing care; and

(e) A review of the evaluations performed by other licensed health care professionals.

(3) Identify a nursing task or activity as delegable if all the following apply:

(a) The nursing task or activity requires no judgment based on nursing knowledge and expertise on the part of the community health worker performing the task;

(b) The results of the nursing task or activity are reasonably predictable;

(c) The nursing task or activity can be safely performed according to exact, unchanging directions, with no need to alter the standard procedures for performing the task;

(d) The performance of the nursing task or activity does not require that complex observations or critical decisions be made with respect to the nursing task or activity;

(e) The nursing task or activity does not require repeated performance of nursing assessments by the delegating registered nurse; and

(f) The consequences of performing the nursing task or activity improperly are minimal and not life-threatening.

(D) The registered nurse shall be accountable for the acts of delegation to and supervision of the community health worker in the performance of the delegated nursing task or activity.

(E) If a registered nurse determines that a community health worker is not performing a delegated task or activity according to the community health worker’s training and in accordance with the registered nurse’s direction, the registered nurse shall immediately withdraw the delegation.

(F) A registered nurse shall not be responsible for the delegation of a nursing task or activity by another licensed health care practitioner to a community health worker.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Statutory Authority: 4723.88

Rule Amplifies: 4723.82

R.C. 119.032 review dates: 02/01/2010

(A) When a community health worker is performing a delegable nursing task or activity in accordance with this chapter, supervision shall be provided by a registered nurse. For purposes of this rule, supervision includes initial and ongoing direction, procedural guidance, and observation and evaluation. The registered nurse providing the supervision for a delegated nursing task or activity shall evaluate and document the following on an ongoing basis:

(1) The degree to which the nursing care needs of the individual are being met;

(2) The performance by the community health worker of the delegated nursing task or activity;

(3) The need for further instruction to the community health worker to whom the nursing task or activity is delegated; and

(4) The need to withdraw the delegation.

(B) For purposes of providing supervision to a community health worker performing a delegated nursing task or activity, the registered nurse must be either:

(1) Continually accessible to the community health worker in person; or

(2) Continually available to the community health worker by some form of telecommunication.

(C) In determining the number of community health workers that a registered nurse may supervise, the registered nurse shall consider all of the following:

(1) A registered nurse may not supervise any more than five community health workers at one given time;

(2) The number of clients who require nursing care and the health status of those clients;

(3) The types and numbers of nursing tasks or activities to be delegated to each community health worker;

(4) The competency, dependability, and reliability of each community health worker to be supervised;

(5) The number of different settings in which the community health workers will be providing services and the proximity between these settings and the location of the registered nurse; and

(6) The availability of emergency aid if the registered nurse is not able to reach, in a timely manner, the setting in which the community health workers are providing services.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Statutory Authority: 4723.88

Rule Amplifies: 4723.82

R.C. 119.032 review dates: 02/01/2010

(A) The purpose of this chapter is to establish minimal acceptable standards of safe and effective care provided by community health workers holding a certificate issued by the board of nursing pursuant to Chapter 4723. of the Revised Code.

(B) A community health worker shall maintain knowledge of the duties, responsibilities, and accountabilities of a community health worker and shall practice in accordance with the following:

(1) Laws regulating the provision of care by a community health worker as set forth in Chapter 4723. of the Revised Code;

(2) Rules adopted by the board in accordance with Chapter 119. of the Revised Code; and

(3) Any other applicable state or federal laws and rules.

(C) A community health worker shall perform nursing tasks or activities in accordance with sections 4723.81 and 4723.82 of the Revised Code, only as delegated and supervised by a registered nurse holding a current, valid license issued by the board under Chapter 4723. of the Revised Code.

(D) A community health worker shall demonstrate competence and accountability in performing nursing tasks or activities as delegated by a registered nurse, including, but not limited to, the following:

(1) Consistent performance of nursing tasks or activities as delegated by a registered nurse; and

(2) Consulting with the supervising nurse in a timely manner to facilitate appropriate referral, consultation, or intervention when a community health worker identifies factors or conditions adversely affecting, or potentially affecting, a client’s health status.

(E) A community health worker shall, in a timely manner:

(1) Perform the nursing tasks or activities as delegated by a registered nurse, unless the community health worker believes or should have reason to believe any of the following:

(a) Performing the nursing task or activity is harmful or potentially harmful to the client;

(b) The nursing task or activity is contraindicated by other documented information;

(c) The nursing task or activity is inappropriate for the client;

(d) The nursing task or activity is not properly authorized; or

(e) The condition of the client has changed.

(2) Seek clarification of the appropriateness of any delegated nursing task or activity if the community health worker believes, or should have reason to believe, any of the following:

(a) Performing the nursing task or activity is harmful or potentially harmful to the client;

(b) The nursing task or activity is contraindicated by other documented information;

(c) The nursing task or activity is inappropriate for the client;

(d) The nursing task or activity is not properly authorized; or

(e) The condition of the client has changed.

(F) When clarifying the appropriateness of a nursing task or activity the community health worker shall, in a timely manner:

(1) Consult with the supervising registered nurse to explain the cause of concern;

(2) Advise the supervising registered nurse if the community health worker decides not to perform the nursing task or activity;

(3) Document that the supervising registered nurse was advised of the community health worker’s decision not to perform the nursing task or activity as delegated; and

(4) Take any other actions reasonable and appropriate to protect the safety of the client.

(G) A community health worker shall, in a timely manner, document, report to, and consult with, the supervising registered nurse when a client refuses to follow the health care regimen.

(H) A community health worker shall maintain the confidentiality of client information obtained in the course of the community health worker’s duties and responsibilities. A community health worker is not precluded from communicating appropriate client information to other members of the health care team for client care purposes only.

(I) A community health worker shall do all of the following to promote client safety:

(1) Display the applicable title set forth in section 4723.82 of the Revised Code at all times when providing direct client care;

(2) In a timely manner, completely and accurately document and report all client data obtained while performing nursing tasks or activities delegated by the supervising registered nurse, and the client’s response to the care;

(3) In a timely manner, completely and accurately document and report to the supervising registered nurse all errors in, or deviations from, the delegated nursing tasks or activities;

(4) Not falsify any client records or other documents prepared in the course of, or in conjunction with, the performance of delegated nursing tasks or activities;

(5) Implement reasonable and appropriate measures to provide a safe environment for the client including consulting with a supervising registered nurse any time that the community health worker suspects client abuse or neglect;

(6) Establish, delineate, and maintain professional boundaries with all clients;

(7) Refrain from all behavior that causes or may cause physical, verbal, mental, or emotional abuse or distress to a client, or in behavior that may be reasonably interpreted to cause physical, verbal, mental, or emotional abuse or distress;

(8) Not misappropriate a client’s property, engage in behavior to seek or obtain personal gain at the client’s expense, or engage in behavior that constitutes inappropriate involvement in a client’s personal relationships;

(9) Not engage in sexual misconduct or in conduct that may reasonably be interpreted as sexual, or in any verbal behavior that is seductive or sexually demeaning to a client, or in behavior that may reasonably be interpreted as seductive or sexually demeaning to a client; and

(10) Treat each client with courtesy, respect, and with full recognition of the dignity of each individual client.

For purposes of paragraphs (E)(8) and (E)(9) of this rule, a client is always considered to be incapable of giving free, full, or informed consent to the actions of a community health worker.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Statutory Authority: 4723.88

Rule Amplifies: 4723.81, 4723.82

R.C. 119.032 review dates: 02/01/2010

(A) By the vote of a quorum, the board may revoke or may refuse to grant or renew a community health worker certificate to a person found by the board to have committed fraud, misrepresentation, or deception in applying for a community health worker certificate.

(B) By the vote of a quorum, the board may impose one or more of the following sanctions on an individual who applies for, or holds, a community health worker certificate:

(1) Deny, revoke, suspend, or place restrictions on a community health worker certificate; or

(2) Reprimand or otherwise discipline a holder of a community health worker certificate.

(C) The sanctions set forth in paragraph (B) of this rule may be imposed by the board for:

(1) Any of the acts or omissions included in division (B) of section 4723.28 of the Revised Code; or

(2) Failure by a community health worker to conform to the standards of safe care established in rule 4723-26-10 of the Administrative Code.

(D) Any actions taken by the board under section 4723.86 of the Revised Code or this rule shall be taken in accordance with the standards and procedures set forth in sections 4723.28, 4723.281, 4723.282, and 4723.35 of the Revised Code.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Statutory Authority: 4723.88

Rule Amplifies: 4723.86

R.C. 119.032 review dates: 02/01/2010

(A) In order to be approved by the board in accordance with division (G) of section 4723.88 of the Revised Code, a community health worker training program shall employ or contract with a person to serve as program administrator. Such person shall meet one of the following criteria:

(1) Hold a license or certificate to practice as one of the following health care professionals:

(a) A dentist licensed under Chapter 4715. of the Revised Code;

(b) A nurse licensed under Chapter 4723. of the Revised Code;

(c) An optometrist licensed under Chapter 4725. of the Revised Code;

(d) A pharmacist licensed under Chapter 4729. of the Revised Code;

(e) A physician assistant certified under Chapter 4730. of the Revised Code;

(f) A physician licensed under Chapter 4731. of the Revised Code;

(g) A psychologist licensed under Chapter 4732. of the Revised Code;

(h) A chiropractor licensed under Chapter 4734. of the Revised Code;

(i) A nursing home administrator licensed under Chapter 4751. of the Revised Code;

(j) A counselor, social worker, or marriage and family therapist licensed under Chapter 4757. of the Revised Code; or

(k) A dietician licensed under Chapter 4759. of the Revised Code.

(2) Hold credentials as an education professional that are recognized by:

(a) The Ohio department of education;

(b) The Ohio board of regents; or

(c) A nationally or regionally recognized accreditation body for programs of postsecondary education.

(B) The administrator of a community health worker training program shall be responsible for the following:

(1) Assuring that the governing board of the community health worker training program establishes written policies addressing the issues set forth in paragraph (C) of this rule;

(2) Assuring that the policies of the program are implemented as written;

(3) Assuring that the nursing tasks or activities included in the curriculum of an approved community health worker training program are taught by an individual who:

(a) Has held an Ohio license to practice registered nursing for a minimum of two years;

(b) Is not prohibited by law from teaching such services;

(c) Satisfies one of the following:

(i) Has experience in working directly with community health workers for a minimum of six months prior to entering into an instructor role; or

(ii) Within six months after assuming instructor responsibilities in the community health worker training program, successfully completes the community health worker program coursework.

(4) Assuring that the training program utilizes other licensed health care professionals to provide portions of the relevant classroom and clinical instruction in accordance with the professional’s educational background and applicable scope of practice as set forth in the appropriate section or sections of the Revised Code.

(C) A community health worker training program shall adopt and implement program policies that address all of the following:

(1) Criteria for students to enroll and continue in the program that establish a basic level of ability necessary for an individual to safely perform the essential functions of a community health worker;

(2) Criteria for student re-enrollment in the program;

(3) Criteria for successful completion of the program;

(4) A process for determining that a student has sufficient knowledge and understanding to safely provide the care and services of a community health worker including both nursing tasks or activities, and non-nursing tasks or activities.

(a) A registered nurse shall provide written verification that a community health worker student has been taught the skills necessary to perform delegated nursing tasks or activities;

(b) A registered nurse or other qualified individual engaged in providing training in a community health worker training program shall provide written verification that a student has been taught skills appropriate for the provision of non-nursing task or activities by a community health worker.

(5) A process for maintaining student records including but not limited to:

(a) The date a student began the program;

(b) The date a student completed the program; and

(c) The competency check lists for each individual student.

(6) An accurate, timely process for providing verification to the board that a student seeking certification as a community health worker has successfully completed the approved training program;

(7) A process for program evaluation that includes, but is not limited to, feedback from students, instructors and employers of individuals who have successfully completed the community health worker training program;

(8) Designation of those persons with authority to notify the board regarding student enrollment, re-enrollment, and completion of the program; and

(9) A process for addressing the unexpected vacancy of the administrator of the program.

(D) When the administrator of an approved community health worker training program vacates the position or is replaced, an authorized representative of the program shall provide written notice to the board within thirty days after the position is vacated and within thirty days after a new person assumes the role.

(E) An approved training program shall not initiate a new community health worker training program unless an administrator who meets the requirements of paragraph (A) of this rule is in place.

(F) When a decision is made to close a community health worker training program, the board shall be notified in writing of the decision and provided with the following information:

(1) The tentative date of closing;

(2) The location of the program’s records, including but not limited to, trainees’ records; and

(3) The name and address of the custodian of the records.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Statutory Authority: 4723.88

Rule Amplifies: 4723.87

R.C. 119.032 review dates: 02/01/2010

(A) An approved curriculum for a training program for community health workers shall be the standard minimum curriculum set forth in paragraph (B) of this rule and shall satisfy all of the following:

(1) Include a program philosophy, program objectives or outcomes, course objectives or outcomes, teaching strategies, and core competencies or other evaluation methods that are:

(a) Consistent with the law regulating the practice of the community health worker;

(b) Internally consistent;

(c) Implemented as written; and

(d) Distributed to community health worker students;

(2) Include a curriculum plan showing the sequence of courses, laboratory experiences, and units of credit or number of clock hours allotted to theory and laboratory experiences; and

(3) Include a curriculum content that is a minimum of one hundred hours of didactic classroom instruction and one hundred thirty hours of clinical experience. Relevant laboratory experiences may be integrated into the curriculum.

(B) As part of the classroom instruction required in paragraph (A) of this rule, related clinical and laboratory experiences shall provide a community health worker with an opportunity to practice cognitive, psychomotor, and affective skills in the performance of a variety of basic tasks and activities with individuals or groups across the life span. Portions of the relevant clinical experience shall be provided in a community setting similar to the settings in which a community health worker will provide services.

(C) The standard minimum curriculum for community health workers shall include courses, content, and expected outcomes, relative to the defined role of the community health worker, in the following major areas:

(1) Health care, including expected competencies in the areas of:

(a) The physical, mental, emotional and spiritual impacts on health;

(b) Basic anatomy and physiology of major body systems;

(c) Substance use and affects on health;

(d) Signs indicating a change in a client’s health status;

(e) Obtaining accurate vital signs;

(f) Basic cardiopulmonary resuscitation skills;

(g) Medical terminology;

(h) Documentation methods; and

(i) Utilization of local health and referral systems.

(2) Community resources, including expected competencies in the areas of:

(a) Referral methods to assist various target population groups;

(b) Utilization of community resources and their referral processes;

(c) Utilization of resources related to entitlement programs;

(d) Recognizing and reporting signs of family violence, abuse and neglect; and

(e) Recognizing and making appropriate referral for signs of mental health and addiction problems.

(3) Communication skills, including expected competencies in the areas of:

(a) Interpersonal communication skills;

(b) Effective interview techniques;

(c) Effective written communications to health care and service care providers; and

(d) Utilization of appropriate telephone technique.

(4) Individual and community advocacy, including expected competencies in the areas of:

(a) Recognition of diversity, and the role of the community health worker in an interdisciplinary team;

(b) Supporting development of self care skills in various target population groups;

(c) Utilization of skills to assure that different target population groups receive needed services; and

(d) Methods of serving as a community liaison between different target population groups and local agencies and providers.

(5) Health education, including expected competencies in the areas of:

(a) Educating on healthy lifestyle choices, including nutrition, exercise, and stress management to reduce health risk factors;

(b) Educating on adverse health consequences of smoking, drinking; and drugs of abuse;

(c) Educating on the importance of oral health care across the lifespan;

(d) Explaining basic prevention and wellness topics; and

(e) Explaining age-appropriate safety and injury prevention techniques.

(6) Service skills and responsibilities, including expected competencies in the areas of:

(a) Protocols and policies regarding:

(i) Confidentiality;

(ii) Care coordination;

(iii) Documentation;

(iv) Submission of documentation for review by a supervisor; and

(v) Release of client information.

(b) Skills necessary to carry out an effective home visit, including:

(i) Personal safety;

(ii) Emotional dynamics;

(iii) Setting appropriate boundaries with clients;

(iv) Time management; and

(v) Conflict management skills.

(c) Performance of basic clerical, computing, and office skills necessary in the role of the community health worker.

(D) The standard minimum curriculum for community health workers shall also educate students on needs throughout the span of a lifetime including the following:

(1) Content related to the family during childbearing years, including expected competencies in the areas of:

(a) Health education related to the childbearing years; and

(b) A basic understanding of related anatomy, physiology, and appropriate health care.

(2) Content related to the family during pregnancy, including expected competencies in the areas of:

(a) Basic anatomy, physiology, and normal signs related to pregnancy;

(b) Recognition of warning signs during pregnancy requiring immediate reporting to the registered nurse supervisor; and

(c) Health education related to pregnancy, labor, and postpartum care.

(3) Content related to the newborn, infant, and young child, including expected competencies in the areas of:

(a) Routine infant feeding and newborn care;

(b) Recognizing and reporting problems that can occur in early infancy;

(c) Immunization schedules and information regarding referral to appropriate health care facilities and practitioners;

(d) Basic methods to enhance typical child development; and

(e) Identification of potential developmental delays.

(4) Content related to adolescents including expected competencies in the areas of:

(a) Age appropriate health education;

(b) Acute and chronic illnesses including, but not limited to asthma, obesity, and eating disorders; and

(c) High risk behaviors.

(5) Content related to adults and seniors, including expected competencies in the areas of:

(a) The aging process;

(b) Prevention strategies;

(c) Recommended screenings;

(d) Top causes of morbidity and mortality by age group; and

(e) Acute and chronic illnesses of adulthood including but not limited to heart disease, cancer, stroke, diabetes, and lung disease.

(6) Content related to special health care and social needs of target population groups including:

(a) Grandparents raising grandchildren;

(b) Adults caring for aging parents; and

(c) Children and adults with disabilities.

(E) For purposes of paragraph (B) of this rule, students participating in a clinical practicum in a community setting shall be supervised by qualified instructional personnel employed by, or under contract with, the community health worker training program.

(F) It is the intent of the board that this curriculum is structured in such a way as to assure that participants who successfully complete a program that provides the curriculum may be able to utilize a portion of the credit hours earned toward additional career-related education.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Statutory Authority: 4723.88

Rule Amplifies: 4723.88(G)

R.C. 119.032 review dates: 02/01/2010

The board shall approve and reapprove community health worker training programs as follows:

(A) A community health worker training program that seeks to be approved by the board shall submit to the board all of the following:

(1) A completed application on a form specified by the board;

(2) Payment of a program approval fee of three hundred dollars; and

(3) Any other information requested by the board.

(B) A community health worker training program seeking reapproval by the board shall submit the following to the board within ninety days prior to the expiration of its current approval:

(1) A reapproval application on a form specified by the board;

(2) Payment of a program reapproval fee of three hundred dollars; and

(3) Any other information requested by the board.

(C) If the board determines that additional information is necessary prior to rendering a decision on an application for program approval or reapproval, the board shall provide written notice to the applicant and shall specify a reasonable timeframe within which such information shall be provided to the board.

(D) Not more than one hundred twenty days after receipt of a complete application for approval or reapproval, the board shall provide the applicant with written notification regarding the approval status of its application.

(E) The board may conduct a site visit of a community health worker training program either prior to approving or reapproving a program application, or at any time during the two year period for which a program is approved.

(F) At a regularly scheduled board meeting the board shall review the completed application for approval or reapproval and all other relevant documentation to determine whether a program complies with standards set forth in this chapter. If the board finds that the program meets all the requirements of this chapter it shall issue its approval or reapproval, in writing, to the applicant program.

(G) Program approval shall extend for two years provided the program continues to meet the program standards set forth in this chapter.

(H) If the board determines that an application for program approval or reapproval does not demonstrate that the applicant program meets or maintains the minimum standards set forth in this chapter, the board shall submit to the administrator of the program a written report that identifies the specific deficiencies, and includes the date on which the board is to consider the deficiency report. The date for consideration of a deficiency report shall be not less than thirty days after the date on which the applicant program could reasonably be expected to have received the written deficiency report.

(I) Within thirty days after receipt of the deficiency report, the administrator of the program may submit to the board either:

(1) A written plan of correction that sets forth the steps taken by the program to meet or maintain each minimum standard identified in the report as not being met or maintained; or

(2) A written response to the report setting forth evidence that the program is meeting and maintaining each minimum standard identified in the report as not being met or maintained.

(J) Based on the deficiency report, the program’s response to the report, if any, and any other relevant evidence, the board may grant approval, grant provisional approval, continue approval, or propose to deny or withdraw approval of the program. The board shall deny or withdraw approval of a program only pursuant to an adjudication in accordance with Chapter 119. of the Revised Code.

(K) If at any time a program with full approval fails to meet and maintain the minimum standards set forth in this chapter, the board shall place the program on provisional approval. When a program is placed on provisional approval, the board shall specify the minimum standard or standards the program is not meeting or maintaining and shall establish the time period during which the program will be on provisional approval. When the time period for provisional approval has expired, the board shall reconsider the program’s approval status.

(L) If a program on provisional approval continues to fail to meet or maintain minimum standards at the end of the time period established for provisional approval, the board may propose to continue provisional approval for a period of time specified by the board or may propose to withdraw approval pursuant to an adjudication under Chapter 119. of the Revised Code. The adjudication may result in the continuance of provisional approval, withdrawal of approval or granting of full approval.

(M) When a complete application for reapproval is submitted to the board in accordance with paragraph (B) of this rule, and the board fails to make a determination before the current program approval expires, the board shall issue a notice to the administrator of the program extending approval of the program until board action is taken on the reapproval application.

(N) The board shall provide to the administrator of the program written notice of any actions taken by the board.

HISTORY: Eff 2-1-05

Rule promulgated under: RC 119.03

Statutory Authority: 4723.88

Rule Amplifies: 4723.87

R.C. 119.032 review dates: 02/01/2010