Neb. Admin. Code tit. 172 — Professional and Occupational Licensure

Chapter 1 Rules of Practice and Procedure Governing Reinstatement of a Health Professional License

Neb. Admin. Code tit. 172, ch. 1 Rules of Practice and Procedure Governing Reinstatement of a Health Professional License {#sec-172-nac-1 omnilex-key=us-ne-regs-official--title-172--172 NAC 1}

001. SCOPE AND AUTHORITY . These rules govern practice and procedure for reinstatement of a credential to practice a profession or occupation under the Uniform Credentialing Act (UCA), Nebraska Revised Statutes (Neb. Rev. Stat.) §§ 38-101 to 38-1,142.

002. APPLICATIONS FOR REINSTATEMENT . An application for reinstatement of a credential under this chapter must comply with the requirements of 172 NAC 10.

003. REQUESTS FOR HEARINGS . An applicant may request a hearing before the board if the board recommends denial of the application; to modify a suspension or limitation of a credential; or to reinstate the credential subject to probation with terms or conditions, or subject to limitations, in accordance with Neb. Rev. Stat. § 38-149(4).

003.01 CONDUCT OF HEARINGS. Hearings before a board shall be conducted in accordance with 184 NAC 1.

History

Effective 2024-06-02

Chapter 2 Fees

Neb. Admin. Code tit. 172, ch. 2 Fees {#sec-172-nac-2 omnilex-key=us-ne-regs-official--title-172--172 NAC 2}

001. SCOPE AND AUTHORITY . These regulations establish fees related to the credentialing of individuals and businesses under the Uniform Credentialing Act (UCA), Nebraska Revised Statutes (Neb. Rev. Stat.) §§ 38-101 to 38-1,142.

002. CREDENTIALING FEES . Credentials are renewed biennially unless otherwise noted.

| PROFESSION, OCCUPATION, BUSINESS | INITIAL | RENEWAL | OTHER CREDENTIALING FEES, IF ANY | | --- | --- | --- | --- | | Acupuncture | | | | | Acupuncturist | $300 | $121 | | | Alcohol and Drug Counseling | | | | | Alcohol and Drug Counselor | $175 | $175 | | | Provisional Alcohol and Drug Counselor | $275 | $175 | | | Athletic Training | | | | | Athletic Trainer | $117 | $117 | | | Audiology | | | | | Audiologist | $140 | $140 | | | Certification to Supervise Audiology Assistant | $25 | NA | | | Temporary Audiologist | $140 | NA | | | Audiology Assistant | $60 | $60 annually | | | Body Art | | | | | Body Brander | $95 | $118 | | | Body Piercer | $95 | $118 | | | Permanent Color Technician | $95 | $118 | | | Tattoo Artist | $95 | $118 | | | Body Art Facility | $150 | $150 | $50 for re-inspection if required | | Chiropractic | | | | | Chiropractor | $144 | $144 | | | Cosmetology | | | | | Cosmetologist | $95 | $118 | | | Temporary Cosmetologist | $25 | NA | | | Cosmetology Instructor | $50 | $50 | | | Temporary Cosmetology Instructor | $25 | NA | | | Apprentice Salon | $300 | $300 | $50 for re-inspection if required | | Cosmetology Salon or Mobile Cosmetology Salon | $150 | $150 | $50 for re-inspection if required | | Home Service Permit | $118 | $118 | $50 for re-inspection if required | | School of Cosmetology | $300 | $300 | $150 to transfer location within county | | Satellite Classroom | $200 | $200 | $50 for re-inspection if required | | Dentistry | | | | | Dental Faculty | $165 | $165 | | | Dentist | $165 | $165 | | | Temporary Dentist | $50 | NA | | | General Anesthesia – Deep Sedation Permit | $200 | $200 | | | Minimal Sedation Permit | $200 | $200 | | | Moderate Sedation Permit | $200 | $200 | | | Dental Hygiene | | | | | Dental Hygienist | $110 | $110 | | | Local Anesthesia Certificate | $25 | NA | | | Expanded Function Permit | $25 | $25 | | | Additional Competency Permit | $10 | NA | | | Public Health Authorization | $0 | NA | | | Dental Assisting | | | | | Licensed Dental Assistant | $95 | $95 | | | Expanded Function Permit | $25 | $25 | | | Additional Competency Permit | $10 | NA | | | Dialysis Patient Care Technician | $95 | $95 | | | Electrology | | | | | Electrologist | $95 | $118 | | | Electrology Instructor | $50 | $50 | | | Emergency Medical Services | | | | | Emergency Medical Responder | $0 | $0 | | | Emergency Medical Technician | $0 | $0 | | | Advanced Emergency Medical Technician | $0 | $0 | | | Paramedic | $0 | $0 | | | Emergency Medical Services Instructor | $0 | $0 | | | Emergency Medical Services | $0 | $0 | | | Environmental Health | | | | | Registered Environmental Health Specialist | $116 | $116 | | | Provisional Environmental Health Specialist | $116 | $116 annually | | | Esthetics | | | | | Esthetician | $95 | $118 | | | Esthetics Instructor | $50 | $50 | | | Esthetics Salon | $150 | $150 | $50 for re-inspection if required | | School of Esthetics | $300 | $300 | $50 for re-inspection if required; $150 to transfer location within county | | Apprentice Salon | $300 | $300 | $50 for re-inspection if required | | Funeral Directing and Embalming | | | | | Funeral Director and Embalmer | $90 | $90 | | | Apprentice | $25 | NA | | | Embalmer | NA | $15 | | | Funeral Director | NA | $15 | | | Funeral Establishment | $250 | $250 | $100 for location change; $10 for manager change; $10 for name change | | Branch Establishment | $75 | $75 | $50 for location change; $10 for manager change; $10 for name change | | Genetic Counseling | | | | | Genetic Counselor | $150 | $110 | | | Hearing Instrument Dispensing and Fitting | | | | | Hearing Instrument Specialist | $165 | $165 | | | Temporary Hearing Instrument Specialist | $85 | $85 annually | | | Massage Therapy | | | | | Massage Therapist | $110 | $110 | | | Temporary Massage Therapist | $25 | NA | | | Massage Therapy Establishment or Mobile Massage Therapy Establishment | $127 | $127 | $127 for location change; $10 for name change; $10 for owner change | | Massage Therapy School | $150 | $150 | $150 for location change; $10 for name change; $10 for owner change | | Medical Nutrition Therapy | | | | | Medical Nutrition Therapist | $114 | $114 | | | Medical Radiography | | | | | Medical Radiographer | $146 | $146 | | | Limited Radiographer | $146 | $146 | | | Limited Computed Tomography Radiographer | $146 | $146 | | | Temporary Limited Computed Tomography Radiographer | $15 | NA | | | Podiatric Limited Radiographer | $0 | $0 | | | Temporary Medical Radiographer | $15 | NA | | | Medicine and Surgery | | | | | Osteopathic Physician | $300 | $121 | | | Osteopathic Physician and Surgeon | $300 | $121 | | | Physician | $300 | $121 | | | Physician Assistant | $150 | $110 | | | Physician Locum Tenens | $100 | NA | | | Surgical First Assistant | $150 | $110 | | | Temporary Educational Permit | $25 | $25 annually | | | Temporary Visiting Faculty Permit | $25 | $25 annually | | | Mental Health Practice | | | | | Mental Health Practitioner | $155 | $155 | | | Independent Mental Health Practitioner (without LMHP) | $155 | $155 | | | Independent Mental Health Practitioner (with LMHP) | $50 | $50 | | | Marriage and Family Therapist | $50 | $50 | | | Professional Counselor | $50 | $50 | | | Master Social Worker (with LMHP or LIMHP) | $50 | $50 | | | Master Social Worker (without LMHP or LIMHP) | $125 | $125 | | | Social Worker | $125 | $125 | | | Provisional Mental Health Practitioner | $125 | NA | | | Provisional Master Social Worker (without PLMHP) | $125 | NA | | | Nail Technology | | | | | Nail Technician | $95 | $118 | | | Home Service Permit | $118 | $118 | | | Nail Technology Instructor | $50 | $50 | | | Nail Technology Salon or Mobile Nail Technology Salon | $150 | $150 | $50 for re-inspection if required | | Nail Technology School | $300 | $300 | $50 for re-inspection if required; $150 to transfer location within county | | Nursing | | | | | Registered Nurse | $123 | $123 | | | Licensed Practical Nurse | $123 | $123 | | | Advanced Practice Nursing (in addition to RN license) | $68 | $68 | | | Nursing Home Administration | | | | | Nursing Home Administrator | $166 | $166 | | | Administrator-in-Training or Mentoring Trainee | $50 | NA | | | Preceptor, Certified | $25 | $25 4-year renewal | | | Provisional Nursing Home Administrator | $110 | NA | | | Occupational Therapy | | | | | Occupational Therapist | $120 | $120 | | | Occupational Therapist Deep Thermal Agents Modality, Electrotherapeutic Agents Modality, Superficial Thermal Agents Modality, or combination of modalities | $120 | NA | | | Temporary Occupational Therapist | $25 | NA | | | Occupational Therapy Assistant | $120 | $120 | | | Occupational Therapy Assistant Superficial Thermal Agents Modality | $120 | NA | | | Temporary Occupational Therapy Assistant | $25 | NA | | | Optometry | | | | | Optometrist | $146 | $146 | $10 for diagnostic certification; $10 for therapeutic certification | | Perfusion | | | | | Perfusionist | $150 | $110 | | | Pharmacy | | | | | Pharmacist | $178 | $178 | | | Pharmacist Intern | $50 | NA | | | Pharmacy Technician | $25 | $25 | | | Temporary Educational Permit | $50 | $50 annually | | | Delegated Dispensing Permit | $125 | $75 | | | Dialysis Drug or Device Distributor | $125 | $75 | | | Medical Gas Distributor | $125 | $75 | | | Public Health Clinic | $125 | $75 | | | Physical Therapy | | | | | Physical Therapist | $133 | $133 | | | Physical Therapist Assistant | $90 | $90 | | | Podiatry | | | | | Podiatrist | $131 | $131 | | | Psychology | | | | | Psychologist | $183 | $183 | | | Provisional Psychologist | $50 | NA | | | Special License | NA | $183 | | | Temporary Psychologist | $50 | NA | | | 30-Day Psychologist | $50 | NA | | | Special License to Full License | $50 | NA | | | Psychological Assistant | $50 | NA | | | Psychologist Associate | $50 | NA | | | Respiratory Care | | | | | Respiratory Care Practitioner | $118 | $118 | | | Speech-Language Pathology | | | | | Speech-Language Pathologist | $140 | $140 | | | Certification to Supervise Speech-Language Pathology Assistant | $25 | NA | | | Speech-Language Pathology Assistant | $60 | $60 annually | | | Temporary Speech-Language Pathologist | $140 | NA | | | Veterinary Medicine and Surgery | | | | | Veterinarian | $250 | $168 | | | Veterinary Technician | $100 | $63 | | | Animal Therapist - Acupuncture | $142 | $142 | | | Animal Therapist - Chiropractic | $142 | $142 | | | Animal Therapist - Chiropractic Veterinary Orthopedic Manipulation (VOM) | $142 | $142 | | | Animal Therapist - Massage Therapy | $142 | $142 | | | Animal Therapist - Physical Therapy | $142 | $142 | |

History

Effective 2020-09-15

Chapter 3 Regulations Establishing Definitions of Conflicts of Interest for Members of the Boards of Examiners in the Health Professions

Neb. Admin. Code tit. 172, ch. 3 Regulations Establishing Definitions of Conflicts of Interest for Members of the Boards of Examiners in the Health Professions {#sec-172-nac-3 omnilex-key=us-ne-regs-official--title-172--172 NAC 3}

001 SCOPE OF DEFINITION. As used in these regulations, the term "member of a board of examiners in the health professions" shall mean a member of one of the following: the boards of examiners set forth in the Uniform Licensing Law, Neb. Rev. Stat. 71-112, Board of Nursing, Board of Hearing Aid Instrument Dispensers and Fitters, Board of Registration for Environmental Health Specialists, Board of Advanced Emergency Medical Care, Board of Occupational Therapy Practice, Board of Examiners in Massage, Board of Cosmetology Examiners, and Board of Advanced Registered Nurse Practitioners. Each of the situations described in this section shall be considered a conflict of interest on the part of a member of a board of examiners in the health professions.

001.01. No member of a board of examiners in the health professions shall solicit or accept anything of value, including a gift, loan, contribution, reward, or promise of future employment, for himself or herself, or for a member of his or her immediate family or for a business with which any such individual is associated, based on an agreement that the vote, official action, or judgment of the member of a board of examiners in the health professions would be influenced thereby.

001.02. No member of a board of examiners in the health professions shall use that public office or any confidential information received through the holding of the position of board member to obtain financial gain, other than compensation provided by law, for himself or herself, a member of his or her immediate family, or a business with which any such individual is associated.

001.03. No member of a board of examiners in the health professions shall use personnel, resources, property, or funds under that board member's official care and control, other than in accordance with prescribed constitutional, statutory, and regulatory procedures, or use such items, other than compensation provided by law, for personal financial gain or for the financial gain of a member of his or her immediate family or a business with which any such individual is associated.

001.04. Except as otherwise provided by law, no member of a board of examiners in the health professions, a member of that board member's immediate family, or a business with which any such individual is associated shall enter into a contract valued at two thousand dollars or more, in any one year, with the Department of Health unless the contract is awarded through an open and public process which includes prior public notice and subsequent availability for public inspection during the regular office hours of the Department of Health of the proposals considered and the contract awarded. No contract may be divided for the purposes of evading the requirements of this subsection. This subsection is intended to prevent a member of a board of examiners in the health professions from engaging in certain activities under circumstances creating a substantial conflict of interest and is not intended to penalize innocent persons and a contract shall not be absolutely void by reason of this subsection.

002 RESOLUTION OF CONFLICT OF INTEREST. A member of a board of examiners in the health professions who, in the discharge of his or her official duties, would be required to take any action or make any decision that may cause financial benefit or detriment to him or her, a member of his or her immediate family, or a business with which he or she is associated, which is distinguishable from the effects of such action on the public generally, or a broad segment of the public, shall take the following actions as soon as he or she is aware of such potential conflict of interest, or should reasonably be aware of such potential conflict, whichever is sooner:

002.01. Prepare a written statement describing the matter requiring action or decision and the nature of the potential conflict;

002.02. Deliver a copy of the statement to the Nebraska Accountability and Disclosure Commission; and

002.03. Deliver a copy of the statement to the Director of Health.

002.04. The member of a board of examiners in the health professions shall also exercise one or more of the following steps to remove himself or herself from influence over actions and decisions on the matter:

002.04A. Refrain from discussion with other board members of those matters on which a conflict exists, or

002.04B. Abstain from voting on the matter on which the potential conflict exists whether by voice vote, secret ballot, or any other method.

002.05. This restriction shall not prevent a member of a board of examiners in the health professions from making or participating in the making of a board decision to the extent that the board member's participation is legally required for the action or decision to be made, and no action could be taken by the board of examiners otherwise due to lack of a quorum or other reason. However, in such event the member of a board of examiners in the health professions shall report the occurrence to the Director of Health and to the Nebraska Accountability and Disclosure Commission.

003 DISCIPLINARY MEASURES. Any member of a board of examiners in the health professions violating the provisions of subsections 001.01, 001.02 or 001.03 shall be guilty of a Class III misdemeanor pursuant to Neb. Rev. Stat. §49-14,101, which upon conviction can result in a maximum penalty of three months imprisonment or five hundred dollars fine, or both, with no minimum penalty, pursuant to Neb. Rev. Stat. §28-106. A contract involving a prohibited conflict of interest under subsection 001.04 shall be voidable pursuant to Neb. Rev. Stat. §49-14,103. Violation of any of the provisions of section 001 or failure to take any of the steps outlined in section 002 shall constitute malfeasance in office and due cause for action of removal of a member from the board of examiners pursuant to Neb. Rev. Stat. §71-118, other appropriate statute, or Article IV, Section 10 of the Constitution of the State of Nebraska, as applicable.

SOURCE: Nebraska Revised Statutes Sections 71-115.01, 71-379, 49-1493(7), 49-1499, 49-14,101, 49-14,102, 49-14,103 (Reissue 1986); 71-1,132.07(4), 71-4715.01, 71-3706, 71-5507.01, 71-6115(2), 71-2704.01 (Supp. 1987)

History

Effective 1997-01-07

Chapter 4 Credentialing Review Program

Neb. Admin. Code tit. 172, ch. 4 Credentialing Review Program {#sec-172-nac-4 omnilex-key=us-ne-regs-official--title-172--172 NAC 4}

001. SCOPE AND AUTHORITY . This chapter implements the Nebraska Regulation of Health Professions Act, Nebraska Revised Statutes (Neb. Rev. Stat.) §§ 71-6201 to 71-6229. This chapter establishes standards for the use of criteria by review bodies in recommending whether proposals for regulation or change in scope of practice meet the criteria.

002. DEFINITIONS . The definitions set out in Neb. Rev. Stat. §§ 71-6201 to 71-6229 and the following apply to this chapter.

002.01 APPLICATION. The document prepared by the applicant group that contains the proposal and evidence supporting or explaining the proposal is the application.

002.02 LEVEL OF EVIDENCE. Level of evidence is the ranking of the strength of these types of evidence, in descending order:

(A) Randomized trial;

(B) Comparison groups;

(D) Correlation study;

(E) Case study;

(F) Anecdotal; and

(G) Other evidence as appropriate.

002.03 PROPOSAL. A proposal is the concept submitted for review under the Nebraska Regulation of Health Professions Act for either regulating a health profession that is not currently regulated in Nebraska or changing the scope of practice of a regulated health profession.

002.04 SCOPE OF PRACTICE. Scope of practice is the activities, functions, procedures, and responsibilities of a licensed health profession as defined by the profession’s licensure statute as well as any statutory provisions that restrict or limit the circumstances or location in which the activities may occur.

003. CRITERIA AND STANDARDS FOR A NEW CREDENTIAL . The Nebraska Regulation of Health Professions Act sets out criteria for new credentialing of a health profession. These are professions currently not credentialed but allowed to practice in Nebraska. The review body determines whether the following criteria are met.

003.01 CRITERION ONE. Unregulated practice can clearly harm or endanger the health, safety, or welfare of the public. The review body must apply the following standards in determining whether this criterion is met:

(A) Is the public suffering harm or danger, is the harm or danger, if any, clearly and directly attributable to the absence of regulation of the profession, and whether the harm or danger, if any, is of sufficient magnitude to warrant state intervention.

(B) The documentation of harm or danger to the public must be sufficient to demonstrate that the harm or danger is clear and is attributable to the lack of regulation of the profession in question. Evaluation of harm or danger must be based on the highest level of evidence available.

(C) Harm or danger to the public must be clearly, directly, and primarily attributable to the absence of regulation of the profession. Evidence of harm or danger that cannot meet this test must not be considered.

(D) Harm or danger to the health, safety, or welfare of the public may occur in physical, emotional, economic, or social contexts; and as such all of these can be considered.

(E) Harm or danger to the public must be of sufficient extent and severity to warrant governmental intervention. A certain level of harm or danger attributable to human error and uncontrollable factors will always occur within any health care field.

003.02 CRITERION TWO. Regulation of the health profession does not impose significant new economic hardship on the public, significantly diminish the supply of qualified practitioners, or otherwise create barriers to service that are not consistent with the public welfare and interest. The review body must use the following to determine if this criterion is met:

(A) Will regulating the profession, in itself, bring about significant harm or danger to the health, safety, or welfare of the public through the creation of unnecessary barriers to service.

(B) Documentation of harm or danger to the public must be sufficient to demonstrate that the harm or danger is clear, that it is attributable to the creation of the separate regulated profession in question, and that it is serious and extensive.

(C) Evidence supporting the status quo must clearly demonstrate how and why this situation protects the public from harm or danger.

(D) Evidence must show the benefits of creating the new regulated health profession clearly to be greater in extent and impact than any harm or danger that would be created.

(E) If regulation of the profession would require a scope of practice to be defined, the scope of practice must be coordinated with those of regulated professions to minimize fragmentation of the health care system.

(F) Regulation of the profession must not lead to unnecessary limitations on the utilization of personnel by employers or to underutilization of qualified personnel.

(G) Regulation of the profession must not result in an unnecessary reduction in competition.

003.03 CRITERION THREE. The public needs assurance from the state of initial and continuing professional ability. The review body must use the following to determine if this criterion is met:

(A) In order to find that this criterion is met for a profession whose practice is typically autonomous, the review body must determine that the need of the public for this assurance can be demonstrated, that members of the public play an active role in choosing their caregiver, that information about the qualifications of the caregiver is an important element in making that choice, and that currently there is no mechanism that will provide such information as effectively as would the issuance of a State credential.

(B) In order to find that this criterion is met for a profession whose practice typically is not autonomous, the review body must determine that the institutional or supervisory structure is inadequate to protect the public from harm, and that the issuance of a State credential to the practitioners of this profession would overcome these inadequacies.

(C) Evidence presented must show why a state-issued credential is necessary to allow the public to identify competent practitioners. This is especially significant for professions that already have a strong recognized private system of credentialing.

(D) If there is a recognized system of private credentialing, the proposed requirements for obtaining state credentialing must be compared closely to those for private credentialing. If they are essentially identical, there must be compelling evidence to show why such redundancy is in the public interest.

(E) Evidence must show that if practitioners are generally supervised by members of other credentialed professions, or if they practice under institutional or similar regulation, it must be demonstrated that such supervision or regulation is not sufficient to protect the public.

(F) Evidence must show that members of the public are unable easily to evaluate the qualifications of persons offering the service in question.

(G) Whether the education and training requirements set forth in the proposal are necessary and adequate for safe and effective practice.

003.04 CRITERION FOUR. The public cannot be protected by a more effective alternative. The review body must determine whether:

(A) The credentialing proposal as presented is an effective remedy to the harm or danger identified, and that no other evident means of dealing with this harm or danger, including the status quo, would provide a more effective alternative.

(B) Viable alternatives to the proposal have been identified and, if available, if the alternative are able to address the same harm or danger raised in the applicant proposal.

(C) Evidence supporting the proposal shows that its enactment would clearly, specifically, and directly solve or alleviate the problems, including harm or danger to the public, that are used to justify the application.

(D) Any and all evident alternatives to the proposal might provide the same or greater problem-solving potential as the proposal, while being more cost-effective or less restrictive. Alternatives may include different levels or types of state credentialing or regulation of the profession, maintenance of the status quo, and other potential solutions. Reviewers are not limited to evaluating only alternatives presented to them by the applicant group; they can actively seek to identify and analyze potential alternatives. The recommendations of the reviewing body must reflect their best assessment of the most likely solution to the problems identified.

(E) The costs of the proposal, and of any alternatives considered, must be evaluated for unnecessary financial burden to the public.

004. CRITERIA AND STANDARDS FOR A PROFESSION NOT CURRENTLY ALLOWED TO PRACTICE IN NEBRASKA . The Nebraska Regulation of Health Professions Act sets out criteria for the regulation of a profession not currently allowed to practice in Nebraska. These are professions currently not credentialed and currently not allowed to practice in Nebraska. The review body must determine whether the following criteria are met.

004.01 CRITERION ONE. Absence of a separate regulated profession creates a situation of harm or danger to the health, safety, or welfare of the public. The review body must apply the following standards in determining whether this criterion is met:

(A) The public is suffering harm or danger, which is clearly and directly attributable to the absence of the separately regulated health profession under review, and that this harm or danger is of sufficient magnitude to warrant state intervention.

(B) The Documentation of harm or danger to the public must be sufficient to demonstrate that the harm or danger is clear, that it is attributable to the absence of the separate regulated health profession in question. Evaluation of harm or danger is based on the highest level of evidence available.

(C) Harm or danger to the health, safety, or welfare of the public may occur in physical, emotional, or social contexts and as such all of these can be considered.

(D) Harm or danger to the public must be of sufficient extent and severity to warrant governmental intervention. A certain level of harm or danger attributable to human error and uncontrollable factors will always occur within any health care field.

004.02 CRITERION TWO. Creation of a separate regulated profession would not create a significant new danger to the health, safety, or welfare of the public. The review body must apply the following standards in determining whether this criterion is met:

(A) Any harm or danger that might result from the creation of the separate regulated profession would not be outweighed by the benefits of providing legal access to the profession in question.

(C) Evidence supporting the status quo must clearly demonstrate how and why this situation protects the public from harm or danger.

(D) Evidence must show the benefits of creating the new regulated health profession clearly to be greater in extent and impact than any harm or danger that would be created.

(F) Regulation of the profession must not lead to unnecessary limitations on the utilization of personnel by employers or to underutilization of qualified personnel.

(G) Regulation of the profession must not result in an unnecessary reduction in competition.

004.03 CRITERION THREE. Creation of a separate regulated profession would benefit the health, safety, or welfare of the public. The review body must use the following to determine if this criterion is met.

(A) The creation of a separate regulated profession would likely produce widespread benefits for the public, and that the amount and extent of the benefits would outweigh any possible harm or danger that might be caused by creating this newly credentialed and legalized profession.

(B) Documentation of benefits to the public must be sufficient to demonstrate that there is a realistic expectation of their occurrence following enactment of the desired legislation, and that they will be of significant amount and extent. Evaluation of benefits to the public is based on the highest level of evidence available.

(C) The extent and amount of benefit to the public must clearly outweigh any potential harm or danger to the public that might be brought about by the creation of a separate regulated profession.

(D) Benefits to the public may occur in physical, emotional, economic, or social contexts and as such all of these can be considered.

(E) Whether the education and training requirements set forth in the proposal are necessary and adequate for safe and effective practice.

004.04 CRITERION FOUR. The public cannot be protected by a more effective alternative. The review body must determine whether:

(A) The creation of the separately regulated profession would be an effective remedy to the harm or danger identified, and that no other evident means of dealing with this harm or danger, including the status quo, would provide a more effective alternative.

(B) Viable alternatives to the proposal have been identified and, if available, if the alternative are able to address the same harm or danger raised in the applicant proposal.

(D) Protection of the public must be interpreted as protecting it both from any harm or danger caused by absence of the profession, and from any harm or danger caused by permitting the separate practice of the profession.

(E) Any and all evident alternatives to the proposal might provide the same or greater problem-solving potential as the proposal, while being more cost-effective or less restrictive. Alternatives may include different levels or types of state credentialing or regulation of the profession, maintenance of the status quo, and other potential solutions. Reviewers are not limited to evaluating only alternatives presented to them by the applicant group; they can actively seek to identify and analyze potential alternatives. The recommendations of the reviewing body must reflect their best assessment of the most likely solution to the problems identified.

(F) The costs of the proposal, and of any alternatives considered, must be evaluated for unnecessary financial burden to the public.

005. CRITERIA AND STANDARDS FOR A CHANGE IN SCOPE OF PRACTICE OF A REGULATED PROFESSION . The Nebraska Regulation of Health Professions Act sets out criteria for a change in scope of practice of a regulated profession. The review body must determine whether the following criteria are met.

005.01 CRITERION ONE. The health, safety, and welfare of the public are inadequately addressed by the present scope of practice or limitations on the scope of practice.

005.01(A) DETERMINATION. The review body must determine that at least one of the following is occurring:

(i) The cost of the services in question is prohibitive for some members of the public under the current limitations on scope of practice.

(ii) Access to the services in question is very difficult for some members of the public under the current limitations on scope of practice.

(iii) The quality of the services in question is adversely impacted under the current limitations on scope of practice.

(iv) The range of services of the profession under review is too limited under the current scope of practice raising concerns about consumers having to access the services of other providers whose practices are not as accessible or whose services are more costly.

(v) Actual harm or danger to the public health and safety is occurring because of the absence of the proposed scope of practice.

005.02 CRITERION TWO. Enactment of the proposed change in scope of practice would benefit the health, safety, or welfare of the public. The review body must use the following to determine if this criterion is met:

(A) The enactment of the proposed changes in scope of practice would produce widespread benefits for the public, and the amount and extent of the benefits would outweigh any potential harm or danger to the public that might be caused by enactment of these changes.

(B) Documentation of benefits to the public must be sufficient to show that there is a realistic expectation of their occurrence following enactment of the proposed changes in scope of practice, and that they would be of significant amount and extent. Evidence from other jurisdictions in which the profession has practiced with the proposed change in scope of practice is preferred.

005.03 CRITERION THREE. The proposed change in scope of practice does not create a significant new danger to the health, safety, or welfare of the public. The review body must use the following to determine if this criterion is met:

(A) Evaluation of physical, emotional, economic, or social danger to determine whether any evident danger would be created by the proposed change in scope of practice and significant enough to outweigh the benefits of implementing the proposed change in scope of practice.

(B) Evaluation of danger is based on the highest level of evidence available.

005.04 CRITERION FOUR. The current education and training for the health profession adequately prepares practitioners to perform the new skill or service. The review body must use the following to determine if this criterion is met:

(A) Analysis of the current education and training must show that it adequately prepares the practitioners in question to perform the new skill or service being proposed in a safe and effective manner.

(B) Evidence must be presented to demonstrate that the current education and training is adequately and appropriately accredited.

005.05 CRITERION FIVE. There are appropriate post-professional programs and competence assessment measures available to ensure that the practitioner is competent to perform the new skill or service in a safe manner. The review body must use the following to determine if this criterion is met:

(A) There are programs in place and the programs show that they are adequate to ensure that the practitioners are able to perform the new skill or service being proposed in a safe and effective manner.

(B) Evidence that demonstrates programs comply with acceptable standards.

005.06 CRITERION SIX. There are adequate measures to assess whether practitioners are competently performing the new skill or service and to take appropriate action if they are not performing competently. The review body must use the following to determine if this criterion is met:

(A) Practitioners of the proposed new scope of practice must be subject to the complaint, investigation, and discipline provisions of the Uniform Credentialing Act.

(B) If the proposed new scope of practice will be implemented through the issuance of a new credential, and appropriate continuing competency requirements are established for the credential.

006. AMENDING OR WITHDRAWING A PROPOSAL . A proposal may be amended only by the applicant group and only with the approval of a majority of the technical review committee members. A proposal can only be amended prior to the public hearing on the proposal. The applicant group may withdraw the proposal at any time.

History

Effective 2021-01-10

Chapter 5 Mandatory Reporting by Health Care Professionals, Facilities, Peer Review Organizations, Professional Associations, and Insurers

Neb. Admin. Code tit. 172, ch. 5 Mandatory Reporting by Health Care Professionals, Facilities, Peer Review Organizations, Professional Associations, and Insurers {#sec-172-nac-5 omnilex-key=us-ne-regs-official--title-172--172 NAC 5}

001. SCOPE AND AUTHORITY . These regulations govern the manner and method in which health care professionals, health care facilities, peer review organizations, professional associations and insurers must report actions or conduct which may violate laws or regulations governing health care professionals who are licensed, certified, or registered by the Department. The authority for this chapter is the Uniform Credentialing Act, Nebraska Revised Statutes (Neb. Rev. Stat.) §§ 38-101 to 38-1,142 and the Wholesale Drug Distributor Licensing Act, Neb. Rev. Stat. §§ 71-7427 to 71-7463. This chapter does not apply to pharmacist interns and pharmacy technicians.

001.01 VOLUNTARY COMPLAINTS. Nothing in law or under this chapter is intended to preclude a health care professional, a health care facility, a peer review organization, a professional association, or an insurer from voluntarily reporting information or filing a complaint against a health care professional.

002. DEFINITIONS . Definitions set out in the Uniform Credentialing Act, the Wholesale Drug Distributor Licensing Act, 172 Nebraska Administrative Code (NAC) 10, and the following apply to this chapter.

002.01 CONVICTION. A finding of guilt for a crime committed. Such finding may be made on a:

(A) Verdict of a jury;

(B) Non-jury trial before a court or other tribunal; or

002.02 EMPLOYMENT. Services performed for another for wages or salary, or under agreement or contract in partnership or association with other health care professionals.

002.03 FIRSTHAND KNOWLEDGE. Information or knowledge gleaned directly from the original source through use of the senses, such as an eyewitness.

002.04 GROSS INCOMPETENCE. An extreme deficiency on the part of an individual that connotes a lack of the basic knowledge and skill necessary to practice at the threshold level of competence.

002.05 HEALTH CARE PROFESSIONAL. A person regulated by the Department under the Uniform Credentialing Act or the Wholesale Drug Distributor Act.

002.06 PATTERN OF INCOMPETENT OR NEGLIGENT CONDUCT. Pattern of incompetent or negligent conduct has the meaning set out in Neb. Rev. Stat. § 38-177.

002.07 PAYMENT. Monetary compensation made by or on behalf of a health care professional due to acts or omissions of a health care professional in his or her personal or corporate capacity.

002.08 PEER REVIEW ORGANIZATION OR COMMITTEE. A professional society or committee or agency, including those at the national, state or local level, or a facility's peer review or utilization review committee or similar body, that engages in professional credentialing or quality review activities involving the competence of, professional conduct of, or quality of care provided by a health care professional through a formal peer review process to further quality of care or conducts any attendant hearing process initiated as a result of a peer review committee’s recommendations or actions.

002.09 PERSON IN THE SAME PROFESSION. For purpose of this chapter, person in the same profession is a person who is regulated by the same Practice Act.

002.10 PERSON IN A DIFFERENT PROFESSION. For purpose of this chapter, person in a different profession is a person who is regulated by a different Practice Act.

002.11 PRACTICING WHILE IMPAIRED. Practicing while impaired with respect to the following includes:

(A) Alcohol, controlled substances or narcotic drugs means demonstrating drug or alcohol use, which diminishes or otherwise impacts the ability to practice safely or competently;

(B) A physical disability means engaging in practice of some or all of the essential functions or duties of a health care profession while the ability to do so safely or competently is diminished or otherwise impacted because of physical limitations; and

(C) A mental or emotional disability means engaging in practice of some or all of the essential functions or duties of a health care profession while the ability to do so safely or competently is diminished or otherwise impacted due to a disorder of thought, mood, perception, orientation or memory.

002.12 PRIVILEGES. The authorization by a facility for a health care professional to provide health care services, including privileges and membership on the medical staff of the facility.

002.13 PROFESSIONAL ASSOCIATION, SOCIETY OR ORGANIZATION. Any organization of individual health care professionals who are required to obtain a credential or other legal authorization prior to performing a professional service.

002.14 PROFESSIONAL LIABILITY CLAIM OR CLAIM. A complaint or demand for payment based on a health care professional's provision of or failure to provide health care services, and includes complaints or demands made prior to suit and the filing of a cause of action based on the law of tort brought in any state or federal court or any adjudicative body or agency in the health care professional's personal or corporate capacity.

002.15 SETTLEMENT. A settlement, as referred to in Neb. Rev. Stat. § 38-1,125, includes the provision of either money, devices, products or services by a health care professional to a patient or client in an amount that exceeds the total fee charged to a patient or a client to resolve a claim, including settlements made prior to the suit if the patient or client releases any professional liability claim against you. The date of the settlement for the purpose of this chapter is the date of release from the claim. A settlement does not include the following situations:

(A) When a health care professional waives either all or part of an outstanding debt to resolve a patient’s or client’s claim;

(B) When a health care professional refunds either all or part of a fee paid for services, products, or devices to resolve a patient’s or client’s claim; or

(C) When a health care professional returns either all or part of any reimbursement to a third party payers for services, products, or devices provided to a patient or client to resolve a claim.

003. REPORTING BY HEALTH CARE PROFESSIONALS . All health care professionals must report as required by Neb. Rev. Stat. §§ 38-1,124 to 38-1,126 and this chapter. Reports must be made on a form provided by the Department and contain all the requested information.

003.01 PROFESSIONAL LIABILITY. A health care professional must report the following:

(A) Your professional liability insurance coverage has been cancelled, limited, or otherwise modified due to a professional liability claim; and

(B) You have been refused professional liability insurance coverage on an initial or renewal basis due to a professional liability claim.

003.02 EXCEPTION FROM REPORTING CONVICTIONS. As an exception from the conviction reporting requirements, any health care professional whose case disposition involves diversion is not required to report the diversion.

003.03 EXCEPTION FROM REPORTING PERSONS IN THE SAME OR A DIFFERENT PROFESSION. A health care professional who is providing treatment to another health care professional in a practitioner patient relationship is not required to report information based on confidential medical records protected by confidentiality provisions of the federal Public Health Services Act, 42 U.S.C. 290ee-3 and 290dd-3 and federal administrative rules and regulations, except as may be provided in such laws or regulations.

004. REPORTING BY HEALTH CARE FACILITIES, PEER REVIEW ORGANIZATIONS, AND PROFESSIONAL ASSOCIATIONS . All health care facilities, peer review organizations, and professional associations must report as required by Neb. Rev. Stat. §§ 38-1,127 to 38-1,128 and this chapter. Reports must be made on a form provided by the Department and contain all the requested information.

004.01 NEBRASKA SUPPLEMENTAL REPORT. In addition to National Practitioner Data Bank reports, facilities, peer review organizations, and professional associations must report to the Department information that is not included on the National Practitioner Data Bank reports by using a Nebraska Supplemental Report form provided by the Department that contains all the requested information.

005. REPORTING BY INSURERS . All insurers must report as required by Neb. Rev. Stat. §§ 38-1,129 to 38-1,135 and this chapter. Reports must be made on a form provided by the Department and contain all the requested information.

005.01 NATIONAL PRACTITIONER DATA BANK. Insurers who report practitioners under the requirements of the National Practitioner Data Bank authorized by the Health Care Quality Improvement Act of 1986, as amended, must submit to the Department:

(A) A copy of the National Practitioner Data Bank report; and

(B) A Nebraska Supplemental Report on a form provided by the Department that contains all the requested information.

History

Effective 2020-09-15

Chapter 9 Professional and Occupational Licensure

Neb. Admin. Code tit. 172, ch. 9 Professional and Occupational Licensure {#sec-172-nac-9 omnilex-key=us-ne-regs-official--title-172--172 NAC 9}

001. SCOPE AND AUTHORITY . These regulations govern credentials to operate a business set out in Nebraska Revised Statute (Neb. Rev. Stat.) § 38-121. Additional requirements are found in the statutes and regulations of the applicable business.

002. DEFINITIONS . The following definitions apply to all regulations governing credentials to operate a business.

002.01 ATTEST OR ATTESTATION. The individual declares that all statements on the application are true and complete.

002.02 COMPLETE APPLICATION. An application that contains all of the information requested on the application, with attestation to its truth and completeness, and submitted with all required fees and documentation.

003. INITIAL BUSINESS CREDENTIAL OR RENEWAL . To obtain a credential to operate a business or to renew a business credential, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the credentialing requirements. A renewal application must be submitted prior to the expiration date.

003.01 REQUIREMENTS AND DOCUMENTATION. All applicants must meet minimum requirements for credentialing and submit documentary proof of same.

003.01(A) CITIZENSHIP OR LAWFUL PRESENCE. The owner, if the owner is a sole proprietor, must submit documentation that he or she meets the requirements set out in Neb. Rev. Stat. §§ 4-108 through 4-111.

003.01(B) CONVICTION INFORMATION. If the applicant is a sole proprietorship and if the owner has ever been convicted of a felony or misdemeanor in Nebraska or in another jurisdiction, submit:

(i) A copy of the court record related to all misdemeanor and felony convictions, that includes the statement of charges and final disposition, if the conviction(s) occurred in a state other than Nebraska;

(ii) An explanation of the events leading to the conviction (what, when, where, why) and a summary of actions that the applicant has taken to address the behaviors or actions related to the conviction; and

(iii) A letter from the applicant’s probation officer addressing the terms and current status of the probation, if the applicant is currently on probation.

003.01(C) DRUG OR ALCOHOL RELATED CONVICTIONS. If the applicant is a sole proprietorship and if the owner has ever been convicted of a felony or misdemeanor in Nebraska or in another jurisdiction, to aid in the evaluation of an applicant’s drug or alcohol related conviction(s), an applicant may submit evaluation and discharge summaries where drug or alcohol treatment was obtained or required.

003.01(D) OTHER CREDENTIAL INFORMATION. If the applicant is a sole proprietorship and the owner holds a credential in another jurisdiction and that credential has been disciplined, must provide the name of the jurisdiction, credential number, a list of any disciplinary actions taken against the owner’s credential, and a copy of the disciplinary action(s), including charges and disposition.

003.01(E) APPLICANT INFORMATION. The applicant must provide the information set out in Neb. Rev. Stat. § 38-130(2) and the following:

(i) If the owner is a sole proprietor, the social security number (SSN) or Alien Registration Number (A#) of the owner. Some applicants may have both a social security number (SSN) and an Alien Registration Number (A#) and if so, the applicant must report both;

(ii) The name of the manager, if applicable; and

(iii) For initial application only, a statement that the applicant has not operated this business at this address in Nebraska before submitting the application; or if the applicant has operated before submitting the application, a statement of the number of days of operation.

004. CREDENTIAL NOT TRANSFERABLE . A business credential is issued only for the premises named in the application and is not transferable or assignable. A change of owner or location terminates the credential.

005. DISCIPLINARY ACTION . A credential to operate a business may be denied, refused renewal, or have other disciplinary measures taken against the credential for grounds specified in Neb. Rev. Stat. § 38-182.

006. VOLUNTARY SURRENDER OR LIMITATION . An owner of a credential to operate a business may offer to voluntarily surrender or limit a business credential issued by the department. The offer must be in writing and include:

(A) The full name and address of the business;

(B) The business phone number and e-mail address;

(D) The desired time frame for offered surrender or limitation:

(i) Permanently;

(ii) Indefinitely; or

(iii) Definite period of time (specify);

(E) The specific reason for offered surrender or limitation of the business credential;

(F) Any specific terms and conditions that the owner wishes to have the department consider and apply to the offer;

(G) An attestation that all the information on the offer is true and complete; and

(H) The owner’s signature and date.

007. REAPPLICATION . This section applies to businesses previously credentialed in Nebraska who seek the authority to return to operation in Nebraska with a valid Nebraska credential.

(A) A business whose credential has expired, voluntarily surrendered for an indefinite period of time, or suspended or limited for disciplinary reasons may apply at any time to the Department for and obtain another credential as specified in 172 NAC 9, Section 003.

(B) A business whose credential has been voluntarily surrendered for a definite period may apply to obtain another credential after that period of time has elapsed as specified in 172 NAC 9, Section 003.

(C) A business whose credential has been revoked may apply for another credential as specified in 172 NAC 9, Section 003, only after a period of 2 years has elapsed from the date of revocation.

(D) A business whose credential has been permanently voluntarily surrendered may not apply for another credential.

008. CLOSING A BUSINESS . When an owner anticipates closing a business, the owner must notify the Department of the closing date.

009. NON-ENGLISH DOCUMENTS . Any documents written in a language other than English must be accompanied by a complete translation into the English language. The translation must be an original document and contain the notarized or equivalent signature of the translator. An individual may not translate his or her own documents.

010. WITHDRAWN APPLICATIONS . An applicant for an initial business credential or a renewal of a business credential may request to withdraw the application. The request will be granted when:

(A) The application is incomplete; or

(B) The request is received within 5 business days after the receipt of a completed application.

011. FEES . Fees referred to in these regulations are set out in 172 NAC 2.

History

Effective 2020-06-11

Chapter 10 Credentials Issued Under the Uniform Credentialing Act

Neb. Admin. Code tit. 172, ch. 10 Credentials Issued Under the Uniform Credentialing Act {#sec-172-nac-10 omnilex-key=us-ne-regs-official--title-172--172 NAC 10}

001. SCOPE AND AUTHORITY . These regulations govern credentials issued to individuals set out in Nebraska Revised Statute (Neb. Rev. Stat.) § 38-121. Additional requirements are found in the statutes and regulations of the applicable profession or occupation.

002. DEFINITIONS . The following definitions apply to all regulations governing professional credentials.

002.01 ATTEST OR ATTESTATION. The individual declares that all statements on the application are true and complete.

002.03 ANOTHER JURISDICTION. Any jurisdiction other than the State of Nebraska.

002.04 MILITARY SERVICE. Full-time duty in the active military service of the United States, a National Guard call to active service for more than 30 consecutive days, or active service as a commissioned officer of the Public Health Service or the National Oceanic and Atmospheric Administration. Military service may also include any period during which a servicemember is absent from duty on account of sickness, wounds, leave, or other lawful cause. (From the Servicemembers Civil Relief Act, 50 U.S.C. App. 501 et seq., as it existed in 2016.)

002.05 OFFICIAL TRANSCRIPT. A transcript issued by an educational institution.

002.06 SERVED IN THE REGULAR ARMED FORCES. This term has the same meaning as “military service” in these regulations.

003. INITIAL CREDENTIAL . To obtain a credential, an individual must submit a complete application and provide documentation demonstrating that the applicant meets the credentialing requirements.

003.01 REQUIREMENTS AND DOCUMENTATION. All applicants must meet minimum requirements for credentialing and submit documentary proof of same.

003.01(A) AGE AND GOOD CHARACTER. An applicant must be at least 19 years old, except as otherwise provided by statute, and of good character.

003.01(B) CITIZENSHIP OR LAWFUL PRESENCE. Applicants must submit documentation that he or she meets the requirements set out in Neb. Rev. Stats. § 38-129 and §§ 4-108 through 4-111.

003.01(C) EDUCATION. Applicants for a credential must provide:

(i) Documentation that the applicant has completed the required course of study for the credential, if applicable; or

(ii) Satisfactory evidence that the education, training, or service completed by an applicant while a member of the armed forces of the United States, active or reserve, the National Guard of any state, the military reserves of any state, or the naval militia of any state is substantially similar to the education required for the credential.

003.01(D) EXAMINATION. The applicant must provide documentation that he or she has completed the required examination for the credential, if applicable.

003.01(E) OTHER CREDENTIAL INFORMATION. If the applicant holds a credential to provide health services, health-related services, or environmental services in another jurisdiction, the applicant must provide the name of the jurisdiction, credential number, type of credential, date issued, and expiration date for each credential the applicant holds or has held.

003.01(F) DISCIPLINARY ACTION. If the applicant’s credential in another jurisdiction has been disciplined, the applicant must provide a list of any disciplinary actions taken against the applicant’s credential and a copy of the disciplinary action(s), including charges and disposition.

003.01(G) DENIAL. If the applicant was denied a credential in another jurisdiction, the applicant must submit an explanation of the basis for the denial and a copy of the denial documentation.

003.01(H) CONVICTION INFORMATION. If the applicant has ever been convicted of a felony or misdemeanor in Nebraska or in another jurisdiction, the applicant must submit:

(iii) A letter from the applicant’s probation officer addressing the terms and current status of the probation, if the applicant is currently on probation.

003.01(I) DRUG OR ALCOHOL RELATED CONVICTIONS. To aid in the evaluation of an applicant’s drug or alcohol related conviction(s), an applicant may submit evaluation and discharge summaries where drug or alcohol treatment was obtained or required. Evaluations and discharge summaries may be submitted by the provider directly to the department.

003.02 APPLICATION. All applicants must submit a complete application.

003.02(A) APPLICANT INFORMATION. The applicant must provide the following:

(i) Legal name and any other names by which the applicant is known;

(ii) Complete mailing address;

(iii) Social security number (SSN) or Alien Registration Number (A#). Some applicants may have both a social security number (SSN) and an Alien Registration Number (A#) and if so, the applicant must report both; and

(iv) Telephone number and e-mail address.

003.02(B) PRACTICE STATEMENT. A statement that the applicant has not practiced the profession or represented himself or herself as holding a credential in Nebraska before submitting the application; or if the applicant has, a statement of the number of days practiced and the name and location of practice.

003.03 MILITARY SPOUSE TEMPORARY CREDENTIAL. The department, with the recommendation of the appropriate board, will issue a temporary credential to a military spouse who complies with and meets the requirements of Neb. Rev. Stat. § 38-129.01 pending issuance of the applicable credential under the Uniform Credentialing Act. This does not apply to a credential to practice dentistry, including a temporary license issued under Neb. Rev. Stat. § 38-1123.

004. RENEWAL . To renew a credential, a credential holder must, prior to the expiration date, submit a complete application for renewal, and demonstrate compliance with continuing competency requirements set out in Neb. Rev. Stats. §§ 38-145 and § 38-146.

004.01 RENEWAL INFORMATION. The credential holder must provide:

(A) Legal name and any other names by which the credential holder is known;

(B) Complete mailing address;

(C) Social security number (SSN) or Alien Registration Number (A#). Some applicants may have both a social security number (SSN) and an Alien Registration Number (A#) and if so, the credential holder must report both; and

(D) Telephone number and e-mail address.

004.02 DOCUMENTATION. The credential holder must submit the following documentation and information with the renewal application to the department:

(A) CITIZENSHIP OR LAWFUL PRESENCE. Documentation that the credential holder meets the requirements set out in Neb. Rev. Stats. §38-129 and §§4-108 through 4-111.

(B) CONVICTION INFORMATION. If the credential holder has been convicted of a felony or misdemeanor in Nebraska or another jurisdiction since his or her last renewal or during the time period since initial credentialing if such occurred within the previous two years, the credential holder must submit:

(ii) An explanation of the events leading to the conviction (what, when, where, why) and a summary of actions that the credential holder has taken to address the behaviors or actions related to the conviction; and

(iii) A letter from the credential holder’s probation officer addressing the terms and current status of the probation, if the credential holder is currently on probation.

(C) DRUG OR ALCOHOL RELATED CONVICTIONS. To aid in the evaluation of a credential holder’s drug or alcohol related conviction(s), a credential holder may submit evaluation and discharge summaries where drug or alcohol treatment was obtained or required. Evaluations and discharge summaries may be submitted by the provider directly to the department.

(D) OTHER CREDENTIAL INFORMATION. If the credential holder holds a credential in another jurisdiction and that credential has been disciplined, provide the name of the jurisdiction, credential number, a list of any disciplinary actions taken against the individual’s credential, and a copy of the disciplinary action(s), including charges and disposition.

(E) DENIAL. If the credential holder was denied a credential in another jurisdiction, provide an explanation of the basis for the denial and a copy of the denial documentation.

004.03 WAIVERS OF CONTINUING COMPETENCY REQUIREMENTS. Continuing competency requirements and renewal fees can be waived under certain circumstances.

004.03(A) MILITARY SERVICE. Credential holders actively engaged in military service are not required to pay the renewal fee or meet the continuing competency requirements. The department may conduct an audit of military status. Each credential holder selected for audit must produce documentation of active military services within 30 days.

004.03(B) FIRST CREDENTIALED. The department waives continuing competency requirements for credential holders who were first credentialed within the 24-month period immediately prior to the renewal date.

004.04 INACTIVE STATUS. When a credential holder wants to have his or her credential placed on inactive status, the credential holder must comply with the requirements of Neb. Rev. Stat. § 38-142(3).

005. DISCIPLINARY ACTION AND UNPROFESSIONAL CONDUCT . A credential holder may be denied, refused renewal, or have other disciplinary measures taken against the credential for grounds specified in Neb. Rev. Stat. § 38-178, including for unprofessional conduct as set out in Neb. Rev. Stat. § 38-179.

006. VOLUNTARY SURRENDER OR LIMITATION . A credential holder may offer to voluntarily surrender or limit a credential issued by the department. The offer must be in writing and include:

(A) The credential holder’s legal name and any other names by which the credential holder is known;

(B) The credential holder’s complete mailing address;

(D) The credential(s) and credential number(s) that would be surrendered or limited;

(E) The desired time frame for offered surrender or limitation:

(i) Permanently;

(ii) Indefinitely; or

(iii) Definite period of time (specify);

(F) The specific reason for offered surrender or limitation of the credential;

(G) Any specific terms and conditions that the credential holder wishes to have the department consider and apply to the offer;

(H) An attestation that all the information on the offer is true and complete; and

(I) The credential holder’s signature and date.

007. REINSTATEMENT . This section applies to an individual previously credentialed in Nebraska who wishes to return to practice in Nebraska.

007.01 ELIGIBILITY. An individual may apply for reinstatement as follows:

(A) An individual whose credential has expired, been placed on inactive status, voluntarily surrendered for an indefinite period of time, or suspended or limited for disciplinary reasons, may apply for reinstatement at any time.

(B) An individual whose credential has been voluntarily surrendered for a definite period of time may apply for reinstatement after that period of time has elapsed.

(C) An individual whose credential has been revoked may apply for reinstatement only after a period of two years has elapsed from the date of revocation.

007.02 INELIGIBILITY. An individual whose credential has been permanently voluntarily surrendered is not eligible to have his or her credential reinstated and may not apply for a new credential to practice the same profession or occupation.

007.03 APPLICATION AND DOCUMENTATION. To reinstate a credential, an individual must submit a complete application, have met the continuing competency requirements, and meet the requirements set out in Neb. Rev. Stats. § 38-129 and §§ 4-108 through 4-111.

007.03(A) INFORMATION. The individual must submit the following information:

(i) Legal name and any other names by which the individual is known;

(ii) Complete mailing address;

(iii) Social security number (SSN) or Alien Registration Number (A#). Some individuals may have both a social security number and an Alien Registration Number and if so, the individual must report both;

(iv) Telephone number and e-mail address;

(v) Whether the individual holds a credential(s) in another jurisdiction(s) to provide health services, health-related services or environmental services; and

(vi) If making application following voluntary surrender or disciplinary action, information relating to what actions the individual has taken to address the reasons that caused the action.

007.03(B) DOCUMENTATION. The individual must submit the following documentation and information with the reinstatement application to the department:

(i) CITIZENSHIP OR LAWFUL PRESENCE. Documentation that the individual meets the requirements set out in Neb. Rev. Stats. § 38-129 and §§ 4-108 through 4-111.

(ii) OTHER CREDENTIAL INFORMATION. If the individual holds a credential to provide health services, health-related services, or environmental services in another jurisdiction, provide the name of the jurisdiction, credential number, type of credential, date issued, and expiration date for each credential the applicant holds or has held;

(iii) DISCIPLINARY ACTION. If the credential has been disciplined, a list of any disciplinary actions taken against the individual’s credential and a copy of the disciplinary action(s), including charges and disposition;

(iv) DENIAL. If the individual was denied a credential, an explanation of the basis for the denial and a copy of the denial documentation;

(v) CONVICTION INFORMATION. If the individual has been convicted of a felony or misdemeanor in Nebraska or another jurisdiction since the credential was last renewed or since the effective date of the disciplinary action was taken by the department, the individual must submit:

(1) A copy of the court record related to all misdemeanor and felony convictions, that includes the statement of charges and final disposition, if the conviction(s) occurred in a state other than Nebraska;

(2) An explanation of the events leading to the conviction (what, when, where, why) and a summary of actions that the applicant has taken to address the behaviors or actions related to the conviction;

(3) A letter from the individual’s probation officer addressing the terms and current status of the probation, if the individual is currently on probation;

(vi) DRUG OR ALCOHOL RELATED CONVICTIONS. To aid in the evaluation of an individual’s drug or alcohol related conviction(s), an individual may submit evaluation and discharge summaries where drug or alcohol treatment was obtained or required. Evaluations and discharge summaries may be submitted by the provider directly to the department.

008. NON-ENGLISH DOCUMENTS . Any documents written in a language other than English must include a complete translation into the English language. The translation must be an original document and contain the notarized or equivalent signature of the translator. An individual may not translate his or her own documents.

009. WITHDRAWN APPLICATIONS . An applicant for an initial credential, a renewal of a credential, or a reinstatement of a credential may request to withdraw the application. A request to withdraw will be granted when:

(A) The application is incomplete; or

(B) The request for withdrawal is received within five business days after the receipt of a completed application.

010. FEES . Fees referred to in these regulations are set out in 172 NAC 2, unless otherwise specified by rules and regulations under the applicable profession.

History

Effective 2019-06-24

Chapter 11 Licensure of Emergency Care Providers

Neb. Admin. Code tit. 172, ch. 11 Licensure of Emergency Care Providers {#sec-172-nac-11 omnilex-key=us-ne-regs-official--title-172--172 NAC 11}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 11 LICENSURE OF EMERGENCY CARE PROVIDERS

001. SCOPE AND AUTHORITY . These regulations govern the licensure of emergency care providers under the Emergency Medical Services Practice Act Nebraska Revised Statute (Neb. Rev. Stat.) § 38-1201 to § 38-1237 and the Uniform Credentialing Act, Neb. Rev. Stat. § 38-101 to § 38-1,146.

002. DEFINITIONS . For purposes of these regulations, definitions in the Uniform Credentialing Act, the Emergency Medical Services Practice Act, 172 Nebraska Administrative Code (NAC) 10, 12, and 13, and the following definitions are hereby adopted.

002.01 COMMUNITY CARE PROVIDER. Community paramedic who has a current license as an emergency medical technician, advanced emergency care technician, emergency medical technician – intermediate, or a paramedic and holds a license to practice as a community paramedic.

002.02 DIRECT SUPERVISION. The supervisor is present with the patient visually monitoring, providing verbal direction, and overseeing patient care that is being provided by temporary licensee.

002.03 EMERGENCY MEDICAL SERVICE INSTRUCTOR. An individual who has a current license to practice as an emergency medical service instructor.

002.04 NATIONAL CONTINUED COMPETENCY PROGRAM. A program developed by the National Registry of Emergency Medical Technicians to ensure evidenced based continuing education for emergency care providers. As of the effective date this chapter, the National Continued Competency Program level requirements are adopted as part of the continuing competency requirements for renewal of emergency care provider licenses. A copy of the National Continued Competency Program is available on the Department’s website or by contacting the Department at 301 Centennial Mall South, Lincoln, Nebraska.

002.05 NON-VISUALIZED AIRWAY MANAGEMENT. The insertion of a supraglottic airway device without visualization of airway anatomical structures and the removal of airway adjuncts as the sole means to provide for a patent airway.

002.06 SUPERVISOR. An individual who is a licensed emergency care provider, licensed healthcare practitioner or under the direction of a registered nurse, with an unencumbered license and is the same or higher level as the temporary licensee and is responsible for holders of temporary licenses.

003. INITIAL CREDENTIAL . To obtain a license an applicant must submit a complete application provided by the Department and provide documentation demonstrating the applicant meets the statutory requirements, 172 NAC 10, and this chapter.

003.01 LICENSURE EXAMINATION. The National Registry of Emergency Medical Technicians Cognitive Exam is the approved licensure examination for all levels except critical care paramedic and community care providers. The certification examination for Critical Care Paramedic or the Flight Paramedic Certification examination provided by The International Board of Specialty Certification is the approved licensure examination for critical care paramedic. The community care provider must take a community paramedicine certification examination provided by The International Board of Specialty Certification is the approved licensure examination for a community care provider. An applicant must have passed the licensure exam for the level of licensure for which the applicant is applying. The passing of a licensure examination is determined by The Standards for Educational and Psychological Testing.

003.02 APPLICATION. An applicant must be at least 18 years of age and submit documentation of having a current certificate for the level of license applied for or higher level from the National Registry of Emergency Medical Technicians as evidence of meeting the education and examination requirements. An applicant for a license as a critical care paramedic must have a license as a paramedic and have successfully completed the approved licensure examination for critical care paramedic. An applicant for a license as a community care provider must have a license as an emergency medical technician, advanced emergency medical technician, or paramedic and have successfully completed the approved licensure examination for a community care provider.

004. TEMPORARY LICENSE . An applicant for a temporary license must meet all statutory requirements, the requirements of 172 NAC 10, the requirements of this chapter and submit a complete application and documentation to the Department that the applicant meets all requirements, except for passing the required examination. An applicant must have an official certificate of completion from the training agency showing successful course completion with the date of completion sent directly to the Department from the originating program or institution.

004.01 PRACTICE UNDER A TEMPORARY LICENSE. An individual with a temporary license must be under direct supervision by the same or higher level of emergency care provider, licensed healthcare practitioner, or under the direction of a registered nurse, when performing practices or procedures at the level permitted by the temporary license.

005. RECIPROCITY . To obtain a license based on reciprocity, an applicant must meet the requirements of Neb. Rev. Stat. § 38-129.02, 172 NAC 10, and this chapter.

005.01 RESIDENCY. All applicants receiving a license pursuant to 172 NAC 11 must submit documentation of establishing residency in Nebraska as required by Neb. Rev. Stat. § 38-129.02. Such documentation must be submitted within 90 days of establishment of residency and consist of a rental or lease agreement with the signature of the owner or landlord and the applicant, a deed or title to residential real property with the name of the applicant as an owner, or documents with the name and address of the applicant such as mortgage bills, home utility bills, medical or employee documents or similar documents that show the applicant residing in Nebraska.

006. RENEWAL . To renew a license, an applicant must meet all statutory requirements, the requirements of 172 NAC 10, and this chapter. All emergency care provider licenses except emergency medical technicians issued by the Department expire on March 31 of each odd-numbered year. Emergency medical technicians expire on March 31 of each even-numbered year.

007. DOWNGRADE . An applicant may change licensure level at the time of renewal as set out below:

(A) Paramedics who do not meet the continuing competency requirements as provided in this chapter for their level of licensure may be licensed as an advanced emergency medical technician, emergency medical technician, or as an emergency medical responder if they meet the continuing competency requirements of the respective license;

(B) Emergency medical technician-intermediates who do not meet the continuing competency requirements as provided in this chapter for their level of licensure may be licensed as an advanced emergency medical technician, emergency medical technician, or an emergency medical responder if they meet the continuing competency requirements for the respective license;

(C) Advanced emergency medical technicians who do not meet the continuing competency requirements as provided in this chapter for their level may be licensed as an emergency medical technician, or an emergency medical responder if they meet the continuing competency requirements for the respective license; or

(D) Emergency medical technicians who do not meet the continuing competency requirements as provided in this chapter for their level of licensure may be licensed as an emergency medical responder if they meet the continuing competency requirements for that license.

008. CONTINUING COMPETENCY REQUIREMENTS . On or before the license expiration date, each licensed emergency care provider must complete continued competency requirements for their level of licensure as follows:

(A) Emergency medical responders must:

(i) Complete 8 hours of continuing education that meets the standards of the national component of the National Continuing Competency Program’s continued competency requirements for emergency medical responders; or

(ii) Hold a current Emergency Medical Responder certificate from the National Registry of Emergency Medical Technicians.

(B) Emergency medical technicians must:

(i) Complete 20 hours of continuing education that meets the standards of the national component of the National Continuing Competency Program’s continued competency requirements for emergency medical technicians; or

(ii) Hold a current Emergency Medical Technician certificate from the National Registry of Emergency Medical Technicians.

(i) Complete 25 hours of continuing education that meets the standards of the national component of the National Continuing Competency Program’s continued competency requirements for advanced emergency medical technicians and have documentation from the physician medical director or qualified physician surrogate of demonstrated competency in peripheral IV access, non-visualized advanced airway management and administration of approved medications in a clinical, out-of-hospital, or educational setting; or

(ii) Hold a current Advanced Emergency Medical Technician certificate from the National Registry of Emergency Medical Technicians.

(D) Emergency medical technician-intermediates must attest to completing 30 hours of continuing education, 20 hours in the subject matter of the emergency medical technician course and 10 hours in the subject matter covering the emergency medical technician-intermediate practice and procedures and have documentation from a physician or qualified physician surrogate of demonstrated competency in peripheral IV administration and endotracheal intubation in a clinical, out-of-hospital, or educational setting.

(E) Paramedics must:

(i) Complete 30 hours of continuing education that meets the standards of the national component of the National Continuing Competency Program’s continued competency requirements for paramedics and have documentation by a physician or qualified physician surrogate of demonstrated competency in peripheral IV administration, drug administration, cardiac skills, and endotracheal intubation in a clinical, out-of-hospital, or educational setting; or

(ii) Hold a current Paramedic certificate from the National Registry of Emergency Medical Technicians.

(F) Critical care paramedic must:

(i) Maintain a current Nebraska Paramedic License; and

(ii) Hold a current International Board of Specialty Certification Critical Care Paramedic Certification or Flight Paramedic Certification.

(G) Community care provider must:

(i) Maintain a current Nebraska emergency medical technician, advanced emergency medical technician, or paramedic license; and

(ii) Hold a current International Board of Specialty Certification Community Paramedic Certification.

009. ACCEPTABLE CONTINUING COMPETENCY . In order for an activity to be accepted for continuing competency to renew a license, the activity must meet the following criteria:

(A) Be a planned, formally organized program of learning which directly contributes to the professional competency of emergency care providers;

(B) Have objectives that demonstrate a reasonable connection to the practice of emergency medicine;

(D) Have an instructor who has experience or training in the content area(s) of the course being taught;

(E) Have a course title consisting of content at least one-half hour in duration;

(F) Delineate the number of contact hours, excluding meals and breaks to be awarded at the completion of the activity, with proof of such completion being documented; and

(G) Have a mechanism that documents attendance and participation; and

(H) A licensee who is an instructor of an Emergency Medical Service Course, may receive continuing education hours for initial instruction of an Emergency Medical Service Course on an hour-for-hour basis. Credit will not be given to the licensee for subsequent instruction of the same Emergency Medical Service Course or continuing education course.

010. NON-ACCEPTABLE CONTINUING COMPETENCY . The following activities are not acceptable for continuing education to renew a license:

(A) Advanced National Incident Management System Training where the subject matter does not have an emergency medical service focus;

(B) Advanced scene management courses where the subject matter does not have an emergency medical service focus;

(D) Courses where the subject matter does not demonstrate a reasonable connection to the practice of emergency medical care; or

(E) Fire training courses where the subject matter does not have an emergency medical service focus.

011. WAIVER OF CONTINUING EDUCATION . In addition to the waivers allowed by 172 NAC 10, the Department may waive continuing competency requirements, in whole or in part, upon submission by a credential holder of documentation that circumstances beyond their control have prevented completion of these requirements. These circumstances may include suffering from a serious or disabling illness or physical disability, which prevented completion of the continuing competency requirements during the 24 months immediately preceding the license renewal date. Waiver of continuing education may not be used for consecutive renewal periods.

012. PRACTICE WITH NON AFFILIATED SERVICES . An emergency care provider may perform any practice or procedure which they are authorized to perform with an emergency medical service other than the service with which they are affiliated when requested by the other service when the patient for whom they are to render services is in danger of loss of life.

013. EMERGENCY CARE PROVIDER UNPROFESSIONAL CONDUCT . Unprofessional conduct includes but is not limited to the acts set out in Neb. Rev. Stat. § 38-179 and the following:

(A) Providing or attempting to provide a service for which such provider is not trained or authorized by the physician medical director;

(B) Failure of a provider to be accountable, responsible, and answerable for decisions and action or inaction of self or others, and for the resultant patient outcomes related to decisions and actions or inactions;

(C) Failure for a provider to exhibit a state or quality of being competent or capable as a result of having the required knowledge, skills, and ability;

(D) Committing any act which endangers patient safety or welfare;

(E) Encouraging or promoting emergency medical care by untrained or unqualified persons;

(F) Failure to comply with emergency vehicle operating requirements pursuant to Neb. Rev. Stat. § 60-6,114;

(G) Failure to comply or follow the physician medical director’s directives;

(H) Committing any of the following acts or behavior that do not safeguard the welfare of patients and maintain professional relationships with patients:

(i) Failure to be aware of the intimacy and responsibilities inherent in the care of a patient and failure to avoid actions that seek to meet their personal needs at the expense of clients. Providers must avoid exploiting the trust of a patient and make every effort to avoid conditions that could impair professional judgment or increase the risk of exploitation of another person for one's own advantage;

(ii) Failure to decline to carry out emergency medical care services that have been requested when the services are known to be contraindicated or unjustified;

(iii) Failure to decline to carry out procedures that have been requested when the services are known to be outside of the emergency care provider's scope of practice;

(iv) Verbally or physically abusing patients;

(v) Falsification, unauthorized destruction, or failure to document patient care records;

(vi) Attempting to provide diagnostic or treatment information to patient(s) that are beyond the emergency care provider's level of training and expertise; or

(vii) Assigning to other personnel those patient related services when the clinical skills and expertise of an emergency care provider is required or is beyond the individual’s scope of practice;

(I) Engaging in sexual harassment of patients or coworkers. Sexual harassment includes making unwelcome sexual advances, requesting sexual favors, and engaging in other verbal or physical conduct of a sexual nature as a condition of:

(i) The provision or denial of emergency medical care to a patient;

(ii) The provision or denial of employment;

(iii) The provision or denial of promotions to a co-worker; or

(iv) For the purpose or effect of creating an intimidating, hostile, or offensive environment for the patient or unreasonably interfering with a patient's ability to recover or for the purpose or effect of creating an intimidating, hostile, or offensive working environment or unreasonably interfering with the co-worker's ability to perform their work;

(J) Failure to follow employer or emergency medical service policies or procedures implemented in the practice to safeguard patient care;

(K) Failure to provide professional assistance to patients without discrimination on the basis of race, color, religion, sex, disability, marital status, national origin, age, familial status, and ancestry;

(L) Failure to safeguard the patient's dignity and right to privacy; or

(M) Failure of a licensee or applicant, who is the subject of a disciplinary investigation, to furnish the Board or its investigator with requested information or requested documents.

014. INITIAL EMERGENCY MEDICAL SERVICE INSTRUCTOR LICENSURE . Any person who wishes to represent themselves as an emergency medical service instructor must be licensed as such. To obtain a license, an applicant must submit a complete application provided by the Department and provide documentation demonstrating the applicant meets the statutory requirements, 172 NAC 10, and this chapter.

014.01 QUALIFICATIONS. An applicant who wishes to be licensed as an emergency medical service instructor must meet the requirements described below:

(A) Be at least 18 years of age and of good character;

(B) Hold a current license as an emergency care provider at or above the level being taught or hold a current license as a registered nurse, advanced practice registered nurse, physician assistant, doctor of medicine, or doctor of osteopathy;

(i) The 1986, 1995, or 2002 U.S. Department of Transportation, National Highway

Traffic Administration Emergency Medical Service Instructor Course;

(ii) A college or university program where the applicant received a bachelor’s degree

or above in education;

(iii) The National Fire Protection Agency 1041 Instructor 2 Course; or

(iv) An equivalent course as approved by the Board; and

(D) All applicants for an initial emergency medical services instructor must hold a current National Registry of Emergency Medical Technician certification at or above the level being instructed. An applicant currently licensed as a registered nurse, advanced practice registered nurse, physician assistant, doctor of medicine, or doctor of osteopathy is deemed to have met this requirement and must submit a copy of their current and unrestricted license.

015. EMERGENCY MEDICAL SERVICES INSTRUCTOR CONTINUING COMPETENCY REQUIREMENTS . Each emergency medical service instructor holding an active credential must, on or before the date of expiration of the credential, continue to meet the requirements for an initial license and comply with the continuing competency requirements for the instructor as set out in this chapter. Each licensee is responsible for maintaining certificates or records of continuing competency activities and:

015.01 CONTINUING EDUCATION. An emergency medical services instructor must complete a total of 8 hours of continuing education, within the 24 months preceding the license expiration date, in educational subject matter that at a minimum must include the following subjects:

(A) Emergency medical service course curriculum updates;

(B) Emergency medical service legislation and regulations;

(D) Fundamentals of teaching adults.

015.02 TEACHING REQUIREMENTS. An emergency medical services instructor must teach at least 12 hours of adult education over emergency medical services care topics within 24 months prior to the expiration date of the license.

016. EMERGENCY MEDICAL SERVICE INSTRUCTOR RENEWAL . To renew an emergency medical service instructor credential, an applicant must maintain a current emergency care provider license and meet all statutory requirements, the requirements of 172 NAC 10, and this chapter. All emergency medical services instructor credentials issued by the Department will expire on March 31 of each odd-numbered year.

017. GROUNDS FOR DISCIPLINARY ACTION AGAINST A CREDENTIAL . A credential to practice as an emergency medical service instructor may have disciplinary actions taken against it on any of the following grounds:

017.01 EMERGENCY MEDICAL SERVICE INSTRUCTOR UNPROFESSIONAL CONDUCT. Unprofessional conduct includes but is not limited to the acts set out in Neb. Rev. Stat. § 38-179 and the following:

(A) Use of inappropriate language during the course of instruction, such as obscenities, vulgarisms, or other offensive language;

(B) Assigning duties to unqualified personnel for which the emergency medical service instructor is responsible;

(C) Engaging in conduct involving dishonesty, fraud, deceit, or misrepresentation in the performance of duties involving instruction;

(D) Engaging in harassment or sexual harassment. Sexual harassment includes making unwelcome sexual advances, requesting sexual favors, and engaging in other verbal or physical conduct of a sexual nature for the purpose or effect of creating an intimidating, hostile, or offensive learning environment. Harassment includes but is not limited to creating an intimidating, hostile, or offensive learning environment;

(E) Teaching outside the scope of practice identified by the definition of emergency medical service courses as outlined in this chapter; or

(F) Failure of a licensee or applicant, who is the subject of a disciplinary investigation, to furnish the Department, Board, or its investigator with requested information or requested documents.

018. REINSTATEMENT . This section applies to individuals previously licensed in Nebraska who seek the authority to return to practice in Nebraska with a valid Nebraska license. In addition to the requirements outlined in 172 NAC 10, the applicant must submit documentation of meeting the following applicable requirements for the level applied for:

(A) If an emergency medical responder license has been expired for less than five years and the applicant did not meet the renewal requirements by the renewal expiration date, the applicant must submit the following:

(i) A copy of the applicant’s current National Registry of Emergency Medical Technicians Certificate for the level applied for; or

(ii) Documentation of successful completion, within the two years preceding a renewal application, of a refresher course that meets the National Registry of Emergency Medical Technicians National Continuing Competency requirements for the level applied for as set out in this chapter.

(B) If an emergency medical responder license has been expired for more than five years, the applicant must submit a copy of the applicant’s current National Registry of Emergency Medical Technicians Certificate for the level applied.

(C) If an emergency medical technician, advanced emergency medical technician, or a paramedic license has been expired for less than three years and did not meet the renewal requirements by the renewal expiration date, the applicant must submit the following:

(i) A copy of the applicant’s current National Registry of Emergency Medical Technicians Certificate for the level applied for; or

(D) If a critical care paramedic license has been expired and did not meet the renewal requirements by the renewal expiration date, the applicant must submit the following:

(i) A copy of the applicant’s current International Board of Specialty Certification Critical Care Paramedic or Flight Paramedic; and

(ii) Documentation of Nebraska paramedic licensure.

(E) If a community care provider license has been expired and did not meet the renewal requirements by the renewal expiration date, the applicant must submit the following:

(i) A copy of the applicant’s current International Board of Specialty Certification Community Paramedicine certification; and

(ii) Documentation of a Nebraska emergency care provider license.

(F) If an emergency medical technician, advanced emergency medical technician, or paramedic license has been expired for more than three years, the applicant must submit a copy of the applicant’s current National Registry of Emergency Medical Technicians Certificate for the level applied.

(G) If an emergency medical services instructor has been expired for less than five years and the applicant did not meet the renewal requirements by the renewal expiration date, the applicant must submit the following:

(i) Meet the requirements of 172 NAC 11-014.01(A), 014.01(B), and 014.01(D); and

(ii) Documentation of the current renewal period continuing competency requirements set forth in this chapter.

(H) If an emergency medical services instructor has been expired for more than five years, the applicant must meet the requirements for an initial license as set out in this chapter.

History

Effective 2023-07-15

Chapter 12 Licensure of Emergency Medical Services

Neb. Admin. Code tit. 172, ch. 12 Licensure of Emergency Medical Services {#sec-172-nac-12 omnilex-key=us-ne-regs-official--title-172--172 NAC 12}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 12 LICENSURE OF EMERGENCY MEDICAL SERVICES

001. SCOPE AND AUTHORITY . These regulations govern the licensure of emergency medical services under the Emergency Medical Services Practice Act Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-1201 to 38-1237 and the Uniform Credentialing Act, Neb. Rev. Stat. §§ 38-101 to 38-1,146.

002. DEFINITIONS . For purposes of these regulations, definitions in the Uniform Credentialing Act, the Emergency Medical Services Practice Act, 172 Nebraska Administrative Code (NAC) 9, 11, and 13, and the following definitions are hereby adopted.

002.01 ADVANCED LIFE SUPPORT SERVICE. An emergency medical service that utilizes personnel trained and licensed as advanced emergency medical technicians, emergency medical technician-intermediates, or paramedics and has equipment available commensurate with that level of training.

002.02 BASIC LIFE SUPPORT SERVICE. An emergency medical service that utilizes personnel trained and licensed, at a minimum, as emergency medical technicians and has equipment available commensurate with that level of training.

002.03 DRY RUN. Travel to a scene where there could be a medical emergency but no one was found to be injured or ill at that location.

002.04 EMERGENCY CALL. A call for an ambulance in which the reporting party utilizes a dedicated activation number or system intended for rapid notification of emergency services and the reporting party indicates endangerment to a person’s life or limb.

002.05 INCIDENT. An occurrence, natural or manmade, requiring a response to a perceived individual need for medical care in order to prevent loss of life or aggravation of physiological or psychological illness or injury. For the purpose of these regulations “run”, “response”, or “call” are equivalent terms.

002.06 PATIENT ASSESSMENT. The act of determining the type and degree of injury, illness, or other medical disability.

002.07 PROTOCOL. A set of written policies, procedures, and directions from a physician medical director to an emergency care provider concerning the medical procedures to be performed in specific situations.

003. EMERGENCY MEDICAL SERVICE LICENSE . To receive a license, an applicant must submit a complete application, meet the requirements for a license set out in statute, 172 NAC 9, this chapter, and submit documentation of the following:

(A) Meets the standards for transporting patients or has a written agreement with a licensed emergency medical service that meets such standards;

(B) Has a physician medical director;

(D) Has an advanced emergency medical technician, emergency medical technician - intermediate, paramedic, registered nurse, advanced practice registered nurse, physician assistant, doctor of medicine, or doctor of osteopathy as a member or employee of the service, if applying for an advanced life support service license;

(E) Has protocols approved by the physician medical director of the service; and

(F) Has passed an inspection by the Department.

004. DOWNGRADE . An applicant may change licensure level if the applicant is unable to meet the requirements of an Advanced Life Support Service.

005. STANDARDS FOR PROVIDING COMMUNITY PARAMEDIC SERVICES . Any Nebraska licensed basic or advanced emergency medical service providing community paramedic services must:

(A) Implement a written plan which includes:

(i) Area and populations being served;

(ii) Conclusions or recommendations of a healthcare gap assessment in the area and population;

(iii) Healthcare goals and objectives; and

(iv) Benchmarks and performance measures that will be utilized to measure the efficacy of the program to include clinical and financial data;

(B) Minimum of one licensed community paramedic as member or employee of the service and on each community paramedic response; and

(i) Provides monitoring and supervision of community paramedic services;

(ii) Is involved in a community paramedicine training and competency evaluation; and

(iii) Establishes and maintains appropriate treatment protocols, standing orders, and equipment.

006. STANDARDS FOR EMERGENCY MEDICAL SERVICES . All applicants and licensees who own or lease an ambulance must meet the standards as set forth below:

006.01 AMBULANCE STANDARDS. Ambulance standards are available on the Department’s website or may be requested from the Department at 301 Centennial Mall South, Lincoln, NE 68509. Licensees must have documentation of the date an ambulance was acquired. Ambulances and aircraft must:

(A) After the effective date of the regulations, meet the National Fire Protection Association (NFPA) 1917 Standard for Automotive Ambulances that is current on the effective date of these regulations or the Commission on Accreditation of Ambulance Services (CAAS) Ground Vehicle Standard for Ambulances that is current on the effective date of these regulations;

(B) After the effective date of the regulations, remounted ambulances must meet the requirements of 172 NAC 12-006.01(A);

(C) Aircraft used for the transportation of patients must comply with Federal Aviation Administration Regulations 14 CFR 135 that is current on the effective date of these regulations and related bulletins and supplements; or

(D) Ambulances, including remounted ambulances, that are owned by a licensed emergency medical service on the effective date of these regulations may continue to be used as ambulances.

(i) If the ownership of an ambulance meets the requirements of 172 NAC 12-006 .01(D) is transferred to another emergency medical service after the effective date of these regulations, then the ambulance cannot be used as an ambulance. unless the ambulance:

(1) Meets the requirements of 172 NAC 12-006.01 (A) or (B); or

(2) The ambulance is fifteen years of age or less; and,

(3) Meets or exceeds the Federal Specifications for Ambulances, KKK-A-1822C.

(ii) Section 006.01(D)(i) (2) and (3) terminate ten years after effective date of these regulations.

006.02 STANDARDS FOR EMERGENCY MEDICAL SERVICES EQUIPMENT. Ambulances and non-transporting emergency medical services must carry supplies and equipment, approved by the physician medical director for providing care to pediatric and adult patients. The equipment and supplies must include:

(A) Equipment that can be used to provide the following procedures as authorized by the service's license:

(i) Patient assessment and diagnostic measurements;

(ii) Airway management;

(iii) Bleeding control and wound management;

(iv) Extremity fracture immobilization;

(v) Cervical and spinal motion restriction;

(vi) Burn care;

(vii) Cardiac care;

(viii) Obstetrics and gynecology care;

(ix) Intravenous administration sets and fluids; and

(x) Administration of medications and controlled substances;

(B) Patient transport and comfort supplies;

(C) Supplies and equipment for the protection of personnel and patients from infectious diseases and for personal safety; and

(D) Equipment and supplies appropriate for a critical care transport.

006.03 DRUG ENFORCEMENT AGENCY CONTROLLED SUBSTANCE REGISTRATION. An advanced life support emergency medical service must have a Drug Enforcement Agency Controlled Substance Registration to deliver, store, or otherwise handle controlled substances.

006.04 CLINICAL LABORATORY IMPROVEMENT AMENDMENTS. An emergency medical service must have a current Clinical Laboratory Improvement Amendments (CLIA) certificate for all levels of point-of-care testing utilized by the service.

006.05 COMMUNICATION SYSTEMS. Each licensee must have a communications system that is capable of two-way communications with receiving hospitals, dispatchers, and medical control authorities.

006.06 AMBULANCE MAINTENANCE STANDARDS. Each licensee must meet the maintenance standards set out below:

(A) Ambulances must be maintained as specified in the chassis manufacturer owner’s manual and the recommendations of the ambulance manufacturer;

(B) Aircraft must be maintained in accordance with Federal Aviation Regulation 14 CFR Part 135 and 14 CFR Part 91 and related bulletins, and supplements as required by this chapter;

(C) Equipment used for patient care or support must be maintained in accordance with the manufacturer’s recommended procedures; and

(D) The licensee must keep and maintain all ambulance and operational equipment owner manuals and maintenance procedure manuals for the life of the ambulance or operational equipment or as long as the equipment is owned or used by the emergency medical service.

006.07 INFECTION CONTROL STANDARDS. The licensee must follow written policies, approved by its physician medical director, concerning sanitation and infection control and the following:

(A) Pre-exposure precautions;

(B) Post-exposure procedures for personnel. Such procedures must be in accordance with Neb. Rev. Stat. §§ 71-506 to 71-514.05;

(D) Procedures for the decontamination and cleaning of equipment; and

(E) Procedures for the disposal of contaminated or single use equipment and supplies.

006.08 AMBULANCE INSPECTION STANDARDS. A licensee which transports patients must establish and perform, at a minimum, monthly vehicle inspections to assure the vehicle’s emergency warning devices, electrical systems, engine, and fuel systems are in proper working order. Operational equipment, used for patient care or support, must be inspected, at a minimum, monthly and tested by the service for proper operation or function. All drugs must be inventoried, at a minimum, monthly. Checklists must be developed and used by the service to conduct these inspections monthly. Completed checklists must be maintained for five years.

006.09 PERSONNEL STANDARDS. A licensee must meet the statutory requirements and the following personnel standards:

(A) Maintain a current roster of the names of its employees and members of the service;

(B) Only use licensed emergency care providers and individuals as identified in Neb. Rev. Stat. § 38-1226 to provide patient care;

(C) When acting as an emergency care provider for a basic life support service, the provider may only provide the level of care as defined in Neb. Rev. Stat. §§ 38-1206.01 and 38-1207.01. When acting as an emergency care provider for an advanced life support service, the provider may provide the level of care for a basic life support service and the level of care as defined in Neb. Rev. Stat. §§ 38-1204.01, 38-1207.01, and 38-1208.01; and

(D) Staffing of at least one critical care paramedic or a licensed physician, registered nurse, physician assistant, or advanced practice nurse practitioner when providing critical care transportation.

006.10 PERSONNEL TRAINING STANDARDS. A licensee must provide training every two years for its members that includes, but is not limited to, the following areas:

(A) Emergency vehicle driving for operators of ambulances or aircraft safety for operators of aircraft;

(B) Infection control standards;

(D) Health Insurance Portability and Accountability Act (HIPAA) Training;

(E) Personal safety issues; and

(F) Equipment used in the care of patients.

006.11 PERSONNEL TRAINING DOCUMENTATION. Training must be documented for each individual that participated in training provided by the licensee. The documentation must be maintained by the service for five years.

006.12 PHYSICIAN MEDICAL DIRECTION STANDARDS. Every licensee must have a physician medical director who meets the requirements and responsibilities in the Emergency Medical Services Practice Act and this chapter.

006.12(A) PHYSICIAN MEDICAL DIRECTOR QUALIFICATIONS. A physician medical director must have the following:

(i) Experience in, and knowledge of, emergency care of acutely ill or traumatized patients;

(ii) Be familiar with the design and operation of local, regional, and state emergency medical service systems;

(iii) Obtain at least three hours of category one continuing medical education within the subject area of emergency medical services every twenty-four months; and

(iv) An advanced life support service providing critical care services shall maintain a physician medical director with specialty board certification in emergency medicine or a critical care subspecialty.

006.12(B) PHYSICIAN MEDICAL DIRECTOR RESPONSIBILITIES. A physician medical director is responsible for:

(i) Notifying the Department of the name(s) of licensed emergency medical services for which the individual is the physician medical director;

(ii) Notifying the Department immediately when responsibility as the physician medical director for an emergency medical service is terminated and the date of the termination;

(iii) Development and approval of protocols and standing orders for the emergency medical service;

(iv) Ensuring and documenting the competency of each licensed emergency care provider to perform skills used by the emergency medical service and documentation of any limitations on the practice of any emergency care provider;

(v) Implementation of a medical quality assurance program. The medical quality assurance program must include:

(1) An annual review of protocols and standing orders;

(2) Documentation of medical care audits as required by physician medical director; and

(3) Continuing medical education for the emergency medical services personnel;

(vi) Ultimate authority and responsibility for monitoring and for the overall supervision of the medical aspects of the emergency medical service;

(vii) Ensuring each written standing order and protocol is appropriate for the licensure and skill level of each of the individuals to whom the performance of medical acts is delegated and authorized; and

(viii) The oversight of the distribution, storage, ownership and security of medications and controlled substances utilized by the emergency medical service.

006.13 RECORDS MAINTENANCE STANDARDS. Each licensee must maintain records as set out below:

006.13(A) PERSONNEL RECORDS. Current personnel files on each emergency care provider must be maintained. All records must be maintained until superseded. Each file must include the following:

(i) Name, address, and telephone number;

(ii) Current level of licensure; and

(iii) Current cardiopulmonary resuscitation certification.

006.13(B) AMBULANCE AND EQUIPMENT RECORDS. A licensee must maintain records of vehicle and equipment maintenance and repair for no less than five years.

007. RENEWAL OF AN EMERGENCY MEDICAL SERVICES . All emergency medical service’s licenses issued by the Department expire on March 31 of each odd-numbered year. On or before the license expiration date, each emergency medical service must submit a complete application, meet all statutory requirements, meet the requirements of 172 NAC 9, this chapter, and

(A) Submit documentation of meeting 172 NAC 12-003(A) through (G); or

(B) Submit proof of current accreditation from the Commission on Accreditation of Medical Transportation Systems or Commission on Accreditation of Ambulance Services.

008. PATIENT CARE AND TREATMENT . Each licensee must provide the necessary care and treatment within its ability to meet the needs of patients. Care and treatment provided must meet prevailing professional standards and scope of practice requirements. Each licensee is to implement written policies and procedures that encompass care and treatment provided to patients.

009. PATIENT CARE RECORDS . A licensee must ensure a patient care record for each incident, dry run, refused transportation, critical care run, community paramedic response, and stand-by service is completed by responding personnel. Patient care records must contain all data points as defined in the Nebraska Emergency Medical Services Data Dictionary.

009.01 MAINTENANCE OF PATIENT CARE RECORDS. All patient care records for each incident, dry run, refused transportation, stand-by, critical care run, community paramedic response, and reporting of no incidents for a month must be:

(A) Maintained and preserved, in electronic form, for a period of at least five years or in the case of minors, the records must be kept until three years after the age of majority has been attained;

(B) Compliant with the highest standard as certified by the National Emergency Medical Services Information System, or successor organizations;

(C) Sent to the Department as a complete record within 72 hours upon completion of an incident and when a unit is back in service to be used for inspection, data collection and research;

(D) Submitted electronically to the Department. This requirement does not supersede any medical or legal requirements for maintenance of patient records; and

(E) Compliant with the current version of the Nebraska Emergency Medical Services Data Dictionary.

009.02 THIRD PARTY PATIENT CARE REPORTING SYSTEMS. If a licensee chooses not to use the electronic Nebraska Ambulance Rescue Service Information System, the patient care and incident information must meet all requirements in this chapter:

009.03 PATIENT CARE RECORD CONFIDENTIALITY. Patient data must be kept confidential as required by Neb. Rev. Stat. § 38-1225. Records must be available for examination by authorized representatives of the Department.

009.04 DESTRUCTION OF PATIENT CARE RECORDS. In order to ensure the patient’s right of confidentiality, medical records must be destroyed or disposed of by shredding, incineration, electronic deletion, or another equally effective protective measure or as otherwise provided by law.

010. BACKUP RESPONSE PLAN . A licensee must have a written back-up response plan in the event of their inability to respond to requests for their services except for interfacility transport and flight transport. The back-up response plan must:

(A) List how many times the service is dispatched and the time period between each dispatch if there is no response;

(B) List the back-up service that must be called no more than ten minutes after the original call activation; and

011. DEEMED COMPLIANCE . A licensee may be deemed in compliance with this set of regulations based on its accreditation. The service may still be selected for inspection in accordance with this set of regulations.

011.01 ACCREDITATION. A licensee may be deemed in compliance with this chapter on its accreditation by:

(A) Commission on Accreditation of Medical Transport Systems; or

(B) Commission on Accreditation of Ambulance Services.

011.02 REQUIREMENTS FOR EMERGENCY MEDICAL SERVICE TO BECOME DEEMED. A licensee may request the Department deem the emergency medical service in compliance with this chapter. The request must be:

(A) Made in writing to the department;

(B) Submitted within 30 days of receipt of a report granting accreditation; and

011.03 MAINTAINANCE OF DEEMED COMPLIANCE. The licensee must maintain the accreditation or certification on which the license was issued. If the accreditation or certification has been sanctioned, modified, terminated, or withdrawn, the licensee must notify the Department within 15 days of receipt of notification of the action. After notifying the Department, the licensee may continue to operate unless the Department determines the licensee no longer meets the requirements for licensure under the Uniform Credentialing Act, Emergency Medical Services Practice Act, or this chapter. If the Department determines the licensee no longer qualifies for deemed compliance, the licensee is subject to inspections in accordance with this chapter.

012. COMPLIANCE INSPECTIONS . Each licensee has the responsibility to be in compliance, and to remain in compliance, with the statutes and this chapter. To determine compliance with the statutes and regulations, the Department may conduct announced or unannounced inspections of emergency medical services.

013. REQUIREMENTS FOR CHANGING PHYSICIAN MEDICAL DIRECTOR . Prior to a change in a physician medical director, the licensee must submit a change in medical director form provided by the Department. A licensee may not operate without a physician medical director.

014. REQUIREMENTS FOR CLOSING A LICENSED EMERGENCY MEDICAL SERVICE . The following procedures must be followed by a licensee that wishes to close:

(A) Notify the Department in advance of closing, when possible. All requirements for operation must be maintained until the emergency medical service is officially closed;

(B) All patient care records that have not met the record retention timeline, must be stored, or relinquished to the patient or the patient’s authorized representative. The Department must be notified as to where the records are stored if the records were relinquished to patients or destroyed. If records are stored, the Department must be notified of the storage address, name, and telephone number of the person who has access to the records; and

(C) The owner of the emergency medical service is responsible for the retention and preservation of the appropriate records upon termination of license.

015. UNPROFESSIONAL CONDUCT . Unprofessional conduct includes but is not limited to the acts set out in Neb. Rev. Stat. §§ 38-179, § 38-182 and the following:

(A) Competence: A licensee must not provide services for which the service has not been licensed or individuals licensed or authorized by the physician medical director. Unprofessional conduct while providing services as an Emergency Medical Service will include but is not limited to:

(i) Encouraging or promoting emergency medical care by untrained or unqualified persons;

(ii) Failure to comply with emergency vehicle operating requirements in accordance with Neb. Rev. Stat. § 60-6,114; and

(iii) Failure to comply with the lawful directions of the physician medical director;

(B) Confidentiality: A licensee must hold in confidence information obtained from a patient, except in those unusual circumstances in which to do so would result in clear danger to the person or to others, or where otherwise required by law. Failure to do so will constitute unprofessional conduct;

(C) Failure to decline to carry out emergency medical care services that have been requested when the services are known to be contraindicated or unjustified;

(D) Failure to accurately provide interfacility arrival response time;

(E) Failure to ensure and document emergency care provider competency;

(F) Failure to decline to carry out procedures that have been requested when the services are known to be outside of the emergency medical services licensure level;

(G) Falsification or unauthorized destruction of patient records;

(H) Delegating to unqualified personnel those patient related services when the clinical skills and expertise of an emergency care provider is required;

(I) Failure of a licensee to appropriately account for shortages or overages of controlled substances;

(J) Failure to discipline emergency care providers who have engaged in sexual harassment or any form of harassment of patients or co-workers;

(K) Violating an assurance of compliance entered into under Neb. Rev. Stat. § 38-1,108;

(L) Failure to exercise appropriate supervision over persons who are authorized to practice only under the supervision of the licensed professional;

(M) Practicing as an emergency medical service in this state without a current Nebraska license;

(N) Obtaining any fee for professional services by fraud, deceit, or misrepresentation, including, but not limited to, falsification of third-party claim documents;

(O) Failure to permit access by an agent or employee of the Department for the purposes of inspection, investigation, or other information collection activities necessary to carry out the duties of the Department; and

(P) Failure of a licensee or applicant, who is subject of a disciplinary investigation, to furnish the Department, Board, or its investigator with requested information or requested documents.

History

Effective 2023-07-15

Chapter 13 Emergency Medical Services Training Agency

Neb. Admin. Code tit. 172, ch. 13 Emergency Medical Services Training Agency {#sec-172-nac-13 omnilex-key=us-ne-regs-official--title-172--172 NAC 13}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 13 EMERGENCY MEDICAL SERVICES TRAINING AGENCY

001. SCOPE AND AUTHORITY . These regulations govern the credentialing of emergency medical services training agencies under the Emergency Medical Services Practice Act Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-1201 to 38-1237 and the Uniform Credentialing Act Neb. Rev. Stat. §§ 38-101 to 38-1,146.

002. DEFINITIONS . Definitions in the Uniform Credentialing Act, the Emergency Medical Services Practice Act, 172 Nebraska Administrative Code (NAC) 9, 11, and 12, and the following definitions apply to this chapter.

002.01 ACCREDITED. An accrediting body recognized by the United States Department of Education.

002.02 APPROVED TRAINING AGENCY. A person which is approved to conduct Emergency Medical Service course training by the Department upon recommendation of the Board.

002.03 CLINICAL TRAINING. The instruction or training in a supervised practice of emergency medical skills in hospital settings such as critical care units, emergency departments, obstetrical units, or operating rooms or in other medical settings such as a clinic or office of an individual licensed to practice medicine and surgery.

002.04 DIRECT SUPERVISION. The visual monitoring, providing of verbal direction, and overseeing patient care that is being provided by a student.

002.05 FIELD EXPERIENCE. Time in an emergency medical service course when a student is directly supervised while operating with an emergency medical service, hospital, health clinic, or physician’s office that provides care to a perceived individual need for medical care and proceeds from observation to providing care commensurate with the student’s training.

002.06 PRIMARY INSTRUCTOR. A licensed emergency medical service instructor who must attend a majority of the class sessions to assure course continuity and who is responsible for identifying students have the cognitive, affective, and psychomotor skills necessary to function at the level being taught.

003. REQUIREMENTS FOR APPROVAL AS AN EMERGENCY MEDICAL SERVICE TRAINING AGENCY . To receive approval, an applicant must meet all statutory requirements, 172 NAC 9, and this chapter and submit a complete application and documentation the applicant meets the following qualifications:

(A) Be an accredited community college, college, university, or a school of nursing in this state that awards an academic degree to its graduates;

(B) Paramedic training programs must be accredited by the Commission on Accreditation of Allied Health Education Program (CAAHEP) upon the recommendation of the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (COAEMSP). Programs holding a current Letter of Review from the Commission on Accreditation of Allied Health Education Program will be deemed to meet this requirement;

(D) Have written agreements with hospital(s), health care clinics, or physician offices for clinical training of students for the level of training being conducted;

(E) Have written agreements with licensed emergency medical services for field experience for the level of training being conducted;

(F) Direct supervision of students must be performed by an individual who is a licensed emergency care provider, with an unencumbered license, and is the same or higher level of emergency care provider as the student’s course of study, or a licensed health care practitioner, or under the direction of a registered nurse;

(G) Meet the standards for operating set in this chapter;

(H) Emergency Medical Service Instructors must meet the requirements set forth in 172 NAC 11;

(I) Provide adequate facilities, equipment, apparatus, supplies, and staffing;

(J) Publish a catalog which includes at least the following information:

(i) The full name and address of the school;

(ii) Names of owners and officers, including any governing boards;

(iii) A description of each authorized educational service offered, including courses or programs offered, tuition, fees, and length of courses;

(iv) Enrollment procedures and entrance requirements, including late enrollment, if permitted;

(v) A description of the training agencies placement assistance. If no assistance is offered, the school must state this fact;

(vi) Attendance policy including minimum attendance requirements;

(vii) A description of how the agency determines a student’s progress. The description must include:

(1) How student progress is measured and evaluated, including an explanation of any system of grading used;

(2) The conditions under which the student may be readmitted if terminated for unsatisfactory progress;

(3) An explanation of any probation policy; and

(4) Information about the system used to make progress reports to students;

(viii) An explanation of the refund policy which also includes the training agencies method of determining the official date of termination; and

(x) A description of its policy that addresses student harassment and training agency action if such harassment takes place;

(K) Provide resources to support students who may need disability accommodations, student support, and other counseling services; and

(L) Pass an on-site inspection.

004. TRAINING AGENCY STANDARDS AND COURSES . Training agencies must:

(A) Provide official verification to individuals who have successfully completed any of the emergency medical service courses. The official verification must include the following:

(i) Training agency name and location of central or headquarters office;

(ii) Signature and title or position of a training agency individual attesting to the official verification;

(iii) Date student successfully completed the emergency medical service course;

(iv) Student full name including first and last name;

(v) Name of course that was successfully completed; and

(vi) Total number of hours the emergency medical service course provided. Advanced emergency medical technician and paramedic courses must include the number of didactic hours, clinical hours, and field internship hours;

(B) Maintain, for a minimum of five years, the following records for each emergency medical service course taught including:

(i) All student records must include:

(1) Name and address for each student enrolled in emergency medical service courses;

(2) Grades for each cognitive examination;

(3) Documentation of successful completion of each student’s psychomotor skill, patient contacts, and scenario evaluations;

(4) Documentation of the Advanced Emergency Medical Technician intravenous starts and non-visualized airway placement; and

(5) A copy of each student’s documentation of meeting entrance requirements to each course;

(ii) All instructor and course records must include:

(1) Names and qualifications of the primary instructors;

(2) Names and qualifications of other emergency medical service course instructors;

(3) Instructor evaluation records completed by students and training agency personnel;

(4) Names and qualifications of the psychomotor skills evaluators for the emergency medical service courses;

(5) Names and qualifications of the person providing direct supervision for field experience; and

(6) Agreements with other entities for use of equipment needed to conduct an emergency medical service course if the equipment is not provided by the training agency;

(D) Submit the following information to the Department for each course taught within 30 days of the completion of each course:

(i) Course location;

(ii) Name of training agency;

(iii) Name of instructor(s) of each course;

(iv) Name of course;

(v) Number of students enrolled;

(vi) Number of students that left prior to course completion; and

(vii) Number of students who:

(1) Completed the course;

(2) Total number of didactic hours; and

(3) For advanced emergency medical technician and paramedic courses, the total number of clinical and field internship hours;

(E) Obtain at least a 75% aggregate pass rate for each emergency medical service course for a period of two consecutive years on all attempts of the licensure examination as set forth in 172 NAC 11;

(F) Implement a written quality assurance program for instruction. The quality assurance program must:

(i) Include the implementation of written policies and procedures for periodic observation of all instructors including the feedback for strengths and opportunities for improvement;

(ii) Include the completion of student evaluations during and after each emergency medical service course taught;

(iii) Include the implementation of remediation plan(s) for instructor deficiencies. Documentation of such remediation must be maintained for five years; and

(iv) Conduct semi-annual meetings with each emergency medical service course instructor for the purpose of discussing training issues and identifying any instruction needs. Documentation of such meetings must be maintained for five years.

004.01 EMERGENCY MEDICAL SERVICE COURSE. Each emergency medical service course listed below must meet the requirements of the Uniform Credentialing Act, Emergency Medical Services Practice Act, United States Department of Transportation guidelines for Emergency Medical Service Instructors, and the current United States Department of Transportation and National Highway Traffic Safety Administration National Emergency Medical Services Educational Standards, on the date of the adoption of this chapter. The standards are available on the Department’s website or may be requested from the Department at 301 Centennial Mall South, Lincoln, NE 68509. Each training agency must:

(A) Use primary instructors for the administration, coordination, and teaching of each emergency medical service course;

(i) Primary instructors may utilize subject matter experts to assist in the teaching of emergency medical service course.

(B) Conduct, at the end of the course, the psychomotor skill component in accordance with the Department approved licensure examination for the emergency medical responder, emergency medical technician, emergency medical responder to emergency medical technician bridge, and pre-hospital emergency medical technician for nurses courses.

(C) Adhere to all components of the Department approved Emergency Medical Services Basic Life Support psychomotor examination handbook. The components are available on the Department’s website or may be requested from the Department at 301 Centennial Mall South, Lincoln, NE 68509.

(D) Ensure each student in an Advanced Emergency Medical Technician Course completes at least 25 patient contacts, at least 24 intravenous starts, and placement of at least 12 non-visualized airways during a minimum of 150 hours of field experience. These requirements may also be completed in a hospital emergency department, clinic, or physician’s office. If the student cannot meet the required patient contacts during the field experience because of a low number of emergency or medical requests, these patient contacts may be obtained in a simulated patient encounter laboratory setting. Documentation of each of these must be maintained.

(E) An Emergency Medical Technician to Advanced Emergency Medical Technician bridge course must meet the requirements in this chapter for an advanced emergency medical technician course specific to the educational material and psychomotor skills not taught in the emergency medical technician course.

(F) Ensure each student in an Emergency Medical Technician Course completes a minimum of five patient contacts during field experience. If the student cannot meet the five patient contacts during the field experience because of a low number of emergency or medical requests, these contacts may be obtained in a hospital emergency department, clinic, physicians’ office, or in a simulated patient encounter laboratory setting. Each student must successfully complete simulated adult and, when applicable, pediatric patient encounters in a laboratory setting that must include a minimum of cardiac, trauma, pediatrics, geriatric, stroke, obstetric, difficulty breathing, altered mental status, and toxicology. Documentation of each of these must be maintained.

(G) An Emergency Medical Responder Course must meet the requirements in this chapter.

(H) An Emergency Medical Responder to Emergency Medical Technician Bridge Course must meet the requirements in this chapter for an emergency medical technician course specific to the educational material and psychomotor skills not taught in the Emergency Medical Responder Course.

(I) Pre-Hospital Emergency Medical Technician for Nurses Course is a course of instruction for licensed registered nurses and licensed practical nurses to become emergency medical technicians that must meet the requirements in this chapter for an emergency medical technician course specific to the educational material and psychomotor skills not taught in a nursing course.

(J) A Paramedic Course must meet the requirements in this chapter.

(K) An Advanced Emergency Medical Technician to Paramedic Bridge Course must meet the requirements in this chapter for a paramedic course specific to the educational material and psychomotor skills not taught in the Advanced Emergency Medical Technician Course.

(L) Pre-Hospital Paramedic for Nurses Course is a course of instruction for licensed registered nurses to become a paramedic that must meet the requirements in this chapter for a paramedic specific to the educational material and psychomotor skills not taught in a nursing course.

(M)A Nebraska Emergency Medical Service Instructor Course must meet the requirements set out in this chapter.

(N) Emergency medical service refresher courses must meet the National Continued Competency Program requirements set out as defined in 172 NAC 11.

005. RESPONSIBILITIES AND QUALIFICATIONS OF APPROVED TRAINING AGENCY MEDICAL DIRECTORS . The emergency medical service training agency medical director must be responsible for the medical oversight of the program and the following:

(A) Responsible for the medical supervision of the curriculum of an approved training agency and verification of entry level competency of the students;

(B) Review and approve education course content, procedures, and protocols related to medical care for appropriateness, accuracy and evidence-based care;

(C) Review and approve minimum number of required patient contacts and procedures not addressed in this chapter of regulation;

(D) Review and approve any evaluation tools and processes used to evaluate student’s didactic, laboratory, and field experience;

(E) Review the progress of each student to assist in determining appropriate corrective action;

(F) Ensure the cognitive, psychomotor, and affective domains for students; and

(G) Ensure the effectiveness and quality of any training agency medical director responsibility that is delegated to another qualified physician.

005.01 MEDICAL DIRECTOR QUALIFICATIONS. A medical director must:

(A) Have a current license in Nebraska to practice medicine and surgery;

(B) Have experience providing emergency care to acutely ill and injured patients;

(C) Have training or experience in the delivery of the practice of emergency medical care, including the proper care and transport of patients, medical direction, and quality improvement in the practice of emergency medical care;

(D) Be active in the medical community and participate in activities related to the practice of emergency medical care; and

(E) Be knowledgeable about emergency medical service education including professional, legislative, and regulatory issues regarding emergency medical services education.

006. CHANGE IN MEDICAL DIRECTOR . Prior to a change in the training agency medical director, the licensee must submit a change in medical director form provided by the Department. A licensee may operate no more than 30 days without a physician medical director and must notify the Department immediately if a medical director resigns with no notice or due to unforeseen circumstances.

007. CLOSURE OF A TRAINING AGENCY . A training agency must notify the Department, in writing, a minimum of six months prior to a planned closure of the training agency. The notification must include a plan for completion of the training or transfer of students currently enrolled in the approved training agency and the disposition and storage of the records of the approved training agency. All requirements for operation must be maintained until the approved training agency is officially closed.

008. DEEMED COMPLIANCE . An approved training agency may be deemed in compliance with this chapter based on accreditation or certification by the Commission on Accreditation of Allied Health Education Programs. The approved training agency may still be selected for inspection.

008.01 REQUIREMENTS FOR APPROVED TRAINING AGENCY TO BECOME DEEMED. An approved training agency may request the Department to recognize the accreditation. The request must be:

(A) Made in writing to the Department;

(B) Submitted within 30 days of receipt of a report granting accreditation or certification; and

008.02 MAINTENANCE OF DEEMED COMPLIANCE. An approved training agency must maintain the accreditation or certification on which the approval was issued. If the accreditation is sanctioned, modified, terminated, or withdrawn, the training agency must notify the Department within 15 days of receipt of notification of the action. After notifying the Department, the training agency may continue to operate unless the Department determines the training agency no longer meets the requirements for deemed compliance. If the Department determines the approved training agency no longer qualifies for deemed compliance, the approved training agency is subject to compliance inspection.

009. COMPLIANCE INSPECTIONS . Each approved training agency has the responsibility to be in compliance and to remain in compliance with all requirements. To determine compliance with the statutes and regulations, the Department may conduct announced or unannounced inspections of the approved training agency.

010. GROUNDS ON WHICH THE DEPARTMENT MAY DENY APPROVAL OR DISCIPLINE AN EMERGENCY MEDICAL SERVICE TRAINING AGENCY . The Department may deny an application for approval when the applicant fails to meet the requirements. The Department may deny, suspend, or revoke approval or otherwise discipline an applicant, or approved training agency for any of the grounds listed in Neb. Rev. Stat. § 38-182 or for any of the following grounds:

(A) Violation of the regulations promulgated thereto governing the approval of approved training agencies;

(B) Misrepresentation of material facts, in procuring or attempting to procure approval as an approved training agency; or

(C) Providing an emergency medical service course while the approved training agency’s approval is suspended or in contravention of a limitation placed upon the approval.

010.01 TYPE OF DISCIPLINE. Types of disciplinary action that may be taken are those set in Neb. Rev. Stat. § 38-196.

011. PLAN OF CORRECTION PROCEDURE . In lieu of denial or other sanctions when an approved training agency is found to be in violation, the Department may require such agency to submit and complete a plan of correction. When requested, the approved training agency must submit to the Department a plan of correction containing the steps it will take to correct violations and the estimated time for correction. Such plan must be submitted within 30 days from date of mailing of the request from the Department. The estimated time for correction may not exceed one year. The plan of correction must be acceptable to the Department. Failure to submit an acceptable plan is grounds for denial, suspension, or revocation or otherwise discipline the agency’s approval. The approved training agency must submit to the Department documentation of completion of the plan of correction. The Department may conduct an inspection to determine if correction has been obtained. If the approved training agency fails to successfully complete an approved plan of correction or to correct a violation, the Department may suspend or revoke or otherwise discipline the agency’s approval.

012. REAPPLICATION REQUIREMENTS AND PROCEDURES FOR AN EMERGENCY MEDICAL SERVICE TRAINING AGENCY . An emergency medical service training agency whose approval has been terminated may apply for a new approval as provided in 172 NAC 13-003.

History

Effective 2023-07-15

Chapter 15 Alcohol and Drug Counselors

Neb. Admin. Code tit. 172, ch. 15 Alcohol and Drug Counselors {#sec-172-nac-15 omnilex-key=us-ne-regs-official--title-172--172 NAC 15}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 15 ALCOHOL AND DRUG COUNSELORS

001. SCOPE AND AUTHORITY . This chapter govern the licensure of alcohol and drug counselors under the Uniform Credential Act and the Alcohol and Drug Counseling Practice Act Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-301 to 38-321.

002. DEFINITIONS . Definitions set out in the Alcohol and Drug Counseling Practice Act, the Uniform Credentialing Act, and 172 Nebraska Administrative Code (NAC) 10, and the following apply to this chapter.

002.01 CLIENT. A person being assessed for a possible substance use disorder or an individual with a substance use disorder diagnosis who is receiving the direct services of the counselor. It includes those client cases the counselor may review, consult on or staff as part of an agency. Client may also include significant others for whom counseling or other services are provided in the context of treatment for the diagnosed substance use disordered person.

002.02 CLINICAL SUPERVISION. Supervision directed towards enhancing and promoting the clinical skills and competencies of persons who are earning the 6,000 hours of clinical work experience by providing alcohol and drug counseling.

002.03 CLINICAL SUPERVISOR. The person directly responsible for supervising the 6,000 hours of clinical work experience set out in 172 NAC 15-005.

002.04 HOUR. Applies to education or continuing education as follows:

(A) One hour equals 60 minutes.

(B) One semester hour of post-secondary education equals 15 hours.

(D) One trimester hour of academic credit equals 14 hours.

002.05 CORE FUNCTIONS. Core functions are defined in § Neb. Rev. Stat. 38-309. Each core function is defined as follows:

(A) Screening is the process of determining whether a client is appropriate and eligible for admission to a particular program.

(B) Intake is the administrative and initial assessment procedure for admission to a program.

(C) Orientation is the process of describing to the client the general nature and goals of the program; the rules governing client conduct and infractions that can lead to disciplinary actions or discharge from the program, in a non-residential program, the hours during which services are available, treatment costs to be borne by the client, if any, and client rights.

(D) Assessment is the procedure used by a counselor or program to identify and evaluate an individual's strengths, weaknesses, problems, and needs for the development of the treatment plan.

(E) Treatment planning is the process by which the counselor and the client identify and rank problems needing resolution, establish agreed upon immediate and long-term goals, and decide on a treatment process and the resources to be utilized.

(F) Counseling is the utilization of special skills to assist individuals, families, or groups in achieving objectives through exploring a problem and its ramifications, examining attitudes and feelings, considering alternative solutions, and decision making.

(G) Case management means activities to bring services, agencies, resources, or people together within a planned framework of action toward the achievement of established client goals. It may involve liaison activities and collateral contacts.

(H) Crisis intervention means providing services which respond to an alcohol or drug user's needs during acute emotional or physical distress, or both.

(I) Client education means providing information to the client and significant others, either individually or in a group, concerning alcohol and other drug use and available services and resources.

(J) Consultation with other professionals in regard to client treatment or services, includes relating with professionals from one's own profession and from other professions to assure comprehensive, quality care for the client.

(K) Referral means identifying the needs of the client that cannot be met by the counselor or agency and assisting the client to utilize the support systems and community resources available.

(L) Reports and recordkeeping is charting the results of the assessment and treatment plan, writing reports, progress notes, discharge summaries, and other client-related data.

002.06 FAMILY MEMBER. A spouse, significant other, children, parents, grandparents, grandchildren, brothers, sisters, aunts, uncles, cousins, or persons bearing the same relationship to the spouse.

002.07 PRACTICAL TRAINING SUPERVISOR. The person directly responsible for supervising the 300 hours of practical training or internship or practicum is a practical training supervisor.

002.08 PRACTICAL TRAINING SUPERVISION. Supervision directed towards enhancing and promoting the clinical skills and competencies of persons who are earning the 300 hours of practical training or internship or practicum by providing alcohol and drug counseling.

002.09 SUPERVISED CLINICAL WORK EXPERIENCE. Work activity performed while obtaining the required 6,000 hours of clinical work experience under clinical supervision which involve primary responsibility for providing alcohol and drug treatment counseling services to alcohol and other drug clients and for which remuneration is received.

003. PROVISIONAL LICENSED ALCOHOL AND DRUG COUNSELOR REQUIREMENTS . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. § 38-314, 172 NAC 10, and this chapter. Applicants must submit the following:

003.01 HIGH SCHOOL. A copy of the high school diploma or its equivalent. An official transcript submitted directly from the issuing institution, verifying receipt of a post-secondary degree may be submitted as documentation of having the equivalent of a high school diploma.

003.02 EDUCATION. Documentation of having completed the education set out in Neb. Rev. Stat. § 38-314 through workshops, seminars, institutions, college or university coursework. Applicants must submit:

(A) An official transcript directly to the Department from the issuing institution for any hours completed through a college or university.

(B) Certificates of completion for hours earned through workshops or seminars and institutes.

(C) Official descriptions for each educational area, such as, syllabi, course catalogue, brochure, or a similar document, for the time of attendance and indication of the course name and course number, which documents completion of the following:

(i) A minimum of 45 clock hours in counseling theories and techniques, which includes the study and practice of theories, principles, and techniques of counseling and include the study and practice of:

(1) At least 4 counseling techniques such as, but not limited to, active listening, reflective feedback, summarizing, self-disclosing, displaying empathy, confronting, establishing rapport, and communicating at the client's comprehension level; and

(2) At least 4 counseling theories such as, but not limited to, Adlerian, cognitive behavioral, client-centered, Gestalt, rational emotive, reality, and Postmodern theories.

(ii) A minimum of 45 clock hours in group counseling, which includes the study and practice of group theories, processes, dynamics, techniques, methods, and group counseling and facilitation.

(iii) A minimum of 30 clock hours in human growth and development, which includes the study of the nature and needs of individuals at all normal developmental levels from conception to death.

(iv) A minimum of 15 clock hours in professional ethics and issues, which addresses the standards of conduct and professional behavior expectations for counselors.

(v) A minimum of 30 clock hours in alcohol and drug assessment, case planning and management, which includes the process of collecting client data for making decisions regarding substance use disorder diagnosis, level of care placement, and treatment and referral and include:

(1) The study of 2 or more alcohol or drug or both assessment instruments; and

(2) The practice of record keeping addressing the development of substance use assessments, diagnosis, treatment plans, progress notes, discharge plans and clinical case reviews including case management activities to bring together services, agencies, and resources to achieve client treatment goals while adhering to confidentiality as it relates to these areas.

(vi) A minimum of 30 clock hours in multicultural counseling, which includes the adaptation of traditional counseling theories and techniques and consider cultural, social, lifestyle, spiritual, and economic factors relevant to the provision of competent and relevant counseling to varied populations.

(vi) A minimum of 45 clock hours in medical and psychosocial aspects of substance use disorders, which includes physiological, psychological, and sociological aspects of substance use disorders and includes:

(1) Studying the development of substance use disorders, covering signs, symptoms, and behavior patterns; and

(2) The study of drug types and pharmacology.

(vii) A minimum of 30 clock hours in clinical treatment issues in substance use disorders, which includes the clinical treatment needs of individuals with substance use disorders taking into consideration the client’s individualized needs and includes. This education must include the study of treatment issues specific to substance use such as, but not limited to, family dynamics, relapse, defense mechanisms, co-occurring disorders, spirituality, trauma exposure, and influences of self-help groups.

(D) Applicants who hold an active license as a provisional mental health practitioner, mental health practitioner, or independent mental health practitioner, meet 5 of the 8 educational areas as specified in Neb. Rev. Stat. § 38-318.

003.03 PRACTICAL TRAINING. Documentation of completion of the supervised training set out in Neb. Rev. Stat. § 38-314. On-line counseling services are not acceptable for the 300 hours of supervised practical training.

004. PRACTICAL TRAINING SUPERVISOR . To be a practical training supervisor, the individual must meet the requirements of Neb. Rev. Stat. § 38-315 and:

(A) Not have had his or her license disciplined, limited, suspended, or placed on probation during the 1 year immediately preceding supervision as a practical training supervisor. If any of these actions are taken by the Department during the practical training supervision period, supervisor must terminate the supervision immediately.

(B) If the supervisor is a physician, the supervisor must meet the following:

(i) Hold an American Board of Psychiatry and Neurology subspecialty certification in addiction psychiatry; or

(ii) Hold an American Society of Addiction Medicine (ASAM) certification; or

(iii) Have significant work in substance abuse treatment, which includes 3 years with at least 20% of time working in the substance use treatment field. These physicians must maintain competency by demonstrating that at least 20% of their continuing medical education (CME) is focused on substance use issues and must incorporate knowledge of the 12 core functions of substance use counseling into the supervisory experience.

(C) If the supervisor is a psychologist, the supervisor have completed at least 3 hours of training, pre-approved by the Board of Psychology, relating to the 12 core functions.

005. ALCOHOL AND DRUG COUNSELOR LICENSE REQUIREMENTS . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. § 38-316, 172 NAC 10, and this chapter. Applicants must submit the following:

005.01 PROVISIONAL LICENSE. Evidence that the applicant has met the requirements for or holds a provisional license as an alcohol and drug counselor.

005.02 EXAMINATION. Documentation of passing the Alcohol and Drug Counselor written examination by the International Certification & Reciprocity Consortium, or its successor, with a minimum scaled score of 500.

005.03 SUPERVISED CLINICAL WORK EXPERIENCE. Documentation of completion of at least 6,000 hours of supervised clinical work experience providing alcohol and drug counseling services to alcohol and other drug clients for remuneration. An applicant must hold a provisional license as an alcohol and drug counselor if gaining work experience hours in Nebraska. Any hours obtained in Nebraska prior to the receipt of the provisional license as an alcohol and drug counselor will not be considered towards meeting the 6,000 hours of supervised clinical work experience required for a license as an alcohol and drug counselor. Face-to-face clinical supervision may include in-person or interactive video conferencing. The format for supervision must be either one-on-one or small group.

005.04 WORK EXPERIENCE SUBSTITUTION. If the applicant seeks a substitution for clinical work experience hours based on a degree, an official transcript, submitted directly from the issuing post-secondary educational institution, verifying completion of one of the degrees set out in Neb. Rev. Stat. § 38-316.

006. CLINICAL SUPERVISOR . To be a clinical supervisor, the individual must meet the requirements of Neb. Rev. Stat. § 38-317 and the requirements of 172 NAC 15-004 (A) through (C).

007. RECIPROCITY ALCOHOL AND DRUG COUNSELOR LICENSE REQUIREMENTS . To obtain a license by reciprocity, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. § 38-319, 172 NAC 10, and this chapter. Applicants must submit the following:

(A) Documentation from a member jurisdiction of the International Certification & Reciprocity Consortium, or its successor, that the application holds a valid reciprocal level credential for the license requested; or

(B) Documentation that the applicant holds a current license or certification in another jurisdiction that authorizes the applicant to provide alcohol and drug counseling, has at least 270 hours of alcohol and drug counseling education, has at least 3 years of full-time alcohol and drug counseling practice following initial licensure or certification in the other jurisdiction, and has passed an alcohol and drug counseling examination.

008. EXAMINATION . To be eligible and approved to take the examination, applicants must meet the following:

(A) Hold a provisional license as an alcohol and drug counselor; and

(B) Submit a complete application as provided by the Department.

009. APPROVAL OF INITIAL 270 HOURS OF EDUCATION FOR LICENSURE . The Board may review coursework to determine if it meets the 270 hours of education for initial licensure. Approval is valid for a maximum of 5 years. Education providers desiring to obtain approval for subsequent periods must reapply. To apply for review, an education provider must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the following:

009.01 COURSE INFORMATION. The education provider must submit the following:

(A) The course name and course number under the educational area for which they are seeking approval;

(B) Official course curricula for each course submitted;

(C) Number of and type of academic credit hours for post-secondary education or clock hours for non-post-secondary education;

(D) Course objectives and amount of instructional time based on clock hours, spent in each course objective; and

(E) Signature, telephone number, and e-mail of an official of the education provider.

009.02 CHANGE IN TITLE, NUMBER, OR CONTENT. If the course title, number or content change, the approval is null and void effective the date of the change and a new application for approval is required.

010. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10 and this chapter. Alcohol and Drug Counseling licenses expire on September 1 of each even-numbered year.

011. CONTINUING EDUCATION . Each licensee must complete 40 hours of continuing education during the 24 months prior to the expiration date. Additional hours earned during this period, which are above and beyond the required 40 hours, cannot be utilized for subsequent renewals. The same continuing education program may not be completed more than once per biennial renewal period.

011.01 MANDATORY HOURS. At least 20 hours of continuing education must be alcohol and drug specific as set out in 172 NAC 15-002.05. All 40 hours of continuing education per biennial renewal period may be alcohol and drug specific. Continuing education hours presented by or approved by one of the following organizations is considered alcohol and drug specific:

(A) Addiction Technology Transfer Centers (ATTC);

(B) American Society of Addiction Medicine (ASAM); and

011.02 OTHER HOURS. A licensee may earn up to 20 hours of continuing education in activities that may not be alcohol and drug specific but must be approved by one of the following organizations:

(A) American Counselors Association (ACA) or its state chapters or National Board for Certified Counselors (NBCC);

(B) American Medical Association (AMA) or its state chapters;

(D) American Nurses Credentialing Center’s Commission on Accreditation;

(E) American Psychological Association (APA) or its state chapters;

(F) National Association of Social Workers (NASW) or its state chapters;

(G) American Association of Marriage and Family Therapists (AAMFT) or its state chapters; or

(H) Nebraska Nurses Association (NNA).

011.03 TYPES OF CONTINUING EDUCATION AND HOUR CALCULATIONS. Types and hours include:

(A) Workshops, academic credit, home study, internet, other electronic means;

(B) Research, which must be a peer review environment by either poster session or publication; and

(C) Presenter of a continuing education program. The presenter may earn the same number of hours as the attendees; hours will not be granted for repeat presentations within the same biennial.

012. UNPROFESSIONAL CONDUCT OR CODE OF ETHICS . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179 and this chapter.

012.01 COMPETENCE. An alcohol and drug counselor must not provide services for which he or she is not trained or experienced. This includes but is not limited to:

(A) Committing any act which endangers client safety or welfare.

(B) Failure to refer or release a client to other professionals or services if that is in the client’s best interests.

(C) Failure to consider a client as an individual and imposing on the client any stereotypes of behavior, values or roles related to race, color, religion, sex, disability, marital status, national origin, age, familial status, and ancestry.

(D) Failure to respect the rights of the client to make the client’s own decisions, to participate in any plans made in his or her interest, and to reject services.

(E) Failure to assess personal and professional strengths, limitations, biases, and effectiveness on a continuing basis; to strive for self-improvement; and to assume responsibility for professional growth through further education and training.

(F) Failure to follow procedures and policies of the agency or employer to ensure safety of the client.

012.02 CONFIDENTIALITY. A licensee must hold in confidence information received from a client or potential client with respect to the service requested, except in those unusual circumstances in which to do so would result in clear danger to the person or to others, or where otherwise required or permitted by law. A person who communicates information unilaterally to a credential holder without a reasonable expectation that the credential holder is willing to form a client-therapist relationship, is not a potential client. Commission of any of the following acts or behavior constitutes unprofessional conduct:

(A) Violating 42 Code of Federal Requirements (CFR) Part 2 or other federal or state law relating to confidentiality.

(B) Releasing client information without a signed release except where otherwise allowed by law.

(C) Releasing client identifying data without a signed release and where another party would be able to recognize the identity of the client except where otherwise allowed by law.

012.03 PROFESSIONAL RELATIONSHIPS. A licensee must safeguard the welfare of clients and maintain professional relationships with clients. Commission of any of the following acts or behaviors constitutes unprofessional conduct:

(A) Exploiting a client for one’s own advantage.

(B) Performing or agreeing to perform alcohol and drug counseling services when the services are known to be contraindicated or unjustified.

(D) Attempting to provide diagnostic or treatment information to a client that is beyond the licensee’s level of education, training, and expertise.

(E) Assigning to other personnel those client-related services for which the clinical skills and expertise of a licensee are required.

(F) Failure to safeguard the client’s dignity and right to privacy.

012.04 SEXUAL HARASSMENT. A licensee must not under any circumstances engage in sexual harassment of clients. Sexual harassment includes making unwelcome sexual advances, requesting sexual favors, and engaging in other verbal or physical conduct of a sexual nature which may result in but does not have to result in:

(A) Providing or denying care to a client.

(B) Creating an intimidating, hostile, or offensive environment for the client.

012.05 DUAL RELATIONSHIP. Licensees must make every effort to avoid dual relationships with clients that could impair professional judgment or increase the risk of exploitation. When a dual relationship cannot be avoided, licensees must take appropriate professional precautions to ensure judgment is not impaired and no exploitation occurs. Examples of dual relationships include, but are not limited to, business or personal relationships with a client. In the therapeutic relationship, licensees are aware of the intimacy and responsibilities inherent in the therapeutic relationship and must avoid actions that seek to meet their personal needs at the expense of the client. Licensees are aware of their influential positions with respect to clients and must avoid exploiting the trust and dependency of such persons. Licensees, therefore, must make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation. Commission of any of the following acts or behavior constitutes unprofessional conduct:

(A) Entering into a professional counseling relationship with family members, with friends or with other persons closely connected to the licensee, or with an individual the licensee currently has or previously had a personal, sexually intimate, dating, or romantic relationship.

(B) Developing a business or personal relationship with a client during the provision of professional services or within 2 years following the termination of professional services. This includes hiring ex-clients or serving as a practical training supervisor or clinical supervisor of ex-clients pursuant to this chapter within the 2-year time period.

(C) Developing a sexually intimate, dating, or romantic relationship with a client during the provision of professional services or within 5 years following the termination of professional services.

(i) Sexually intimate means any written, verbal, or physical behavior which a reasonable person would find to be sexually seductive or sexually demeaning. Sexually intimate may or may not mean sexual contact.

(ii) Sexual contact is defined as sexual intercourse, either genital or anal, cunnilingus, fellatio, sodomy, or the handling of breasts, genital areas, buttocks or thighs, whether clothed or unclothed, regardless of whether such contact was initiated or consented to by licensee.

012.06 OTHER ACTS. The following acts are considered unprofessional conduct:

(A) Refusal of an applicant for licensure or a licensee to submit to a physical, mental, or alcohol and drug assessment or evaluation requested by the Department to determine qualifications to practice or to continue to practice alcohol and drug counseling and to provide the results to the Department.

(B) Rendering services as a provisional alcohol and drug counselor without clinical supervision as set out in this chapter.

(C) Failure of a provisional alcohol and drug counselor to inform all clients that he or she holds a provisional license and is practicing under supervision and to inform the clients of the name of the clinical supervisor.

013. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

014. FEES . Fees are set out in 172 NAC 2 and this chapter.

History

Effective 2021-06-15

Chapter 17 Licensure of Athletic Trainers

Neb. Admin. Code tit. 172, ch. 17 Licensure of Athletic Trainers {#sec-172-nac-17 omnilex-key=us-ne-regs-official--title-172--172 NAC 17}

001. SCOPE AND AUTHORITY. These regulations govern the licensure of athletic trainers under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-401 to 38-414 of the Athletic Training Practice Act and the Uniform Credentialing Act (UCA).

002. DEFINITIONS. Definitions are set out in the Athletic Training Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 ACCREDITED COLLEGE OR UNIVERSITY. A college or university which is accredited by North Central Association of Colleges and Schools or a comparable regional accrediting body or one whose athletic training curriculum is accredited by the Commission on Accreditation in Athletic Training Education in conjunction with the Council for Higher Education Accreditation.

002.02 CONTINUING EDUCATION ACTIVITY. The various methods in which a licensee can obtain the necessary continuing education for license renewal.

002.03 CONTINUING EDUCATION HOURS. The number of actual clock hours spent in direct participation in a structured education format.

(A) 1 academic semester hour is equal to 15 contact hours. A 3 credit hour course provides 45 contact hours of continuing education credit. (B) 1 academic quarter hour is equal to 10 contact hours. A 3 credit hour course provides 30 contact hours of continuing education credit.

002.04 LICENSURE EXAMINATION. The examination administered by the Board of Certification, Inc. (BOC).

002.05 REFEREED. Both the editor and 1 or more specialists in the field examine all manuscripts.

002.06 ATHLETIC TRAINING STUDENT. A student who is enrolled in an athletic training education program accredited by an accrediting body approved by the Board. Individuals who graduated prior to January 1, 2004, and who met the Board of Certification, Inc (BOC) internship requirement for certification, are deemed to have met the athletic training student requirement as outlined in Neb. Rev. Stat. § 38-411.

002.07 SUPERVISION. When providing supervision of an athletic training student, a supervising athletic trainer must be physically present and immediately available and have the ability to intervene on behalf of the athletic training student and patient.

002.08 THERAPEUTIC INTERVENTION. Treatment, techniques, and services designed to identify and prevent injuries and illness, as well as to provide optimal recovery for patients.

003. LICENSE REQUIREMENTS. To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. §§ 38-401 to 38-414, 172 NAC 10, and this chapter.

003.01 DOCUMENTATION. The following documentation must be provided to the Department.

003.01(A) EDUCATION. Submit documentation and an official transcript, directly from the issuing institution, verifying:

(i) For any person who graduated prior to January 1, 2004:

(1) Graduation after successful completion of an accredited athletic training education program at an accredited college or university. Applicants must provide an official transcript sent directly from the college or university; or (2) Graduation with a 4-year degree from an accredited college or university and completion of at least 2 consecutive years as an athletic training student under the supervision of an athletic trainer approved by the Board. Applicants must submit documentation verifying certification by the Board of Certification, Inc. (BOC) directly to the Department.

(ii) For any person who graduated after January 1, 2004:

(1) Graduation after successful completion of an accredited athletic training education program at an accredited college or university.

003.01(B) EXAMINATION. Documentation of successfully passing the licensure examination.

003.01(C) PASSED LICENSURE EXAMINATION BUT NOT PRACTICING. An applicant who passed the licensure examination more than 3 years prior to the date of application for licensure, and who is not practicing at the time of application for licensure, must present proof to the Department that they meet 1 of the following within the 3 years immediately preceding the application for licensure:

(i) Completion of 25 hours of continuing education pursuant to these regulations, and holds a current cardiopulmonary resuscitation for healthcare providers (CPR) certificate from a nationally recognized organization that issues the certificates; or (ii) Holds a current certification from the Board of Certification, Inc. (BOC).

003.01(D) LICENSED IN ANOTHER JURISDICTION BUT NOT PRACTICING. An applicant who is licensed in another jurisdiction and who is not practicing at the time of application for licensure, in addition to 172 NAC 17-003.01(A) and 172 NAC 17-003.01(B), must present proof to the Department that they:

(i) Have completed 25 hours of continuing education within 3 years of the date of application for licensure and, hold a current cardiopulmonary resuscitation for health care providers (CPR) certificate from a nationally recognized organization that issues the certificates; or (ii) Hold a current certification from the Board of Certification, Inc. (BOC).

004. DRY NEEDLING. An athletic trainer may perform dry needling only in accordance with the level of education and training successfully completed. Education and training must have been approved by the Board of Certification, Inc. (BOC) and includes clinical instruction and application on the performance of dry needling.

005. USE OF EMERGENCY MEDICATION. The athletic trainer is responsible for safe storage of emergency drugs in accordance with the manufacturer’s instructions. The athletic trainer must administer emergency drugs as directed in a written protocol developed with the prescriber issuing the prescription. The protocol shall describe:

(A) Appropriate route of administration; (B) Appropriate dose of administration; and (C) Any other information deemed necessary by the athletic trainer or the prescriber for emergency management of the patient.

006. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS. The applicant must meet the requirements set out in 172 NAC 10. All athletic trainer licenses expire on May 1 of each odd-numbered year.

007. CONTINUING EDUCATION. On or before May 1 of each odd-numbered year, athletic trainers holding an active license in the State of Nebraska must complete at least 25 hours of acceptable continuing education hours during the preceding 24-month period and hold a current cardiopulmonary resuscitation for healthcare providers (CPR) certificate from a nationally recognized organization that issues the certificates. Documentation of current certification from the Board of Certification, Inc. (BOC) will also meet the requirements for continuing education.

007.01 ACCEPTABLE CONTINUING EDUCATION PROGRAM ACTIVITIES. The Board does not approve continuing education programs or activities. In order for a continuing education activity or program to be accepted for renewal or reinstatement of a license, the activity must be directly related to the practice of athletic training.

007.01(A) CONTINUING EDUCATION HOUR AND CREDIT CALCULATIONS. The following is a list of acceptable continuing education programs. Credit is awarded for the actual time spent participating in the continuing education program. Credit will not be awarded for non-working breaks or meals.

007.01(A)(i) PROGRAMS AT STATE, DISTRICT, AND NATIONAL ASSOCIATION MEETINGS. Must relate to the theory or clinical application of theory pertaining to the practice of athletic training, for example, a meeting of Nebraska or other state athletic training associations or the Board of Certification, Inc (BOC).

007.01(A)(ii) WORKSHOPS, SEMINARS, AND CONFERENCES. This includes distance learning opportunities and in-service programs, where the content of the continuing education program or activity directly relates to athletic training.

007.01(A)(iii) UNIVERSITY OR COLLEGE SPONSORED COURSES. The content of the course must relate to athletic training. The licensee must provide documentation of successful completion of the course.

007.01(A)(iv) FORMAL SELF-STUDY. The content of the self-study activity must relate to athletic training. The self-study program must have a testing mechanism scored by the formal self-study provider.

007.01(A)(v) RESEARCH AND SCHOLARLY PUBLICATIONS. Must relate to athletic training and be intended for an audience of health care professionals. Licensees may earn up to a maximum of 10 hours of continuing education each renewal period for:

(1) Authoring an article in a non-refereed journal. 5 hours may be earned per article. Required documentation must include a copy of the article. (2) Authoring an article in a refereed journal. 10 hours may be earned per article. Required documentation must include a copy of the article. (3) Authoring a published textbook. 10 hours may be earned per book. Required documentation must include a copy of the title page. (4) Authoring a poster presentation. 5 hours may be earned per presentation. Required documentation must include a letter of acknowledgement. (5) Authoring a home study course. 5 hours may be earned per course. Required documentation must include a copy of the home study course and materials.

007.01(A)(vi) SCIENTIFIC PRESENTATION. A licensee acting as an essayist or a lecturer to athletic trainers or other credentialed health care professionals will be awarded 1 hour credit for each hour of scientific presentation at workshops, seminars, in-service training, conferences, or guest lectures if the program or activity relates to the practice of athletic training. A licensee may receive continuing education credit for only the initial presentation during a renewal period. Credit will not be given for subsequent presentations of the same program. A licensee may complete a maximum of 4 hours of continuing education credit for presentations in a renewal period.

007.02 NON-ACCEPTABLE CONTINUING EDUCATION. Continuing education credit will not be awarded for programs where the content does not relate to athletic training. The following list includes subjects that may be directly related to the practice of athletic training, but are not acceptable for continuing education:

(A) Medical terminology courses; (B) Athletic training daily activities, which may include:

(i) Activities included with contract employment; (ii) Athletic training facility responsibilities; (iii) Observation of other athletic trainers; and

(C) Athletic training orientation programs or activities that include new policies, procedures, equipment, forms, responsibilities, and services.

008. UNPROFESSIONAL CONDUCT. Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179, 172 NAC 10, and this chapter:

(A) Providing services for which the athletic trainer is not educated, trained, or experienced; (B) Performing or agreeing to perform procedures when the procedures are known to be a departure from standard or acceptable and prevailing practice in athletic training, but not to include a single act of ordinary negligence; (C) Committing any act which endangers public safety or welfare or failure to follow policies and procedures implemented in the practice situation to safeguard the public; (D) Failing to safeguard the welfare of the public and maintain professional relationships with patients; (E) Delegating to other personnel those services for which the clinical skills and expertise of an athletic trainer are required; (F) Providing services or promoting the sale of devices, appliances, or products to a person who cannot reasonably be expected to benefit from the services, devices, appliances, or products; (G) Discriminating in the provision of services to individuals on the basis of gender, race, religion, or national origin; (H) Failing to exercise appropriate supervision over persons who are authorized to practice only under the supervision of an athletic trainer; and (I) Failing to furnish the Department or its investigator with requested information or requested documents during an investigation of the licensee.

009. REINSTATEMENT. The applicant must meet the requirements set out in 172 NAC 10.

010. FEES. Fees are set out in 172 NAC 2.

History

Effective 2024-05-21

Chapter 23 Licensure of Audiologists and Speech-Language Pathologists

Neb. Admin. Code tit. 172, ch. 23 Licensure of Audiologists and Speech-Language Pathologists {#sec-172-nac-23 omnilex-key=us-ne-regs-official--title-172--172 NAC 23}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 23 LICENSURE OF AUDIOLOGISTS AND SPEECH-LANGUAGE PATHOLOGISTS

001. SCOPE AND AUTHORITY . These regulations govern the licensure of audiologists and speech-language pathologists under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-501 to 38-527 of the Audiology and Speech-Language Pathology Practice Act and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions are set out in the Audiology and Speech-Language Pathology Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 APPROVED ACADEMIC PROGRAM. An educational program that has been accredited by the Council Academic Accreditation in Audiology and Speech-Language Pathology (CAA), the Accreditation Commission for Audiology Education (ACAE) or a nationally recognized equivalent accreditation association approved by the Board.

002.02 LICENSURE EXAMINATION. The Praxis Series Specialty Tests in Speech-Language Pathology and Audiology approved by the Department upon the recommendation of the Board.

002.03 NATIONWIDE PROFESSIONAL ACCREDITING ORGANIZATION. The American Speech-Language-Hearing Association or equivalent as recommended by the Board and approved by the Department.

002.04 PROFESSIONAL EXPERIENCE. Meeting the core standards of a clinical fellowship as defined by the American Speech-Language Hearing Association or equivalent agency recommended by the Board and approved by the Department. Experience must be at least 36 weeks of full-time professional experience of 35 clock hours per week or 72 weeks of at least half-time professional experience with 15 to 19 hours per week in speech-language pathology or audiology supervised in the area in which licensure is sought.

003. LICENSE REQUIREMENTS . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating the applicant meets the licensing requirements of Neb. Rev. Stat. §§ 38-501 to 38-527, 172 NAC 10 and this chapter.

003.01 DOCUMENTATION. The applicant must provide the following documentation to the Department.

003.01(A) EDUCATION. Submit an official transcript, sent directly from the issuing institution, verifying completion of an approved academic program in audiology or speech-language pathology as follows:

(i) An audiologist graduating prior to September 1, 2007, will present proof of having a master’s degree or a doctoral degree, or the equivalent of a master’s degree or doctoral degree in audiology;

(ii) An audiologist graduating on or after September 1, 2007, will present proof of having a doctoral degree or its equivalent in audiology; or

(iii) A speech-language pathologist will present proof of a master’s degree, doctoral degree, or the equivalent of a master’s degree or doctoral degree in speech-language pathology.

003.01(B) EXAMINATION. Submit documentation of passing the licensure examination;

003.01(C) EXPERIENCE. Submit documentation of successfully completing the professional experience which was supervised in the area in which licensure is sought by an audiologist or speech-language pathologist who holds a valid Nebraska license or who meets Nebraska requirements for licensure; or an audiologist or speech-language pathologist who holds a certification of clinical competency from the American Speech-Language-Hearing Association.

003.01(C)(i) SUPERVISOR. The supervisor's license or certification must be in the professional area in which the applicant seeks experience.

003.01(C)(ii) PROFESSIONAL EXPERIENCE. The professional experience must include direct clinical work with patients, consultations, record keeping, and other duties relevant to a program of clinical work including clinical experience with persons who have communication impairments, direct management of treatment programs for specific patients or clients, and monitoring and evaluation by the supervising audiologist or speech-language pathologist of the applicant's satisfactory performance for at least 36 weeks of full-time experience or equivalent half-time experience.

003.01(D) ENDORSEMENT. Documentation of certification of clinical competency from the American Speech-Language Hearing Association to practice audiology or speech-language pathology will be sufficient documentation to meet the requirements listed in 172 NAC 23-003.01, items (A), (B) and (C).

003.01(E) PASSED LICENSURE EXAMINATION BUT NOT PRACTICING. An applicant who has met the education, examination and experience requirements, who took the examination more than 3 years ago and who is not practicing will provide documentation to the Department that the applicant has completed 30 hours of continuing education over the subject areas outlined in this chapter as Content Area I under 172 NAC 23-005.02 item (A) and obtained within the 3 years immediately preceding the application for licensure.

003.01(F) LICENSED IN ANOTHER STATE BUT NOT PRACTICING. An applicant who has an active license in another jurisdiction and who is not practicing at the time of application for licensure will meet the education, examination and experience requirements listed in 172 NAC 23-003.01(A), (B) and (C), or (D) and present proof to the Department, that they have completed 30 hours of continuing education over the subject areas outlined in this chapter as Content Area I under 172 NAC 23-005.02 item (A) and obtained within the 3 years immediately preceding the application for licensure.

003.02 TEMPORARY LICENSE. A temporary license may be issued as outlined in Neb. Rev. Stat. § 38-519.

004. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10. All Audiologist and Speech- Language Pathologist licenses expire on December 1st of even-numbered years.

005. CONTINUING EDUCATION . On or before December 1st of each even-numbered year, individuals holding an active license in the State of Nebraska must complete at least 20 hours of acceptable continuing education hours during the preceding 24-month period.

005.01 CONTINUING EDUCATION HOUR OR CREDIT CALCULATIONS. The following provides the hour calculations for acceptable continuing education.

005.01(A) CURRENT AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION CERTIFICATION. Documentation must include a current certification. Current certification will satisfy the continuing education requirement for the preceding 24-month period.

005.01(B) PROGRAMS AT STATE AND NATIONAL MEETINGS. Documentation must include a certificate of attendance, a listing of presentations attended and program outline or objectives. .5 hour of credit for each 30 minutes of attendance.

005.01(C) FORMAL EDUCATION COURSES AND PRESENTATIONS. Documentation must include a certificate of attendance and program outline or objectives. .5 hour of credit for each 30 minutes attended. The courses or presentations must be formally organized and planned instructional experiences that have a:

(i) Date;

(ii) Location;

(iii) Course title;

(iv)Number of continuing education hours;

(v) Signed certificate of attendance; and

(vi)The instructor has specialized experience or training to meet the objectives of the course.

005.01(D) UNIVERSITY SPONSORED COURSES. Accredited courses taken for college credit including internet courses will be accepted upon submission of an official transcript and program outline or objectives. 1 academic semester credit hour is equal to 15 continuing education hours. 1 academic quarter credit hour is equal to 10 continuing education hours.

005.01(E) HOME STUDY. The home study activity must have a testing mechanism scored by the named home study provider. Home study includes, but is not limited to, independent study, self-study, and online education. Documentation must include a certificate of completion and program outline or objectives. .5 hour of credit for each 30 minutes completed.

005.01(F) RESEARCH OR OTHER SCHOLARLY ACTIVITIES. Research or other scholarly activities that result in professional publication or acceptance for publication. Participation must include authorship, editorship, co-authorship, co-editorship or all of these of a juried publication. 5 hours of credit for each publication with a maximum of 10 hours for each 24-month renewal period. Documentation must include a copy of the final publication or verification of publication.

005.01(G) NATIONALLY RECOGNIZED SPECIALTY CERTIFICATION EXAMINATIONS. Documentation must include a copy of the certification. 10 hours of credit per 24-month renewal period for successfully completing a specialty certification examination.

005.01(H) SCIENTIFIC PRESENTATIONS. A licensee acting as an essayist or a lecturer to licensed audiologists, speech-language pathologists or other credentialed health care professionals may receive continuing education credit for only the initial presentation during a renewal period. .5 hour of credit for each 30 minutes of scientific presentation and a maximum of 4 hours of continuing education for presentations per 24-month renewal period. Documentation must include a program brochure that includes the licensee’s name as presenter, the continuing competency course outline or objectives and a statement of the instructor’s qualifications to teach the course.

005.01(I) POSTER SESSIONS. Poster session at State and National meetings which relate to the theory or clinical application of theory pertaining to the practice of audiology or speech-language pathology. Documentation must include a certificate of attendance, a listing of individuals poster sessions attended, and a program outline or objectives. .5 hour of credit for each 30 minutes of attendance.

005.02 ACCEPTABLE CONTINUING EDUCATION TOPIC AREAS. The board does not approve continuing education programs or activities. The board retains final authority for acceptance of any educational program or activity submitted by the licensee to meet the continuing education requirements. In order for continuing education programs or activities to be accepted for renewal or reinstatement of a license, they must relate to the theory or clinical application of theory pertaining to the practice of audiology or speech-language pathology and must be open to all licensees. The licensee may participate in all 20 hours from Content Area I with no more than 5 hours from Content Area II as specified below:

(A) Content Area I includes the following:

(i) Anatomic and physiologic bases for the normal development and use of speech, language, hearing, swallowing and balance;

(ii) Physical bases and processes of swallowing, hearing, balance and the production and perception of speech and language;

(iii) Linguistic and psycho-linguistic variables related to normal development and use of speech, language and hearing;

(iv) Technological, biomedical, engineering and instrumentation information which would enable expansion of knowledge in basic speech, language, hearing, balance and swallowing processes;

(v) Various types of disorders of speech, language, hearing, balance and swallowing, their manifestations, classification and cause;

(vi) Evaluation skills, including procedures, techniques and instrumentation for assessment of speech, language, hearing, balance and swallowing; and

(vii) Principles in habilitation and rehabilitation of speech, language, hearing, balance and swallowing disorders.

(B) Content Area II includes the following:

(i) Regulations and implementation of federal or state regulated programs;

(ii) Service delivery models;

(iii) Ethical practices;

(iv) Supervision issues related to the practice of audiology or speech-language pathology;

(v) Related disciplines which interface with delivery of audiology or speech-language pathology services; and

(vi) Reimbursement issues.

005.03 NON-ACCEPTABLE CONTINUING EDUCATION TOPIC AREAS. Continuing education topic areas that are not acceptable include:

(A) Marketing and business communications and operations;

(B) Courses which deal with personal self-improvement, human relations, financial gain, time management, or career options;

(D) Teaching non-credentialed persons or any preparation for the same;

(E) Courses less than 30 minutes in duration; and

(F) Participation in or attendance at case conferences and facility tours.

006. UNPROFESSIONAL CONDUCT . Commission of acts or behaviors constituting unprofessional conduct are outlined in Neb. Rev. Stat. § 38-179 and this chapter and include:

(A) Providing services for which the licensee is not trained or experienced;

(B) Performing or agreeing to perform procedures when the procedures are known to be a departure from standard or acceptable and prevailing practice in audiology and speech- language pathology, but not to include a single act of ordinary negligence;

(D) Failing to safeguard the welfare of patients and maintain appropriate professional relationships with patients and other healthcare practitioners;

(E) Performing or agreeing to perform audiology or speech-language pathology therapy services that have been requested when the services are known to be contraindicated or unjustified;

(F) Falsification or unauthorized destruction of patient’s records;

(G) Delegating to other personnel those patient-related services for which the clinical skills and expertise of an audiologist or speech-language pathologist are required;

(H) Failure to safeguard a patient’s dignity and right to privacy;

(I) Filing a false report or record in the practice of audiology or speech-language pathology including, but not limited to, collecting a fee;

(J) Falsely representing the use or availability of the services or advice of a physician;

(K) Providing services or promoting the sale of devices, appliances or products to a person who cannot reasonably be expected to benefit from the services, devices, appliances, or products;

(L) Discriminating in the provision of services to individuals on the basis of sex, race, religion or national origin;

(M) Engaging in sexual harassment of patients which includes, but is not limited to, making unwelcome sexual advances, requesting sexual favors, and engaging in other verbal or physical conduct of a sexual nature which results in providing or denying service to a patient, creating an intimidating, hostile, or offensive environment for the patient or interfering with a patient's ability to recover;

(N) Failing to follow policies or procedures implemented in the practice situation to safeguard patient care;

(O) Failing to exercise appropriate supervision over persons who are authorized to practice only under the supervision of an audiologist or speech-language pathologist;

(P) Failing to take steps to transfer the continuum of care of the patient, as appropriate, to another health care provider in the event of elective termination of audiology or speech- language pathology therapy services by an audiologist or speech-language pathologist;

(Q) Failure of the applicant or licensee, who is the subject of a pre-licensure or disciplinary investigation, to furnish the Department or its investigator with requested information or requested documents.

007. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

008. FEES . Fees are set out in 172 NAC 2.

History

Effective 2020-12-13

Chapter 24 Registration of Audiology and Speech-Language Pathology Assistants

Neb. Admin. Code tit. 172, ch. 24 Registration of Audiology and Speech-Language Pathology Assistants {#sec-172-nac-24 omnilex-key=us-ne-regs-official--title-172--172 NAC 24}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 24 REGISTRATION OF AUDIOLOGY AND SPEECH- LANGUAGE PATHOLOGY ASSISTANTS

001. SCOPE AND AUTHORITY . These regulations govern the registration requirements for audiology or speech-language pathology assistants and the certification requirements to supervise audiology or speech-language pathology assistants under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-501 to 38-527 of the Audiology and Speech-Language Pathology Practice Act, and the Uniform Credentialing Act (UCA). Additional licensure information regarding audiology and speech-language pathology requirements may be found in 172 Nebraska Administrative Code (NAC) 23.

002. DEFINITIONS . Definitions are set out in the Audiology and Speech-Language Pathology Practice Act, the Uniform Credentialing Act, 172 NAC 10, 172 NAC 23, and this chapter.

002.01 ACCREDITED TRAINING PROGRAM. A postsecondary school accredited by a regional accrediting institution recognized by the United States Department of Education. This includes, but is not limited to, the North Central Association of Colleges and Schools, Higher Learning Commission, and Southern Association of Colleges and Schools, Commission on Colleges.

002.02 ALTERNATE SUPERVISOR. A licensed audiologist or speech-language pathologist who provides supervisory coverage due to absences of the supervisor not to exceed 3 months.

002.03 DIRECT ONSITE SUPERVISION. The direction given by a licensed audiologist or speech-language pathologist who:

(A) Is present in the room in which clinical services are being given; or

(B) Observes the clinical setting either by use of an observation window or by closed circuit television with amplification from the clinical setting.

003. REGISTRATION REQUIREMENTS . To register as an audiology or speech-language pathology assistant, an individual must submit a complete application provided by the Department and provide documentation demonstrating the applicant meets the registration requirements of Neb. Rev. Stat. § 38-501 to 38-527, and this chapter.

003.01 DOCUMENTATION. The applicant must provide the following documentation to the Department.

003.01(A) EDUCATION. Submit an official transcript, sent directly from the issuing institution, verifying a bachelor’s degree from an accredited training program in communication disorders, or an associate’s degree from an accredited training program in communication disorders; or professional education that is equivalent to an associate’s degree or a bachelor’s degree. The equivalent coursework will meet the requirements outlined in Neb. Rev. Stat. § 38-521 and consist of the following:

(i) A minimum of 30 semester credit hours in general education that includes the following areas:

(1) Oral and written communication which may include grammar and usage, composition, public speaking, or business writing; and

(2) Mathematics which may include general mathematics, business mathematics, accounting, algebra, or higher level mathematics; or

(3) Computer applications which may include computer basics, computer literacy, word processing, software applications, web-based applications; or

(4) Social and natural sciences which may include psychology, sociology, biology, anatomy, or physiology of speech and hearing mechanisms; and

(ii) A minimum of 40 semester credit hours in technical knowledge that includes the following areas:

(1) Overview of normal processes of communication across the life span which must include normal speech, language, communication, hearing development and swallowing physiology; and phonetics;

(2) Overview of communication disorders including dysphagia which must include speech, language, and hearing disorders, and dysphagia;

(3) Overview of the practice of audiology and speech-language pathology;

(4) Instruction in assistant-level service delivery practices which must include technical procedures and legal and professional issues and ethics for audiology and speech-language pathology assistants, assisting the audiologist and speech-language pathologist in service delivery, and audiology and speech-language pathology assistant technical skills in speech, language and hearing disorders, behavior management and modification;

(5) Instruction in workplace behaviors which must include workplace behaviors of the audiology or speech-language pathology assistant and must include relating to clients or patients in a supportive and professional manner, observing and recording patient progress, following the supervisor’s instructions, maintaining confidentiality, communicating in oral and written formats, following health and safety precautions, and appropriate recordkeeping; and

(6) Cultural and linguistic factors in communication which may include language and culture, nonverbal communications, sign language and other manually coded systems, bilingualism, or multicultural issues.

003.01(B) ADDITIONAL TRAINING. If the applicant will provide aural rehabilitation services, he or she must provide documentation showing completion of additional training that includes the following:

(i) Information concerning the nature of hearing loss;

(ii) Purposes and principles of auditory and visual training;

(iii) Maintenance and use of amplification devices; and

(iv) Communication options for individuals with hearing loss. This includes sign language and the use of assistive technology.

004. CERTIFICATION REQUIREMENTS TO SUPERVISE AN ASSISTANT . To obtain certification to supervise an assistant, a Nebraska licensed audiologist or speech-language pathologist must submit an application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. §§ 38-501 to 38-527 and this chapter.

004.01 DENIAL OF CERTIFICATION TO SUPERVISE. The Department may deny an audiologist or speech-language pathologist the right to supervise an audiology or speech- language pathology assistant upon evidence of any of the following:

(A) The supervising audiologist or speech-language pathologist is not licensed to practice audiology or speech-language pathology in Nebraska;

(B) The audiology or speech-language pathology assistant is not registered in Nebraska;

(C) The supervising audiologist or speech-language pathologist proposes to permit the audiology or speech-language pathology assistant to perform duties beyond the scope of practice of an audiology or speech-language pathology assistant as outlined in Neb. Rev. Stat. §§ 38-501 to 38-527; or

(D) The audiologist or speech-language pathologist is supervising more than 2 audiology or speech-language pathology assistants.

005. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10. All registrations expire one year from date of issuance.

006. CONTINUING COMPETENCY REQUIREMENTS . On or before December 1st of each even-numbered year, individuals holding an active registration in the State of Nebraska must complete at least 10 hours of in-service training. The in-service training may be formal or informal and must be directly related to the particular services provided by the audiology or speech-language pathology assistant.

007. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179 and 172 NAC 23.

008. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

009. FEES . Fees are set out in 172 NAC 2.

History

Effective 2020-12-13

Chapter 29 Chiropractic

Neb. Admin. Code tit. 172, ch. 29 Chiropractic {#sec-172-nac-29 omnilex-key=us-ne-regs-official--title-172--172 NAC 29}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 29 CHIROPRACTIC

001. SCOPE AND AUTHORITY . This chapter governs the licensure of chiropractors or chiropractic physicians under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-801 to 38-811 of the Chiropractic Practice Act and the Uniform Credentialing Act (UCA).

002. DEFINITIONS . Definitions are set out in the Chiropractic Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 ACCOUNTABILITY. Being responsible and answerable for decisions and for the action or inaction of self and others, and for the resultant patient outcomes related to decisions and action or inaction.

002.02 ACUPUNCTURE. For the purposes of this chapter, acupuncture has the same meaning as Neb. Rev. Stat. § 38-2006.

002.03 CHIROPRACTIC ADJUSTMENT. The same as the term joint manipulation. A high velocity thrust, which carries a joint beyond the normal physiological range of motion and is accompanied by joint cavitations whether audible or inaudible. The patient cannot prevent motion beyond the physiological range. Joint manipulation commences where manual therapy or grades one through four mobilization ends. Motion beyond the physiological range of motion occurs without the patient’s ability to control such motion. This includes, but is not limited to, a high velocity low amplitude thrust.

002.04 CHIROPRACTOR OR CHIROPRACTIC PHYSICIAN. An individual who is currently licensed or otherwise authorized to practice chiropractic under the Uniform Credentialing Act.

002.05 COMPLEX TASKS. Those tasks that require:

(A) Chiropractic judgment to safely alter standard procedures pursuant to the needs of the client or patient;

(B) Chiropractic judgment to determine how to proceed from one step to the next; or

002.06 PROTOCOL. A written document that is created or approved by a chiropractor or chiropractic physician that guides subjective and objective data collection, and defines interventions, treatments, or tasks to be performed based upon the collected data.

002.07 STABLE OR PREDICTABLE. A situation where the client or patient’s clinical and behavioral status and chiropractic care needs are determined by a chiropractor or chiropractic physician to be non-fluctuating and consistent or where the fluctuations are expected and the interventions are planned, including those clients or patients whose deteriorating condition is expected.

002.08 SUPERVISION. The provision of oversight that includes maintaining accountability to determine whether or not chiropractic care is adequate and delivered appropriately. Supervision includes the assessment and evaluation of client or patient condition and responses to the chiropractic plan of care, and evaluation of the competence of persons providing chiropractic care.

(A) Direct supervision means that the responsible chiropractor or chiropractic physician is physically present in the clinical area, and is able to assess, evaluate, and respond immediately. Direct supervision does not mean that the responsible chiropractor or chiropractic physician must be in the same room, or “looking-over-the-shoulder” of the persons providing chiropractic care; and

(B) Indirect supervision means that the responsible chiropractor or chiropractic physician is available through periodic inspection and evaluation and telecommunication for direction, consultation, and collaboration.

002.09 UNLICENSED PERSON. A person who does not have a license to practice chiropractic and who functions in an assistant or subordinate role to the chiropractor or chiropractic physician. Although unlicensed persons may be used to complement chiropractors or chiropractic physicians in the provision of chiropractic care, these persons cannot be used as a substitute for a licensed chiropractor or chiropractic physician.

003. LICENSE REQUIREMENTS . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. §§ 38-801 to 38-811, 172 NAC 10, and this chapter.

003.01 DOCUMENTATION. The following documentation must be provided to the Department.

003.01(A) EDUCATION. Submit an official transcript, directly from the issuing institution, verifying graduation from a Board approved accredited college of chiropractic. Accreditation must be by the Council on Chiropractic Education-United States or The Councils on Chiropractic Education International.

003.01(B) EXAMINATION. Documentation of successful completion of the licensure examination sent directly to the Department from the National Board of Chiropractic Examiners:

(i) For applicants who apply no more than 3 years after passing the examination, results of Parts I, II, III, IV, and physiotherapy of the examination given by the National Board of Chiropractic Examiners with a scaled score of at least 375 in each part; or

(ii) For applicants who have met the examination requirements in 172 NAC 29-003.01(B)(i) more than 3 years prior to the time of application, and who are not practicing in another jurisdiction at the time of application, documentation of successfully passing the National Board of Chiropractic Examiners' Special Purposes Examination for Chiropractic (SPEC) with a scaled score of at least 375 within the 3 years immediately preceding the application.

003.01(C) OTHER PROOF OF COMPETENCY. Documentation for applicants that are licensed in another jurisdiction.

(i) For applicants who are currently licensed and practicing in another jurisdiction at the time of application:

(1) The examination set out in 172 NAC 29-003.01(B)(i); or

(2) Parts I, II and physiotherapy of the examination given by the National Board of Chiropractic Examiners with a scaled score of at least 375 in each part; and the National Board of Chiropractic Examiners' Special Purposes Examination for Chiropractic (SPEC) with a scaled score of at least 375;

(ii) For applicants currently licensed in another jurisdiction, but are not practicing at the time of application:

(1) The examination set out in 172 NAC 29-003.01(B)(i); or

(2) Parts I, II and physiotherapy of the examination given by the National Board of Chiropractic Examiners with a scaled score of at least 375 in each part and, the National Board of Chiropractic Examiners' Special Purposes Examination for Chiropractic (SPEC) with a scaled score of at least 375 within the 2 years immediately preceding the application and, documentation of completing 36 hours of approved continuing education within 24 months prior to making application.

004. USE OF UNLICENSED PERSONNEL . The full utilization of chiropractors or chiropractic physicians may require auxiliary client or patient care services provided by persons carrying out tasks, treatments, or interventions to support the provision of chiropractic services as assigned or directed by a licensed chiropractor or chiropractic physician. The scope of assignment or direction may vary depending on the level of judgment required for the task, treatment, or intervention, the knowledge and skills of the unlicensed person, the method and frequency of supervision, and the client or patient’s condition, ability and willingness to be involved in the management of their own care.

004.01 ACCOUNTABILITY. A licensed chiropractor or chiropractic physician retains accountability for the application of the chiropractic service when making the decision to assign or direct chiropractic tasks, treatments, or interventions and for the adequacy of client or patient care and outcomes related to the assignment or direction decision.

004.02 ASSIGNMENT OF TASKS, TREATMENTS, OR INTERVENTIONS; ALLOWED. A licensed chiropractor or chiropractic physician may assign or direct unlicensed persons to perform selected tasks, treatments, or interventions that:

(A) Reoccur frequently in the care of a client or patient or group of clients or patients;

(B) Do not require the unlicensed person to exercise independent chiropractic judgment;

(D) The results of the task, treatment, or intervention are predictable and the potential risk is minimal; and

(E) Utilize a standard and unchanging procedure.

004.03 ASSIGNMENT OF TASKS, TREATMENTS, OR INTERVENTIONS; NOT ALLOWED. Tasks, treatments, or interventions that may not be assigned or directed include, but are not limited to:

(A) Tasks, treatments, or interventions that require a license or other credential, unless the individual has the required license or credential.

(B) Activities, including data collection, problem identification, and outcome evaluation that require independent chiropractic judgment;

(D) Tasks, treatments, or interventions that are complex based on the definitions of this chapter.

004.04 PATIENT OR CLIENT ASSESMENTS. An unlicensed person as assigned or directed by a chiropractor or chiropractic physician may contribute to the assessment of the health status or determination of diagnosis by a chiropractor or chiropractic physician of individuals including interactions of individuals with family members or group members by:

(A) Collecting basic subjective and objective data from observations and interviews. The data to be collected must be identified by the chiropractor or chiropractic physician; and

(B) Reporting and recording the collected data.

004.05 PATIENT OR CLIENT PLANS OF CARE. An unlicensed person as assigned or directed by a chiropractor or chiropractic physician may participate in the implementation of a plan of care for clients or patients by the performance of non-complex tasks, treatments, or interventions. This includes documenting and communicating completion of the tasks, treatments, or interventions and client or patient responses and seeking guidance and direction when appropriate.

004.06 SUPERVISION. A licensed chiropractor or chiropractic physician must provide direction to unlicensed persons or assign tasks, treatments, or interventions to unlicensed persons through either direct or indirect supervision or a combination of both.

004.06(A) INDIRECT SUPERVISION. Indirect supervision may occur when client or patient conditions are stable or predictable, and the client or patient is competent to make informed decisions and provide necessary information relative to the tasks, treatments, or interventions. Indirect supervision may be provided through protocols and periodic inspection and evaluation in combination with plans of care.

004.06(A)(i) INDIRECT SUPERVISION THROUGH PROTOCOLS. When using protocols as a method of indirect supervision, the protocols approved by the chiropractor or chiropractic physician must:

(1) Be written;

(2) Identify any specific assessment data to be gathered and reported and the specific parameters for any task, treatment, or intervention to be performed; and

(3) Identify tasks, treatments, or interventions that may be provided. Tasks, treatments, or interventions may include, but are not limited to:

(a) Monitoring client or patient’s condition by the unlicensed person;

(b) The direct or provision of chiropractic tasks, treatments, or interventions;

(d) Consultation with the chiropractor or chiropractic physician for specific direction.

004.06(A)(ii) INDIRECT SUPERVISION THROUGH PERIODIC INSPECTION AND EVALUATION. When using periodic inspection and evaluation as a method of indirect supervision, the chiropractor or chiropractic physician must include:

(1) An evaluation by the chiropractor or chiropractic physician to determine the adequacy of the protocols to serve the intended purpose; and

(2) The availability of the chiropractor or chiropractic physician, or an appropriate substitute, to the unlicensed person by consultation and collaboration. An appropriate substitute may be another licensed practitioner in an emergency room, the client or patient’s primary health care provider, or another specifically designated chiropractor or chiropractic physician.

004.06(B) DIRECT SUPERVISION. Direct supervision of unlicensed personnel is required when the client or patient is not competent to make informed decisions or cannot provide necessary information relative to the tasks, treatments, or interventions.

005. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10 and this chapter. All chiropractic licenses issued by the Department expire on August 1st of each even-numbered year.

005.01 WAIVER OF CONTINUING COMPETENCY REQUIREMENT DUE TO ILLNESS OR DISABILITY. The Department may waive continuing education requirements, in whole or in part, upon submission of proof that the license holder was suffering from a serious or disabling illness or physical disability which prevented completion of the required number of continuing education hours during the 24 months immediately preceding the license renewal date.

006. CONTINUING EDUCATION . On or before August 1st of each even-numbered year, individuals holding an active license in the State of Nebraska must complete at least 36 hours of acceptable continuing education hours during the preceding 24-month period. The Board does not approve individual continuing education programs or activities. In order for a continuing education activity or program to be acceptable for renewal or reinstatement of a license, the activity must relate directly to the practice of chiropractic and must include:

(A) At least 4 hours related to technical skills in one or a combination of the following categories:

(i) Continuing education designed to enhance the practitioner’s technical and clinical skill related to x-ray physics, quality control, x-ray production, and interpretation of diagnostic imaging; or

(ii) Continuing education designed to enhance the practitioner’s skill in utilizing chiropractic adjustive technique; and

(B) At least 4 hours related to practice issues in one or a combination of the following categories:

(i) Continuing education pertaining to Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS), infectious diseases and related conditions as they relate to chiropractic;

(ii) Continuing education designed to enhance the practitioner’s awareness of gender sensitivity and sexual harassment issues, commonly referred to as boundary training;

(iii) Continuing education related to the chiropractic scope of practice in the State of Nebraska, which must include adopted practice guidelines and practice law specific to Nebraska only;

(iv) Continuing education designed to enhance the practitioner’s skill related to ordering laboratory tests and interpreting information from laboratory tests;

(v) Continuing education designed to enhance the practitioner’s skill in performing physical, neurological, and orthopedic examination procedures as they relate to chiropractic practice;

(vi) Continuing education related to prevention of fraud, system set-ups, coding, quality control, and standards of practice;

(vii) Continuing education pertaining to the provision of rehabilitative care as it relates to chiropractic practice;

(viii) Continuing education related to practice ethics as recognized by state or national associations; and

(ix) Continuing education related to the use of unlicensed personnel.

006.01 CONTINUING EDUCATION HOUR OR CREDIT CALCULATIONS: The following provides the hour calculations for acceptable continuing education:

006.01(A) ACADEMIC COURSEWORK. Courses taken either in person or online for college credit will be accepted for continuing education upon submission of a transcript by the college or university from which the course was taken. Continuing education hours will be awarded as follows:

(i) One academic semester credit hour equates to 15 contact hours.

(ii) One academic quarter credit hour equates to 10 contact hours.

006.01(B) CONFERENCES, WORKSHOPS, OR SEMINARS. Attendance at these types of offerings will be accepted for continuing education upon submission of a certificate of completion which includes:

(i) The date;

(ii) The location;

(iii) The course title;

(iv) The number of hours awarded;

(v) A signature by the representative of the offering; and

(vi) A course brochure or course outline.

006.01(C) PRESENTERS, SPEAKERS, OR INSTRUCTORS. A licensee who is a presenter of a continuing education program may receive credit for the initial presentation of the program during a renewal period. Credit will not be given to the licensee for subsequent presentations of the same program. Presentations will be accepted for continuing education upon submission of materials which show the content of the presentation, including:

(i) The title and date of the presentation; and

(ii) An outline or copies of the materials utilized in the presentation; or

(iii) A copy of the presentation brochure that includes the name of the presenter.

006.01(D) INDEPENDENT STUDY. Independent study hours through written, audio or electronic media will be accepted for continuing education when the program has an examination to determine satisfactory completion of the program. Continuing education hours obtained through independent study cannot be used to fulfill the mandatory hours for technical skills or for practice issues required in 006.(A) and 006.(B). A maximum of 6 hours of credit may be obtained by independent study each 24 month renewal period. Credit will be given for the independent study upon submission of a certificate of completion which includes:

(i) The date;

(ii) The course title;

(iii) The number of hours awarded;

(iv) The course brochure or outline; and

(v) The exam score.

006.01(E) REQUIREMENTS OF CONTINUING EDUCATION INSTRUCTORS. Instructors for programs on subject areas listed in 172 NAC 29-006.02(A) through (B) for purposes of meeting the mandatory continuing education requirement:

(i) Must have provided at least 1 continuing education program relating to the practice of chiropractic each year for the previous 3 years; and

(ii) The instructor must have specialized experience or training to meet the objectives of the course. The presenter of any course on interpreting diagnostic imaging must:

(1) Be a Diplomate of the American Chiropractic Board of Radiology or its equivalent; or

(2) Have 5 years of experience in teaching diagnostic imaging.

006.02 NON-ACCEPTABLE CONTINUING EDUCATION TOPIC AREAS. Examples of non-acceptable subject matter include, but are not limited to, practice promotion.

007. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. §38-179 and this chapter. Commission of any of the following acts or behavior constitutes unprofessional conduct.

007.01 COOPERATION. Refusal to cooperate or failure to furnish requested information during a licensing or discipline investigation by the Department;

007.02 PROFESSIONAL RELATIONSHIPS. Failure to safeguard the welfare of patients and maintain appropriate professional relationships with patients and other health care practitioners. This includes, but is not limited to:

(A) Improper use of another person for one’s own advantage;

(B) Failure to decline to carry out chiropractic services that have been requested when the services are known to be contraindicated or unjustified;

(C) Failure to decline to carry out procedures that have been requested when the services are known to be outside of the chiropractor’s or chiropractic physician’s scope of practice;

(D) Verbally or physically abusing patients;

(E) Falsification or unauthorized destruction of patient records;

(F) Delegating to other personnel those patient related services when the clinical skills and expertise of a chiropractor or chiropractic physician is required;

(G) Over-utilization of laboratory and x-ray procedures, and the devices or nutritional products that are in the best interest of the patient;

(H) Failure to assure that the patient possesses enough information to enable intelligent choices in regard to proposed chiropractic treatment;

(I) Failure to terminate a professional relationship when it becomes clear that the patient is not benefiting from further care or treatment; and

(J) Failure to consult and seek the talents of other health care professionals when the consultation would benefit the patient or when the patient expressed a desire for the consultation.

007.03 SEXUAL HARASSMENT. Engaging in sexual misconduct which is defined as sexual harassment of patients or employees. Sexual harassment includes, but is not limited to, making unwelcome sexual advances, requesting sexual favors, and engaging in other verbal or physical conduct of a sexual nature which results in:

(A) Providing or denying service to a client;

(B) Creating an intimidating, hostile, or offensive environment for the patient or employee; or

007.04 SEXUAL RELATIONSHIP. Engaging in a sexual relationship during the provision of professional services, or for 3 months following the termination of professional services.

007.05 ADVERTISING, PUBLICITY AND SOLICITATION. The following outlines unprofessional conduct for chiropractors in relation to advertising, publicity and solicitation:

(A) A chiropractor or chiropractic physician must not make a false or misleading communication about the chiropractor or chiropractic physician or the chiropractor’s or chiropractic physician’s services. A communication is false or misleading if:

(i) The chiropractor or chiropractic physician charges a fee for any chiropractic service conducted within 24 hours after performing a chiropractic service that was advertised as being free;

(ii) The chiropractor or chiropractic physician bills an insurance company or third-party payee for a service that has been offered through an advertisement to a prospective patient as free without explaining to the prospective patient which services are billable and which are free;

(iii) It contains a material misrepresentation of fact or law, or omits a fact necessary to make the statement considered as a whole not materially misleading;

(iv) It is likely to create an unjustified expectation about the results the chiropractor or chiropractic physician can achieve, or states or implies that the chiropractor or chiropractic physician can achieve results by means that violate this chapter or the Uniform Credentialing Act; or

(v) It compares the chiropractor’s or chiropractic physician’s services with other chiropractor’s or chiropractic physicians’ services, unless the comparison can be factually substantiated;

(B) Subject to the requirements of this chapter, a chiropractor or chiropractic physician may advertise services. A copy or recording of an advertisement or written communication must be kept for 1 year after its dissemination along with a record of when and where it was used;

(C) A chiropractor or chiropractic physician or any person designated, contracted, or paid by a chiropractor or chiropractic physician must not solicit professional employment as a chiropractor or chiropractic physician for themselves, their partner or their associate, from any person when the professional employment concerns the evaluation or treatment of any injury or potential injury that relates to an accident or disaster involving the person to whom the solicitation is directed or a relative of that person, unless the accident or disaster occurred more than 30 days prior to the solicitation. This prohibition does not apply to any contact with any person who has sought their advice regarding employment of a chiropractor or chiropractic physician or other health care provider;

(D) A chiropractor or chiropractic physician cannot compensate or give anything of value to representatives of the press, radio, television, or other communication medium in anticipation of or in return for professional publicity in a news item;

(E) A chiropractor or chiropractic physician or any person designated, contracted, or paid by a chiropractor or chiropractic physician cannot solicit professional employment as a chiropractor or chiropractic physician for themselves, their partner or associate, either through direct contact or through a written communication to, a potential patient, if:

(i) The chiropractor or chiropractic physician knows or reasonably should know that the physical, emotional, or mental state of the person is such that the person could not exercise reasonable judgment in employing a chiropractor or chiropractic physician;

(ii) The person has made known to the chiropractor or chiropractic physician or their agent a desire not to receive communications from the chiropractor or chiropractic physician; or

(iii) The communication involves coercion, duress, fraud, misrepresentation, overreaching, harassment, intimidation, or undue influence;

(F) If a chiropractor or chiropractic physician advertises a fee for a service, the chiropractor or chiropractic physician must render that service for no more than the fee advertised;

(G) Unless otherwise specified, if a chiropractor or chiropractic physician advertises fee information, the chiropractor or chiropractic physician is bound by any representation made therein for a period of not less than 30 days after such advertisement;

(H) On the front of each envelope in which an advertisement of a chiropractor or chiropractic physician is mailed or delivered on or the front of each post card, if the advertisement is printed on a post card, must be the words: “This is an advertisement.” These words must be printed in type size at least as large as the print of the address and must be located in a conspicuous place on the envelope or card; or

(I) An advertisement or written communication of a chiropractor or chiropractic physician seeking professional employment by a specific potential patient cannot reveal on the envelope, or on the outside of a self-mailing brochure or pamphlet, the nature of the potential patient’s medical problem.

007.06 SUPERVISION. Failure to exercise appropriate supervision over persons who are authorized to practice only under the supervision of the licensed chiropractor or chiropractic physician.

008. DIAGNOSTIC TESTING . A chiropractor or chiropractic physician who accepts a patient for any professional reason has a duty and responsibility to perform an appropriate clinical evaluation on that patient for the purpose of assessing the patient's current health status or identify if the patient is a proper subject for chiropractic care. Such a clinical evaluation may involve diagnostic procedures which aid in arriving at a clinical impression. The diagnostic procedures may include, but are not limited to, urine and blood analysis and diagnostic imaging.

009. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

010. FEES . Fees are set out in 172 NAC 2.

History

Effective 2020-10-20

Chapter 34 Sanitation and Safety Relating to Cosmetology, Esthetic, and Nail Technology Services

Neb. Admin. Code tit. 172, ch. 34 Sanitation and Safety Relating to Cosmetology, Esthetic, and Nail Technology Services {#sec-172-nac-34 omnilex-key=us-ne-regs-official--title-172--172 NAC 34}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 34 SANITATION AND SAFETY RELATING TO COSMETOLOGY, ESTHETIC, AND NAIL TECHNOLOGY SERVICES

001. SCOPE AND AUTHORITY . These regulations apply to the safe practice of cosmetology, esthetics, and nail technology by cosmetologists, nail technicians, and students in cosmetology, esthetic, and nail technology salons and schools as defined in the Cosmetology, Electrology, Esthetics, Nail Technology and Body Art Practice Act.

002. DEFINITIONS . Definitions set out in the Cosmetology, Electrology, Esthetics, Nail Technology and Body Art Practice Act and the following apply to this chapter.

002.01 CLOSED COVERED RECEPTACLE, CONTAINER, BOTTLE, AND DRAWER. Fits tightly with a lid, door, or shutting of a drawer, and may have vents.

002.02 CONTACT TIME. The amount of moist contact time required for a disinfectant to be effective against the pathogens on the label.

002.03 DISINFECT. The process of making a non-porous item safe for use. Requires the use of a chemical intended to kill bacteria, viruses, or fungus.

002.04 DISINFECTANT. A United States Environmental Protection Agency (EPA) registered bactericidal, virucidal, and fungicidal agent that is approved for use in hospital settings, following label instructions for dilution ratio and contact time.

002.05 DISINFECTION. To remove agents of infection, disease, or infestation by insects or pests, and soil, dust, or foreign material.

002.06 DISINFECTION CONTAINER. A closed receptacle which holds the disinfectant solution.

002.07 DISPOSABLE SUPPLIES. Tools that cannot be disinfected, such as cotton balls or pads, orangewood sticks, card board files, pumice stones, end papers, foil, frost caps, disposable capes, neck strips, single use cosmetic applicators, sponges, or other similar items.

002.08 ELECTRICAL APPLIANCES. Drills or electric files, airbrush machines, polish dryers, gel lights, footbaths or foot spas, paraffin wax warmers, blow dryers, wax warmers, thermal curling irons, microdermabrasion machine, facial machines, and similar portable electric powered appliances.

002.09 ENCLOSED CONTAINER, DRAWER, AND CABINET. Fits tightly with a lid, door, or shutting of a drawer and does not have vents.

002.10 EQUIPMENT OR FURNITURE. Those items needed to operate a salon or a school usually considered stationary, such as, waiting chairs, client chairs, cabinets, sinks, nail technology tables and stools, stations, and facial beds.

002.11 IMPLEMENTS OR TOOLS. Nail files, nail nippers, cuticle pushers, nail clippers, manicure brushes, nail tip cutters, product brushes, nail drill bits, shears, combs, brushes, rollers, perm rods, bobby pins, clippies, tweezers, clippers, razors, comedone extractors, or other similar items.

002.12 PIPED FOOTBATH OR PIPED FOOT SPA. The water in the basin is re-circulated through a plumbing system by water.

002.13 PIPELESS FOOTBATH OR PIPELESS FOOT SPA. The water in the basin is circulated by air.

002.14 STATION. A nail table, client chair, and licensee chair.

002.15 TRASH CONTAINER. A waste receptacle with solid sides, a lid, and a plastic liner.

002.16 WASHABLE IMPLEMENT OR TOOL. A tool that is sanitizable or disinfectable, such as one made of mylar, plastic, metal, or cloth.

003. EMPLOYEE IDENTIFICATION . Each employee providing services must have a government-issued or state-issued photo identification card or document available for viewing by a Department inspector.

004. HAND CLEANLINESS . Licensees, students, and clients must comply with the following cleanliness procedures.

004.01 LICENSEE AND STUDENT HAND CLEANLINESS. Every licensee and student must:

(A) Wash his or her hands thoroughly with liquid soap and water or an instant hand sanitizer before serving each client.

(B) If wearing gloves during a service, they must be free of tears or holes and the gloves must be changed upon contamination.

004.02 CLIENT HAND CLEANLINESS. If the client is receiving nail technology services, every client must thoroughly wash his or her hands with liquid soap and water or an instant hand sanitizer before receiving services.

005. PHYSICAL STRUCTURE . The salon or school must be well lighted, well ventilated and kept in a clean, orderly, sanitary condition at all times.

006. WATER . The salon or school must have hot and cold running water.

007. SAFETY . The salon or school must be maintained in a safe and sanitary condition as follows:

(A) Floors, floor coverings, walls, woodwork, ceilings, furniture, fixtures, and equipment must be clean and in good repair.

(B) Floors must be free of unsafe objects and slippery or uneven surfaces.

(D) Electrical appliances must be clean and have no worn or bare wiring.

(E) Water or product spills on the floor must be removed immediately and the floor dried.

008. RESTROOM FACILITIES . Restrooms must be clean and sanitary and comply with the following requirements:

(A) The toilets and sinks must be clean and operational.

(B) The following must be available at all times:

(i) Suitable holders for toilet paper.

(ii) An adequate supply of toilet paper.

(iii) A clean waste receptacle.

(iv) A sink with hot and cold running water.

(v) Liquid soap.

(vi) Single-use disposable towels in an appropriate clean holder or an electric hand dryer.

009. TABLES AND CHAIRS . All tables and chairs must be in good repair and in a sanitary condition at all times.

(A) All table tops must be disinfected immediately following each client.

(B) All nail stations and client chairs must be disinfected at the end of the day.

010. LAUNDRY FACILITIES . If the establishment has a laundry facility, it must:

(A) Be clean, including the washer and dryer.

(B) Have a receptacle to store soiled towels.

011. STORAGE AND USE OF SUPPLIES, IMPLEMENTS, TOWELS, LINENS, PRODUCTS, EQUIPMENT, AND MATERIALS . The storage and use of various chemicals, supplies, implements, and products used in salons and schools must meet the following requirements:

011.01 CHEMICALS. The storage of chemicals must comply with the following requirements:

(A) Flammable and combustible chemicals must be stored away from potential sources of ignition such as an open flame or electrical devices.

(B) All chemicals must be stored in closed bottles or containers and properly labeled.

011.02 STORAGE UNITS. Cabinets, drawers, and containers used for storage of implements and towels must be clean.

011.03 SUPPLIES AND IMPLEMENTS. The following requirements for supplies and implements apply:

(A) Unused supplies must be stored in a clean, closed container or drawer.

(B) Used or soiled disposable supplies must be discarded immediately in a clean, closed waste receptacle with a plastic liner.

(C) Implements that have been used on a client or soiled in any manner must be placed in a properly labeled covered receptacle until disinfected as described in 172 Nebraska Administrative Code (NAC) 34-014.

(D) Disinfected implements must be stored in a clean closed container or drawer until used.

(E) Used product application brushes must be cleaned and stored in a clean closed container after each client.

(F) Tools and implements must not be placed in or on clothes, aprons, pockets, bags, or holsters, or worn by the licensee, and must not come into contact with surfaces that have not been disinfected as described in 172 NAC 34-014.

011.04 TOWELS AND LINENS. The following requirements for towels and linens apply:

(A) Used or soiled cloth towels and linens must not be used again until laundered and dried.

(B) Containers for used linens must be covered and have vented sides to reduce the growth of pathogens. Containers used for soiled linens must be disinfected weekly with disinfectant sprays or wipes in accordance with the directions on the manufacturer’s label.

(D) Disposable towels must be discarded in a covered waste receptacle immediately following each service.

(E) All towels used in towel warmers must be washed and dried at end of the day and stored overnight in a clean, covered, closed container.

(F) Salons and schools using hot steamed towels for services must meet these requirements:

(i) Towel warmers must be disinfected daily with a disinfectant wipe or spray;

(ii) Towels used in a warmer must be washed with detergent and bleach and dried using a hot dryer setting.

(iii) Licensees preparing towels for the warmers must first wash their hands or wear gloves.

(iv) Wet towels used in services must be prepared fresh each day. At the end of the day, unused steamed towels must be removed and laundered.

(G) Towel warmers must be left open overnight to allow unit to dry completely.

011.05 PRODUCTS. Products used in salons and schools must meet the following requirements:

(A) No product containing methacrylate monomers may be used in the salon or school.

(B) Artificial nails or nail enhancements must be removed in accordance with manufacturer’s directions.

(D) Original product bottles and containers must have an original manufacturer label.

(E) When only a portion of the product, except for nail polish, is to be used on a client, the product must be removed from the container by a spatula, scoop, spoon, or dropper so that the product does not come in direct contact with a client or licensee and the ensure the remaining product is not contaminated.

(F) If a product is poured into another container, such as a shaker, dispenser pump container, or spray container, the container must be labeled to identify the product. Dappen or acrylic liquid dishes do not need labeling.

011.06 EQUIPMENT AND MATERIALS. Equipment and materials must meet the following requirements:

(A) No nail dusters or hand dusters must be used.

(B) Nail buffers can be used if properly disinfected between clients.

(D) Client hand supports must have plastic or vinyl coverings.

(E) A disinfection container must be deep enough to fully immerse implements and tools and must be available in the salon or school for disinfecting implements and tools.

(F) If providing nail technology services, a trash container must be located at each station.

(G) Dry use implements made of materials that melt when wet, such as wood or cardboard and nail drill disposable bands must be discarded in a closed waste receptacle immediately after use.

(H) When providing cosmetology or esthetic services, disinfectable brushes, such as plastic, nylon, sable, or natural hair may be used, provided they are sanitized between clients in accordance with the manufacturer’s instructions.

(I) When providing cosmetology services, neck strips or a clean towel must be used under a cape in order to prevent the cape from coming into contact with the skin or hair of each client. A sanitized or disposable cape, 1 per client, may be used in lieu of neck strips or towels.

(J) Supplies and implements which come in direct contact with a client and cannot be disinfected, such as cotton pads, cotton balls, paper neck strips, orangewood sticks, pads, “Q-tips”, sponges, and other similar items, must be disposed of in a covered waste receptacle, with a plastic liner, immediately after use.

(K) A first aid kit must be available in the salon or school.

012. SAFETY DATA SHEET (SDS) . Safety Data Sheets for every product pertaining to cosmetology and esthetics client services, and for every disinfectant, must be accessible at all times to all employees either by paper or electronically.

013. DISINFECTANT MIXING, DISPOSAL, AND LABELING . The mixing, disposal, and labeling of disinfectants must comply with the following requirements:

(A) All disinfectants must be mixed as directed on the manufacturer’s label.

(B) If the disinfectant becomes contaminated or cloudy, it must be discarded immediately.

(C) All disinfectant containers must be covered at all times and large enough to completely cover all implements and tools, including the handle, that must be placed in the container.

(D) A manufacturer’s label for all disinfectant concentrate must be available at all times. If a concentrate bottle is emptied, it must remain available until a new bottle is obtained.

(E) When mixed disinfectant concentrate is placed in a secondary container such as a spray bottle, tub or jar, that container must be labeled to indicate what chemical is in the container.

(F) Disinfectants must be disposed of in accordance with all local, state and federal standards.

014. METHODS OF DISINFECTION . Salons and schools must comply with the following disinfection methods:

014.01 IMMERSION. The process for disinfecting by immersion is as follows:

(A) Remove foreign matter.

(B) Wash hands with liquid soap and water or an instant hand sanitizer.

(D) Rinse implements after washing.

(E) Place the implement in a disinfectant.

(F) The disinfectant solution must be deep enough to completely cover implements.

(G) The implements must stay in the disinfectant solution for the full contact time as listed on the manufacturer’s label.

(H) All disinfectants used for immersion must be disposed of at the end of the day and fresh disinfectant made at the beginning of each work day. In addition, if the disinfectant becomes contaminated or cloudy, it must be changed immediately.

(I) Before removing the disinfected implements, wash hands with liquid soap and water or an instant hand sanitizer.

(J) Air-dry on a sanitary surface for at least 10 minutes, dry with a clean towel, or with an electric air sanitizer.

(K) Store in a clean enclosed cabinet or covered container reserved for clean implements.

014.02 SPRAY. The process for disinfecting by spray is as follows:

(A) Remove foreign matter.

(B) Wash hands with liquid soap and water or an instant hand sanitizer.

(D) The disinfectant must remain in full contact with the implement as listed on the manufacturer’s label.

014.03 DISINFECTANT WIPES. Follow steps (A) through (D) and (J) and (K) in 172 NAC 34-014.01 when using a disinfectant wipe. Wipe surfaces and ensure that all surfaces remain visibly moist for the contact time listed on the label. When using a wipe to clean and a second wipe to disinfect, steps (C) and (D) are not required.

014.04 METAL IMPLEMENTS. All metal implements must be immersed in a disinfectant following the procedures in 172 NAC 34-014.01 except that nail tip cutters may be sprayed with a disinfectant.

014.05 AUTOCLAVE. Autoclave is an acceptable method of disinfection and must comply with the following requirements:

(A) Autoclave implements in accordance with the manufacturer’s instructions.

(B) Autoclaves must be cleaned and serviced at the frequency recommended by the manufacturer.

014.06 ELECTRICAL APPLIANCES. Electrical appliances such as drills, electric files, airbrush machines, polish dryers, gel lights, footbaths, foot spas, paraffin wax warmers, clippers, blow dryers, thermal curling irons, microdermabrasion machines, facial machines, and similar portable electric powered appliances must be kept clean at all times. The disinfection process is as follows:

(A) Remove all foreign matter.

(B) Spray with a disinfectant or use a disinfectant wipe.

014.07 PIPED AND PIPELESS FOOTBATHS AND FOOT SPAS. Salons and schools must use the following disinfection process for footbaths and foot spas:

04.07(A) AFTER PEDICURES. After every pedicure using piped and pipeless footbaths and foot spas, the following process must be followed:

(i) Drain water from the basin.

(ii) Remove all debris from the basin and components, as well as the top and bottom of the footplate, knobs and screen. Use low-sudsing soap or detergent and a non-abrasive brush. Remove all visible residue from the inside of the basin and all other components.

(iii) Rinse the basin and components with clean water using the sprayer.

(iv) For pipeless footbaths and foot spas, disinfect all components, screen, surfaces and basin with a disinfectant. Let stand for at least 10 minutes following the manufacturer’s recommendations.

(v) For piped footbaths, foot spas, or portable circulating footbaths, fill the basin with water and a disinfectant and let circulate. The disinfection solution must go everywhere the water was and stay there for at least 10 minutes.

(vi) Rinse the basin and components again with clean water.

(vii) Thoroughly dry the basin and all other components with a clean towel.

014.07(B) AFTER PEDICURES USING A DISPOSABLE LINER. After every pedicure when using a disposable liner, the following process must be followed:

(i) Replace the liner with a new liner for each client.

(ii) Any time the base of the footbath or foot spa becomes contaminated, the liner must be replaced immediately and the footbath or foot spa must be disinfected.

014.07(C) AT THE END OF THE WORK DAY FOR PIPED FOOTBATHS AND FOOT SPAS. At the end of the work day, the following process must be followed:

(i) Drain water from the basin.

(ii) Remove all debris from the basin and components, as well as the top and bottom of the footplate, knobs and screen. Use low-sudsing soap or detergent and a non- abrasive brush. Remove all visible residue from the inside of the basin and all other components.

(iii) Fill the basin with water and a disinfectant and let run in accordance with manufacturer’s disinfecting procedures. Let the water and disinfectant sit in the tub for 6-10 hours, then drain the basin.

(iv) Fill the basin with clean water and circulate for 5 minutes and drain the basin.

(v) Rinse the basin and components with clean water using the sprayer and dry with a clean towel.

014.08 UNNACCEPTABLE DISINFECTION METHODS. Ultraviolet light and using isopropyl alcohol or hydrogen peroxide are not acceptable disinfection methods.

015. USING PARAFFIN WAX ON A CLIENT’S HANDS OR FEET . When using paraffin wax on a client’s hands or feet, the following procedures must be followed:

(A) Paraffin wax used on one client must not be re-melted and used on another client.

(B) Paraffin wax must be removed from the machine with a clean, single-use applicator.

(D) Paraffin wax must be portioned out for each client in a bag or other container, or dispensed in a manner that prevents contamination of the unused supply. All portions used on a client must be disposed of immediately following use.

016. WAX . When using wax on a client during a cosmetology or esthetic service, the following procedures must be followed:

(A) Wax used on one client must not be re-melted and used on another client.

(B) Wax must be removed from the machine with a clean single-use applicator.

017. BLOOD SPILL PROCEDURES . When a client, licensee, or student injury occurs, the following procedures must be followed:

017.01 CLIENT INJURY. The following process must be followed:

(A) Stop service.

(B) Scrub licensee or student hands with liquid soap and water.

(D) Change gloves upon contamination, tearing or penetration.

(E) Clean client’s injured area, as necessary.

(F) Apply antiseptic or styptic powder or liquid, as necessary; do not use styptic pencils.

(G) Cover with a band aid or liquid sealant.

(H) Clean blood spill area.

(I) Place all disposable contaminated objects and gloves in a plastic bag.

(J) Dispose of plastic bag in covered waste receptacle.

(K) Clean hands with liquid soap and water.

(L) Clean non-disposable tools with a disinfectant.

(M) Return to service.

017.02 LICENSEE OR STUDENT INJURY. The following process must be followed:

(A) Stop service.

(B) Clean injured area with liquid soap and water.

(D) Cover with a band aid or liquid sealant.

(E) Clean blood spill area, as necessary.

(F) Place all disposable contaminated objects and gloves, if worn, in a plastic bag.

(G) Dispose of plastic bag in covered waste receptacle.

(H) Clean hands with liquid soap and water.

(I) Clean non-disposable tools with a disinfectant.

(J) Return to service.

018. HOME SERVICES KITS . The following applies to home service kits:

(A) Home service kits must be available for inspection at the salon or at the home of the client receiving services.

(B) The kit and all products in the kit must be maintained in a sanitary condition.

(D) Towels or linens stored in the kit must be in a clean, dust-proof, and waterproof container.

(E) Used and soiled towels or linens must be placed in a leak-proof container for transport to the laundering site.

(F) Licensees must use the disinfectant methods described in 172 NAC 34-014 following the service.

019. PROHIBITED IMPLEMENTS, SUPPLIES, PRODUCTS, AND ACTIVITIES . The following implements, supplies, products, and activities are prohibited in salons and schools:

(A) Credo blades and other implements used for cutting nail beds, corns, or calluses.

(B) Products containing methacrylate monomers.

(D) Styptic pencils.

(E) Coarse nail drill bands.

(F) Cabinet fumigants.

(G) Nail services using fish or other living creatures.

(H) Using individual client implement containers.

(I) Smoking or vaping on the clinic floor, or any area where salon products or chemical supplies are used or stored.

(J) Licensees using or consuming intoxicating beverages.

(K) Unlicensed persons, or credential holders with an expired or inactive license, who are providing cosmetology, esthetic, or nail technology services.

History

Effective 2020-09-30

Chapter 36 Cosmetology, Electrology, Esthetics, and Nail Technology

Neb. Admin. Code tit. 172, ch. 36 Cosmetology, Electrology, Esthetics, and Nail Technology {#sec-172-nac-36 omnilex-key=us-ne-regs-official--title-172--172 NAC 36}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 36 COSMETOLOGY, ELECTROLOGY, ESTHETICS, AND NAIL TECHNOLOGY

001. SCOPE AND AUTHORITY . This chapter governs the credentialing of cosmetologists, electrologists, estheticians, instructors, and nail technicians as set out in Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-1001 to 38-10,171 of the Cosmetology, Electrology, Esthetics, Nail Technology, and Body Art Practice Act and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions are set out in the Cosmetology, Electrology, Esthetics, Nail Technology, and Body Art Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 COSMETOLOGY. The definition of cosmetology is set out in Neb. Rev. Stat. § 38-1016, and includes:

(A) Removing superfluous hair from the surface of the body of any person by the use of depilatories, waxing, tweezers, or sugaring, except for the permanent removal of hair through electrology. The practice of threading to remove superfluous hair does not require a license to provide such service;

(B) Applying, coloring, or curling eyelashes;

(D) Mild peels using equal to or less than 30% alpha hydroxy acid concentration;

(E) Superficial exfoliation, including microdermabrasion; and

(F) Airbrushing or painting designs, or similar services, on artificial nails and removal of artificial nails.

(G) The practice of cosmetology does not include using injectables and lasers.

002.02 ESTHETICS. The definition of esthetics is set out in Neb. Rev. Stat. § 38-1026. The practice of esthetics is upon the skin or epidermis. The practice of esthetics does not include using injectables and lasers.

002.03 LICENSE EXAMINATION. The license examination is the National-Interstate Council of State Boards of Cosmetology, Inc. (NIC), examination or an equivalent examination approved by the Board.

002.04 MANICURING. The definition of manicuring is set out in Neb. Rev. Stat. § 38-1033, Manicuring does not include the use of gel polishes.

002.05 NAIL TECHNOLOGY. The definition of nail technology is set out in Neb. Rev. Stat. § 38-1035 and includes:

(A) Gel application systems that include color gel that requires ultraviolet light-emitting diode (LED) light curing for the purpose of long term wear; and

(B) The removal of artificial nails and ultraviolet light-emitting diode (LED) light curing color gels.

003. INITIAL LICENSE . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the credentialing requirements of Neb. Rev. Stat. §§ 38-1062 or 38-10,127, 172 NAC 10, and this chapter.

003.01 REQUIREMENTS AND DOCUMENTATION. Applicants must submit the following:

003.01(A) AGE. Evidence of being at least 17 years of age on or before taking the license examination.

003.01(B) HIGH SCHOOL. A photocopy of a high school diploma, General Educational Development certificate (GED), or equivalent document.

003.01(C) TRAINING DIPLOMA. A photocopy of the diploma verifying graduation from a school of cosmetology, electrology, esthetics or nail technology relating to the applicable license being requested.

003.01(D) TRAINING HOURS. A diploma or certificate from a school or apprentice salon, verifying the applicant completed the required training in 172 NAC 37, and at a minimum, the following number of hours for the license being requested:

(i) For cosmetology, 1800 hours; or

(ii) For electrology, 600 hours; or

(iii) For esthetics, 600 hours; or

(iv) For nail technology, 300 hours.

003.01(E) EXAMINATION RESULTS. Documentation of receiving a scaled score of at least 75 on the license examination must be submitted.

004. RECIPROCITY LICENSE . To obtain a license by reciprocity, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the credentialing requirements of Neb. Rev. Stat. §§ 38-1066 or 38-10,132, 172 NAC 10, and this chapter.

004.01 REQUIREMENTS AND DOCUMENTATION. Applicants must submit the following:

004.01(A) AGE. Evidence of being at least 17 years of age.

004.01(B) HIGH SCHOOL. A photocopy of a high school diploma, General Educational Development certificate (GED), or equivalent document.

004.01(C) CURRENT LICENSE IN ANOTHER JURISDICTION AND EXAMINATION. Certification of holding a current license in the applicable license category in another jurisdiction, issued on the basis of an examination. The applicant must submit documentation of successful completion of the examination in the other jurisdiction. If an examination was not required for the license in the other jurisdiction, the applicant is required to take the appropriate license examination and provide documentation of receiving a scaled score of at least 75 on the license examination.

004.01(D) TRAINING AND PRACTICE. Applications must submit the following:

(i) For cosmetology, esthetics, and electrology, a diploma or transcript issued by the school, verifying the student's training and total hours completed. If the applicant has not completed the required number of hours of training, the applicant may use 100 hours of work experience for each month of full-time practice in the applicable license type towards the license. Work experience must be after issuance of the license in the other jurisdiction and within 5 years immediately prior to application.

(ii) For nail technology, documentation of completion of at least 16 hours of instruction on operating an electric file.

005. INITIAL INSTRUCTOR LICENSE . To obtain an instructor license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the credentialing requirements of Neb. Rev. Stat. §§ 38-1062 or 38-10,128, 172 NAC 10, and this chapter.

005.01 REQUIREMENTS AND DOCUMENTATION. Applicants must submit the following:

005.01(A) HIGH SCHOOL. A photocopy of a high school diploma, General Educational Development certificate (GED), or equivalent document.

005.01(B) CURRENT NEBRASKA LICENSE. Must hold a current Nebraska license as a cosmetologist, electrologist, esthetician, or nail technician relating to the applicable instructor license category being requested.

005.01(C) TRAINING DIPLOMA. A photocopy of the diploma or certificate verifying graduation from a school of cosmetology, electrology, esthetics or nail technology relating to the applicable instructor category license being requested.

005.01(D) INSTRUCTOR TRAINING OR EXPERIENCE HOURS. A certification or transcript of instructor training or practice verification for the license requested as follows:

(i) For a cosmetology instructor, at least 600 hours beyond the program of studies required for a cosmetology license; or

(ii) For an electrology instructor, evidence of having practiced electrology actively for at least 2 years immediately before the application; or

(iii) For an esthetics instructor, at least 300 hours beyond the program of studies required for an esthetic license; or

(iv) For a nail technology instructor, completion of at least 300 hours beyond the program of studies required for a nail technology license.

005.01(E) EXAMINATION RESULTS. Documentation of receiving a scaled score of at least 75 on the instructor license examination must be submitted.

006. INSTRUCTOR RECIPROCITY . To obtain an instructor license by reciprocity, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the credentialing requirements of Neb. Rev. Stat. §§ 38-106 or 38-10,128, 172 NAC 10, and this chapter.

006.01 REQUIREMENTS AND DOCUMENTATION. Applicants must submit the following:

006.01(A) CURRENT NEBRASKA LICENSE. Hold a current Nebraska license as a cosmetologist, electrologist, esthetician or nail technician relating to the applicable instructor license category being requested.

006.01(B) CURRENT LICENSE IN ANOTHER JURISDICTION AND EXAMINATION. Certification of holding a current instructor license in the applicable license category in another jurisdiction, issued on the basis of an examination. The applicant must submit documentation of successful completion of the instructor examination in the other jurisdiction. If an examination was not required for the license in the other jurisdiction, the applicant is required to take the instructor license examination and provide documentation of receiving a scaled score of at least 75 on the instructor license examination.

006.01(C) TRAINING, EXPERIENCE, OR PRACTICE. Applicants must submit documentation of training, experience, or practice as follows:

006.01(C)(i) COSMETOLOGY, ESTHETICS, AND NAIL TECHNOLOGY. A diploma or transcript issued by the school, verifying the instructor student's training and total hours completed. If the applicant has not completed the required number of hours of training, the applicant may use 100 hours of work experience for each month of full-time practice as an instructor in the applicable license type towards the license. Work experience must be after issuance of the license in the other jurisdiction and within 5 years immediately prior to application.

006.01(C)(ii) ELECTROLOGY. Verification of having practiced electrology actively for at least 2 years immediately prior to application.

007. TRAINING IN A FOREIGN COUNTRY . To obtain a license as a cosmetologist, esthetician, or as a cosmetology or esthetic instructor based on training in a foreign country, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the credentialing requirements of Neb. Rev. Stat. § 38-1067, 172 NAC 10, and this chapter.

007.01 REQUIREMENTS AND DOCUMENTATION. Applicants must submit the following:

007.01(A) AGE. Documentation of being at least 17 years of age on or before taking the licensure examination.

007.01(B) HIGH SCHOOL. A photocopy of a high school diploma, General Educational Development certificate (GED), or equivalent document.

007.01(C) LICENSE OR PRACTICE. Applicants must submit evidence of license or practice as follows:

(i) Evidence of holding a current license or equivalent official recognition of the right to practice in a foreign country; or

(ii) Evidence of having practiced at least 5 years within the 8 years immediately prior to making application.

007.01(D) EXAMINATION RESULTS. Documentation of receiving a scaled score of at least 75 on the license examination must be submitted.

008. TEMPORARY PRACTITIONER LICENSE . To obtain a temporary practitioner license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the credentialing requirements of Neb. Rev. Stat. §§ 38-1073, 172 NAC 10, and this chapter. Applicants must submit the following.

008.01 EXAMINATION. Documentation that the applicant has not failed any portion of the licensure examination.

008.02 COSMETOLOGY OR ESTHETICS ACCEPTANCE OF WORK. Documentation that the applicant has been accepted for work in a licensed cosmetology establishment as defined in Neb. Rev. Stat. § 38-1017 under supervision at all times.

(A) For cosmetology, the supervisor must be a licensed cosmetologist or cosmetology instructor.

(B) For esthetics, the supervisor must be a licensed cosmetologist, esthetician, or instructor.

008.03 NAIL TECHNOLOGY ACCEPTANCE OF WORK. Documentation that the applicant has been accepted for work in a licensed nail technology establishment as defined in Neb. Rev. Stat. § 38-1036, under the supervision at all times of a licensed nail technician or nail technology instructor.

008.04 CHANGE IN A TEMPORARY LICENSE. If the establishment or supervisor listed on the temporary license changes, the temporary license expires and a new complete application is required before resuming practice.

009. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10 and this chapter. To renew, an individual must, prior to the expiration date, complete an application for renewal as set out in 172 NAC 10, pay the fee and attest to completion of at least 8 hours of acceptable continuing education during the prior 24 month period. Licenses issued by the Department expire as follows:

(A) Cosmetologists on December 31 of each even-numbered year.

(B) Cosmetology instructors on December 31 of each even-numbered year.

(D) Electrology instructors on July 31 of each odd-numbered year.

(E) Estheticians on September 30 of each even-numbered year.

(F) Esthetic instructors on September 30 of each even-numbered year.

(G) Nail technicians on December 31 of each odd-numbered year.

(H) Nail technology instructors on December 31 of each odd-numbered year.

009.01 INSTRUCTORS. To renew an instructor license, an individual must also renew his or her applicable cosmetology, electrology, esthetic, or nail technology license.

010. CONTINUING EDUCATION REQUIREMENTS . Actively licensed cosmetologists, electrologists, estheticians, and nail technicians must complete at least 8 hours of acceptable continuing education hours during the 24-months immediately prior to the expiration date of their license.

010.01 MANDATORY HOURS. All licensees must complete at least 4 hours of continuing education in the applicable license category based on his or her scope of practice; all 8 hours may be obtained through these mandatory hours.

010.02 OTHER HOURS. Licensees may earn the remaining 4 hours through the following:

(A) Cardiopulmonary resuscitation (CPR) or first aid;

(B) Equipment use as related to the profession;

(D) Subject areas outlined in the program of study found in 172 NAC 37;

(E) Product knowledge;

(F) People skills, special needs, other similar titles;

(G) Marketing;

(H) Technical school, university, or college courses, only the following types of courses are considered acceptable:

(i) Practice related;

(ii) Communications;

(iii) Humanities;

(iv) Sciences;

(v) Business, including finance, marketing, computer, or other similar courses; and

(vi) Well-being, including psychology, sociology, or other similar courses;

(I) Nebraska Jurisprudence Examination, counting as 2 hours;

(J) Barbering school classes; and

(K) Sanitation or safety courses.

010.03 INSTRUCTOR HOURS. In addition to the 8 hours required for a cosmetologist, electrologist, esthetician or nail technology license, instructors must complete at least 4 additional hours of continuing education. These 4 hours must be earned in at least one of the following areas:

(1) Teaching styles;

(2) Learning styles;

(3) Personality types;

(4) Presentation methods;

(5) Lesson planning;

(6) Test development;

(7) Teaching difficult students;

(8) Language class;

(9) Record keeping;

(10) Motivation;

(11) Multimedia technology, including power point, or computer training;

(12) Resume writing;

(13) English grammar; or

(14) Other similar topics.

010.03(A) INSTRUCTOR. An instructor who completes all 12 hours in the topic areas listed in 172 NAC 36-010.02, items A through K, is exempt from also having to meet the 8 hours for their cosmetologist, electrologist, esthetic, or nail technician license for that renewal period.

010.04 CONTINUING EDUCATION CRITERIA. In order for a continuing education activity to be considered acceptable, it must meet the following criteria:

010.04(A) PROGRAMS, SCHOOLS, IN-SERVICE, OR CLASSROOM INSTRUCTION. The following must be met in order for the program to be acceptable:

(i) Be at least 60 minutes;

(ii) Be an organized event;

(iii) Have a defined agenda identifying the acceptable topic areas set out in 172 NAC

010.02 or 010.03.

(iv) Presenters of programs must be qualified by education, experience or training; and

(v) Program providers must have a process for verifying attendance.

010.04(B) HOME STUDY, ON-LINE, VIDEOTAPES, OTHER ELECTRONIC MEDIA. The following must be met in order for the program to be acceptable:

(i) Be at least 60 minutes; and

(ii) Have program objectives that relate to topic areas defined in 172 NAC 010.02 or 010.03.

010.04(C) HOURS. 60 minutes of participation equals 1 continuing education hour or credit.

010.04(D) CERTIFICATE OF COMPLETION. Each program provider must provide to each person completing the program, a certificate of completion at the end of the program. The certificate of completion must include:

(i) Name of the licensee and his or her license number;

(ii) Provider's name, address, telephone number;

(iii) Date the program began and ended;

(iv) Location, including city and state of program;

(v) Number of hours completed by the licensee; and

(vi) Name of the program.

010.04(E) LICENSEE RECORDS. It is the licensee’s responsibility to obtain and maintain a copy of the certificate of completion for each program completed.

010.04(F) PRESENTER CREDIT. A presenter may receive credit for the initial presentation during a renewal period. Credit will not be given for subsequent presentations of the same program.

011. UNPROFESSIONAL CONDUCT . Unprofessional conduct includes but is not limited to the acts set out in Neb. Rev. Stat. § 38-179 and the following:

(A) Refusal to cooperate or failure to furnish requested information during an application review or investigation by the Department.

012. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

013. FEES . Fees are set out in 172 NAC 2.

History

Effective 2020-06-20

Chapter 37 Cosmetology, Esthetic, and Nail Technology Schools, Satellite Classrooms, and Apprentice Salons

Neb. Admin. Code tit. 172, ch. 37 Cosmetology, Esthetic, and Nail Technology Schools, Satellite Classrooms, and Apprentice Salons {#sec-172-nac-37 omnilex-key=us-ne-regs-official--title-172--172 NAC 37}

001. SCOPE AND AUTHORITY . This chapter governs the licensing of schools of cosmetology, esthetics, nail technology, satellite classrooms, and apprentice salons set out in Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-1001 to 38-10,171 of the Cosmetology, Electrology, Esthetics, Nail Technology, and Body Art Practice Act and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions are set out in the Cosmetology, Electrology, Esthetic, Nail Technology, and Body Art Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 9, and this chapter.

002.01 SCHOOL. School is an apprentice salon, satellite classroom, school of cosmetology, school of esthetics, or nail technology school and is a post-secondary educational institution.

003. INITIAL SCHOOL LICENSE . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the license requirements of Neb. Rev. Stat. §§ 38-130, 38-1097 through 38-10,108 for cosmetology and esthetics, § 38-10,111 for satellite classrooms, § 38-10,113 through § 38-10,114 for apprentice salons, § 38-10,150 for nail technology, §§ 4-108 through 4-111, and this chapter. Applicants must submit the following:

003.01 SELF-INSPECTION. A completed self-accreditation and operation inspection verifying compliance with172 NAC 34, and 172 NAC 37-010 of this chapter.

004. CHANGE IN LICENSE FOR EXISTING SCHOOLS . Any school may apply for a change to its license, due to a change in ownership, change in name, or a change in county of location. An application must be approved by the Department before a school may reopen.

004.01 CHANGE IN OWNERSHIP OR COUNTY OF LOCATION. For a change in ownership or county of location, the applicant must apply to the Department for and obtain another credential as specified in 172 NAC 37-003 at least 30 days prior to the change.

004.02 CHANGE IN SCHOOL NAME. To change the name of the school, the applicant must submit a request for a change in the school name at least 30 days prior to the change and submit the required fee for a reissued license.

005. COSMETOLOGY PROGRAM OF STUDY . All Nebraska licensed cosmetology schools providing a cosmetology program must provide the required program of studies. Schools must not pay direct compensation to any of its students. All theory and practical hours must be obtained in the school, except that the unassigned hours may be obtained outside of the school area.

005.01 COSMETOLOGY PROGRAM. The program of study must include at least 1800 hours. The program must include freshman training and advanced training as follows:

(A) Freshman theory and related theory that includes at least 200 hours and at the completion of the freshman training, there must be an evaluation. (B) Advanced theory that includes at least 200 hours and may be gained through lecture, video, demonstration, observation, or other similar methods of training. (C) Advanced clinical that includes at least 1,165 hours practice on mannequins, classroom models, students or the public. (D) The school may elect to provide 100 hours of optional hours in the advanced training. These hours may be earned outside of the school and are limited to activities set out in the training curriculum. In order for hours to be gained outside of the school, there must be a pre-arranged agreement setting out the duties of the student and the name of the supervisor. This agreement must be on file in the school and be signed by the school representative or owner and the supervisor. The student cannot receive any compensation for services. (E) The school may elect to use 135 flexible hours in subject areas related to cosmetology in either the freshman or advanced classes or 235 if not using optional hours. (F) As a condition of graduation, completion of a final practical and written examination that covers all the subject areas listed in the curriculum. (G) Schools must provide the following training:

| FRESHMAN COSMETOLOGY THEORY AND PRACTICAL 200 HOURS MINIMUM Training must include, but is not limited to, the following subjects: | | | | | --- | --- | --- | --- | | 1. | Chemical texturizing | 6. | General sciences | | a. | Permanent waving | a. | Infection control | | b. | Relaxers | b. | Diseases and disorders | | c. | Curl re-forming | | | | 2. | Haircutting | 7. | Facials and body services | | a. | Tools, including shears, razors and clippers | a. | Massage | | b. | Basic haircuts | b. | Treatment | | | c. | Conturing and custom blending | | | | d. | Contraindications | | | | e. | Infection control practices | | | 3. | Hairstyling | 8. | Hair removal | | a. | Wet styling | a. | Tweezing | | b. | Thermal styling | b. | Waxing | | | c. | Contraindications | | | | d. | Infection control practices | | | 4. | Hair coloring | 9. | Nail services | | a. | Depositing | a. | Anatomy | | b. | Lightening | b. | Infection control | | | c. | Diseases and disorders | | | 5. | Shampoos, conditioners, and scalp treatments | 10. | Nebraska statues, rules and regulations |

| ADVANCED COSMETOLOGY THEORY 200 HOURS MINIMUM Training must include the following subjects: | | | | | --- | --- | --- | --- | | 1. | Chemical texturizing | 6. | General sciences | | a. | Permanent waving | a. | Infection control | | b. | Relaxers | b. | Human anatomy | | c. | Curl re-forming | c. | Chemistry | | | d. | Diseases and disorders | | | | e. | Applied electricity | | | 2. | Haircutting | 7. | Facials and body services | | a. | Tools, including shears, razors and clippers | a. | Massage | | b. | Advanced haircutting techniques | b. | Treatment | | | c. | Conturing and custom blending | | | | d. | Contraindications | | | | e. | Infection control practices | | | 3. | Hairstyling | 8. | Hair removal | | a. | Wet styling | a. | Tweezing | | b. | Thermal styling | b. | Waxing | | c. | Wiggery | c. | Contraindications | | | | d. | Infection control practices | | 4. | Hair coloring | 9. | Nail services | | a. | Depositing | a. | Anatomy | | b. | Lightening | b. | Infection control practices | | c. | Corrections | c. | Diseases and disorders | | | d. | Nail enhancements | | | 5. | Shampoos, conditioners, and scalp treatments | 10. | Nebraska statutes, rules and regulations, and salon management and business |

| ADVANCED CLINICAL 1165 HOURS MINIMUM All services performed on models, students or the public must be performed following infection control methods. Hours required in each subject area are listed below: | | | | | --- | --- | --- | --- | | 1. Chemical texturizing | 200 | 6. Facials and body services | 60 | | 2. Haircutting | 300 | 7. Hair removal | 30 | | 3. Hairstyling | 200 | 8. Nail services | 50 | | 4. Hair coloring | 300 | 9. Infection control | 20 | | 5. Shampoos, conditioners, and scalp treatments 5 | | | |

| OPTIONAL HOURS 100 HOURS MAXIMUM The school may elect to provide 100 hours of ‘optional hours’ in the advanced classes. These hours may be earned outside of the school and are limited to the following: | | | --- | --- | | 1. | Licensed salon or Department licensed facility. Direct supervision is required by a licensed instructor, student instructor or licensed cosmetologist and the student may only observe services The student cannot perform any services on a person. | | 2. | Theatrical presentation, fashion or style show, charitable event, photo shoots, career show, or similar activities. Direct supervision is required by a licensed instructor, student instructor or licensed cosmetologist and the student may provide the following services: make-up; nail polishing; or hairstyling. |

| 3. | Continuing competency programs and distance learning. A licensed instructor is responsible for overseeing the activity, but is not required to be on-site. | | --- | --- |

FLEXIBLE HOURS 135 HOURS MAXIMUM The school may use flexible hours in either the freshman or advanced classes.

006. ESTHETICS PROGRAM OF STUDY . All Nebraska licensed cosmetology schools or esthetic schools providing an esthetic program must provide the required program of study. Schools must not pay direct compensation to any of its students. All theory and practical hours must be obtained in the school, except that the unassigned hours may be obtained outside of the school area.

006.01 ESTHETICS PROGRAM. The program of study must include at least 600 hours as follows:

(A) Freshman theory and related theory that includes at least 140 hours and at the completion of the freshman training, there must be an evaluation. (B) Advanced theory and clinical that includes at least 60 hours and may be gained through lecture, video, demonstration, observation, or other similar methods of training. Practical hours include practice on mannequins, classroom models, students or the public. (C) The school may elect to provide 40 hours of optional hours in the advanced training. These hours may be earned outside of the school and are limited to activities set out in the training curriculum. In order for hours to be gained outside of the school, there must be a pre-arranged agreement setting out the duties of the student and the name of the supervisor. This agreement must be on file in the school and be signed by the school representative or owner and the supervisor. The student cannot receive any compensation for services. (D) The school may elect to use 40 flexible hours in subject areas related to cosmetology in either the freshman or advanced classes. (E) As a condition of graduation, completion of a final practical and written examination that covers all the subject areas listed in the curriculum. (F) Schools must provide the following training:

| FRESHMAN ESTHETIC THEORY AND PRACTICAL CURRICULUM 140 HOURS MINIMUM Training must include, but is not limited to, the following subjects: | | | | | --- | --- | --- | --- | | 1. | Basic facial | 6. | Skin sciences | | a. | Skin care | a. | Physiology or histology | | b. | Massage | b. | Skin diseases | | c. | Benefits or contraindications | c. | Skin disorders | | d. | Skin types | | | | e. | Treatments or contraindications | | | | f. | Infection control practices | | | | 2. | Skin analysis | 7. | Anatomy | | a. | Skin types or skin conditions | a. | Cell | | b. | Contraindications | b. | Tissues | | c. | Infection control practices | c. | Organs and body systems | | 3. | Hair removal | 8. | General sciences |

| | a. | Tweezing | | a. | Infection control practices | | --- | --- | --- | --- | --- | --- | | b. | Waxing | b. | Microbiology | | | | c. | Contraindications | c. | First Aid | | | | d. | Infection control practices | | | | | | 4. | Body treatments | 9. | Chemistry | | | | a. | Body scrubs or wraps | a. | Understanding the power of hydrogen (PH) | | | | b. | Water therapy treatments | b. | Cosmetic products | | | | c. | Contraindications | c. | Cosmetic ingredients | | | | d. | Infection control practices | d. | Cosmetic regulations | | | | 5. | Exfoliants | 10. | Nebraska statues, rules and regulations | | | | a. | Manual, mechanical, chemical | | | | | | b. | Contraindications | | | | | | c. | Infection control practices | | | | |

| ADVANCED ESTHETIC THEORY AND PRACTICAL CURRICULUM 60 HOURS MINIMUM Training must include, but is not limited to, the following subjects: | | | | | --- | --- | --- | --- | | 1. | Facials | 6. | Electricity | | a. | Skin analysis | a. | Basic principles | | b. | Massage advanced techniques | b. | Electrotherapy in esthetics | | c. | Treatments | c. | Electrical equipment in the treatment room | | d. | Contraindications | | | | e. | Infection control practices | d. | Contraindications | | | e. | Infection control practices | | | 2. | Hair removal | 7. | General sciences | | a. | Tweezing | a. | Infection control practices | | b. | Waxing and advanced body waxing | b. | Human anatomy | | c. | Contraindications | c. | Diseases and disorders | | d. | Infection control practices | d. | Chemistry | | 3. | Contouring and custom blending | 8. | Advanced topics | | a. | Facial shapes and features | a. | Nutrition for the skin | | b. | Products and techniques | b. | Cosmetic surgery information | | c. | Contraindications | c. | Esthetics in the medical field | | d. | Infection control practices | | | | 4. | Body treatments | 9. | Advanced contouring and custom blending | | a. | Aromatherapy and botanicals | a. | Custom blending | | b. | Advanced body treatments | b. | Corrective and camouflaged | | c. | Contraindications | c. | Lash and brow services | | d. | Infection control practices | d. | Infection control practices | | 5. | Exfoliants | 10. | Nebraska statues, rules and regulations, and salon management and business | | a. | Manual, mechanical, and chemical | | | | b. | Contraindications | | | | c. | Infection control practices | | |

| ADVANCED CLINICAL 320 HOURS MINIMUM All services performed on models, students or the public must be performed following infection control methods. Hours required in each subject area are listed below: | | | --- | --- | | 1. Facial treatments 145 | 5. Hair removal or tweezing or waxing 50 |

| 2. Chemical or manual exfoliation | 40 | 6. Makeup applications | 20 | | --- | --- | --- | --- | | 3. Machine aided exfoliation | 40 | 7. Infection control practices | 10 | | 4. Body treatments with skin analysis | 15 | | |

| OPTIONAL HOURS 40 HOURS MAXIMUM The school may elect to provide 40 hours of ‘optional hours’ in the advanced classes. The hours earned outside of the school area are limited to the following: | | | --- | --- | | 1. | Licensed salon or Department licensed facility. Direct supervision is required by a licensed instructor, student instructor or licensed cosmetologist or esthetician and the student may only observe services. The student cannot perform any services on a person. | | 2. | Theatrical presentation, fashion or style show, charitable event, photo shoots, career show, or similar activities. Direct supervision is required by a licensed instructor, student instructor or licensed cosmetologist or esthetician and the student may provide the following: make-up, nail polishing, or lash and brow services. | | 3. | Continuing competency programs and distance learning. A licensed instructor is responsible for overseeing the activity, but is not required to be on-site. |

FLEXIBLE HOURS 40 HOURS MAXIMUM The school may use flexible hours in either the freshman or advanced classes.

007. NAIL TECHNOLOGY PROGRAM OF STUDY . All Nebraska licensed schools providing a nail technology program must provide the required program of studies. Schools must not pay direct compensation to any of its students. All theory and clinical hours must be obtained in the school, except that the unassigned hours may be obtained outside of the school area.

007.01 NAIL TECHNOLOGY PROGRAM. The program of study must include at least 300 hours as follows:

(A) Theory hours that includes at least 75 hours. A maximum of 18 hours and 45 minutes may be presented using video tapes, electronic media, or self-study. (B) Clinical hours that includes at least 225 hours as follows:

(i) 100 hours of practice on an artificial nail or hand or live person; and (ii) 125 hours of practice on a live person or through demonstration.

(C) The school may use 50 hours in additional subject areas in the practical curriculum to equal a total of 225 hours of practical training hours. (D) As a condition of graduation, completion of a final practical and written examination that covers all the subject areas listed in the curriculum. (E) Schools must provide the following training:

| NAIL TECHNOLOGY THEORY 75 HOURS MINIMUM Up to 18 hours and 45 minutes may be presented using video tapes, electronic medial or self-study. Training must include the following subjects: | | | --- | --- | | 1. | Client consultation | | a. | Client intake form, professionalism, communications | | 2. | Infection control and disinfection | | a. | Methods | | b. | Sterilization |

| | c. | Sanitation, cleaning, storage and Nebraska regulations | | --- | --- | --- | | d. | Disinfection | | | e. | Supplies and implements | | | 3. | Safety in salon, including chemicals, following infection control methods | | | a. | Safety Data Sheets (SDS) | | | b. | Nail product chemistry | | | c. | Chemical hazards | | | d. | Personal and client safety | | | 4. | Basic first aid | | | 5. | Bacteria and other infectious agents following infection control methods | | | | a. | Bacteria | | b. | Parasites | | | c. | Viruses | | | d. | Fungus | | | e. | Infections | | | f. | Immunity and communicable diseases | | | 6. | Anatomy and physiology | | | a. | Nail composition | | | b. | Skin of the hands and feet | | | c. | Structure of the hands and feet | | | 7. | Nail and skin disorders and diseases following infection control methods and Nebraska regulations | | | a. | Client services that can be done | | | b. | Client services that cannot be done | | | c. | Implement disinfection and storage, pedicure throne disinfection following infection contro methods | | | 8. | Chemistry and Electricity | | | a. | Nail product chemistry | | | b. | Occupational Safety and Health Administration (OSHA) standards | | | 9. | Manicures following infection control methods | | | a. | Supplies | | | b. | Check for disease and disorders | | | c. | Pre-service, service, post service | | | d. | Filing the natural nails | | | e. | Hand massage techniques | | | 10. | Pedicures following infection control methods | | | a. | Checking for disease and disorders | | | b. | Pre-service, service, post service | | | c. | Filing the toe nails | | | d. | Foot massage techniques | | | e. | Diabetic pedicures and pregnancy pedicures | | | 11. | Application, repair, maintenance and removal of nail enhancements following infection control methods | | | a. | Wraps, including fabric | | | b. | Acrylic, including tip overlay, natural overlay, and sculpt or forms | | | c. | Gels, including hard or soft or forms | | | d. | Dipped | | | 12. | Filing techniques following infection control methods | | | a. | Hand file | | | b. | Electric file | | | 13. | Nail salon business | |

| | a. | Professional image or ethics | | --- | --- | --- | | b. | Building a clientele, rebooking, referrals, retailing, social media | | | c. | Salon management and business | |

| NAIL TECHNOLOGY PRACTICAL 225 HOURS MINIMUM 1. 100 hours of practice on an artificial nail or hand or live person; 2. 125 hours of practice on a live person or through demonstration Training must include the following subjects: | | | | --- | --- | --- | | 1. | Nail enhancement application following infection control methods: Total 55 hours | | | a. | Wraps, including fabric: 5 hours | | | | b. | Acrylic including tip overlay, natural overlay, and sculpt: 25 hours | | | c. | Gels, including hard, soft: 20 hours | | | d. | Dipped nail: 5 hours | | 2. | Filing techniques following infection control methods: Total 15 hours | | | a. | Manual filing: 1 hour | | | b. | Electric filing: 14 hours | | | 3. | Repair, maintenance, and removal following infection control methods: Total 40 hours | | | a. | Wrap fill: 5 hours | | | b. | Acrylic fill including two tone and forms: 15 hours | | | c. | Gel fill: 15 hours | | | d. | Dipped nail: 5 hours | | | 4. | Manicure or pedicure following infection control methods: Total 15 hours | | | | a. | Manicure: 5 hours | | b. | Pedicure: 10 hours | | | | | | | PRACTICAL FLEXIBLE HOURS 50 HOURS MAXIMUM The school may use 50 hours in additional subject areas in the practical curriculum to equal a total of 225 hours of practical training hours. | | |

008. INSTRUCTOR PROGRAM OF STUDY . All Nebraska licensed schools, except an apprentice salon, may provide an instructor program. The program must include the following:

(A) For a cosmetology instructor program, at least 600 hours of instructor training in a school of cosmetology. (B) For an esthetic instructor program, at least 300 hours of instructor training in a school of cosmetology or school of esthetics. (C) For a nail technology instructor program, at least 300 hours of instructor training in a school of cosmetology or nail technology. (D) As a condition of graduation, completion of a final practical and written examination that covers all the subject areas listed in the curriculum. (E) Schools must provide the following training:

| STUDENT INSTRUCTOR CURRICULUM 300 HOURS MINIMUM Training must include the following subjects: | | | --- | --- | | 1. | Student instructor orientation | | a. | Introduction to faculty, staff, student body | | b. | School policy | | c. | Overview of the student instructor training program |

| 2. | Nebraska statutes and regulations | | --- | --- | | a. | Teaching techniques and educational tools | | b. | Student and instructor relations or counseling | | 3. | Preparation of a cosmetology program | | a. | Overview of student curriculum as required by state and school | | b. | Detailed course outline including chapters | | c. | Detailed subject layout or daily lessons | | 4. | Theory and practical techniques, including freshman and advanced student training experiences | | a. | Classroom observations | | 1) | Assist with a) Presentations or lectures b) Teaching basic skills c) Practical activities | | b. | Practical observations | | c. | Supervision of services | | d. | Student or client relationships | | e. | Practical activities | | 1) | Supervision of procedures or demonstrations | | 2) | Practice teaching or basic skills | | 5. | The student instructor learns to evaluate student progress and basic evaluation techniques, including written, observation, and oral | | 6. | Administrative techniques | | a. | Office management | | 1) | Student folder | | 2) | Recording student hours | | 3) | Entrance notification | | 4) | Graduate records | | b. | Office records | | 1) | State rules and regulations | | 2) | Nail technology schools | | 3) | Enrollment procedures | | 4) | Maintaining student records | | c. | School management and business | | 1) | Client and student scheduling | | 2) | Record keeping procedures | | 3) | Receptionist responsibilities | | 4) | Inventory control, purchasing, retailing |

009. METHOD OF INSTRUCTION . Each instructor must teach from long range lesson plans, including subject outlines with daily lesson plans, for a complete course of training as defined in 172 NAC 37-005 for cosmetology, 172 NAC 37-006 for estheticians, 172 NAC 37-007 for nail technology and, 172 NAC 37-008 for instructors.

010. ACCREDITATION INSPECTION CRITERIA . Accreditation inspections will be conducted as set out in Neb. Rev. Stat. § 38-10,169. Schools must comply with the following requirements:

010.01 RECORDS AND DOCUMENTATION. Schools must retain all student and training records for at least 5 years after the student has completed or has officially dropped. Records include the following:

010.01(A) STUDENT RECORDS. The student records must include:

(i) Record for every student enrolled; (ii) Daily records of student attendance; (iii) Student grading system in place; (iv) Examinations and grades; (v) Student progress reports; (vi) Evidence that each student is 17 years old on or before enrollment; (vii) Evidence of a high school diploma or equivalent for each student; (viii) Evidence of final examination grade, both practical and written, for each student and apprentice; and (ix) If special study students or apprentices are enrolled, the following must also be documented:

(1) Evidence of at least 10th grade completion; and (2) Evidence that students are continuing high school on a full-time basis.

(x) Daily records of each student’s practical and theory hours.

010.02 DOCUMENTS POSTED OR AVAILABLE. The following documents must be posted or available in the designated area of the school as specified below.

010.02(A) DISPENSARY. The following documents must be in the dispensary:

(i) Sanitation regulations, 172 NAC 34, must be available; and (ii) Emergency evacuation plan must be posted.

010.02(B) EACH CLASSROOM. Emergency evacuation plan must be posted in each classroom.

010.02(C) PRACTICAL AREA. The following documents must be in the practical area:

(i) Sanitation regulations, 172 NAC 34, must be available; (ii) Emergency evacuation plan must be posted; and (iii) A sign posted for viewing by the public, which reads: “All services in this school are performed by students who are in training.”

010.02(D) SCHOOL ENTRANCE. The name of school must be posted at the entrance to the school.

010.02(E) PUBLIC AREA. The following documents must be in the public area:

(i) Each instructor’s current license card or verification of licensure must be posted; and (ii) The latest inspection report must be posted.

010.02(F) RESOURCE AREA. The following documents must be assessable to students or apprentices during the school’s operating hours:

(i) If teaching a cosmetology program, a copy of the latest printing of the cosmetology references published on the National-Interstate Council of State Boards of Cosmetology Examination Candidate Information Bulletin; (ii) If teaching a separate esthetic program, a copy of the latest printing of the esthetics references published on the National-Interstate Council of State Boards of Cosmetology Examination Candidate Information Bulletin; (iii) If teaching a nail technology program, a copy of the latest printing of the nail technology references published on the National-Interstate Council of State Boards of Cosmetology Examination Candidate Information Bulletin; (iv) If teaching an instructor program, a copy of the latest printing of the references published on the National-Interstate Council of State Boards of Cosmetology Examination Instructor Candidate Information Bulletin; (v) Standard dictionary of the English language; (vi) A copy of the current school rules; (vii) A copy of the latest printing of the Cosmetology, Electrology, Esthetics, Nail Technology and Body Art Practice Act; and (viii) A copy of latest printing of the regulations relating to cosmetology, esthetics, and nail technology, including 172 NAC 34, 36, and 37.

010.03 COSMETOLOGY EQUIPMENT. The following cosmetology equipment is required:

010.03(A) STUDENT OR APPRENTICE EQUIPMENT. Each cosmetology student must receive a kit which includes:

(i) Blow dryer; (ii) Brushes; (iii) Cape; (iv) Clips; (v) Combs; (vi) Cuticle pusher; (vii) Hair iron; (viii) Make-up applicators; (ix) Mannequin and clamp; (x) Nail clipper; (xi) Nail files; (xii) Razor; (xiii) Shears; (xiv) Textbook or training materials; and (xv) Tweezers;

0010.03(B) SCHOOL EQUIPMENT. The school must have the following cosmetology equipment:

(i) Blow dryer; (ii) Clipper; (iii) Disinfectant containers; (iv) Chair or table used for esthetic services; (v) First aid kit; (vi) Hair dryers; (vii) Hair irons, including flat and curling; (viii) Nail table with chairs; (ix) Pedicure tubs or spas; (x) Products, supplies and equipment for cosmetology services; (xi) Products, supplies and equipment for facial services, waxing services and make-up application; (xii) Products, supplies and equipment for manicuring, pedicuring and nail technology services; (xiii) Shampoo bowls and chairs; (xiv) Station or work area with mirror and chair for each student assigned to the clinic floor; (xv) Work area for each student attending theory and practical class; and (xvi) Textbook or training materials.

010.04 ESTHETIC EQUIPMENT. The following esthetic equipment is required

010.04(A) STUDENT OR APPRENTICE EQUIPMENT. Each esthetic student must receive a kit which includes:

(i) Facial and body treatment brushes; (ii) Mixing jars and bowls; (iii) Cleansing gauze; (iv) Spa gown wrap and headbands; (v) Non-latex makeup sponge wedges; (vi) Cosmetic makeup brush kit; (vii) Makeup mirror and cape cover-up; (viii) Makeup pencil sharpener; (ix) Box of vinyl gloves; (x) Wax warmer; (xi) Waxing applicators, large, medium and small; (xii) Tweezers, including slanted and splinter; (xiii) Eyebrow scissors; (xiv) Sanitizing and disinfecting spray; and (xv) Textbooks or training materials.

010.04(B) SCHOOL EQUIPMENT. The school must have the following esthetic equipment:

(i) Facial table and stool; (ii) Hot towel heating cabinet; (iii) Facial steamer and multifunctional machine; (iv) Magnifying lamp; (v) Ultra violet (UV) sterilizer; (vi) First aid kit; (vii) Disinfectant containers; (viii) Wax warmer; (ix) Products, supplies and equipment for esthetic services, facial and body services, waxing services, and makeup services; (x) Station or work area with facial table and stool for each student assigned to the clinic floor; (xi) Work area for each student attending theory and practical class; and (xii) Textbooks or training material.

010.05 NAIL TECHNOLOGY EQUIPMENT. The following nail technology equipment is required:

010.05(A) STUDENT EQUIPMENT. Each student must receive a kit which includes:

(i) Nail and foot files; (ii) Acrylic nail brush; (iii) Cuticle pusher; (iv) Nail clipper and nail nipper; and (v) Textbook or training information.

010.05(B) SCHOOL EQUIPMENT. The school must have the following nail technology equipment:

(i) Disinfectant containers; (ii) Electric file; (iii) Electric file bits; (iv) First aid kit; (v) Gel light; (vi) Nail tables with chairs; (vii) Practice finger or hand; (viii) Suitable work area for each student attending theory and clinical class; (ix) Supplies, products, and equipment necessary to comply with the curriculum; (x) Nail technology supplies, for providing the following services:

(1) Liquid and powder; (2) Gels; and (3) Wraps.

011. INSPECTIONS . All schools will receive an initial and routine inspection. School owners must ensure that all licensees comply with 172 NAC 34, and this chapter. The criteria for inspections required by the Department and the Board is specified below:

011.01 INITIAL SELF-INSPECTION. Pursuant to 172 NAC 37- 003, the applicant must conduct a self-evaluation inspection prior to the proposed opening date of the school.

011.02 INITIAL ON-SITE INSPECTION. The Department will immediately conduct an on-site announced inspection upon approval of the application.

011.03 RENEWAL INSPECTION. The Department may conduct an on-site or paper accreditation inspection within the six months immediately prior to the date of license renewal.

011.04 INSPECTIONS. The Department may conduct an unannounced inspection of a school at any time it deems necessary.

012. CLOSING A SCHOOL . When any school is permanently closed, the holder of the license must notify the Department in writing at least 30 days prior to closure.

013. RENEWAL . To renew a school or apprentice salon license, a licensee must, prior to the expiration date of December 31 of odd-numbered years, complete an application for renewal, provide evidence of insurance coverage, pay the fee, and comply with Neb. Rev. Stat. §§ 38-143, 4-108 through 4-111, 172 NAC 9, and the following:

(A) Schools of cosmetology and esthetics must also comply with Neb. Rev. Stat. § 38-10,109; (B) Apprentice salons must also comply with Neb. Rev. Stat. § 38-10,116; and (C) Nail technology schools must also comply with Neb. Rev. Stat. § 38-10,157.

014. RE-APPLICATION . The re-application process is set out in 172 NAC 9.

015. FEES . Fees are set out in 172 NAC 2.

History

Effective 2020-06-20

Chapter 44 Body Artists and Body Art Facilities

Neb. Admin. Code tit. 172, ch. 44 Body Artists and Body Art Facilities {#sec-172-nac-44 omnilex-key=us-ne-regs-official--title-172--172 NAC 44}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 44 BODY ARTISTS AND BODY ART FACILITIES

001. SCOPE AND AUTHORITY . This chapter applies to the practice of body art and body art facilities as defined by Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-1001 to 38-10,171 of the Cosmetology, Electrology, Esthetics, Nail Technology and Body Art Practice Act and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions are found in the Cosmetology, Electrology, Esthetic, Nail Technology, and Body Art Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 9 and 10, and this chapter.

002.01 AFTERCARE. Written instructions given to the client, informing the client how to take care of the site of a body art procedure and its surrounding area.

002.02 ANTISEPTIC. A disinfecting agent that reduces the number of microorganisms present on the skin or mucosa.

002.03 AUTOCLAVE. A sterilization device using steam, heat and pressure which meets the standards of the American Society for Mechanical Engineering (ASME). Ultrasonic cleaning units or dry heat sterilizers are not autoclaves.

002.04 BODY ARTIST. A body artist is a body piercer, body brander, permanent color technologist, or tattoo artist.

002.05 CLIENT. An individual upon whom a body artist performs a body art procedure.

002.06 CLOSED OR COVERED RECEPTACLE, CONTAINER, BOTTLE, AND DRAWER. Fitting tightly with a lid, door, or shutting of a drawer, and may have vents.

002.07 DISINFECT. The use of a chemical intended to kill bacteria, virus or fungus on a non-porous object or surface. Ultra-violet lights are not acceptable for disinfection.

002.08 DISINFECTION. The destruction of disease-causing microorganisms on non-porous objects or surfaces.

002.09 GLOVES. Single use covering for the hand having separate sections for each finger, worn for protection against disease transmission, that is disposable medical or examination grade.

002.10 INSTRUMENT OR TOOL. Hand pieces, needles, and other tools, including suspension hooks, that may come in contact with a client's body or be exposed to body fluids during body art procedures.

002.11 JURISPRUDENCE EXAMINATION. An examination, approved by the board, relating to statutes and regulations governing the practice of body art.

002.12 MINOR. Any person who has not attained the age of 18 years.

002.13 REGULATED OR INFECTIOUS WASTE. Waste that is described as follows:

(A) Blood and body fluids in a liquid or semi-liquid state;

(B) Items contaminated with blood or body fluids, which, if compressed or disturbed, may release liquid or semi-liquid blood or body fluids;

(D) Pathological and microbial waste containing blood or other potentially infectious materials that exposure to the waste directly or indirectly creates a significant risk of disease.

002.14 SHARPS. Any rigid object used to puncture or penetrate the skin or mucosa.

002.15 SHARPS CONTAINER. A closable rigid, leak and puncture resistant, and labeled container, manufactured for the containment of sharps. Labeling must include the international biohazard symbol.

002.16 SINGLE USE. Products or items intended for one-time, one-person use that are disposed of after use on each client.

002.17 STERILIZATION. The destruction of all forms of microbial life, including highly resistant bacterial spores.

003. BODY ARTIST LICENSE . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. § 38-1060, 172 NAC 10, and this chapter.

003.01 HIGH SCHOOL EDUCATION. Applicants must submit a photocopy of a high school diploma, General Educational Development certificate (GED), or equivalent document.

003.02 TRAINING. Applicants must submit documentation showing completion of a basic first aid class and bloodborne pathogens training. This training must have been completed within 1 year immediately prior to submitting the application for a license as a body artist. The training must be sponsored by one of the following:

(A) A professional body art organization or association;

(B) Local government;

(D) A college;

(E) The Occupation and Safety Hazards Administration (OSHA);

(F) A national or local Safety Counsel;

(G) The American Heart Association; or

(H) The American Red Cross.

003.03 EXAMINATION. Applicants must provide documentation of successful completion of the jurisprudence examination with a score of at least 75%.

004. BODY ART RENEWAL, WAIVER OF CONTINUING COMPETENCY, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10 and this chapter. All body art licenses issued by the Department will expire on March 31 of each odd-numbered year.

005. CONTINUING COMPETENCY REQUIREMENTS . During the 24 months prior to the license renewal date, each body artist must complete at least 2 hours of bloodborne pathogens training. The training must be sponsored by an organization or association set out in 172 NAC 44-003.02.

006. REINSTATEMENT OF A BODY ART LICENSE . The applicant must meet the requirements set out in 172 NAC 10.

007. BODY ART FACILITY LICENSE . To obtain a facility license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. §§ 38-130 and 38-1080, 172 NAC 9, and this chapter.

007.01 FLOOR PLAN. Applicants must submit a floor plan of the proposed facility which includes the following:

(A) Restroom(s) location;

(B) Sink locations; and

007.02 SELF-EVALUATION. Applicants must complete a self-evaluation inspection report showing compliance with 172 NAC 44-012.

008. CHANGE IN LICENSE FOR EXISTING FACILITIES . Owners may request a change in name, ownership, or location of a facility.

008.01 CHANGE IN NAME. To change the name of a facility, the applicant must submit a request for a change in the establishment or school name at least 30 days prior to the change and submit the required fee for a reissued license.

008.02 CHANGE IN OWNERSHIP OR LOCATION. To change ownership or location of a facility, the applicant must apply to the Department for and obtain another license as specified in 172 NAC 44-007 at least 30 days prior to the change.

009. BODY ART FACILITY RENEWAL . The applicant must meet the requirements set out in 172 NAC 9 and this chapter. All body art issued by the Department expire March 31 of each odd-numbered year.

010. BODY ART FACILITY REAPPLICATION . Facilities that were previously licensed in Nebraska and seek the authority to return to operation must meet the requirements set out in 172 NAC 9.

011. BODY ART FACILITY INSPECTIONS . All body art facilities will receive an inspection that includes compliance with 172 NAC 44-012.

011.01 INITIAL SELF-EVALUATION INSPECTION. Under 172 NAC 44-007, the applicant must conduct a self-evaluation inspection prior to the proposed opening date of the facility.

011.02 INITIAL ON-SITE INSPECTION. The Department will conduct an initial unannounced on-site inspection within 1 year of receipt of a completed application for a facility.

012. REQUIRED DOCUMENTS, PHYSICAL STRUCTURE, EQUIPMENT, AND SUPPLIES FOR A BODY ART FACILITY . All body art facilities must comply with the following requirements.

012.01 DOCUMENTS POSTED. The following documents must be posted in each facility in an area visible and assessable to the public:

(A) A copy of the current regulations governing sanitation and safety, 172 NAC 44;

(B) The current inspection report;

(D) Pamphlets or literature explaining body art aftercare.

012.02 IDENTIFICATION. Each person providing body art procedures must have a government-issued or state-issued photo identification card or document available for viewing by the Department inspector.

012.03 CLIENT RECORDS. Body art facilities must maintain client records. The following specifies the information that must be documented in client records and the retention schedule.

012.03(A) ALL CLIENTS. The following information must be maintained in the client record:

(i) Name, address, and date of birth of the client;

(ii) A copy of the client’s federal or state Identification which has a current photograph and date of birth on the document, such as, driver’s license, military identification document, state identification documents, or passport;

(iii) Any known client allergies;

(iv) Any condition that may affect or hamper healing;

(v) The name of the body artist who performed the procedure;

(vi) The date of the procedure;

(vii) The location of the procedure on the client’s body; and

(viii) A description of the type of procedure provided.

012.03(B) CLIENTS UNDER 18 YEARS OF AGE. If the client is under 18 years of age, the following information must be maintained in the client record in addition to the information set out in 172 NAC 44-012.03(A):

(i) A copy of the parent or legal guardian’s federal or state identification which has a current photograph and date of birth on the document, such as, driver’s license, military identification, state identification, or passport;

(ii) Consent form for all persons under 18 years of age, signed by the parent or legal guardian and client; and

(iii) A copy of a document that verifies the parent or guardian of the minor, such as, birth certificate, adoption record, guardian records, or court documents.

012.03(C) CLIENT RECORD RETENTION SCHEDULE. Client records must be retained as follows and made available to the Department upon request:

(i) All records must be maintained in a confidential manner;

(ii) For clients 18 or older, the records must be retained for 3 years;

(iii) For clients under 18 years of age, the client records and consent forms must be retained for 5 years; and

(iv) For inspection purposes, all client records for the past year must be maintained on-site at the facility.

012.04 PHYSICAL STRUCTURE. The facility must be well lighted, well ventilated and kept in a clean, orderly, and sanitary condition at all times. The following applies:

(A) All walls, floors and procedure areas must be washable, in good repair, and in a safe and sanitary condition;

(B) All body art facilities must have a dedicated physical address;

(i) An entrance leading directly into the facility;

(ii) There can be no direct opening between a facility and any building or portion of a building used as a food, liquor, or tobacco facility; and

(iii) Body art facilities located in a cosmetology salon, esthetic salon, or nail technology salon may share an entrance into the entire facility; the body art facility must be separated from the salon by at least 6-foot high walls. The same room can be shared by an esthetician and permanent color technician;

(D) Each facility must have an area that can be screened from public view for clients requesting privacy or for all genitalia body art procedures; and

(E) Branding procedures must be provided in an enclosed room with doors that shut.

012.05 WATER. The facility must have hot and cold running water.

012.06 SAFETY. The facility must be maintained in a safe and sanitary condition and meet the following requirements:

(A) Floors, floor coverings, walls, woodwork, ceilings, furniture, fixtures and equipment must be clean and in good repair;

(B) Floors must be free of unsafe objects and slippery or uneven surfaces;

(D) Electrical appliances must be clean and have no worn or bare wiring; and

(E) Water or product spills on the floor must be removed immediately and floor dried.

012.07 RESTROOM FACILITIES. Restrooms must be clean and sanitary at all times and include the following:

(A) A toilet which is operational;

(B) Suitable holders for toilet paper;

(D) A clean waste receptacle;

(E) A sink which is operational and has hot and cold running water;

(F) Liquid soap or foam; and

(G) Single-use disposable towels in a clean holder or an electric hand dryer.

012.08 REQUIRED EQUIPMENT AND FURNISHINGS. Each facility must have the following equipment and furnishings that are in good repair, cleanable, and in a sanitary condition at all times.

012.08(A) PROCEDURE HAND WASHING SINK AREA. The hand washing sink area must be clean and include:

(i) A hand washing sink with hot and cold running water that passes through a mixing type of faucet;

(ii) Liquid or foam soap;

(iii) Single-use paper towels; and

(iv) Waste receptacle.

012.08(B) EQUIPMENT WASHING SINK AREA FOR EMPLOYEE USE ONLY. Facilities which use all disposable equipment are not required to have an equipment washing sink area. The equipment washing sink area must be clean, dedicated to equipment washing only, and include:

(i) An equipment washing sink with hot and cold running water that passes through a mixing type of faucet;

(ii) Liquid or foam soap;

(iii) Single-use paper towels; and

(iv) Waste receptacle.

012.08(C) SHARPS CONTAINER. Contaminated sharps must be disposed of in an approved sharps container in a manner to ensure the prevention of cross-contamination.

012.08(D) AUTOCLAVE. If the facility uses non-disposable equipment or instruments, it must have an autoclave.

012.08(E) WASTE RECEPTACLE. A facility must have at least 1 waste receptacle for each workstation, which is covered and has a plastic liner.

012.08(F) WORK TABLES OR COUNTERS. All work tables or counters must be smooth, non-absorbent, non-porous, and be able to be disinfected.

012.08(G) FIRST AID KIT. All facilities must have a first aid kit.

012.08(H) CLIENT CHAIRS AND BODY ARTIST CHAIRS. Chairs must be made of cleanable non-porous material.

012.08(I) BARRIERS. Disposable protection or covering on equipment and supplies must be used during procedures and be changed between procedures to ensure the prevention of cross-contamination.

012.08(J) STORAGE. The facility must have clean cabinets or containers for storing clean instruments, supplies, cloth towels and linens. Storage within the facility must comply with the following requirements:

(i) Flammable and combustible chemicals must be stored away from potential sources of ignition such as an open flame or an electrical device;

(ii) All chemicals must be stored in closed bottles or containers and properly labeled;

(iii) Cabinets, drawers, containers used for storage of supplies, instruments and towels must be clean;

(iv) Unused supplies must be stored in a clean, enclosed container, cabinet, or drawer and supplies must be labeled accordingly;

(v) Instruments that have been used on a client or soiled in any manner must be placed in a properly labeled covered receptacle until disinfected;

(vi) Cloth linens must be deposited in a closed receptacle after use;

(vii) Used or soiled cloth linens must not be used again until properly laundered and sanitized and must be kept in a closed receptacle;

(viii) Clean cloth towels or linens must be stored in a clean, labeled, enclosed cabinet or container until used; and

(ix) Disinfectant solution must be used and maintained in accordance with the manufacturer’s directions and covered at all times.

012.08(K) DISPOSABLE SINGLE-USE TOWEL. Only disposable single-use towels must be used for body art procedures and must be discarded in a closed receptacle with a disposable liner, immediately following each body art procedure.

012.09 PRODUCTS. Products must comply with the following requirements:

(A) All liquids, inks, creams, gels, pastes, powders, and other products must be kept in clean, closed containers;

(B) Original product bottles and containers must have an original manufacturer’s label;

(C) When only a portion of the product is to be used on a client, the product must be removed from the container by a spatula, scoop, spoon, or dropper so that the product does not come in direct contact with the client and to assure the remaining product is not contaminated;

(D) If a product is poured into another container, the container must be is labeled to identify the product;

(E) Manufacturer’s directions must be followed when using products;

(F) Single-use products that are not sharps that come in direct contact with a client and cannot be disinfected, such as cotton pads, cotton balls, pads, “Q-tips”, sponges, bandages, tapes, surgical dressing and other similar items, must be disposed of in a covered waste receptacle with a plastic liner immediately after use;

(G) All products applied to the skin, including stencils, must be single-use and disposable. Acetate stencils cannot be re-used. Petroleum jellies, soaps, and other products used in the application of stencils must be dispensed and applied on the area to be tattooed in a manner to prevent contamination of the original container and its contents; and

(H) All products used to stop bleeding or to absorb blood must be sanitary and be single use.

012.10 PIGMENTS, DYES, INKS, AND LIQUIDS. Pigments, dyes, inks, and liquids used from stock solutions for each client must be placed in a single-use cup or cap and remaining solution must be discarded and disposed of after each use.

012.11 INK CAPS. Ink caps are required if providing tattooing and permanent color technology procedures. If the body artist uses a reusable ink cap holder, the holder must be smooth, non-absorbent, non-porous, and able to be autoclaved.

012.12 RASH OR INFECTION. Any skin or mucosa surface to receive a body art procedure must be free of suspected rash or any suspected visible infection. The body artist must be free from any infection or other visible disease that may be transmitted as a result of carrying out the body art procedure.

012.13 BODY ARTIST HAND CLEANLINESS. Body artists must wash their hands thoroughly with liquid soap or foam and water and dry them with single-use disposable towels before and after serving each client and at any time during the procedure when the hands may become contaminated.

012.14 GLOVES. When performing body art procedures, the body artist must wash his or her hands prior to gloving. Gloves must be disposed of after the completion of each procedure on each client. If gloves become torn, punctured or otherwise contaminated, the body artist must remove and dispose of the gloves, wash his or her hands with liquid soap or foam and water, dry with a disposable towel, and then put on a new pair of gloves before resuming the body art procedure.

012.15 REGULATED OR INFECTIOUS WASTE. Regulated or infectious waste must be handled and stored so that human exposure is prevented.

012.16 PREPARATION AND CARE OF THE BODY ART PROCEDURE AREA. The following requirements apply to the preparation and care of the body art procedure area.

012.16(A) WASHING. Before performing body art procedures, the immediate area of the skin or mucous membrane where the body art procedure is to be placed must be washed with liquid soap or foam and water. Only single-use disposable towels, washing pads, blotters, or similar single use materials may be used and these materials must be discarded after a single use.

012.16(B) ORAL BODY ART. Before an oral body art procedure may be performed, the client must rinse his or her mouth with an antiseptic mouthwash which must be provided to the client in single-use cups.

012.16(C) SHAVING. If shaving is necessary, single-use disposable razors or safety razors with single-procedure blades must be used. Single-procedure blades must be discarded after each use and the reusable holder must be autoclaved after each use. Non-disposable clippers may be used prior to any procedure then cleaned and sprayed with a disinfectant solution after each client. Following shaving, the skin and surrounding area must be washed with liquid soap or foam and water or antiseptic.

012.17 AUTOCLAVE, STERILIZATION, AND ULTRASONIC CLEANING UNITS. The following is required:

012.17(A) AUTOCLAVE. If the facility uses non-disposable equipment and instruments, it must have an autoclave used for sterilizing tools or equipment that must be clean and body artists must follow the manufacturer’s directions for use.

012.17(B) AUTOCLAVED INSTRUMENTS. Instruments that are to be autoclaved within the facility must be sterilized in single-use paper pre-packs or other containers designed for sterilizing instruments. If pre-packaged or packages which have been autoclaved in the facility are torn, wet, or compromised, they cannot be used until they are re-packaged and re-autoclaved. Any package which has an expiration date printed on the package cannot be used after the expiration date has passed; they must be re-packed and re-autoclaved prior to use.

012.17(C) JEWELRY STERILIZATION. Jewelry used for new body piercing must be sterilized with an autoclave and the jewelry must be nonporous, smooth, and disinfected.

012.17(D) NON-DISPOSABLE INSTRUMENT STERILIZATION. All non-disposable instruments used for body art must be sterilized after each use. Autoclave sterilization must be conducted for the cycle of time and corresponding operating pressure recommended by the manufacturer of the autoclave.

012.17(E) STERILIZED INSTRUMENTS. Every batch of sterilized instruments must be monitored for sterilization by use of a heat sensitive indicator or integrator that is capable of indicating approximate time and temperature achieved. Sterilized instruments must be individually packed and stored in a clean closed container or drawer until used. Sterilized unwrapped instruments must be stored in a covered container or drawer, and sterilized again immediately prior to use.

012.17(F) ULTRASONIC CLEANING UNITS. If ultrasonic cleaning units or dry heat sterilizers are used, they must be used in addition to autoclaving, must be used and maintained in accordance with the manufacturer’s recommendations, and be clean and sanitary.

012.18 AUTOCLAVE STANDARDS. The following autoclave standards must be followed.

012.18(A) SPORE DESTRUCTION TESTS. Spore destruction tests must be performed to prove that autoclaves are capable of attaining the minimum operating standards. Spore tests must be performed at a minimum of one time every 30 days for each autoclave and must be verified through an independent laboratory or tester. A testing facility must be qualified by the Centers for Disease Control and Prevention (CDC), the American Dental Association (ADA), the American Medical Association (AMA), or the Food and Drug Administration (FDA). A record of all spore tests must be maintained for 3 years and must be maintained for a minimum of 1 year on site.

012.18(B) POSITIVE SPORE TEST. An autoclave which has received a positive spore test must be immediately removed from procedure and cannot be used again until it receives a passing or negative growth report from a qualified testing facility. Equipment and tools run through a positive cycle should not be used until re-sterilized properly.

012.18(C) CLEANING AND SERVICING AUTOCLAVES. All autoclaves must be cleaned and maintained according to manufacturer's instructions. A copy of the manufacturer’s cleaning and servicing instructions must be maintained in the facility.

012.19 NOT ALLOWED OR TO BE USED IN THE FACILITY. The following are not allowed in a body art facility:

(A) Smoking or vaping;

(B) Body artists consuming food or beverages in any area where body art is performed; clients may be allowed to consume food or non-intoxicating drinks;

(C) Body artists and clients consuming, serving, or in any manner possessing or distributing intoxicating beverages upon the facility premises;

(D) Performing body art procedures on clients who appear to be under the influence of alcohol, narcotic drugs, stimulants, or depressants;

(E) Dermal or biopsy punches and lasers;

(F) Unlicensed persons or persons with an expired or inactive license providing body art procedures;

(G) Animals and pets, except service animals; and

(H) Fish aquariums in any procedure area, except covered aquariums are allowed in the waiting room and non-procedure areas.

013. FEES . Fees are set out in 172 NAC 2.

History

Effective 2023-07-14

Chapter 53 Unlicensed Dental Assistants and the Licensure of Dental Assistants

Neb. Admin. Code tit. 172, ch. 53 Unlicensed Dental Assistants and the Licensure of Dental Assistants {#sec-172-nac-53 omnilex-key=us-ne-regs-official--title-172--172 NAC 53}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of dental assistants and the practice of licensed and unlicensed dental assistants under Nebraska Revised Statutes (Neb. Rev. Stats.) §§ 38-1101 to 38-1152 of the Dentistry Practice Act, and the Uniform Credentialing Act (UCA).

002. DEFINITIONS . Definitions set out in the Dentistry Practice Act, the Uniform Credentialing Act, Title 172 Nebraska Administrative Code (NAC) 10, and the following apply to this chapter.

002.01 IMPRESSION. Techniques used to produce a three-dimensional record of an anatomic structure.

002.01(A) FINAL IMPRESSION. A type of oral impression from which a positive reproduction (cast or model) can be formed to enable fabrication of a fixed or removable dental prosthesis.

002.01(B) PRELIMINARY IMPRESSION. A type of oral impression from which a positive reproduction (cast or model) can be formed to fabricate stints, stents, splints, bleaching trays, mouth guards, custom trays, orthodontic appliances and devices, and therapeutic appliances or for direct (intraoral) fabrication of a provisional fixed prostheses. A preliminary impression may not be used for indirect fabrication of a fixed or removable prosthesis.

002.02 ORTHODONTIC APPLIANCES. Braces, brackets, tubes, wires, ties, and similar material used in realigning teeth.

002.03 ORTHODONTIC DEVICES. Devices used to correct or maintain tooth position or occlusal relationship. Such devices include retainers, space maintainers, expanders, clear aligners, and similar functional devices.

002.04 PROSTHESIS. Artificial replacement of any part of the body related to teeth, jaws, or related structures.

002.04(A) DEFINITIVE REMOVABLE PROSTHESIS. Prosthesis which is used over an extended period of time.

002.04(B) DENTAL PROSTHESIS. Any device or appliance that replaces one or more missing teeth or associated structures. It includes crowns, inlays or onlays, bridges, dentures, obturators, or gingival prostheses.

002.04(C) FIXED PROSTHESIS. Non-removable dental prosthesis which is solidly attached to abutment teeth, roots, or implants.

002.04(D) FIXED REMOVABLE PROSTHESIS. Combined prosthesis, one or more parts of which are fixed, and the other(s) attached by devices which allow their detachment, removal, and reinsertion by the dentist only.

002.04(E) INTERIM PROSTHESIS. A prosthesis designed for use over a limited period of time.

002.04(F) REMOVABLE PROSTHESIS. Complete or partial prosthesis which can be removed and reinserted by the consumer.

002.05 RESTORATION.

002.05(A) SIMPLE RESTORATION FOR ONE SURFACE. A restoration that involves single surfaces of a tooth as in Class I, Class V, and Class VI restorations.

002.05(A)(i) CLASS I RESTORATION. Restoration of a lesion or cavity that occurs in pits and fissures on the facial, lingual, and occlusal surfaces of molars and premolars and lingual surfaces of maxillary anterior teeth.

002.05(A)(ii) CLASS V RESTORATION. Restoration of a lesion or cavity that occurs in smooth facial and lingual surfaces in the gingival third of a tooth.

002.05(A)(iii) CLASS VI RESTORATION. Restoration of a lesion or cavity that occurs on the incisal edges of anterior teeth or cusp tips of posterior teeth.

002.05(B) COMPLEX RESTORATION FOR MULTIPLE SURFACES. Restoration of a tooth that involves multiple surfaces of the tooth, as in Class II, Class III, and Class IV restorations.

002.05(B)(i) CLASS II RESTORATION. Restoration of a lesion or cavity that occurs in the proximal surfaces of the posterior teeth (molars and premolars).

002.05(B)(ii) CLASS III RESTORATION. Restoration of a lesion or cavity that occurs in the proximal surfaces of anterior teeth and do not involve an incisal angle.

002.05(B)(iii) CLASS IV RESTORATION. Restoration of a lesion or cavity that occurs in the proximal surfaces of the anterior teeth that involves an incisal angle.

002.06 OBJECTIVE STANDARD SETTING METHOD. A criterion-referenced standard setting method which is used for pre-determining an absolute standard based on the difficulty of the items.

002.07 THERAPEUTIC DENTAL APPLIANCE. An appliance designed to treat a dental condition or used as a surgical stent or radiographic guide.

003. LICENSE REQUIREMENTS . To obtain a license, an individual must submit a complete application provided by the Department, provide documentation demonstrating that the applicant meets the licensing requirements set out in Neb. Rev. Stats. §§ 38-1118.02 to 38-1118.03, 172 NAC 10, and this chapter.

003.01 EXPERIENCE. Submit employment records or a letter from a licensed dentist showing that the applicant has met the required one thousand five hundred hours of experience assisting a dentist; or

003.02 EDUCATION. Submit an official transcript, sent directly from the issuing institution, verifying graduation from an accredited dental assisting program.

003.03 EXAMINATION. All applicants must:

(A) Demonstrate passage of the Certified Dental Assistant examination administered by the Dental Assisting National Board with a passing score as established using the Objective Standard Setting method; and (B) Pass the jurisprudence examination with a score of 75 or above.

003.04 RECIPROCITY. To obtain a license based on reciprocity, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. § 38-129.02, 172 NAC 10, and this chapter.

003.05 RESIDENCY. All applicants receiving a license pursuant to 172 NAC 53 must submit documentation of establishing residency in Nebraska as required by Neb. Rev. Stat. § 38-129.02. Such documentation must be submitted within 90 days of establishment of residency and consist of a rental or lease agreement with the signature of the owner or landlord and the applicant, a deed or title to residential real property with the name of the applicant as an owner, or documents with the name and address of the applicant such as mortgage bills, home utility bills, medical or employee documents or similar documents that show the applicant residing in Nebraska.

004. REMEDIAL COURSE . Any applicant who has failed on two occasions to pass any part of the practical examination will be required to complete a remedial course in accordance with Neb. Rev. Stat. § 38-1119. To receive approval of a remedial course an applicant must submit a complete application and the following:

(A) Description of the subject matter of the remedial course. The subject matter for the remedial course must cover the content of the section(s) of the regional or state practical examination that the applicant failed; (B) Name, title, and qualifications (vitae or resume) of faculty member providing the remedial instruction; (C) Number of hours of didactic instruction, number of hours of clinical instruction, number of hours under direct supervision, and total number of hours in the remedial course. A remedial course must include a minimum of 15 hours of didactic and clinical instruction, of which at least 10 hours must be under the direct supervision of the faculty member providing the remedial instruction; (D) A written plan of evaluation for the course, indicating the method of evaluation; (E) A statement bearing the school seal from the institution providing the remedial course indicating that the course meets the criteria for approval; and (F) The signature of the faculty member providing course and the date signed.

005. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10. All licenses and permits expire on March 1 of each odd-numbered year.

006. CONTINUING EDUCATION . On or before March 1 of each odd-numbered year, each licensed dental assistant must complete at least 30 hours of acceptable continuing education hours during the preceding 24-month period. Each licensee is responsible for maintaining certificates or records of continuing education.

006.01 ACCEPTABLE CONTINUING EDUCATION TOPICS AND ACTIVITIES. The following are acceptable continuing education topics and activities:

(A) State and national meetings of the local, state, or American Dental Association; local, state, or American Dental Assistants Association; local, state, or American Dental Hygiene Association; or educational programs sponsored by the recognized specialty groups of the American Dental Association; (B) Nebraska Dental Assistant Association state, local, and study club meetings; (C) Formal education courses which relate directly to the practice of dentistry, dental assisting or expanded function dental assisting as applicable to the license or permit; (D) College or University-sponsored courses in continuing education in dental assisting; (E) Licensee acting as table clinician or lecturer to licensed dental assistants or licensee attending table clinics; (F) Home study with a testing mechanism. If there is no testing mechanism or certificate of completion, the licensee must submit an abstract or summary of the material covered to the Board of Dentistry. The abstract or summary must be written by only the licensee and will be reviewed. Interactive webinars which include the ability of the participant to interact with the presenter are not considered home study; (G) Direct clinical observation; (H) Initial cardiopulmonary resuscitation (CPR) certification or cardiopulmonary resuscitation recertification; (I) Faculty overseeing student dental assistant or expanded function dental assisting clinics; (J) Dental public health continuing education; (K) Well-being or substance abuse continuing education; (L) Infection control continuing education; (M) Practice management continuing education; (N) Presentation or development of a continuing education program for dental assistants by a licensee; (O) Expanded functions for which a permit is held by the licensee; or (P) Participating in a volunteer activity such as Mission of Mercy or equivalent.

006.02 NO PRE-APPROVAL. The Board of Dentistry does not pre-approve continuing education programs or activities.

006.03 CONTINUING EDUCATION WORKSHOP, ACTIVITY, OR PROGRAM CRITERIA. To be considered acceptable for continuing education, a workshop, activity, or program must meet the following criteria:

(A) Be at least 50 minutes in duration; (B) Objectives must relate to the practice of dentistry, dental assisting, or expanded function dental assisting as applicable to the license; (C) Presenters of programs must be qualified by education, experience, or training; (D) Must be open to all dental assistants licensed by Nebraska who meet the pre-requisites for the program; and (E) The provider must have a process for verifying attendance and issue a certificate of attendance. Each certificate must include the following:

(i) Program name; (ii) Name of the participant and license number; (iii) Provider’s name; (iv) Date the program began and ended; and (v) Number of hours received by the licensee.

006.04 CRITERIA FOR A HOME STUDY PROGRAM. To be considered acceptable, a home study program must meet the following criteria:

(A) Objectives must relate to the practice of dentistry, dental assisting, or expanded function dental assisting as applicable to the license; (B) Must have a post-test or other method of assessment which verifies that the licensee completed the program; and (C) Author(s) of home study programs must meet the following qualifications;

(i) Have experience in the content and subject matter; (ii) Have expertise in teaching and instructional methods suitable to subject presented; and (iii) Have suitable academic qualifications, certification credentials, or experience for subject presented.

006.05 CREDIT HOUR CALCULATIONS. Subject to the credit number limitations and requirements set out in this regulation a licensed dental assistant may receive credit for acceptable continuing education activities. Credits earned in excess of 30 hours in a 24-month renewal period do not carry over into the following period.

(A) A maximum of 10 hours each in the renewal period, may be obtained

(i) Through home study; or (ii) Initial cardiopulmonary resuscitation (CPR) certification.

(B) A maximum of 2 hours each in the renewal period, may be obtained

(i) As a table clinician; (ii) A lecturer; or (iii) For direct clinical observation.

(i) For cardiopulmonary resuscitation (CPR) re-certification; or (ii) For practice management continuing education.

(D) A maximum of 5 hours each in the renewal period may be obtained

(i) For faculty overseeing student dental assistant or expanded function dental assisting clinics; (ii) For dental public health continuing education; (iii) For well-being or substance abuse continuing education; (iv) For ethics and professionalism continuing education; or (v) For participating in a volunteer activity such as Mission of Mercy or equivalent.

(E) Credit may be claimed only for actual time in attendance and only for the time which meets the criteria for a continuing education activity. (F) A licensee who is a presenter of a continuing education program may receive a maximum of 2 hours for the creation of a presentation, and a maximum of 2 hours for the initial presentation of the program during a renewal period. Credit will not be given to the licensee for subsequent presentations of the same program. (G) A minimum of 2 hours in the renewal period must be obtained in infection control continuing education. (H) A minimum of 2 hours in the renewal period must be obtained in each area for which a licensee holds an expanded function permit.

007. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179 and includes the following:

(A) Exercising influence on the consumer in such a manner as to exploit the patient or client for the financial gain of the applicant, credential holder or permit holder, or of a third party, which includes, but is not limited to, the promotion or sale of services, goods, appliances, or drugs; (B) Refusing to provide professional service to a consumer because of such consumer's race, creed, color, sex, national origin, disability, or familial status; (C) Providing dental assisting or expanded function dental assisting services contrary to the current statutes and regulations; (D) Any departure from or failure to conform to the ethics of the “AMERICAN DENTAL ASSISTANT ASSOCIATION (ADAA) PRINCIPLES OF ETHICS AND CODE OF CONDUCT” as published in 2013; (E) Misrepresentation of material facts in applying for or procuring a renewal of a credential or permit; (F) Misrepresenting the material facts of one’s credentials in an application submitted to a healthcare facility, insurance company, or prospective employer; or (G) Disruptive behavior as manifested by the credential holder’s aberrant behavior which interferes with consumer care or could reasonably be expected to interfere with consumer care, including, but not limited to, the following:

(i) Outbursts of rage or violent behavior; (ii) Throwing of instruments, records, or objects; (iii) Insulting comments to a consumer, consumer’s family, dental staff, or other healthcare professionals; (iv) Striking or assaulting a consumer, consumer’s family member, dental staff, or other healthcare professionals; or (v) Poor hygiene.

008. COURSE APPROVAL CRITERIA . The following criteria must be met to obtain approval for all courses except for simple restoration for one surface, complex restorations for multiple surfaces, and coronal polishing:

(A) Be part of an accredited dental assisting training program or offered as a separate course by a program accredited by the American Dental Association Commission on Dental Accreditation or a substantially equivalent accrediting organization; (B) Be led by an instructor of the course who is qualified by education and experience; and (C) Provide the attendee with written verification of demonstrated competency upon completion of the course.

008.01 DENTAL X-RAY. To obtain approval as a dental x-ray course the course must include a minimum of 16 hours of classroom instruction on dental x-ray.

008.02 FIXED PROSTHODONTICS. To obtain approval as a fixed prosthodontics course the course must include both written and practical examinations to determine whether the student has demonstrated the necessary knowledge and proficiency to complete final impressions and records for fixed prostheses.

008.03 FINAL DENTAL IMPRESSIONS AND MINOR ADJUSTMENTS FOR REMOVABLE PROSTHESES. To obtain approval as a final dental impressions and minor adjustments course the course must include both written and practical examinations to determine whether the student has demonstrated the necessary knowledge and proficiency to complete final impressions and records for and to make minor adjustments to definitive prostheses.

008.04 CEMENTING PREFABRICATED FIXED PROSTHESES ON PRIMARY TEETH. To obtain approval as a cementing prefabricated fixed prostheses on primary teeth course the course must include both written and practical examinations to determine whether the student has demonstrated the necessary knowledge and proficiency to fit and cement primary crowns.

008.05 MONITORING AND ADMINISTERING NITROUS OXIDE ANALGESIA. To obtain approval as a monitoring and administering nitrous oxide analgesia course the course must include both written and practical examinations to determine whether the student has demonstrated the necessary knowledge and proficiency to monitor and administer nitrous oxide.

008.06 SIMPLE RESTORATION FOR ONE SURFACE. To obtain approval as a simple restoration for one surface course the course must:

(A) Be offered as a separate course by a program accredited by the American Dental Association Commission on Dental Accreditation or a substantially equivalent accrediting organization; (B) Be led by an instructor of the course who is qualified by education and experience; (C) Provide the attendee with written verification of demonstrated competency upon completion of the course; and (D) Include both written and practical examinations to determine whether the student has acquired the necessary knowledge and proficiency to place simple restorations for one surface which can include Class I, Class V, or Class VI.

008.07 COMPLEX RESTORATIONS FOR MULTIPLE SURFACES. To obtain approval as a complex restorations for multiple surfaces course the course must:

(A) Be offered as a separate course by a program accredited by the American Dental Association Commission on Dental Accreditation or a substantially equivalent accrediting organization; (B) Be led by an instructor of the course who is qualified by education and experience; (C) Provide the attendee with written verification of demonstrated competency upon completion of the course; and (D) Include both written and practical examinations to determine whether the student has acquired the necessary knowledge and proficiency to place complex restorations for multiple surfaces which can include Class II, Class III, or Class IV.

008.08 CORONAL POLISHING. To obtain approval as a coronal polishing course, the course must.

(A) Be offered at an accredited college or institution; (B) Be led by an instructor of the course who is qualified by education and experience; and (C) Contain a minimum of 14 contact hours of coronal polishing instruction which include at least 10 hours of didactic instruction and 4 hours of clinical participation.

008.09 COURSE CHANGES. All entities with approved courses shall keep the Board of Dentistry informed of any changes in course objectives and content at the time such change occurs.

008.10 CONDITIONS OF APPROVAL. Courses that fail to meet or continue to meet criteria for approval of a course may be denied or rescinded upon recommendation by the Board of Dentistry.

009. EXPANDED FUNCTION PERMIT . To obtain a permit to practice an expanded function, an individual must submit a completed application provided by the Department and meet the requirements of Neb. Rev. Stat. § 38-1118.03, Neb. Rev. Stat. § 38-1135, and the following:

009.01 EDUCATION. Provide to the Department:

(A) Employment or staffing records or other reports from an employer(s) demonstrating 1,500 hours of experience as a licensed dental assistant; (B) Documentation of successful completion, after obtaining an initial license to practice dental assisting, of an approved course for the expanded function permit that has been requested; and (C) Score reports sent directly to the Department from the issuing institution showing successful completion of one or both examinations taken after 1500 hours of work experience, for simple restoration for one surface or complex restoration for multiple surfaces with a score of 75 or above to demonstrate meeting the requirements of this chapter.

009.02 EXAMINATION.

(A) An applicant for a permit to perform simple restoration for one surface must pass the practical examination on simple restoration for one surface administered by the Central Regional Dental Testing Service or any other comparable regional or state practical examination approved by the Board of Dentistry with a score of 75 or above; (B) An applicant for a permit to perform complex restoration on multiple surfaces must pass the practical examination on complex restoration for multiple surfaces administered by the Central Regional Dental Testing Service or another comparable regional or state practical examination approved by the Board of Dentistry with a score of 75 or above; (C) Pass the jurisprudence exam specific to expanded functions with a score of 75 or above; and (D) Scores from any of the practical examinations approved by the board are good for up to five years from the date the examination was passed.

010. CORONAL POLISHING . Dental assistants may under indirect supervision of a licensed dentist, polish all exposed tooth surface with a rubber cup or brush driven by a conventional slow-speed hand piece, after meeting the requirements of Dentistry Practice Act and the following:

010.01 REQUIREMENTS. The following requirements must be met prior to providing coronal polishing procedures.

(A) EDUCATION. Have graduated from a dental assisting training program which is accredited and includes a coronal polishing course; or (B) EXPERIENCE. Have 1 year (a minimum of 1,500 hours) of clinical work experience as a dental assistant and have successfully completed a course in polishing procedures which is approved by the Board and the Department.

011. ADDITIONAL PROCEDURES . Additional allowed dental procedures are set out in Neb. Rev. Stat. § 38-1135 and this chapter.

011.01 MONITORING NITROUS OXIDE. To monitor nitrous oxide a dental assistant must hold current certification in healthcare cardiopulmonary resuscitation (CPR) from a course accredited by the American Heart Association, American Red Cross, or an equivalent certification approved by the Board of Dentistry.

011.02 ADDITIONAL DUTIES AS ASSIGNED. A dental assistant under the supervision of a licensed dentist may perform the following:

(A) Provide infection control practices which meet the national standards for dental facilities as outlined by the Centers for Disease Control Summary of Infection Prevention Practices In Dental Settings as published October of 2016; and (B) Complete any task or procedure, that does not require the professional skill or judgment of a licensed dentist or licensed hygienist, except the following;

(i) Cutting of hard and soft tissue; (ii) Irreversible procedures; (iii) Restorative dentistry; (iv) Making a dental diagnosis; or (v) Fabricating a treatment plan.

012. REINSTATEMENT . For reinstatement, the applicant must meet the requirements set out in 172 NAC 10.

013. LICENSE FEES . The initial and renewal fees for dental assistant licenses are $95 each.

013.01 EXPANDED FUNCTION PERMIT. The initial and renewal fees for expanded function permits are $25 each.

013.02 ADDITIONAL PROCEDURES. Fees to add additional procedures to a license that require proof of education and examination are $10 per application.

History

Effective 2024-06-02

Chapter 55 Dental Office Maintenance

Neb. Admin. Code tit. 172, ch. 55 Dental Office Maintenance {#sec-172-nac-55 omnilex-key=us-ne-regs-official--title-172--172 NAC 55}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 55 DENTAL OFFICE MAINTENANCE

001. SCOPE AND AUTHORITY . These regulations govern Dental office maintenance as set out in Nebraska Revised Statute (Neb. Rev. Stat.) § 38-1125.

002. SPACE . In order to maintain conditions of safety and sanitation, each dental office shall contain adequate space for a clinical area, reception room, supply room, toilet facilities, and facilities to maintain sanitary conditions.

003. WATER . Each dental office must be supplied with hot and cold running water in such quantities as necessary to conduct such a dental office in a sanitary manner. Connections shall be made to a municipal or other public water supply system whenever feasible.

004. MAINTENANCE . Dental offices shall be kept well lighted, well ventilated, and in a sanitary condition. All windows, walls, floors, areas used by patients, and all furniture and fixtures must be kept clean at all times.

005. TOWELS . All linen, towels, and similar material must be strictly single service use for each patient. If reusable, no towel or linen that has been used on one patient shall be used on another patient until it has first been properly laundered.

006. EQUIPMENT, INSTRUMENTS, AND IMPLEMENTS . All dental machines and equipment utilizing electrical components must be properly and safely installed, operated, and maintained. All dental instruments and implements which come in contact with patients must be sanitized and any instruments coming in contact with a-patient's bodily secretions shall be sterilized before use on any other patient.

History

Effective 2020-09-15

Chapter 56 Licensure of Dentists; Minimal, Moderate, or General Anesthesia / Deep Sedation

Neb. Admin. Code tit. 172, ch. 56 Licensure of Dentists; Minimal, Moderate, or General Anesthesia / Deep Sedation {#sec-172-nac-56 omnilex-key=us-ne-regs-official--title-172--172 NAC 56}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of dentistry under Nebraska Revised Statutes (Neb. Rev. Stats.) §§ 38-1101 to 38-1152 of the Dentistry Practice Act and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions set out in the Dentistry Practice Act, the Uniform Credentialing Act, Title 172 Nebraska Administrative Code (NAC) 10, 172 NAC 53, and 172 NAC 57 apply to this chapter.

003. LICENSE REQUIREMENTS . To obtain a temporary license or an initial license, an individual must submit a complete application provided by the Department, provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. §§ 38-1117 or 38-1120, Neb. Rev. Stat. § 38-131, 172 NAC 10, and these regulations.

003.01 EXAMINATION. Applicants must meet the requirements of Neb. Rev. Stat. § 38-1117 by:

(A) Passage of the Joint Commission on National Dental Examinations (JCNDE) licensure examination with a score of 75 or above or equivalent as approved by the Board; (B) Passage of the practical examination with the score of 75 or above on each part of the examination within the past 5 years; and (C) Passage of the jurisprudence examination with a score of 75 or above.

003.02 EXPERIENCE. Applicants applying for an initial license or a temporary license on the basis of a credential in another jurisdiction must meet the requirements set for in 172 NAC 56-003.01 except for subsection 003.01(B).

003.03 RECIPROCITY. To obtain a license based on reciprocity, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. § 38-129.02, 172 NAC 10, and this chapter.

003.04 RESIDENCY. All applicants receiving a license pursuant to 172 NAC 56-003.03 must submit documentation of establishing residency in Nebraska as required by Neb. Rev. Stat. § 38-129.02. Such documentation must be submitted within 90 days of establishment of residency and consist of a rental or lease agreement with the signature of the owner or landlord and the applicant, a deed or title to residential real property with the name of the applicant as an owner, or documents with the name and address of the applicant such as mortgage bills, home utility bills, medical or employee documents or similar documents that show the applicant residing in Nebraska.

004. DENTAL LOCUM TENENS . A dental locum tenens license may be issued under the following circumstances:

(A) The unavailability of a Nebraska licensed dentist due to vacation, sickness or hospitalization, or other similar leaves of absence; (B) A public health emergency in the state of Nebraska such as incidents of widespread disease, natural or manmade disaster, or similar causes; or (C) For volunteer dental services such as the Mission of Mercy Program.

004.01 DENTAL LOCUM TENENS REQUIREMENTS. To receive a dental locum tenens license, an applicant must submit a completed application provided by the Department and meet all requirements set in Neb. Rev. Stat. § 38-1122 and the requirements in this chapter.

005. REMEDIAL COURSE . Any applicant who has failed on two occasions to pass any part of the practical examination will be required to complete a remedial course in accordance with Neb. Rev. Stat. § 38-1119. To receive approval of a remedial course an applicant must submit a complete application and the following:

006. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10. All dentistry licenses and permits expire on March 1 of each odd-numbered years.

007. CONTINUING EDUCATION . On or before March 1 of each odd-numbered year, each dentist holding an active license must complete at least 30 hours of acceptable continuing education during the preceding 24-month period. Each licensee is responsible for maintaining certificates or records of continuing education. A dentist holding a dental locum tenens license is not required to meet continuing education requirements. Temporary dental licenses will expire 1 year from the date of issuance, or when the postgraduate or residency program ends and are not required to meet continuing education requirements.

007.01 ACCEPTABLE CONTINUING EDUCATION TOPICS AND ACTIVITIES. The following are acceptable continuing education sources and activities:

(A) State and national meetings of the local, state, or American Dental Association, local, state, or National Dental Association, or educational programs sponsored by the recognized specialty groups in dentistry of the American Dental Association; (B) Attendance at district meetings and study clubs; (C) Formal education courses which relate directly to the practice of dentistry; (D) College or University-sponsored courses in continuing education in dentistry; (E) Licensee acting as table clinician or lecturer to licensed dentists, licensed dental hygienists, licensed or unlicensed dental assistants or licensee attending table clinics; (F) Home study with a testing mechanism. If there is not a testing mechanism or certificate of completion, the licensee must submit an abstract or summary of the material covered to the Board of Dentistry. The abstract or summary must be written by only the licensee and will be reviewed. Interactive webinars which include the ability of the participant to interact with the presenter are not considered home study; (G) Direct clinical observation; (H) Initial cardiopulmonary resuscitation (CPR) certification or cardiopulmonary resuscitation recertification; (I) Faculty overseeing dental clinic education of students; (J) Dental public health continuing education; (K) Ethics and professionalism continuing education; (L) Well-being or substance abuse continuing education; (M) Infection control continuing education; (N) Practice management continuing education; (O) Administration and management of anesthesia or sedation for the dental office continuing education; (P) Prescribing opiates and the prescription drug monitoring program continuing education; or (Q) Participating in a volunteer activity such as Mission of Mercy or equivalent.

007.02 CONTINUING EDUCATION CRITERIA. To be considered acceptable for continuing education, the activity must meet the following criteria:

(A) Be at least 50 minutes in duration; (B) Objectives must relate to the practice of dentistry; (C) Presenters must be qualified by education, experience, or training; (D) Must be open to all licensed dentists who meet the pre-requisites for the activity; and (E) The provider must have a process for verifying attendance and issue a certificate of attendance for each participant. Each certificate must include the following:

(i) Program name; (ii) Name of the participant and the participant’s license number; (iii) Provider’s name; (iv) Dates the activity began and ended; and (v) Number of hours attended by the licensee.

007.03 CRITERIA FOR A HOME STUDY PROGRAM. To be considered acceptable for continuing education, a home study program must meet the following criteria:

(A) Objectives must relate to the practice of dentistry; (B) Must have a post-test or other method of assessment which verifies that the licensee completed the program; and (C) The authors(s) or developer(s) of the program must meet the following qualifications:

(i) Experience in the content and subject matter of the program; (ii) Expertise in teaching and instructional methods suitable to the subject presented; and (iii) Suitable academic qualifications, certification credentials, or experience for or in the subject of the program.

007.04 CREDIT HOUR CALCULATIONS. Credits earned in excess of thirty hours in a 24-month renewal period do not carry over into the following period. A dentist may receive credit for acceptable continuing education activities, subject to the credit number limitations and requirements set out below:

(A) A maximum of 10 hours each in a renewal period may be obtained through home study or for initial cardiopulmonary resuscitation (CPR) certification; (B) A maximum of 2 hours each in a renewal period may be obtained as a table clinician or lecturer or for direct clinical observation; (C) A maximum of 4 hours each in a renewal period may be obtained for cardiopulmonary resuscitation (CPR) re-certification or practice management continuing education; (D) A maximum of 5 hours in a renewal period may be obtained for faculty overseeing dental clinic education of students; (E) A minimum of 2 hours in a renewal period must be obtained in infection control continuing education; (F) If the licensee prescribes controlled substances, continuing education that meets the requirements set in Neb. Rev. Stat. § 38-145; (G) A minimum of 6 hours in a renewal period must be obtained in general anesthesia or sedation administration and management for the dental office continuing education for licensees holding any level of sedation permit; (H) A minimum of 8 hours in an American Heart Association Certified “hands on” course in Advanced Cardiovascular Life Support (ACLS) must be obtained for moderate and general sedation permits; (I) A licensee who is a presenter of a continuing education program may receive a maximum of 2 hours for the creation of a presentation, and a maximum of 2 hours for the initial presentation of the program during a renewal period. Credit will not be given to the licensee for subsequent presentations of the same program; or (J) A maximum of 5 hours in a renewal period for participating in a volunteer activity such as Mission of Mercy or equivalent.

008. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179 and includes the following:

(A) Failure to keep written dental records and medical history records justifying the course of treatment of the consumer including, but not limited to, patient histories, examination results, test results, and X-rays, if taken; (B) Exercising influence on the consumer in such a manner as to exploit the consumer for the financial gain of the applicant, credential holder or permit holder, or of a third party, which includes, but is not limited to, the promotion or sale of services, goods, appliances, or drugs; (C) Refusing to provide professional service to a consumer because of such consumer’s race, creed, color, sex, national origin, disability, or familial status; (D) Prescribing, selling, administering, or distributing any drug legally classified as a prescription drug other than for accepted dental therapeutic purposes; (E) Use of nitrous oxide or inhalants for other than dental therapeutic purposes; (F) Giving fraudulent prescriptions; (G) Maintaining fraudulent controlled substance records; (H) Failure to furnish the Board or Department, their inspectors or representatives, information legally requested by the Board or the Department; (I) Failure to submit a written report to the Board as required by Neb. Rev. Stat. § 38-1147; (J) Allowing a dental hygienist, licensed dental assistant, or a dental assistant to provide or perform services contrary to the statutes or regulations; (K) Any departure from or failure to conform to the American Dental Association’s (ADA) Principles of Ethics and Code of Professional Conduct as published in November, 2018 excluding section 4.A. Patient Selection; (L) Misrepresenting the material facts of an individual’s credential(s) in an application submitted to a healthcare facility, insurance company, or prospective employer; (M) Prescribing drugs to an individual based solely on answers to questions provided by tele-dentistry without first establishing a proper dentist-patient relationship; (N) Disruptive behavior such as:

(i) Outbursts of rage or violent behavior; (ii) Throwing of instruments, records, or objects; (iii) Striking, assaulting, or using insulting comments to a consumer, consumer’s family member, dental staff, or other healthcare professionals; or (iv) Poor hygiene;

(O) Refusal to cooperate or failure to furnish requested information during any investigation by the Department; (P) Failure to ensure that the location requirements in this chapter for a general anesthesia or deep sedation permit or moderate sedation permit are met when the anesthesia or sedation for dental procedures at the location is provided by the dentist or an individual other than the dentist; (Q) Failure to exercise appropriate supervision over persons who are authorized to practice only under the supervision of a dentist; or (R) Advertising as an American Dental Association Specialist without having completed a post-doctoral program in a specialty area of dentistry consisting of at least 2 full-time years and which is accredited by an accreditation agency that is recognized by the United States Department of Education.

009. INITIAL ANESTHESIA OR SEDATION PERMIT . To receive a permit to administer general anesthesia or deep sedation, moderate sedation or minimal sedation at a location, an individual must submit a complete application for each location and meet all statutory requirements and the requirements in this chapter.

009.01 EDUCATION. An applicant must demonstrate the following:

(A) For a general anesthesia or deep sedation permit:

(i) Fellowship in the American Dental Society of Anesthesiology; or (ii) Successful completion of an advanced education program that is equivalent to that required for obtaining a fellowship as approved by the Board.

(B) For a moderate sedation permit:

(i) Fellowship in the American Dental Society of Anesthesiology; or (ii) Successful completion of an advance education program approved by the Board that has at least 60 combined didactic and clinical hours of comprehensive and appropriate training necessary to administer and manage moderate sedation.

(i) Successful completion of an advanced education program approved by the Board that has at least 16 hours of comprehensive and appropriate training necessary to administer and manage minimal sedation; (ii) Training to the level of competency in minimal sedation consistent with the standards set by the American Dental Association for providing such sedation or approved by the board as substantially equivalent to such training; or (iii) A comprehensive training program in minimal sedation approved by the Board.

009.02 CERTIFICATION. An applicant must demonstrate the following:

(A) For a general anesthesia or deep sedation permit:

(i) Current certification in basic life-support skills for health care providers from the American Heart Association or from a substantially equivalent course as approved by the Board and (ii) Current certification in a hands on advanced cardiac life support from the American Heart Association; or (iii) Successful completion of an emergency management course for anesthesia and dental sedation approved by the Board as substantially equivalent to the course in this chapter.

(B) For a moderate sedation permit:

(i) Current certification in basic life-support skills for health care providers from the American Heart Association or from a substantially equivalent course as approved by the Board; and (ii) Current certification in a hands on advanced cardiac life support from the American Heart Association; or (iii) Successful completion of an emergency management course for anesthesia and dental sedation approved by the Board as substantially equivalent to the course in this chapter.

(i) Meet the requirements set out in this chapter; and (ii) If sedation will be provided to individuals 12 years of age and under, have current certification in pediatric advanced life support from the American Heart Association or from a substantially equivalent course as approved by the Board.

009.03 FACILITY REQUIREMENTS. An applicant must demonstrate the following:

(A) For a general anesthesia or deep sedation permit or for a moderate sedation permit, each location must have the following:

(i) An operating room large enough to accommodate a patient on a table or in an operating chair and to allow an operating team consisting of at least 3 individuals to freely move about the patient; (ii) An operating table or chair which permits a patient to be positioned so the operating team can maintain an airway, quickly alter a patient’s position in an emergency and provide a firm platform for the management of cardiopulmonary resuscitation (CPR); (iii) A lighting system which permits evaluation of a patient’s skin and mucosal color and a backup lighting system which is battery powered or on-site generator powered and of an intensity to permit completion of any operation underway at the time of a general power failure; (iv) Suction equipment which permits aspiration of the oral and pharyngeal cavities. A backup suction device must be available; (v) An oxygen delivery system with full face masks and connectors that is capable of delivering 100% oxygen to a patient under positive pressure, together with a backup system; (vi) A recovery area that has oxygen, lighting, suction, and electrical outlets. The recovery area can be the operating room. A member of the staff must be able to observe the patient at all times during the recovery period; (vii) Ancillary equipment, which includes the following:

(1) Laryngoscope complete with selection of blades and spare batteries and bulb; (2) Endotracheal tubes and connectors; (3) Oral airways; (4) Endotracheal tube forceps; (5) Pulse oximeter; (6) Carbon Dioxide (CO2) monitor (general anesthesia or deep sedation and either (6) or (7) for moderate sedation); (7) Precordial stethoscope (general anesthesia or deep sedation and either (6) or (7) for moderate sedation; and (8) Electrocardiogram (EKG) (general anesthesia and deep sedation only);

(viii) Drugs with current dates available for treatment of the following medical emergencies:

(1) Laryngospasm and myocardial infarction (general anesthesia or deep sedation only); (2) Bronchospasm; (3) Angina pectoris; (4) Hypotension; (5) Hypertension; (6) Cardiac arrest (general anesthesia or deep sedation only); (7) Convulsions; and (8) Respiratory arrest;

(ix) Drugs for the reversal of anesthesia or sedation agents; and (x) Written procedures for the following:

(1) Preoperative evaluation of patients: (2) Management of medical at-risk patients; (3) Technique and method of administration of general anesthesia or deep sedation or moderate sedation, as applicable; and (4) Management of emergencies; and

(B) For a minimal sedation permit, each location must:

(i) Have an operating room large enough to accommodate a patient on a table or in an operating chair and to permit an operating team consisting of at least 2 individuals to freely move about the patient; (ii) An oxygen delivery system with full face masks and connectors that is capable of delivering 100% oxygen to a patient under positive pressure, together with a backup system; (iii) A recovery area that has oxygen, lighting, suction, and electrical outlets. The recovery area can be the operating room. A member of the staff must be able to observe the patient at all times during the recovery period; (iv) Meet the requirements of this chapter and have oral pharyngeal airway(s), sphygmomanometer, pulse oximeter and a stethoscope; and (v) Written procedures for the following:

(1) Preoperative evaluation of patients; (2) Management of medical at-risk patients; and (3) Management of emergencies.

009.04 STANDARDS OF OPERATION, CARE, AND TREATMENT. The permit holder for each location has the responsibility for the total operation of the location and administration of anesthesia. The permit holder responsibilities include:

(A) Ensuring compliance with all applicable state statutes and relevant rules and regulations; (B) Verifying the current licensure, certification, registration, or other credentials of staff prior to the staff assuming job responsibilities and must have implement procedures for verifying that such credentials are maintained; (C) Ensuring that each location maintains compliance with the requirements of this chapter, as applicable to the type of permit held; (D) Ensuring all sedation medications are administered per manufacturers labeled instructions; and (E) Ensuring the following documentation is kept:

(i) For a general anesthesia or deep sedation permit or for a moderate sedation permit, each location must maintain records which include the following;

(1) Medical history and physical evaluation records for each patient; (2) Anesthesia records for each patient, which must include blood pressure, pulse, drugs, and amounts administered, length of the procedure, and any complications of anesthesia; (3) Name of and documentation verifying any person who assists a dentist in the administration of general or deep sedation or moderate sedation for each procedure; and (4) Documentation that each staff member assisting the permit holder during a procedure has a current certification in basic life-support for health care providers and the permit-holder performing a procedure has current certification in either advanced cardiac life support or has successfully completed an approved emergency management course for anesthesia and dental sedation.

(ii) For a minimal sedation permit, each location must maintain records which include the following:

(1) Medical history prior to the administration of minimal sedation and physical evaluation records for each patient; (2) Documentation of the medication and dosage administered for each patient; (3) Name of the permit holder and any person who assists the permit holder after the administration of minimal sedation for each procedure; and (4) Documentation verifying that the permit holder and any person who assists the permit holder after the administration of minimal sedation has a current certification as set out in this chapter, as applicable.

010. ADDITIONAL PROCEDURES . A dentist may only delegate duties to a dental assistant, a licensed dental assistant or expanded function dental assistant, a dental hygienist or expanded function dental hygienist as provided by Neb. Rev. Stat. §§ 38-1135, 38-1136, 38-1152, 172 NAC 53, and 172 NAC 57.

011. REINSTATEMENT . For reinstatement, the applicant must meet the requirements set out in 172 NAC 10.

012. FEES . Fees are set out in 172 NAC 2 and these regulations.

012.01 ANESTHESIA PERMIT FEES. The initial and renewal fees for all anesthesia permits is $200.

History

Effective 2024-06-02

Chapter 57 Licensure of Dental Hygienists

Neb. Admin. Code tit. 172, ch. 57 Licensure of Dental Hygienists {#sec-172-nac-57 omnilex-key=us-ne-regs-official--title-172--172 NAC 57}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of dental hygienists under Nebraska Revised Statutes (Neb. Rev. Stats.) §§ 38-1101 to 38-1152 of the Dentistry Practice Act and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions set out in the Dentistry Practice Act, the Uniform Credentialing Act, Title 172 Nebraska Administrative Code (NAC) 10, and the following apply to this chapter.

002.01 IMPRESSION. Techniques used to produce a three-dimensional record of an anatomic structure.

002.01(A) FINAL IMPRESSION. A type of oral impression from which a positive reproduction (cast or model) can be formed to enable fabrication of a fixed or removable dental prosthesis.

002.01(B) PRELIMINARY IMPRESSION. A type of oral impression from which a positive reproduction (cast or model) can be formed to fabricate stints, stents, splints, bleaching trays, mouth guards, custom trays, orthodontic appliances and devices and therapeutic appliances or for direct (intraoral) fabrication of a provisional fixed prostheses. A preliminary impression may not be used for indirect fabrication of a fixed or removable prosthesis.

002.02 ORTHODONTIC APPLIANCES. Braces, brackets, tubes, wires, ties, and similar material used in realigning teeth.

002.04 PROSTHESIS. Artificial replacement of any part of the body related to teeth, jaws, or related structures.

002.04(A) DEFINITIVE REMOVABLE PROSTHESIS. Prosthesis which is used over an extended period of time.

002.04(C) FIXED PROSTHESIS. Non-removable dental prosthesis which is solidly attached to abutment teeth, roots, or implants.

002.04(E) INTERIM PROSTHESIS. A prosthesis designed for use over a limited period of time.

002.04(F) REMOVABLE PROSTHESIS. Complete or partial prosthesis which can be removed and reinserted by the consumer.

002.05 RESTORATION.

002.05(A) SIMPLE RESTORATION FOR ONE SURFACE. A restoration that involves single surfaces of a tooth as in Class I, Class V, and Class VI restorations.

002.05(A)(ii) CLASS V RESTORATION. Restoration of a lesion or cavity that occurs in smooth facial and lingual surfaces in the gingival third of a tooth.

002.05(A)(iii) CLASS VI RESTORATION. Restoration of a lesion or cavity that occurs on the incisal edges of anterior teeth or cusp tips of posterior teeth.

002.05(B) COMPLEX RESTORATION FOR MULTIPLE SURFACES. Restoration of a tooth that involves multiple surfaces of the tooth, as in Class II, Class III, and Class IV restorations.

002.05(B)(i) CLASS II RESTORATION. Restoration of a lesion or cavity that occurs in the proximal surfaces of the posterior teeth (molars and premolars).

002.05(B)(ii) CLASS III RESTORATION. Restoration of a lesion or cavity that occurs in the proximal surfaces of anterior teeth and do not involve an incisal angle.

002.05(B)(iii) CLASS IV RESTORATION. Restoration of a lesion or cavity that occurs in the proximal surfaces of the anterior teeth that involves an incisal angle.

002.06 THERAPEUTIC DENTAL APPLIANCE. An appliance designed to treat a dental condition or used as a surgical stent or radiographic guide.

003. LICENSE REQUIREMENTS . To obtain a license, an individual must submit a complete application provided by the Department, provide documentation demonstrating that the applicant meets the licensing requirements set out in Neb. Rev. Stat. §§ 38-1118 to 38-1118.01, 172 NAC 10, and this chapter.

003.01 EXAMINATION. The applicant must be able to demonstrate completion of all of the following:

(A) Pass the licensure examination given by the Joint Commission on National Board Dental Hygiene Examinations (JCNBDHE) with a score of 75 or above; (B) Pass the practical examination administered by the Central Regional Dental Testing Services (CRDTS) with a score of 75 or above or any other regional or state practical examination that the Board of Dentistry determines is substantially equivalent to such practical examination. Scores from any of the licensure practical examinations approved by the Board are accepted for up to 5 years from the date the examination was passed; and (C) Pass the jurisprudence examination with a score of 75 or above.

003.02 RECIPROCITY. To obtain a license based on reciprocity, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. § 38-129.02, 172 NAC 10, and this chapter.

003.03 RESIDENCY. All applicants receiving a license pursuant to 172 NAC 57 must submit documentation of establishing residency in Nebraska as required by Neb. Rev. Stat. § 38-129.02. Such documentation must be submitted within 90 days of establishment of residency and consist of a rental or lease agreement with the signature of the owner or landlord and the applicant, a deed or title to residential real property with the name of the applicant as an owner, or documents with the name and address of the applicant such as mortgage bills, home utility bills, medical or employee documents or similar documents that show the applicant residing in Nebraska.

005. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10. All dental hygiene licenses and permits expire on March 1 of each odd-numbered year.

006. CONTINUING EDUCATION . On or before March 1 of each odd-numbered year, each dental hygienist holding an active license must complete at least 30 hours of acceptable continuing education hours during the preceding 24-month period. Each licensee is responsible for maintaining certificates or records of continuing education.

006.01 ACCEPTABLE CONTINUING EDUCATION TOPICS AND ACTIVITIES. The following are acceptable continuing education topics and activities:

(A) Attendance at meetings of the local, state, or national American Dental Association or local, state, or national American Dental Hygiene Association; local, state, or national American Dental Assistants Association; or educational programs sponsored by the recognized specialty groups in dentistry of the American Dental Association; (B) Attendance at district meetings and study clubs; (C) Formal education courses which relate directly to the practice of dentistry or dental hygiene; (D) College or University-sponsored courses in continuing education in dentistry or dental hygiene; (E) Licensee acting as table clinician or lecturer to licensed dentists, licensed dental hygienists, licensed or unlicensed dental assistants or licensee attending table clinics; (F) Home study with a testing mechanism. If there is not a testing mechanism or certificate of completion, the licensee must submit an abstract or summary of the material covered to the Board of Dentistry. The abstract or summary must be written by only the licensee and will be reviewed. Interactive webinars which include the ability of the participant to interact with the presenter are not considered home study; (G) Direct clinical observation; (H) Initial cardiopulmonary resuscitation (CPR) certification or cardiopulmonary resuscitation recertification; (I) Faculty overseeing dental clinic education of students; (J) Dental public health continuing education; (K) Ethics and professionalism continuing education; (L) Well-being or substance abuse continuing education; (M) Infection control continuing education; (N) Practice management continuing education; (O) Presentation or development of a continuing education program for dental hygienists by a licensee; (P) Expanded functions for which the licensee holds a permit; or (Q) Participating in a volunteer activity such as Mission of Mercy or equivalent.

006.02 NO PRE-APPROVAL. The Board of Dentistry does not pre-approve continuing education programs or activities.

006.03 CONTINUING EDUCATION CRITERIA. To be considered acceptable for continuing education, the activity must meet the following criteria:

(A) Be at least 50 minutes in duration; (B) Objectives must relate to the practice of dental hygiene; (C) Presenters must be qualified by education, experience, or training; (D) Must be open to all licensed dental hygienists who meet the pre-requisites for the activity; and (E) The provider must have a process for verifying attendance and issue a certificate of attendance for each participant. Each certificate must include the following:

006.04 CRITERIA FOR A HOME STUDY PROGRAM. To be considered acceptable for continuing education, a home study program must meet the following criteria;

(A) Objectives must relate to the practice of dental hygiene; (B) Must have a post-test or other method of assessment which verifies that the licensee completed the program; and (C) The authors(s) or developer(s) of the program must meet the following qualifications:

006.05 CREDIT HOUR CALCULATIONS. Credits earned in excess of thirty hours in a 24-month renewal period do not carry over into the following period. A dental hygienist may receive credit for acceptable continuing education activities, subject to the credit number limitations and requirements set out below:

(A) A maximum of 10 hours each in a renewal period may be obtained through home study or for initial cardiopulmonary resuscitation (CPR) certification; (B) A maximum of 2 hours each in a renewal period may be obtained as a table clinician or lecturer or for direct clinical observation; (C) A maximum of 4 hours each in a renewal period may be obtained for cardiopulmonary resuscitation (CPR) re-certification or practice management continuing education; (D) A maximum of 5 hours each in a renewal period may be obtained for faculty overseeing student dental hygiene or expanded function dental hygiene clinics, dental public health continuing education activities, well-being or substance abuse continuing education activities or ethics and professionalism continuing education; (E) A minimum of 2 hours in a renewal period must be obtained in infection control continuing education; (F) A minimum of 2 hours in a renewal period must be obtained in each area for which a licensee holds an expanded function permit; (G) A licensee who is a presenter of a continuing education program may receive a maximum of 2 hours for the creation of a presentation, and a maximum of 2 hours for the initial presentation of the program during a renewal period. Credit will not be given to the licensee for subsequent presentations of the same program; or (H) A maximum of 5 hours in a renewal period for participating in a volunteer activity such as Mission of Mercy or equivalent.

007. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179 and includes the following:

(A) Exercising influence on the consumer in such a manner as to exploit the consumer for the financial gain of the applicant, credential holder or permit holder, or of a third party, which includes, but is not limited to, the promotion or sale of services, goods, appliances, or drugs; (B) Refusing to provide professional service to a consumer because of such consumer’s race, creed, color, sex, national origin, disability, or familial status; (C) Prescribing, selling, administering, or distributing any drug legally classified as a prescription drug other than for accepted dental therapeutic purposes; (D) Giving fraudulent prescriptions; (E) Failure to furnish or refusal to cooperate with the Board or Department, their inspectors or representatives, information legally requested by the Board or the Department; (F) Any departure from or failure to conform to the CODE OF ETHICS FOR DENTAL HYGIENISTS of the “AMERICAN DENTAL HYGIENIST ASSOCIATION (ADHA) BYLAWS & CODE OF ETHICS” as published on June 25, 2018; (G) Misrepresentation of a material fact(s) in applying for or procuring a renewal of a credential or permit; (H) Misrepresenting the material facts of one’s credential(s) in an application submitted to a healthcare facility, insurance company, or prospective employer; or (I) Disruptive behavior such as:

008. COURSE APPROVAL CRITERIA . The following criteria must be met to obtain approval for all courses except for simple restoration for one surface, complex restorations for multiple surfaces:

(A) Be part of an accredited dental hygiene training program or be provided as a separate course by a program accredited by the American Dental Association Commission on Dental Accreditation or a substantially equivalent accrediting organization; (B) Be taught by an instructor who is qualified by education and experience; and (C) Provide the attendee with written verification of demonstrated competency upon completion of the course.

008.01 INTERIM THERAPEUTIC RESTORATION TECHNIQUE. To obtain approval as a course on interim therapeutic restoration technique the course must include both written and practical examinations to determine whether a student has demonstrated the necessary knowledge and proficiency to perform interim therapeutic restoration technique.

008.02 WRITING PRESCRIPTIONS FOR MOUTH RINSES AND FLUORIDE PRODUCTS. To obtain approval as a course on writing prescriptions for mouth rinses and fluoride products the course must include written examinations to determine whether the student has demonstrated the necessary knowledge and proficiency to write prescriptions for mouth rinses and fluoride products.

008.03 ADMINISTERING AND TITRATING NITROUS OXIDE ANALGESIA. To obtain approval as a course on administering and titrating nitrous oxide analgesia the course must include both written and practical examinations to determine whether a student has acquired the necessary knowledge and proficiency to administer and titrate nitrous oxide analgesia.

008.04 MINOR DENTURE ADJUSTMENTS. To obtain approval as a course on minor denture adjustments the course must include both written and practical examinations to determine whether a student has acquired the necessary knowledge and proficiency to perform minor denture adjustments.

008.05 SIMPLE RESTORATION FOR ONE SURFACE. To obtain approval as a simple restoration for one surface course the course must:

008.06 COMPLEX RESTORATIONS FOR MULTIPLE SURFACES. To obtain approval as a complex restorations for multiple surfaces course the course must:

(A) Be offered as a separate course by a program accredited by the American Dental Association Commission on Dental Accreditation or a substantially equivalent accrediting organization; (B) Be led by an instructor of the course who is qualified by education and experience; (C) Provide the attendee with written verification of demonstrated competency upon completion of the course; and (D) Include both written and practical examinations to determine whether a student has acquired the necessary knowledge and proficiency to perform complex restorations for multiple surfaces which can include Class II, Class III, or Class IV.

008.07 ADMINISTERING LOCAL ANESTHESIA. To obtain approval as a course on administering local anesthesia the course must:

(A) Be offered by a program accredited by a regional or professional accrediting organization which is recognized by the United States Department of Education; and (B) Meet the requirements set out in Neb. Rev. Stat. § 38-1132(2).

008.08 COURSE CHANGES. All entities with approved courses must inform the Board of any changes in course objectives and content at the time such change occurs.

008.09 CONDITIONS OF APPROVAL. Courses that fail to meet the criteria for approval may be denied approval or have the approval rescinded by the Board or Department, as applicable.

009. EXPANDED FUNCTION PERMITS . To receive a permit to practice an expanded function an individual must submit a completed application and meet the requirements set forth in Neb. Rev. Stats. §§ 38-1118.01, 38-1130, 38-1132, and 38-1152, as applicable, and these regulations.

009.01 EDUCATION. Provide to the Department:

(A) Employment or staffing records or other reports from an employer(s) demonstrating 1,500 hours of experience as a licensed dental hygienist in Nebraska or any United States jurisdiction with substantially similar standards or a combination of such experience as allowed by law; (B) Documentation of successful completion, after obtaining an initial license to practice dental hygiene, of an approved course for the expanded function permit that has been requested; and (C) Score reports sent directly to the Department from the issuing institution showing successful completion of one or both examinations taken after 1500 hours of work experience, for simple restoration for one surface or complex restoration for multiple surfaces with a score of 75 or above to demonstrate meeting the requirements of this chapter.

009.02 EXAMINATION.

(A) An applicant for a permit to perform simple restoration for one surface must pass the practical examination on simple restoration for one surface administered by the Central Regional Dental Testing Service or any other comparable regional or state practical examination approved by the Board of Dentistry with a score of 75 or above; (B) An applicant for a permit to perform complex restoration on multiple surfaces must pass the practical examination on complex restoration for multiple surfaces administered by the Central Regional Dental testing Service or another comparable regional or state practical examination approved by the Board of Dentistry with a score of 75 or above; (C) Pass the jurisprudence exam specific to Expanded Functions with a score of 75 or above; and (D) Scores from any of the practical examinations approved by the board are good for up to five years from the date the examination was passed.

010. LOCAL ANESTHESIA PERMIT . To obtain a local anesthesia permit an individual must submit a completed application provided by the Department and meet the requirements set forth in Neb. Rev. Stat. § 38-1132.

011. PUBLIC HEALTH AUTHORIZATION . To obtain a public health authorization an individual must submit a completed application provided by the Department and meet the requirements set forth in Neb. Rev. Stat. § 38-1130.

012. ADDITIONAL PROCEDURES . In addition to those permitted by Neb. Rev. Stat. § 38-1133, and Neb. Rev. Stat. § 38-1136(5) a licensed dental hygienist under the supervision of a licensed dentist may perform the following:

(A) Complete any task or procedure that does not require the professional skill or judgment of a licensed dentist except the following;

(i) Cutting of hard and soft tissue; (ii) Irreversible procedures; (iii) Restorative dentistry; (iv) Making a dental diagnosis; or (v) Fabricating a dental treatment plan; and

(B) Provide infection control practices which meet the national standards for dental facilities as outlined by the Centers for Disease Control Summary of Infection Prevention Practices In Dental Settings as published October of 2016.

013. REINSTATEMENT . For reinstatement, the applicant must meet the requirements set out in 172 NAC 10.

014. FEES . Fees are set out in 172 NAC 2 and this chapter.

014.01 EXPANDED FUNCTION PERMIT. The initial and renewal fees for expanded function permits are $25 each.

014.02 ADDITIONAL PROCEDURES. Fees to add additional procedures to a license that require proof of education and examination are $10.

History

Effective 2024-06-02

Chapter 58 Dental Faculty Licenses

Neb. Admin. Code tit. 172, ch. 58 Dental Faculty Licenses {#sec-172-nac-58 omnilex-key=us-ne-regs-official--title-172--172 NAC 58}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of dental faculty under the Nebraska Revised Statutes (Neb. Rev. Stats. §§ 38-1101 to 38-1152) of the Dentistry Practice Act and the Uniform Credentialing Act.

001.01 In addition to the requirements of 172 NAC 58, all dental faculty licensees are subject to 172 Nebraska Administrative Code (NAC) 56-009 Initial Anesthesia or Sedation Permit; and 172 NAC 10.

002. DEFINITIONS . Definitions are set out in the Dentistry Practice Act, the Uniform Credentialing Act, and these regulations.

002.01 ACCREDITED DENTAL EDUCATION INSTITUTION. A school or college of dentistry that is accredited by the Commission on Dental Accreditation of the American Dental Association, The Commission on Dental Accreditation of Canada, or similar organization as determined by the Board.

002.02 NON-ACCREDITED DENTAL EDUCATION INSTITUTION. A school or college of dentistry that is not accredited by the Commission on Dental Accreditation of the American Dental Association, The Commission on Dental Accreditation of Canada, or similar organization as determined by the Board.

002.03 OFFICIAL TRANSCRIPT. A transcript issued by and under the original seal of the educational institution.

002.04 POSTGRADUATE EDUCATION. Advanced dental education programs accredited by the Commission on Dental Accreditation of the American Dental Association, The Commission on Dental Accreditation of Canada, or similar organization as determined by the Board, which includes dental specialties, general practice residencies, and advanced education in general dentistry.

003. LICENSE REQUIREMENTS . To obtain a license an individual must submit a completed application provided by the Department and provide documentation demonstrating the applicant meets the requirements of Neb. Rev. Stat. § 38-1124, 172 NAC 10, and these regulations.

003.01 EDUCATION.

(A) An official transcript from an accredited dental education institution showing the graduation date must be sent directly to the Department by the originating program or institution; or (B) Verification of graduation from a non-accredited dental education institution, sent directly from the originating program or institution to the Department and verification of completing two years of postgraduate education at an accredited dental education institution sent directly from the originating program or institution directly to the Department.

003.01(i) ADDITIONAL EDUCATION IN LIEU OF LICENSE OR POST GRADUATE EDUCATION. Applicants seeking licensure based, in part, on Neb. Rev. Stat. § 38-1124 (4)(a)(iii) must submit a portfolio as required by Neb. Rev. Stat. § 38-1124(6).

003.02 EXAMINATION FROM AN ACCREDITED DENTAL EDUCATION INSTITUTION. Applicants seeking licensure based on graduation from an accredited dental education institution must:

(A) Request certification be sent to the Department directly from the issuing jurisdiction for all licenses held by the applicant; and (B) Pass the jurisprudence examination administered by the Board of Dentistry that relates to the statutes and regulations that govern dentistry with a score of 75 or above.

003.03 EXAMINATION FROM A NON-ACCREDITED DENTAL EDUCATION INSTITUTION. Applicants seeking licensure based on graduation from a non-accredited dental education institution must:

(A) Pass the licensure examination Part I and Part II or the Integrated National Board Dental Examination given by the Joint Commission on National Dental Examinations (JCNDE) or equivalent as determined by the Board of Dentistry with a score of 75 or above on each part of the examination; or (B) Submit proof of one of the following:

(i) Pass a specialty board as recognized by the National Commission on Recognition of Dental Specialties and Certifying Boards; or (ii) Certification from the institution at which such clinical specialty was practiced per Neb. Rev. Stat. § 38-1124(1); or

(C) Submit proof of passing an examination administered by the National Dental Examining Board of Canada; and (D) Pass the jurisprudence examination administered by the Board of Dentistry that relates to the statutes and regulations that govern dentistry with score of 75 or above; and (E) Request certification be sent to the Department of all licenses held by the applicant directly from the issuing jurisdiction.

003.05 RESIDENCY. All applicants receiving a license pursuant to 172 NAC 58 must submit documentation of establishing residency in Nebraska as required by Neb. Rev. Stat. § 38-129.02. Such documentation must be submitted within 90 days of establishment of residency and consist of a rental or lease agreement with the signature of the owner or landlord and the applicant, a deed or title to residential real property with the name of the applicant as an owner, or documents with the name and address of the applicant such as mortgage bills, home utility bills, medical or employee documents or similar documents that show the applicant residing in Nebraska.

004. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10 and this chapter.

004.01 ADDITIONAL INFORMATION. Applicants must submit any other information as requested by the Board or Department.

005. CONTINUING EDUCATION . On or before March 1 of odd-numbered years dental faculty licensees must meet continuing education requirements found in 172 NAC 56-007 and 172 NAC 10, and submit proof of continued employment directly from the accredited school or college in accordance with Neb. Rev. Stat. § 38-1124(5).

006. GROUNDS FOR ACTION AGAINST A CREDENTIAL . A dental faculty license may be denied, refused renewal, or have other disciplinary measures taken against it for grounds specified in Neb. Rev. Stat. § 38-178, 172 NAC 10, or for unprofessional conduct.

007. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179, 172 NAC 56, and this chapter:

(A) Practicing a clinical discipline for which the licensee has not been approved.

008. REINSTATEMENT . For reinstatement, the applicant must meet the requirements set out in 172 NAC 10.

009. FEES . Fees are set out in 172 NAC 2.

History

Effective 2024-06-02

Chapter 61 Medical Nutrition Therapists

Neb. Admin. Code tit. 172, ch. 61 Medical Nutrition Therapists {#sec-172-nac-61 omnilex-key=us-ne-regs-official--title-172--172 NAC 61}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 61 MEDICAL NUTRITION THERAPISTS

001. SCOPE AND AUTHORITY . These regulations govern the licensing of medical nutrition therapists under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-1801 to 38-1816 and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions set out in the Medical Nutrition Therapy Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and the following apply to this chapter.

002.01 ASSESSMENT. Assessment is defined in Neb. Rev. Stat. § 38-1804. It includes the following activities:

(A) The collection of information, review of records, and verification of information. The records and information include anthropometric data, diagnoses, laboratory values, medications, diet orders, physical assessment data, and food preference or diet history information;

(B) Determining a complete nutritional plan of care to meet fluid need, calorie, or protein need, need for specific form of food, need for specific adaptive devices for feeding techniques, or need for supplemental food, fluid, or medical nutritional product for a patient;

(D) Reviewing or refining a plan to achieve the established goals for a patient;

(E) Recommending changes in a physician’s diet order, for a patient, to a physician when a possible need for a change is identified by a medical nutrition therapist; and

(F) Writing a therapeutic diet order for a patient in accordance with Neb. Rev. Stat. 38-1813.

002.02 DATA COLLECTION. Data collection is the collection of anthropometric data such as height, weight, age, laboratory values, current medications, diagnoses, food preference, and diet history.

002.03 HOUR. An hour, for the purposes of 172 NAC 61-003.02(B), 172 NAC 61-003.03(B), and continuing education, is an academic hour and calculated as follows:

(A) 1 semester hour of academic credit equals 15 clock hours;

(B) 1 quarter hour of academic credit equals 10 clock hours; and

002.04 LICENSE EXAMINATION. The license examination is The Registration Examination for Dietitians, as established by the Commission on Dietetic Registration, the credentialing agency of the Academy of Nutrition and Dietetics, or any other examination established by the Commission on Dietetic Registration and determined by the Board to be equivalent.

002.05 OBSERVATION. Observation is watching the patient during intake of food and fluid.

003.01 COMMISSION ON DIETETIC REGISTRATION. If applying based on holding registration, the applicant must submit official documentation of registration with the Commission on Dietetic Registration.

003.02 BACCALAUREATE DEGREE AND SUPERVISED CLINICAL EXPERIENCE. If applying based on a baccalaureate degree, the applicant must provide the following:

(A) An official transcript, submitted directly from the issuing institution, verifying completion of a baccalaureate degree with a major course of study in human nutrition, food and nutrition, dietetics, or an equivalent major course of study approved by the Board;

(B) Documentation of at least 900 hours of supervised clinical experience. An individual must provide documentation of completing at least 60 semester hours, or 90 quarter hours, or 75 trimester hours of academic credit to equal the 900 hours of clinical experience; and

(C) Official documentation of the license examination score sent directly from the Commission on Dietetic Registration or Academy of Nutrition and Dietetics. The examination is scored on a scale of 1–50. The minimum scaled score required to pass the examination is 25.

003.03 MASTER’S OR DOCTORAL DEGREE. If applying based on a master’s or doctoral degree, the applicant must provide the following:

(A) An official transcript, submitted directly from the issuing institution, verifying completion of one of the following:

(i) A master’s or doctorate degree in human nutrition, nutrition education, foods and nutrition, or public health nutrition or in an equivalent major course of study with the intent of the degree being nutrition in nature and approved by the Board; or

(ii) A master’s or doctoral degree which included a major course of study in clinical nutrition;

(B) Verification of completion of not less than a combined 200 hours of biochemistry and physiology and not less than 75 hours in human nutrition. An individual must provide documentation of completing at least 13.5 semester hours, or 20 quarter hours, or 17 trimester hours to equal the 200 hours needed for the combined biochemistry and physiology; and at least 5 semester hours, or 7.5 quarter hours, or 6.25 trimester hours to equal the 75 hours needed in human nutrition; and

003.04 RECIPROCITIY. To obtain a license based on reciprocity, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. §§ 38-1813, 38-129.02, 172 NAC 10, and this chapter.

003.05 RESIDENCY. All applicants receiving a license pursuant to 172 NAC 61 must submit documentation of establishing residency in Nebraska as required by Neb. Rev. Stat. § 38-129.02. Such documentation must be submitted within 90 days of establishment of residency and consist of a rental or lease agreement with the signature of the owner or landlord and the applicant, a deed or title to residential real property with the name of the applicant as an owner, or documents with the name and address of the applicant such as mortgage bills, home utility bills, medical or employee documents or similar documents that show the applicant residing in Nebraska.

004. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10 and this chapter. All medical nutrition therapy licenses issued by the Department will expire on September 1, of each odd-numbered year.

005. CONTINUING EDUCATION REQUIREMENTS . Each medical nutrition therapist who is in active practice in the State of Nebraska must complete 30 hours of continuing education programs or activities during the preceding 24-month period prior to the expiration date.

005.01 ACCEPTABLE SUBJECT MATTER. The subject matter for each continuing education program must clearly relate to maintaining skills necessary for the safe and competent practice of medical nutrition therapy as defined in Neb. Rev. Stat. § 38-1809.

005.01(A) ACADEMIC CREDIT. If using academic credit hours, the hours must be completed through an undergraduate or graduate college or university program.

005.01(B) CONTINUING EDUCATION PROGRAM. 60 minutes of participation equals 1 continuing education hour when completing workshops, seminars, conferences, or electronic interactive presentations for purposes of obtaining continuing education credit.

005.01(C) PRESENTER. A presenter may receive continuing education credit for only the initial presentation during a renewal period. Credit will not be given for subsequent presentations of the same program or activity.

005.01(D) GENERAL NUTRITION PROGRAM. A maximum of 10 hours of continuing education relating to general nutrition, defined in Neb. Rev. Stat. § 38-1807, may be used as credit for each renewal period.

005.01(E) EXHIBITS. 25 exhibits equal 1 continuing education hour. A maximum of 3 continuing education hours may be used as credit per renewal period.

005.01(F) POSTER SESSIONS. 6 poster sessions equal 1 continuing education hour; a maximum of 3 continuing education hours may be used as credit each renewal period.

005.01(G) HOME STUDY PROGRAM. A maximum of 15 hours of continuing education hours may be used as credit for each renewal period. The provider of the program must have a system to monitor knowledge obtained by the licensee completing a home study program, such as, but not limited to a final examination or program evaluation.

005.01(H) VIDEO OR AUDIO MEDIA OR JOURNAL CLUB. A maximum of 15 hours of continuing education hours may be used as credit for obtained each renewal period. The provider of a video or audio media must issue a certificate of completion. A journal club must be an organized activity, with a pre-determined discussion topic and must be conducted in a monitored environment by another licensed medical nutrition therapist.

005.01(I) CERTIFICATE PROGRAMS. 20 hours of continuing education, unless noted otherwise, may be used for completing a certificate program as follows:

(i) Certified Nutrition Support Clinician sponsored by the National Board of Nutrition Support Certification, Inc;

(ii) Certified Diabetes Educator sponsored by the National Certification Board for Diabetes Educators;

(iii) Certified Lifestyle and Weight Management Consultant sponsored by the American Council on Exercise;

(iii) Certificate programs sponsored by the Commission on Dietetic Registration, such as:

(1) Board Certification as a Specialist in Pediatric Nutrition;

(2) Board Certification as a Specialist in Renal Nutrition;

(3) Board Certification as a Specialist in Gerontological Nutrition;

(4) Board Certification as a Specialist in Oncology Nutrition; or

(5) Board Certification as a Specialist in Sports Dietetics;

(v) International Board of Lactation Consultant Examiners; or

(vi) Certificate Programs approved through the Academy of Nutrition and Dietetics, such as:

(1) Certificate of Training in Childhood and Adolescent Weight Management sponsored by the Commission on Dietetic Registration, 29 hours are acceptable; or

(2) Certificate Training in Adult Weight Management sponsored by the Commission on Dietetic Registration, 28 hours are acceptable.

005.02 NONACCEPTABLE SUBJECT MATERIAL. The following topic areas do not count towards continuing education for renewal or reinstatement:

(A) Menu planning;

(B) Dietetic association business meeting or delegate report;

(D) Food service sanitation;

(E) Catering;

(F) Garnishing techniques;

(G) Publishing an employee training manual;

(H) Sales presentation on a company's new product;

(I) Marketing self as dietitian or medical nutrition therapist;

(J) Language training; and

(K) Health service administration, such as management, grant writing, and human resources.

006. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

007. ANCILLARY PERSONNEL . Ancillary personnel may:

(A) Collect data to be submitted to the medical nutrition therapist in writing for medical records;

(B) Document an observation, such as anthropometric data and food preferences, for medical records or on the patient’s chart; and

(C) Direct questions to the physician in charge or the medical nutrition therapist and may make recommendations based on observations.

008. FEES . Fees are set out in 172 NAC 2.

History

Effective 2023-06-14

Chapter 67 Funeral Directors and Embalmers

Neb. Admin. Code tit. 172, ch. 67 Funeral Directors and Embalmers {#sec-172-nac-67 omnilex-key=us-ne-regs-official--title-172--172 NAC 67}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 67 FUNERAL DIRECTORS AND EMBALMERS

001. SCOPE AND AUTHORITY . These regulations govern the licensing of funeral directors and embalmers under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-1401 to 38-1428 of the Funeral Directing and Embalming Practice Act and the Uniform Credentialing Act. Persons providing funeral directing and embalming services to clients located in Nebraska must be licensed as a funeral director and embalmer in Nebraska unless they are exempt under the Act.

002. DEFINITIONS . Definitions set out in the Funeral Directing and Embalming Practice Act, the Uniform Credentialing Act, and 172 Nebraska Administrative Code (NAC) 10 apply to this chapter.

003. LICENSE REQUIREMENTS . To obtain a funeral directing and embalming license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. §§ 38-1414 through 38-1416, 172 NAC 10, and this chapter.

003.01 GENERAL EDUCATION. An applicant must submit an official transcript directly from the issuing institution verifying completion of the required hours of college credit.

003.02 RECIPROCITY. An applicant who holds a license or credential in another state and is applying based on that credential, the Department will accept as equivalent for the specific education coursework identified in Neb. Rev. Stat. § 38-1414, 5 years of practice as a licensed or certified funeral director and embalmer in another state and 16 hours of acceptable funeral directing and embalming continuing education that was completed within the 24 months immediately preceding the application. The applicant must provide:

(A) Direct source verification of certification of a credential to practice funeral directing and embalming submitted to the Department by the jurisdiction showing a minimum of 5 years of holding a credential;

(B) Documentation showing practice for a minimum of five years under the credential; and

(C) Documentation of completion of a minimum of 16 hours of acceptable funeral directing and embalming continuing education within the previous 24 months immediately prior to application.

003.03 MORTUARY SCIENCE EDUCATION. An applicant must submit an official transcript verifying completion of a full course of instruction in an accredited school of mortuary science. Hours earned in a school of mortuary science as part of the mortuary program may not be used for the meeting the requirements of 172 NAC 67-003.01.

003.04 APPRENTICESHIP. An applicant must submit documentation of completion of a 12-month apprenticeship, as set out in this chapter, under the supervision of a licensed Funeral Director and Embalmer practicing in the state of Nebraska. The documentation must include evidence meeting the requirements in Neb. Rev. Stat. §38-1414.

003.04(A) RECIPROCITY. If an applicant has completed 1 year of funeral directing and embalming practice following licensure or certification in another jurisdiction, this practice is deemed equivalent to a 12-month apprenticeship. The applicant must provide direct source verification of a credential to practice funeral directing to the Department by the jurisdiction showing a minimum of 1 year of holding such credential.

003.05 EXAMINATION. The applicant must submit documentation of successful completion of the following examinations:

(A) The International Conference of Funeral Service Examining Boards examination with a scaled score of at least 75; and

(B) The Nebraska jurisprudence examination and the Nebraska vital statistic forms examination with a score of at least 75% on each examination.

004. APPRENTICE LICENSE . To obtain an apprentice license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. § 38-1416, 172 NAC 10, and this chapter.

004.01 GENERAL EDUCATION. The applicant must submit an official transcript verifying completion of the college credit hours as set out in Neb. Rev. Stat. § 38-1416.

004.02 MORTUARY SCIENCE EDUCATION. If applying for a 12-month apprenticeship or the final 6-month apprenticeship, the applicant must submit an official transcript verifying completion of a full course in an accredited school of mortuary science. Hours earned in a school of mortuary science as part of the mortuary program may not be used for the meeting the requirements of 172 NAC 67-003.01.

004.03 SUPERVISOR. The applicant must have a statement from the supervisor verifying agreement to supervise the apprentice. The supervisor must hold a current active license as a funeral director and embalmer in Nebraska.

004.04 CHANGE IN SUPERVISOR. An individual who changes his or her apprentice supervisor or adds a new supervisor, must submit a change in supervisor form provided by the Department within 30 days following the change. An individual may not practice without an apprentice supervisor.

005. EXAMINATION ELIGIBILITY . To be eligible to take the jurisprudence and vital statistics examinations in order to obtain a license as a funeral director and embalmer, an applicant must submit a complete examination application provided by the Department and meet the following:

(A) Have been issued a final 6-month or 12-month apprenticeship license; or

(B) Meet the requirements for licensing by reciprocity as specified in 172 NAC 67-003.

006. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . Applicants must meet the requirements set out in 172 NAC 10. All licenses, except apprentice licenses, issued by the Department expire on February 1st of each even-numbered year.

007. CONTINUING EDUCATION . During the 24 months prior to the license expiration date, each licensed funeral director, embalmer, or funeral director and embalmer must complete:

(A) 12 hours of acceptable continuing education hours; and

(B) Pass the Nebraska jurisprudence examination with a score of at least a 75%.

007.01 ACCEPTABLE CONTINUING EDUCATION ACTIVITIES AND HOURS. The following specifies the type of acceptable continuing education and the hours allowed for each type:

(A) 1 semester hour of academic credit equals 15 continuing education hours.

(B) 1 quarter hour of academic credit equals 10 continuing education hours.

(D) 60 minutes of participation equals 1 continuing education hour obtained through workshops, lectures, or interactive satellite or webinars. Credit will not be awarded for break and meal times.

(E) If a licensee completes supervision of 1 apprentice during the renewal period, 4 hours can be applied towards the continuing education requirements.

(F) A maximum of 2 hours of continuing education may be obtained through a funeral directing and embalming related tour. Conducting a tour of the licensee’s facility does not constitute continuing education. 60 minutes of tour participation equals 1 continuing education hour.

(G) A maximum of 2 hours of continuing education may be obtained through a funeral directing and embalming related exhibit or display. If a continuing education workshop provides an exhibit or display area, a licensee may earn 1 continuing education hour per workshop for viewing the exhibits or displays.

(H) A maximum of 8 hours of continuing education may be obtained through attendance at a District, State, or National Association Business Meeting. 60 minutes of participation constitutes 1 continuing education hour. Only 1 hour may be obtained per meeting.

007.02 ACCEPTABLE CONTINUING EDUCATION TOPIC AREAS. In order for a continuing education activity or program to be accepted for renewal or reinstatement of a license, the activity must include one or a combination of the following topic areas:

(A) Communication or media;

(B) Counseling or arbitration;

(D) Disaster training;

(E) Embalming practice;

(F) Funeral directing practice;

(G) Management, including personnel or business;

(H) Marketing or advertising;

(I) Personal development; or

(J) Pre-need.

008. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

009. FEES . Fees referred to in this chapter are set out in 172 NAC 2.

History

Effective 2020-09-23

Chapter 68 Funeral Establishments and Branch Establishments

Neb. Admin. Code tit. 172, ch. 68 Funeral Establishments and Branch Establishments {#sec-172-nac-68 omnilex-key=us-ne-regs-official--title-172--172 NAC 68}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 68 FUNERAL ESTABLISHMENTS AND BRANCH ESTABLISHMENTS

001. SCOPE AND AUTHORITY . This chapter governs the licensing of funeral establishments and branch establishments under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-1401 to 38-1428 of the Funeral Directing and Embalming Practice Act and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions set out in the Funeral Directing and Embalming Practice Act, the Uniform Credentialing Act, and 172 Nebraska Administrative Code (NAC) 9 apply to this chapter.

003. ESTABLISHMENT LICENSE . To obtain a license, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. §§ 38-130, 38-1419 through 38-1420, 4-108 through 4-111, 172 NAC 9, and this chapter.

003.01 MANAGER LICENSE. The applicant must submit evidence that the proposed manager has a current active Nebraska funeral director or funeral director and embalmer's license.

003.02 SELF-EVALUATION. The applicant must submit a complete self-evaluation inspection report showing compliance with this chapter.

004. CHANGE IN MANAGER, OWNER, NAME AND LOCATION . Owners may request a change in manager, name, owner, or location of an establishment.

004.01 CHANGE IN MANAGER OR OWNER. To change the manager or owner, the applicant must submit a complete application to the Department and obtain another credential as specified in 172 NAC 68-003 as provided in Neb. Rev. Stat. § 38-1419 and submit the required fee for a reissued license.

004.01(A) IMMEDIATE TERMINATION OR DEATH OF MANAGER. In the event of an immediate termination of a manager or in the event of the death of the manager, the application for a change in manager must be submitted to the Department within 5 days following notification of termination or death of the manager. During this period of time, the establishment may operate as long as a licensed funeral director and embalmer is providing funeral directing and embalming services in accordance with the Funeral Directing and Embalming Practice Act and 172 NAC 67 and 172 NAC 68. Such exception terminates after the 5-day period.

004.02 CHANGE IN NAME. To change the name, the applicant must submit a request for a change in the establishment name as provided in Neb. Rev. Stat.§ 38-1419 and submit the required fee for a reissued license.

004.03 CHANGE OF ESTABLISHMENT LOCATION. To change the location, the applicant must apply to the Department for and obtain another license as specified 172 NAC 68-003 as provided in Neb. Rev. Stat. § 38-1419.

004.04 ADDING A PREPARATION ROOM. For establishments that have been licensed without a preparation room and wish to add a preparation room for the care and preparation of dead human bodies for burial, disposition or cremation, the applicant must:

(A) Notify the Department of the establishment’s intent to have a preparation room; and

(B) Have received a successful inspection rating within 30 days of the anticipated change in services.

005. ORGANIZED OR SCHEDULED FUNERAL SERVICES, AUTHORIZED SERVICES BY UNLICENSED PERSONS, AND STUDENTS IN MORTUARY SCHOOLS . The following sets out the requirements for organized or scheduled services, services that do not require a license, and student in an internship.

005.01 ORGANIZED OR SCHEDULED SERVICES. A licensed funeral director and embalmer must be present at each organized or scheduled funeral service, including a wake where an organized service is conducted or a religious service, burial and interment, whenever a dead human body is present.

005.02 SERVICES THAT DO NOT REQUIRE A LICENSE. The following do not require professional knowledge and skills as a funeral director or embalmer in order to provide the services or activities.

005.02(A) IMPLEMENTING ARRANGEMENTS. Persons, who are not licensed as funeral directors and embalmers, may assist in implementing arrangements made by a licensed funeral director and embalmer as long as they are under his or her supervision and responsibility. These activities include:

(i) Driving or maintenance of funeral vehicles and facilities;

(ii) Administrative duties;

(iii) Applying cosmetics;

(iv) Arranging or shampooing the hair of the deceased;

(v) Ceremonial assistance, such as bathing, clothing, dressing and casketing the deceased body, and;

(vi) Religious services.

005.02(B) FIRST CALLS. Persons, at the request of the licensed funeral director and embalmer, may make first calls or removals of dead human bodies.

005.02(C) STUDENTS. A student enrolled in a school accredited by the American Board of Funeral Service Education (ABFSE), may participate in a student practicum or internship in a licensed funeral establishment in Nebraska. The student may assist with funeral directing and embalming services when the student is in a recognized practicum or internship, under the supervision of the school of mortuary science, and under the direct on-site supervision and responsibility of a Nebraska licensed funeral director and embalmer.

006. TRANSPORTATION AND FINAL DISPOSITION OF DEAD HUMAN BODIES . The following applies to transportation and final disposition of dead human bodies who have died due to a communicable disease, transporting a dead human body in-state and out-of-state, and final disposition requirements.

006.01 DECEASED DUE TO AN IMMEDIATELY REPORTABLE COMMUNICABLE DISEASE. Persons who have died due to any communicable disease listed in 173 NAC 1, which must be reported immediately, must be completely wrapped before removal from the premises. These requirements do not prohibit a public funeral, nor does it relieve persons who are quarantined as contacts from quarantine requirements. Bodies dead of such communicable diseases must be:

(1) Thoroughly and promptly embalmed and be held in isolation from the public for a period of 24 hours following the embalming;

(2) Encased immediately after death in a body transfer case or shipping case that is constructed out of 20 gauge steel and is hermetically sealed, and under no condition will the body be removed from the container; or

(3) Cremated immediately. If visitation is to occur prior to cremation, the body must be thoroughly and promptly embalmed and held in isolation from the public for a period of 24 hours following the embalming.

006.01(A) DECEASED DUE TO A COMMUNICABLE DISEASE NOT REQUIRED TO BE IMMEDIATELY REPORTED. Persons who have died due to a communicable disease other than those listed in 173 NAC 1 which must be reported immediately, require no further special handling.

006.02 OUT-OF-STATE TRANSPORTATION. When a body is to be transported out of the state of Nebraska, the Nebraska funeral director and embalmer in charge of the body must determine the regulations governing the transportation of bodies in the other state or states, and must comply fully with the requirements of such regulations, must oversee the removal while the body is in Nebraska, and must comply with the requirements under 172 NAC 68 and with the Interstate Commerce Commission’s requirements for transportation by common carrier.

006.03 IN-STATE TRANSPORTATION. Dead human bodies, which have not been embalmed, may not be transported by common carrier, unless the body is placed immediately after death in a body transfer case or shipping case that is constructed out of 20 gauge steel and is hermetically sealed. Transportation may be made by privately owned conveyance under the supervision and responsibility of a licensed funeral Director. Embalmed bodies may be transported by either common carrier or private carrier.

006.04 FINAL DISPOSITION OF EMBALMED AND UN-EMBALMED BODIES. Final disposition of a dead human body must meet the following:

006.04(A) UN-EMBALMED BODY. Upon receipt of a dead human body, the licensee has 24 hours to either bury, cremate, embalm, place in refrigerated storage, or place in a hermetically sealed container, which cannot be reopened. If placing in refrigerated storage, an un-embalmed body must:

(i) Be retained at a constant temperature of less than 40 degrees Fahrenheit for not more than 8 days. An un-embalmed body may be retained in storage beyond the 8 days only when:

(1) Written notification of a criminal proceeding is received; or

(2) Upon receipt of a court order.

(ii) When the body is removed from storage it must be embalmed, buried, cremated, or placed in a hermetically sealed container within 24 hours following the removal from storage.

006.04(B) EMBALMED BODY. Final disposition of a dead human body, which has been embalmed or been placed in a hermetically sealed container, must be made within 30 days after death. If death did not occur in Nebraska, final disposition of a dead human body must be made within 30 days after receipt of the dead human body.

006.04(B)(i) EXTENSION OF FINAL DISPOSITION. If unforeseen circumstances occur which would prevent final disposition of a dead human body within the required 30 days after death, the license holder must request an extension from the Director of the Division of Public Health to extend the final disposition date. The Director may authorize an extension of the required final disposition date of a dead human body up to 30 days. If final disposition has not occurred by the ending date of the extension, the license holder must seek court action regarding final disposition of the decedent’s remains. To attain an extension, the licensee must submit a written request to the Department, which includes the following:

(1) Name of funeral establishment and license holder overseeing the final disposition;

(2) Name of the deceased;

(3) Date of death of the deceased; and

(4) An explanation of the basis for extending the final disposition, such as but not limited to family dispute, criminal investigation, military burial, shipments outside of the United States, or similar acts.

007. INSPECTIONS . All establishments will receive an initial and thereafter routine inspection. Establishments must be fully in compliance with 172 NAC 68-008.

007.01 INITIAL SELF-EVALUATION INSPECTION. Under 172 NAC 68-003, the applicant must conduct a self-evaluation inspection prior to the proposed opening date of the establishment.

007.02 TIMING OF INSPECTIONS. The Department may conduct an on-site unannounced inspection at any time it deems necessary.

008. FUNERAL ESTABLISHMENT REQUIRED DOCUMENTS, PHYSICAL STRUCTURE AND EQUIPMENT AND SUPPLIES . A licensee is responsible for operating a funeral establishment in compliance with the requirements of the statutes and this chapter.

008.01 PHYSICAL STRUCTURE. The physical structure must be maintained to ensure safety of the public and to ensure compliance with the equipment and sanitation requirements.

008.01(A) CONDUCTING FUNERAL SERVICES. If services include conducting funeral services for dead human bodies, the funeral establishment must have:

(i) Room(s) for:

(1) Counseling families or next of kin;

(2) Conducting the funeral service; and

(3) Viewing the deceased;

(ii) The room(s) must have:

(1) Floor to ceiling walls on all sides, and must be either a part of the funeral establishment or located at a licensed branch establishment, which is within a reasonable distance of the funeral establishment;

(2) Space for public seating;

(3) Space for viewing the dead human body; and

(4) May have an adjacent area for cosmetic services and dressing of the dead human body for viewing purposes;

(iii) A casket selection area, which has either a catalogue or electronic media for ordering caskets, or has sample caskets displayed;

(iv) Motor vehicles, such as, but not limited to, funeral coach, sedans, and vans; and

(v) A general price list (GPL).

008.01(B) PREPARATION FOR FINAL DISPOSITION. If services include preparation for burial, disposition or cremation, the funeral establishment must include:

008.01(B)(i) PREPARATION ROOM. A preparation room for preparing dead human bodies for burial or other final disposition which has floor to ceiling walls on all sides that are cleanable, such as tile or other suitable hard surfaces, and ventilation that meets the Occupational Safety and Health Administration (OSHA) requirements. The preparation room must be clean and sanitary and contain equipment necessary for preparation of dead human bodies.

008.01(B)(ii) MATERIALS OR SUPPLIES. Materials or supplies which come in contact with a dead human body must not be used more than once without being first completely cleansed, disinfected, and then laundered.

008.01(B)(iii) BIO-WASTE MATERIALS. Bandages, cotton, and other bio-waste materials that have been in contact with bodily fluids must be destroyed or placed in the bio-waste receptacle for removal by a waste removal service immediately at the conclusion of each case.

008.01(B)(iv) EQUIPMENT WITHIN A MOTOR VEHICLE. All equipment within a motor vehicle used for the transportation of deceased persons, which comes in contact with a deceased person, must be thoroughly disinfected immediately at the conclusion of each instance of transportation.

009. BRANCH ESTABLISHMENT, PHYSICAL STRUCTURE AND CASKET SELECTION AREA . A branch establishment must comply with the physical structure requirements and may have a casket selection area.

009.01 PHYSICAL STRUCTURE. The physical structure must be maintained to ensure safety of the public and compliance with the equipment and sanitation requirements. The physical structure must have:

(A) Adequate lighting to maintain public safety; and

(B) If viewing of the dead human body is provided at the branch location, the viewing room(s) must have floor to ceiling walls on all sides.

009.02 CASKET SELECTION AREA. If the branch establishment has a casket selection area, the area may include a catalogue or electronic media for ordering caskets or have sample caskets displayed.

010. DOCUMENTS . Copies of the following must be posted or available in establishments:

010.01 POSTED. The following must be posted for public viewing:

(A) The current establishment license;

(B) The current license of the manager and all embalmers, apprentices, funeral directors and funeral directors and embalmers employed by the establishment; and

(C) A sign containing the name of the establishment. The sign must be located on or at the front of the building in a position where it clearly is visible and legible from the outside of the building.

010.02 AVAILABLE. If funeral arrangements are made, written statements containing a list of principal services and furnishings to be supplied by the funeral director and embalmer for the preparation and burial or cremation of a dead human body, including a general price list must be provided to the customer.

011. CLOSING AN ESTABLISHMENT . When a licensee anticipates closing an establishment, the Department must be notified in writing of the closing date. The licensee must retain the establishment’s pre-need records in compliance with the Burial Pre-Need Sale Act and upon closing the establishment, the licensee must forward said records to another funeral establishment in Nebraska. The licensee must remove all signage relating to the name of the funeral establishment or branch establishment upon its closing.

012. RENEWAL . The applicant must meet the requirements of Neb. Rev. Stat. § 38-143 and 172 NAC 9. All establishments issued by the Department will expire February 1 of each even-numbered year.

013. REAPPLICATION . Applicants who were previously licensed in Nebraska and seek the authority to return to operation must meet the requirements set out in 172 NAC 9 and the statutes.

014. FEES . Fees referred to in this chapter are set out in 172 NAC 2.

History

Effective 2020-09-30

Chapter 69 Crematories

Neb. Admin. Code tit. 172, ch. 69 Crematories {#sec-172-nac-69 omnilex-key=us-ne-regs-official--title-172--172 NAC 69}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 69 CREMATORIES

001. SCOPE AND AUTHORITY . These regulations govern the licensing of crematories under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 71-1355 to 71-1385 of the Cremation of Human Remains Act.

002. DEFINITIONS . The definitions set in the Cremation of Human Remains Act and the following apply to this chapter.

002.01 ATTEST OR ATTESTATION. Attest or attestation is when an individual declares that all statements on the application are true and complete.

002.02 CHANGE OF OWNERSHIP. A transfer of more than 50% of the stock or assets of a crematory is a change of ownership.

002.03 COMPLETE APPLICATION. An application that contains all of the information requested on the application, with attestation to its truth and completeness, and that is submitted with the required fees and documentation.

002.04 PULVERIZATION. The reduction of identifiable bone fragments to granulated particles by manual or mechanical means.

003. CREMATORY LICENSE . To obtain a license, an applicant must submit a complete application as provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. §§ 71-1358, 71-1359, 4-108 through 4-111, and this chapter.

003.01 REQUIREMENTS AND DOCUMENTATION. Applicants must submit:

003.01(A) CITIZENSHIP, LAWFUL PRESENCE. The owner, if the owner is a sole proprietor, must submit documentation that he or she meets the requirements set out in Neb. Rev. Stat. §§ 4-108 through 4-111.

003.01(B) ZONING. Copies of zoning approval.

003.01(C) TRAINING. A certificate confirming the crematory operator has attended a training course provided by the Cremation Association of North American or by the manufacturer of the cremation chamber maintained and operated by the crematory.

003.01(D) SELF-EVALUATION. A completed self-evaluation inspection report showing compliance with 172 Nebraska Administrative Code (NAC) 69-005.

003.01(E) PRACTICE STATEMENT. A statement that the applicant has not operated the crematory or represented the crematory as holding a license in Nebraska before submitting the application; or if the applicant has, a statement of the number of days the crematory operated.

003.02 LICENSE DISPLAY. The license must be posted for public viewing in the crematory.

004. INSPECTIONS . The crematory must receive a 100% to pass the inspection by the Department.

004.01 INITIAL SELF-EVALUATION INSPECTION. Under 172 NAC 003, the applicant must conduct a self-evaluation inspection prior to the proposed opening date of the crematory.

004.02 INITIAL ON-SITE INSPECTION. The Department will conduct an on-site unannounced inspection within 180 days following issuance of an initial crematory license.

004.03 TIMING OF INSPECTIONS. The Department may conduct an on-site unannounced inspection at any time it deems necessary.

005. CREMATORY RESPONSIBILITIES, TRAINING, SANITATION, EQUIPMENT AND SUPPLIES, SAFETY, CODES, AND FORMS . The licensee of the crematory authority is required to ensure policies are developed and implemented, the appropriate training is provided, and sanitation requirements are followed as set out in this chapter and the statutes.

005.01 CREMATORY RESPONSIBILITIES. The licensee must determine, implement and monitor policies to assure that the crematory is administered and managed appropriately. The licensee’s responsibilities include:

(A) Monitoring policies to assure appropriate administration and management of the crematory;

(B) Ensuring the crematory’s compliance with all applicable state statutes and regulations; and

005.02 TRAINING. The licensee must provide crematory staff with sufficient training to operate the cremation chamber or retort in compliance with the requirements of the statutes and this chapter.

005.03 INFECTION CONTROL. There must be a system for management of identified infections within the crematory which includes the use of standard precautions for prevention of transmission of infectious diseases among staff.

005.04 ENVIRONMENTAL SERVICES. The crematory must be safe and clean.

005.04(A) MAINTENANCE. The licensee must ensure that the following maintenance requirements are met:

(i) All crematory buildings and grounds must be kept clean, safe and in good repair;

(ii) All garbage and rubbish must be disposed of in a manner as to prevent the attraction of rodents, flies, and all other insects and vermin. Garbage and rubbish must be disposed in a manner as to minimize the transmission of infectious diseases and minimize odor;

(iii) Adequate lighting and environmental temperatures are maintained; and

(iv) The premises are maintained and equipped to prevent the entrance, harborage, or breeding of rodents, flies, and all other insects and vermin.

005.04(B) EQUIPMENT, FIXTURES, FURNISHINGS, TOOLS AND SUPPLIES. All equipment, fixtures, furnishings, tools and supplies must be clean, safe and in good repair. A crematory must meet the following:

(i) Have heat resistant gloves and a filter mask for use by staff;

(ii) The cremation chamber must be built by professional crematory manufacturer, and must be operational;

(iii) Have a designated processing area for pulverization; and

(iv) Establish and implement processes designed for routine and preventative maintenance of equipment and furnishings to ensure that the equipment and furnishings are safe and functional to meet their intended use.

005.05 SAFETY. The crematory must be maintained in a manner that minimizes accidents and meets the following:

(A) The environment must be maintained to protect the health and safety of employees by keeping surfaces smooth and free of sharp edges and mold and dirt, keeping floors free of unsafe objects and slippery or uneven surfaces, and keeping the environment free of other conditions which may pose a potential risk to the health and safety of the employees;

(B) All doors, stairways, passageways, aisles or other means of exit must be maintained in a manner that provides safe and adequate access;

(C) Policies and procedures must be established and implemented to ensure hazardous or poisonous materials are properly handled and stored to prevent accidental ingestion, inhalation, or consumption of the hazardous or poisonous materials;

(D) Access to mechanical equipment which may pose a danger to the public must be restricted to staff of the crematory;

(E) Have a system to identify and prevent the occurrence of hazards to employees; and

(F) Have and implement policies addressing dangerous substances, sharp objects, unprotected electrical outlets, and the prevention of water temperatures above 120 degrees Fahrenheit, and smoking or vaping within the crematory.

005.06 CODES AND GUIDELINES. All crematories must comply with the following codes and guidelines to provide a safe and accessible environment:

(A) The “Building Construction Act”, Neb. Rev. Stat. §§ 71-6401 to 71-6407;

(B) The State Electrical Act, Neb. Rev. Stat. §§ 81-2101 to 81-2143;

(D) The Nebraska Department of Environmental Quality’s Rules and Regulations regarding incineration construction and operating requirements;

(E) The applicable zoning and environmental regulations; and

(F) The building codes of the city and county where it is located.

005.07 RECORD KEEPING AND CREMATION AUTHORIZATION. The licensee must have records evidencing compliance with Neb. Rev. Stat. § 71-1377.

005.08 DELIVERY RECEIPT FORMS. The licensee must have a delivery receipt form for each time the crematory accepts delivery of human remains for cremation. This form must be provided by a funeral establishment to a crematory to document the receipt of human remains for cremation. The delivery receipt form must include:

(A) Name and address of the funeral home;

(B) Name and address of the crematory;

(D) A list of any personal effects which accompanies the cremated human remains;

(E) Date and time of delivery of the human remains;

(F) Signature of the funeral director or his or her representative; and

(G) Signature of the person receiving the human remains for cremation.

005.09 CREMATED REMAINS RECEIPT FORM. The crematory must provide a cremated remains receipt to an authorizing agent or his or her or its representative that identifies cremated remains and the person authorized to receive such human remains. The cremated human remains receipt form must include:

(A) The name of the deceased;

(B) The name of the authorizing agent or his or her representative;

(D) Date of release;

(E) Metallic ID disk number;

(F) Name and address of the crematory; and

(G) The signatures of the owner of the crematory or his or her or its representative.

005.10 CREMATION LOGBOOK. A cremation logbook must be kept for each cremation performed and include:

(A) Name of the deceased;

(B) Date the deceased was brought to the crematory;

(D) Metallic ID disk number;

(E) Cremation unit number;

(F) Name of the person performing the cremation; and

(G) Date and disposition of the cremated remains.

006. CREMATION PROCESSES AND PROCEDURES . A crematory must comply with Neb. Rev. Stat. §§ 71-1376 through 71-1379 and the following:

006.01 HOLDING FACILITY. A crematory, upon receiving human remains, must sign a delivery receipt form and must hold the human remains until cremation. If a crematory is unable to cremate the human remains immediately upon receipt, the crematory must place the remains in a holding facility.

006.01(A) CREMATORIES WITH HOLDING FACILITIES. The human remains may be delivered to the crematory without an alternative container or casket; however, the human remains must be delivered directly to the holding facility for placing the human remains in the alternative container or casket. The holding facility must:

(i) Comply with all applicable public health law;

(ii) Provide for the health and safety of persons employed at the facility;

(iii) Prevent unauthorized access to the facility;

(iv) Be large enough to hold a casket and be able to transport the human remains from the cot to the container;

(v) Be out of the public’s view, except family may view; and

(vi) Be clean, safe and secure.

006.01(B) CREMATORIES WITHOUT HOLDING FACILITIES. If a crematory does not have a holding facility, the crematory must cremate the human remains immediately and the human remains must have been delivered to the crematory in an alternative container or casket.

006.01(C) UNEMBALMED HUMAN REMAINS. Human remains which have not been embalmed, must be cremated in accordance with the following requirements.

006.01(C)(i) REFRIGERATION. If a crematory has refrigeration, the following applies:

(1) Upon receipt of human remains, the funeral director and embalmer has 24 hours to either bury, cremate, embalm, place in refrigerated storage, or place in a hermetically sealed container (which cannot be reopened).

(2) If placing in refrigerated storage, an un-embalmed human remains must be retained at a constant temperature of less than 40 degrees Fahrenheit for not more than 8 days. An un-embalmed human remains may be retained in storage beyond the 8 days only when:

(a) Written notification of a criminal proceeding is received; or

(b) Upon receipt of a court order; and

(3) When human remains are removed from storage they must be cremated within 24 hours following the removal from storage.

006.01(C)(ii) NO REFRIGERATION. If a crematory does not have refrigeration, un-embalmed human remains must be cremated within 24 hours from the time the funeral home received the human remains.

007. DISPUTES, OPERATION LIMITATIONS, HANDLING OF REMAINS FOLLOWING CREMATION, AND DISPOSITION . A licensee must comply with Neb. Rev. Stat. §§ 71-1375, 71-1381, and 71-1382.

008. RENEWAL . To renew a license to operate a crematory a licensee must prior to the expiration of 5 years from date of issuance and every 5 years thereafter, file an application for renewal, pay the fee, and meet the requirements of Neb. Rev. Stat. § 71-1359 and this chapter.

008.01 RENEWAL INFORMATION. The applicant must provide:

(A) Name of crematory;

(B) Complete mailing address;

(C) Name of owner, and if the owner is a sole proprietorship, the social security number (SSN) or Alien Registration Number (A#). Some applicants may have both a social security number (SSN) and an Alien Registration Number (A#) and if so, the applicant must report both; and

(D) Telephone number and e-mail address.

008.02 DOCUMENTATION. If the owner is a sole proprietorship, the applicant must submit documentation that the owner meets the requirements set out in §§ 4-108 through 4-111.

009. DISCIPLINARY ACTION . In addition to the grounds for denial set out in Neb. Rev. Stat. § 71-1367, failure to permit an inspection for the purposes set out in this chapter is grounds for denial of an initial crematory license or other action as specified in Neb. Rev. Stat. §§ 71-1366 to 71-1369.

010. WITHDRAWN APPLICATIONS . An applicant for an initial license or a renewal of a license, may request to withdraw the application. A request to withdraw will be granted when:

(A) The application is incomplete; or

(B) The request for withdrawal is received within 5 business days after the receipt of a completed application.

011. FEES . Fees referred to in these regulations are set out in Neb. Rev. Stat. § 71-1363 and as follows:

(A) $300 for an initial and renewed crematory license;

(B) $300 for reinstatement of a license that has lapsed or has been suspended;

(D) $10 for a change in name.

History

Effective 2020-03-22

Chapter 75 Practice of Hearing Instrument Specialists

Neb. Admin. Code tit. 172, ch. 75 Practice of Hearing Instrument Specialists {#sec-172-nac-75 omnilex-key=us-ne-regs-official--title-172--172 NAC 75}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 75 PRACTICE OF HEARING INSTRUMENT SPECIALISTS

001. SCOPE AND AUTHORITY . These regulations govern the licensure of Hearing Instrument Specialists under the Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-1501 to 38-1518 of the Hearing Instrument Specalists Practice Act and the Uniform Credentialing Act (UCA).

002. DEFINITIONS . Definitions are set out in the Hearing Instrument Specialists Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 ACCREDITED HIGH SCHOOL. A secondary school accredited by a regional accrediting institution.

002.02 INITIAL TRAINING. The first 90 days of training commencing from issuance of the temporary license.

002.03 PRACTICAL EXAMINATION. One part of the qualifying examination. The Nebraska Practical Examination administered by the Department.

002.04 PROVIDER. An individual or sponsoring organization that presents continuing education programs to licensees and requests approval from the Board for those programs.

002.05 QUALIFYING EXAMINATION. Examination consisting of the written and the practical examination.

002.06 SUPERVISOR. An individual that holds an active non-disciplined license as a hearing instrument specialist or audiologist in Nebraska.

002.07 SUPERVISION. The process by which the quality of work of a temporary licensee is monitored. Supervision includes training and guidance in order to prepare the temporary licensee to perform the correct procedures for fitting and selling hearing aid instruments. During the first 90 days of initial training and guidance, the supervisor must be physically present for at least 80 hours while the temporary licensee is carrying out assigned duties.

002.08 WRITTEN EXAMINATION. One part of the qualifying examination. The International Hearing Society’s Written Comprehensive Examination.

003.01 DOCUMENTATION. The following documentation must be provided to the Department.

003.01(A) AGE. Provide documentation showing that the applicant is at least 21 years of age.

003.01(B) EDUCATION. Submit an official transcript, directly from the issuing institution, showing completion of a 4-year course of study from an accredited high school; or an official copy of a diploma or certificate from an accredited high school.

003.01(C) EXAMINATION. Provide documentation of successful completion of the qualifying examination sent directly to the Department.

003.01(D) LICENSED IN ANOTHER JURISDICTION. If an applicant holds a license in another jurisdiction, he or she may apply for licensure based upon licensure in another jurisdiction. The applicant must provide documentation that the standards regulating the practice of hearing instrument specialists in the other jurisdiction are equivalent to those maintained in Nebraska and the license was based on a written examination and practical examination equivalent to the qualifying examination for a Nebraska license, the grades given at the examination, and the date the license was issued.

003.01(E) OTHER PROOF OF COMPETENCY. For applicants who are not practicing at the time of application, the following applies:

003.01(E)(i) PASSED EXAMINATION AND NOT PRACTICING. An applicant who has met the education and examination requirements as listed in 172 NAC 75-003.01, who passed the written examination more than 3 years prior to the time of application, and who is not practicing at the time of application, must within the 3 years immediately preceding the application, present proof of having obtained 20 hours of acceptable continuing education within the 3 years immediately preceding the date of application.

003.01(E)(ii) LICENSED IN ANOTHER JURISDICTION AND NOT PRACTICING. An applicant who holds a license in another jurisdiction, but is not practicing at the time of application, must provide proof of having obtained a minimum of 20 hours of acceptable continuing education within the 3 years immediately preceding the date of application.

003.02 TEMPORARY LICENSE. A temporary license may be issued to an applicant who has submitted documentation of meeting educational requirements for licensure set out in this chapter except passing the practical examination. Previous experience or a waiting period is not required to obtain a temporary license. All temporary licenses will become null and void upon the Department’s notification that the temporary licensee has passed the practical examination or 1 year from the issuance date, whichever comes first. A temporary license may be renewed once pursuant to this chapter. The supervisor of a person who holds a temporary license must immediately notify the Department when supervision of the temporary licensee is terminated.

003.02(A) STANDARDS FOR SUPERVISION. Any person who practices as a temporary hearing instrument specialist must be supervised by a hearing instrument specialist or audiologist licensed in Nebraska whose license is active and has not been disciplined.

003.02(A)(i) MANDATORY SUPERVISORY CONTACT. The supervisor must meet with the temporary licensee face to face for 80 hours during the first 90 days of the initial training session, which will commence upon the issuance of the temporary license. Thereafter, the supervisor must meet with the temporary licensee monthly to evaluate the temporary licensee’s performance in the following areas:

(1) Audiometric evaluations;

(2) Impressions;

(3) Purchase agreements;

(4) Instrument orders;

(5) Hearing instrument fittings; and

(6) Consultation advice and training.

003.02(A)(ii) ADDITIONAL SUBJECTS COVERED. The supervisor must train the temporary licensee in the following areas during the initial 90-day training period:

(1) Basic physics of sound;

(2) Anatomy and physiology of the ear;

(3) Function of hearing aids;

(4) Pure tone audiometry, including air conduction testing and bone conduction testing;

(5) Live voice or recorded voice speech audiometry;

(6) Masking;

(7) Recording and evaluation of audiograms and speech audiometry to determine proper selection and adaptation of a hearing aid; and

(8) Taking earmold impressions.

004. PRACTICAL EXAMINATION . An applicant must successfully complete the practical examination administered by the Department.

004.01 ELIGIBILITY. To be eligible to take the practical examination, an applicant must have met the age, education, and written examination requirements for licensure set out in 172 NAC 75.

004.02 APPLICATION. To register for the practical examination, the applicant must submit a complete application for licensure as provided by the Department.

004.03 PASSING SCORE. The practical examination passing scores obtained must be at least 70 out of 100 in each subject examined.

004.04 REEXAMINATION. An examinee who fails the practical examination may retake the examination pursuant to the requirements as set forth below:

(A) An examinee who fails the practical examination with an overall average of less than

70 must retake the entire examination.

(B) An examinee who fails the practical examination in 1 or 2 subjects with an overall average of 70 or above must retake those sections failed.

(C) An examinee who fails the practical examination in more than 2 subjects with an overall average of 70 or above must retake the entire examination.

(D) The applicant may retake the practical examination upon resubmission of an application and fee.

005. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10 and this chapter. All hearing instrument specialist licenses expire on December 31st of each even-numbered year. Temporary hearing instrument specialist licenses expire one year from the date of issuance and may be renewed for one additional twelve-month period.

005.01 WAIVERS OF CONTINUING EDUCATION REQUIREMENTS FOR ILLNESS OR DISABILITY. The Department may waive continuing education requirements, in whole or in part, upon submission of proof that the license holder was suffering from a serious or disabling illness or physical disability which prevented completion of the required number of continuing education hours during the 24 months immediately preceding the license renewal date.

006. CONTINUING EDUCATION . On or before December 31st of each even-numbered year, individuals holding an active license in the State of Nebraska must complete at least 24 hours of acceptable continuing education hours during the preceding 24-month period.

006.01 CONTINUING EDUCATION HOUR OR CREDIT CALCULATIONS. The following provides the hour calculations for acceptable continuing education:

006.01(A) PROGRAMS AT STATE AND NATIONAL MEETINGS. Includes meetings of the Nebraska Hearing Aid Society and the National Hearing Aid Society. Documentation must include a certificate of attendance and a program outline or objectives. One hour for each hour of attendance.

006.01(B) FORMAL EDUCATION COURSES. The content of the course must relate directly to the practice of hearing aid instrument dispensing and fitting. Live streaming instruction, where the applicant can interact with the lecturer, may count as formal education. Documentation must include a certificate of attendance. One hour for each hour of attendance.

006.01(C) UNIVERSITY OR COLLEGE SPONSORED COURSES. The content of the course must relate directly to the practice of hearing aid instrument dispensing and fitting. Distance learning courses are included. Documentation must include a certificate of attendance. One hour for each hour of attendance.

006.01(D) PRESENTER OR LECTURER. One hour credit will be awarded for each hour of scientific presentation by a licensee acting as an essayist or lecturer to licensed hearing instrument specialists if the program relates to the theory or clinical application of theory pertaining to hearing instrument specialists. A licensee may receive continuing education credit for only the initial presentation during a renewal period.

006.01(E) FORMAL SELF-STUDY. The content of the self-study activity must relate to the practice of hearing aid dispensing and fitting whether the subject is research, treatment, documentation, education, or management. A licensee may complete a maximum of 6 hours of continuing education by formal self-study each 24-month renewal period. The self-study program must have a testing mechanism. Documentation must include a certificate of completion and a program outline or objectives. One hour for each 2 hours of study.

006.01(F) BUSINESS, MANAGEMENT, AND MARKETING COURSES. Must pertain to the practice of hearing aid instrument dispensing and fitting. A licensee may complete a maximum of 8 hours of continuing education utilizing these courses each 24-month renewal period. Documentation must include a certificate of attendance and a program outline or objectives. One hour for each hour attended.

006.01(G) SUPERVISION. Supervision of a temporary hearing instrument specialist by a hearing instrument specialist. One credit hour is earned for each 8 hours of in person supervision. A maximum of 10 hours of continuing education can be earned from supervision during each 24-month renewal period.

006.01(H) OTHER ACTIVITIES. Other types of activity that may be acceptable may include: human relations, governmental regulations and third party reimbursement. One hour for each hour attended.

006.02 ACCEPTABLE CONTINUING EDUCATION PROGRAMS. In order for a continuing education activity or program to be accepted for renewal or reinstatement of a license, the program must be at least 60 minutes in duration; the program's objectives must relate directly to the theory or clinical application of theory pertaining to the practice of hearing aid instrument dispensing and fitting; the presenter of the program must be qualified by education, experience, or training; and the program must be open to all hearing instrument specialists licensed in Nebraska.

007. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179 and this chapter:

(A) Providing services for which he or she is not trained or experienced;

(B) Willfully or intentionally committing any act which endangers patient safety or welfare;

(D) Failing to safeguard the welfare of patients;

(E) Failing to maintain appropriate professional relationships with patients;

(F) Carrying out hearing aid instrument dispensing and fitting services that have been requested when such services are known to be contraindicated or unjustified;

(G) Carrying out procedures that have been requested when such services are known to be outside of the hearing instrument specialist’s scope of practice;

(H) Falsification or unauthorized destruction of patient records; and

(J) Deceiving, misleading, or defrauding the public through advertising, including charging a fee through any hearing instrument specialist service conducted within 24 hours after performing a hearing instrument specialist service that was advertised as being free.

008. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

009. FEES . Fees are set out in 172 NAC 2.

History

Effective 2020-06-16

Chapter 81 Massage Therapists

Neb. Admin. Code tit. 172, ch. 81 Massage Therapists {#sec-172-nac-81 omnilex-key=us-ne-regs-official--title-172--172 NAC 81}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 81 MASSAGE THERAPISTS

001. SCOPE AND AUTHORITY . These regulations govern the licensing of massage therapists under Nebraska Revised Statutes (Neb. Rev. Stat.) §§ 38-1701 to 38-1715 of the Massage Therapy Practice Act and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions are set out in the Massage Therapy Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and these regulations.

002.01 CLIENT. Any person with whom the massage therapist has an agreement to provide massage therapy.

002.02 JURISPRUDENCE EXAMINATION. An examination, approved by the board, relating to statutes and regulations governing the practice of massage therapy in Nebraska.

002.03 LICENSURE EXAMINATION. An examination that is required for initial licensure as a massage therapist. Examinations approved by the board are:

(A) The following examinations developed by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB):

(i) National Certification Examination for Therapeutic Massage and Bodywork (NCETMB);

(ii) National Certification Examination for Therapeutic Massage (NCETM); and

(iii) Advanced Certification Examination (ACE);

(B) The Massage and Bodywork Licensing Examination (MBLEx) developed by the Federation of State Massage Therapy Boards (FSMTB); and

003. MASSAGE THERAPY . Massage therapy is defined in Neb. Rev. Stat. § 38-1706 and includes:

(A) Remedial therapy, using myofacial release, active or passive stretching, and similar modalities;

(B) Relaxation therapy, using Swedish Massage, hot stone, and similar modalities;

(C) Holistic therapy, using Ortho-Bionomy®, polarity, shiatsu, reflexology, acupressure, hands-on reiki, and similar modalities; and

(D) Mechanical or electrical manipulation which includes the use of the following equipment:

(i) Electrical stimulation equipment that does not exceed 35 volts output;

(ii) Oscillating (vibrating) equipment; and

(iii) Hydrotherapy equipment.

004. LICENSE REQUIREMENTS . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. §§ 38-1710, 172 NAC 10, and these regulations.

004.01 EDUCATION. Applicants must submit an official transcript directly from the issuing entity showing completion of a course of study and training in massage therapy as specified in 172 NAC 82.

004.02 RECIPROCITY. An applicant who is credentialed or authorized to practice massage therapy in another jurisdiction and has not completed 1,000 hours of training in massage therapy, may obtain hours to equal the required 1,000 hours of training through a massage therapy program, a college or university, work experience or continuing education. The applicant is not required to have attained the specified hours in the areas identified in 172 NAC 82. Hour equivalents may be granted in the following manner:

(A) 50-60 minutes obtained from a course of study in massage therapy equals 1 hour.

(B) 1 semester credit hour of massage therapy related college or university hours equals 15 hours.

(D) Up to 100 hours obtained from continuing education programs approved by the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB) or the Federation of State Massage Therapy Boards (FSMTB).

005. LICENSURE EXAMINATION . To take an approved licensure examination, an applicant must apply directly to the examination entity. Applicants must submit an official score report directly from the examination entity verifying successful completion of the licensure examination.

05.01 RECIPROCITY. An applicant who is credentialed or authorized to practice massage therapy in another jurisdiction must also successfully pass the jurisprudence examination, with a score of at least 75%.

006. TEMPORARY LICENSE REQUIREMENTS . To obtain a temporary license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the temporary license requirements.

006.01 CHANGE IN SUPERVISION. After the temporary license has been issued, if the temporary licensee intends to practice under the supervision of a different massage therapist, the temporary licensee must submit a supervision form provided by the Department and signed by the new supervising massage therapist, agreeing to provide supervision.

006.02 EXTENSION OF A TEMPORARY LICENSE. An applicant requesting an extension of a temporary license must submit a written request for extension, stating the reason for the request. Circumstances which may result in an extension of the temporary license may include but are not limited to:

(A) The applicant became ill during the licensure examination to the extent that he or she could not complete the examination;

(B) The applicant had to leave the licensure examination due to inclement weather conditions which caused the applicant to be unable to complete the examination; or

(C) The applicant suffered an incapacitating injury prior to the licensure examination which allowed him or her to take the examination but affected his or her ability to perform well on the examination.

007. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10 and these regulations. All massage therapy licenses, except a temporary license, issued by the Department will expire on November 1 of each odd-numbered year.

008. CONTINUING EDUCATION . During the 24 months prior to the license renewal date, each licensed massage therapist must complete 16 hours of continuing education hours, 50% of which may be gained through on-line or electronic media. Continuing education activities and requirements are as follows:

008.01 MANDATORY HANDS-ON HOURS. A licensee must complete at least 8 hours of hands-on massage therapy continuing education through workshops each renewal period. One hour of attendance equals 1 hour of continuing education. A licensee may earn all 16 hours through hands-on workshops. These hours must meet the following requirements:

(A) The content of the workshop must include at least 75% hands-on massage technique; up to 25% may be theory related to hands-on technique; and

(B) The workshop must include a set period of time for class participation which is hands-on practice.

008.02 MANDATORY ETHICS HOURS. Each licensee must obtain at least 3 hours of continuing education relating to massage therapy ethics. Ethics hours may be taken through home study or other electronic media.

008.03 PRACTICAL EXAMINATION. 3 hours will be granted for a licensee who successfully completes a practical examination administered by a Nebraska licensed Massage Therapy School and these hours count towards the mandatory hands-on hours.

008.04 NON-HANDS ON HOURS. Up to 8 hours of non-hands on activities can be applied to the 16-hour requirement.

(A) LICENSURE EXAMINATION. 5 hours will be granted for licensees who successfully pass an approved licensure examination.

(B) PUBLICATION. 3 hours will be granted for authoring an article published in a professional health-related journal; a newsletter article or letter to the editor does not meet this requirement.

(C) JURISPRUDENCE EXAMINATION. 3 hours will be granted for licensees who receive a score of at least 75% on the jurisprudence examination.

(D) INSTRUCTOR AT A MASSAGE THERAPY SCHOOL. Instructors at a Nebraska massage therapy school will be granted 1 hour for each hour of teaching, up to 5 hours.

(E) MASSAGE SCHOOL TRAINING, COLLEGE OR UNIVERSITY COURSEWORK. Hours can be resident or distance learning. One hour of training equals 1 hour of continuing education; 1 semester college credit hour equals 15 hours of continuing education; or 1 quarter college credit equals 10 hours of continuing education. Licensees can use up to 5 hours.

(F) HOME STUDY PROGRAMS OR OTHER ELECTRONIC MEDIA. Licensees can use up to 8 hours of homestudy programs to meet continuing education.

(G) PRESENTER CREDIT. A presenter at a continuing education course may receive the same credit hours as an attendee for only the initial presentation during a renewal period.

008.05 ACCEPTABLE TOPIC AREAS. Topic areas that are acceptable for continuing education activities are as follows:

(A) HANDS-ON. The following are the acceptable topic areas:

(i) Hydrotherapy.

(ii) Massage.

(B) NON HANDS-ON. The following are the acceptable topic areas:

(i) Anatomy.

(ii) Health service management.

(iii) Hygiene.

(iv) Pathology.

(v) Physiology.

009. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. §§ 38-179, 38-1714, and these regulations and includes:

(A) Providing services for which he or she is not trained or experienced;

(B) Willfully or intentionally committing any act which endangers client safety or welfare;

(D) Making deceptive or misleading representations of the massage therapist's education, training, or experience;

(E) Failing to decline to carry out massage therapy services that have been requested when such services are believed to be contraindicated or unjustified;

(F) Failing to exercise appropriate supervision over a temporary licensee who is authorized to practice only under the supervision of the licensed massage therapist;

(G) Verbally or physically abusing clients or engaging in cruel, inhumane, or degrading practices in providing massage therapy to a client;

(H) Willfully or intentionally failing to accurately represent his or her skills to a client;

(I) Soliciting a sexual relationship with a client;

(J) Committing an act with a client punishable as a sexual assault or sexual related offense;

(K) Engaging in deliberate or repeated comments, gestures, or physical contacts of a sexual nature that are unnecessary in the professional relationship with the client; and

(L) Failing to maintain appropriate draping for each client to ensure the comfort level of both the therapist and client.

010. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10 for reinstatement.

011. FEES . Fees are set out in 172 NAC 2.

History

Effective 2021-06-07

Chapter 82 Massage Therapy Establishments and Schools

Neb. Admin. Code tit. 172, ch. 82 Massage Therapy Establishments and Schools {#sec-172-nac-82 omnilex-key=us-ne-regs-official--title-172--172 NAC 82}

001. SCOPE AND AUTHORITY. These regulations govern the licensing of massage therapy establishments and schools under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-1701 to 38-1715 of the Massage Therapy Practice Act and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions are set out in the Massage Therapy Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 9, 172 NAC 81, and these regulations.

002.01 CLIENT. As provided in 172 NAC 81.

002.02 HOUR. 50-60 minutes in duration.

002.03 IMPLEMENT. An electrical or mechanical tool, instrument, or a similar device, including, but not limited to, brushes, electrical massagers, hot stones, shells, hand tools, and any tool that comes in contact with the client.

002.04 MASSAGE THERAPY. As provided in 172 NAC 81.

002.05 MASSAGE THERAPY ESTABLISHMENT. As provided in Neb. Rev. Stat. § 38-1707. Massage Therapy Establishment does not include:

(A) On-site massage performed at the location of the client;

(B) Stand-alone devices, such as chairs, which are operated by the customer;

(C) Establishments located within the confines of a hospital, nursing home, or other similar establishment or facility licensed or otherwise regulated by the Department; or

(D) Corporate massage, such as, but not limited to, health fairs, bridal fairs, employment fairs, or similar events.

002.06 REGULARLY LICENSED PHYSICIAN. A physician licensed to practice medicine and surgery or osteopathy by the licensing authority in the jurisdiction where the school is located.

003. MASSAGE THERAPY ESTABLISHMENT LICENSE REQUIREMENTS . To obtain a massage therapy establishment license, the applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of 172 NAC 9 and these regulations.

003.01 PHYSICAL SPACE. The establishment must have:

(A) Adequate space for providing massage therapy services; and

(B) Restroom facilities.

003.02 DOCUMENTATION. Documentation with the following information must be provided:

(A) The name(s) of licensed massage therapist(s) who will be working in the establishment;

(B) A floor plan of the proposed establishment, including restroom locations;

(D) A statement that the applicant has not operated a massage establishment at the address listed on the application; or if the applicant has operated a massage therapy establishment at that address, a statement of the number of days of operation.

004. MASSAGE THERAPY SCHOOL LICENSE REQUIREMENTS . To obtain a massage therapy school license, the applicant must submit a complete application provided by the Department and must meet the licensing requirements of 172 NAC 9 and these regulations. If the school provides massage therapy services in addition to the student training program, a massage therapy establishment license must be obtained.

004.01 REQUIREMENTS AND DOCUMENTATION. Applicants must provide documentation demonstrating that they meet the following requirements:

(A) STAFF PHYSICIAN. Have a regularly licensed physician on staff.

(B) COURSE OF STUDY. Provide documentation of a course of study consisting of at least 1,000 hours, including at least 100 hours in each of sub-sections (i) through (vii) and at least 300 hours in subsection (viii). For purposes of this section, continuing education is not considered study and training in massage therapy.

(i) ANATOMY. Anatomy hours may include structure of the human body, study of cells, tissues, bones, muscles, organ systems, histology, embryology, kinesiology, biomechanics, and cadaver study.

(ii) HEALTH SERVICE MANAGEMENT. Health Service Management must include a review of 172 NAC 81 and 82. Hours may include professional ethics, legalities of massage, business practices, promotion, employment opportunities, telephone techniques, marketing plan, sales techniques, resumes, bookkeeping, management techniques, insurance coverage, networking, interview techniques, interpersonal client contact, and professional communication.

(iii) HYDROTHERAPY. Hours may include the history and benefits of water treatment, body wraps and masks, salt glows, body scrubs, body shampoos, moisturizers, hot packs, steam cabinets, dry brushing, therapeutic water modalities, methods of cold application, heat therapy, contrast baths, skin contra-irritants, spas, and aromatherapy.

(iv) HYGIENE AND PRACTICAL DEMONSTRATION. Hygiene may include principles and practices that promote client safety, personal wellness, equipment and sanitation, and infectious and contagious disease control. Practical demonstration may include various massage therapy techniques and demonstration, hands-on training, student clinic hours, kinesiology, interpersonal client contact, professional communication, cardiopulmonary resuscitation (CPR), and first aid.

(v) MASSAGE. Hours may include history of massage, equipment and tools, psychology of massage, relaxation and visualization, proper draping techniques, general guidelines for massage, principles of body massage, and body mechanics.

(vi) PATHOLOGY. Hours may include definition of pathology and disease, pharmacology, pathology of body systems, disease entities including cause and effect, injury and soft tissue dysfunction, and immunology.

(vii) PHYSIOLOGY. Hours may include endocrinology, biochemistry, function of human body and organ systems, kinesiology, and biomechanics.

(viii) CLINICAL PRACTICE. The remaining 300 hours may be obtained through an internship in subject areas related to the clinical practice of massage therapy which may include reflexology, deep tissue modalities, structural integration modalities, energy modalities, Swedish massage, sports massage, pregnancy and infant massage, physiology and psychology of exercise, acupressure therapy, review of health histories and documentation, and licensure examination subject areas.

(C) INSTRUCTORS. Provide the name of the instructor who will be teaching each course set out in 172 NAC 82-004.01(B). Instructor requirements for the course of study follows:

(i) Anatomy, health service management, pathology, and physiology may be taught by a person with appropriate education in the topic area and may be taught through e-learning, on-line or other digital means.

(ii) Hydrotherapy, hygiene and practical demonstration, massage, and clinical practice must be taught by a massage therapist who holds an active license in Nebraska or active credential in another state and the hands-on training for each of these course areas must be taught in-person.

(D) CURRICULUM AND SYLLABI. Submit the following:

(i) A copy of the curriculum plan which lists all of the subjects offered for completion of the massage therapy course of study.

(ii) A copy of the syllabus for each subject taught, to include:

(1) Title of course;

(2) Instructor’s name;

(3) Hours associated with each subject;

(4) Description of each subject;

(5) Course objectives;

(6) Text books and resource or supplement references;

(7) Grading system; and

(8) Week by week or day by day class schedule.

(iii) A copy of the school rules and handbook.

(E) STUDENT ENROLLMENT. Require a diploma from an accredited high school or its equivalent as a condition of student enrollment.

(F) FLOOR PLAN. A detailed floor plan or blueprint of the proposed school building must be submitted to the Department at least 30 days prior to the anticipated opening date of the school.

(G) SELF-INSPECTION. A copy of the completed self-inspection showing compliance with 172 NAC 82-005.

(H) PRACTICE STATEMENT. A statement that the applicant has not operated the school or represented the school as holding a license in Nebraska before submitting the application; or if the applicant has, a statement of the number of days the school operated.

005. INSPECTIONS . All in-state establishments and schools will receive an initial inspection and thereafter a routine inspection. Establishment and schools must be fully in compliance with 172 NAC 82-007 through 009.

005.01 INITIAL SELF-EVALUATION INSPECTION. Under 172 NAC 82-003, the applicant must conduct a self-evaluation inspection prior to the proposed opening date of the establishment.

005.02 INITIAL ON-SITE INSPECTION. The Department will conduct an initial unannounced on-site inspection within 1 year of receipt of a completed application for an establishment and 30 days of receipt of a completed application for schools.

005.03 TIMING OF INSPECTIONS. The Department may conduct an on-site unannounced inspection at any time it deems necessary.

005.04 FOCUSED SELECTION INSPECTIONS. The Department may conduct an unannounced inspection when the Department is informed of the following:

(A) The passage of 5 years without an inspection; or

(B) A complaint alleging a violation of statutes or regulations.

006. REQUIRED DOCUMENTS, PHYSICAL STRUCTURE, EQUIPMENT AND SUPPLIES . A school must have equipment necessary to teach massage therapy and an establishment must have equipment necessary to provide massage therapy services.

006.01 PHYSICAL STRUCTURE. The physical structure must have a clearly identifiable location and can be free-standing or part of an existing structure. It must be well ventilated and kept in a clean, orderly, and sanitary condition at all times.

(A) All rooms must have adequate lighting and ventilation.

(B) A restroom must be available on the premises.

(D) Doors, stairways, passageways, aisles, or other means of exit must provide safe and adequate access.

(E) There must be an area that can be screened from public view for clients requesting privacy.

(F) Each room where massage therapy services are provided must have an Environmental Protection Agency (EPA) registered disinfectant that is proven effective against HIV-1, or Hepatitis B, or is a Tuberculocidal, and have liquid soap and water or an instant sanitizer.

(G) If a massage therapy establishment is located within the massage therapy school, the room(s) utilized by the establishment licensee(s) must be clearly identified by the name of the establishment. If these same room(s) are utilized by the establishment for student clinics, the room(s) must be clearly identified as ‘student clinic’ while utilized by the students.

006.02 MASSAGE TABLES AND CHAIRS. All tables and chairs must be safe and in a sanitary condition at all times.

(A) Tables and chairs must be disinfected between clients with an Environmental Protection Agency (EPA) registered disinfectant that is proven effective against HIV- 1, or Hepatitis B, or is a Tuberculocidal.

(B) Clean linens must be used for each client.

(C) Sheeting or pads that come in direct contact with the client or have been soiled must be removed and cleaned between clients.

006.03 STORAGE. Storage must meet the following requirements:

(A) Flammable and combustible chemicals must be stored away from potential sources of ignition such as an open flame or an electrical device.

(B) Cabinets, drawers, and containers used for storage of tools, equipment, implements, towels, and linens must be clean.

(C) Tools, equipment, instruments, or towels and linens which have been used on a client must not be placed in a container with clean tools, equipment, instruments, or towels and linens.

(D) All clean towels are stored in a clean, enclosed, dust-proof cabinet or container until used. Pillows are not required to be stored in a cabinet or container, but must have a clean covering before contact with a client.

006.04 TOWELS AND LINENS. All towels and linens must be clean and sanitary for each client and meet the following requirements:

(A) Cloth towels and linens must be deposited in a closed receptacle after use.

(B) Used cloth towels and linens must be not used again until properly laundered.

006.05 PRODUCTS. The requirements for products used at a school or establishment are as follows:

(A) All liquids, creams, and other products must be kept in clean, closed containers.

(B) Original product bottles and containers must have an original manufacturer label, which discloses their contents.

(C) All products used on a client must be dispensed by a spatula, scoop, spoon, squeeze bottle, pump, dropper or similar dispenser so that the remaining product is not contaminated.

(D) If a product is poured into another container, such as a shaker, dispenser pump container, or spray container, the container must be labeled to identify the product.

(E) Products applied to one client cannot be removed and reused on another client.

006.06 METHODS OF DISINFECTION. All electrical and mechanical tools, instruments, and implements must be disinfected before use on a client, using one of the following procedures:

(A) Spray, immerse, soak, or saturate the implement until it is totally saturated with an

Enivronmental Protection Agency (EPA) registered disinfectant that is proven

effective against HIV-1, or Hepatitis B, or is a Tuberculocidal.

(i) Before removing the sanitized implement, wash hands with liquid soap and water or antibacterial solution.

(ii) Rinse implement.

(iii) Prior to storing, air-dry on a sanitary surface or dry with a clean sanitized towel.

(iv) Store in a clean enclosed cabinet or covered container reserved for clean implements.

(B) Autoclave implements in accordance with the manufacturer’s instructions. Autoclaves must be cleaned and serviced at the frequency recommended by the manufacturer.

006.07 FOOT BATHS, FOOT SPAS, SHOWERS, AND HOT TUBS. All foot baths, foot spas, showers, and hot tubs must be disinfected with an Environmental Protection Agency (EPA) registered disinfectant that is proven effective against HIV-1, or Hepatitis B, or is a Tuberculocidal and in accordance with manufacturer’s instructions.

006.08 PARAFFIN WAX MACHINES. Each paraffin wax machine must be kept clean, the paraffin wax must be removed for each client, and wax cannot be re-melted and used by another client.

006.09 PROHIBITED ACTIVITIES. The following activities are prohibited:

(A) Smoking or vaping; and

(B) Consuming, serving, or in any manner possessing intoxicating beverages upon the premises during the hours the establishment and school is open to the public.

006.10 DOCUMENTS AND RECORDS. The following must be posted or available in establishments and schools:

006.10(A) POSTED. Copies of the following documents must be posted for public viewing:

(i) The current establishment and school license.

(ii) A sign containing the name of the establishment and school. The sign must be located at the entrance to the establishment and school.

(iii) The current license of each massage therapist who practices massage therapy in the establishment.

(iv) The current license of each massage therapist who teaches massage therapy in the school.

(v) The current license of the regularly licensed physician.

006.10(B) AVAILABLE. At least one copy of the latest edition of the Massage Therapy Practice Act and one copy of the latest edition of 172 NAC 81 and 82 must be available.

007. SCHOOL OPERATING REQUIREMENTS . Operating requirements for schools are as follows:

007.01 REQUIREMENTS. The owner of a school must:

(A) Ensure that all students are under the supervision of an instructor at all times. Students in internships and practicums must have an onsite supervisor who is a licensed health care provider whose scope of practice includes massage techniques and who reports directly to the school instructor who must also be a licensed massage therapist.

(B) Record student hours on a daily basis.

(C) Give periodic evaluations that are graded according to a formula established by the school. A student's final average, when in training, must be no less than an average of 75%. A final practical examination, as described below, must be given before issuance of a diploma. The examination must test over the following techniques and skills:

(i) Effleurage;

(ii) Petrissage;

(iii) Tapotement or Percussion;

(iv) Friction;

(v) Vibration;

(vi) Draping; and

(vii) Hygiene and sanitation.

(D) Administer the practical examination to each student. The examination must be administered by at least 2 instructors who must score each part of the examination, and the average of the scores must be the final score for the student.

(E) Allow the Massage Therapy Board to observe any practical examination administered by the school for the purpose of ensuring adherence to the required techniques and skills specified in 172 NAC 82-006.01(C).

(F) Post and adhere to all class schedules and the school curriculum.

(G) Ensure that massage therapy students do not teach the massage curriculum.

(H) Issue an official transcript, under the original seal of the school, to each student completing the program. The transcript must clearly identify each of the required coursework areas as defined in 172 NA C 81-004.01(B), the hours earned in each coursework area, the name of the student, and the enrollment and graduation date.

(I) Ensure that all advertising by the school states that services are performed by students who are in training in massage therapy.

007.02 PROHIBITED ACTIVITIES. The owner of a school must not:

(A) Pay direct compensation to any of its students; tips are considered direct compensation.

(B) Credit a student with hours except when such hours were earned in the study or practice of massage therapy in accordance with the required curriculum, except massage schools may transfer college or university credit into the massage course of study.

008. CHANGE IN LICENSE FOR AN EXISTING ESTABLISHMENT AND SCHOOL . Owners may request a change in ownership, location, or name of an establishment or school.

008.01 CHANGE IN OWNERSHIP OR LOCATION. To change the ownership, location, or name of the establishment or school, the applicant must apply to the Department for and obtain another license as specified in 172 NAC 83-003 or 004 at least 15 days prior to the change. If the establishment is mobile, the owner is not required to obtain another credential for each location change. If applying for a school, the applicant must also identify:

(A) Any changes to the school’s curriculum plan, staff employed, handbook or school bulletin, or schedule of proposed hours of operation; and

(B) Any change in the physical design. If a change in the physical design has occurred, passage of an inspection maybe required prior to issuance of a license.

008.02 CHANGE IN NAME. The applicant must submit a request for a change in the establishment or school name at least 15 days prior to the change and submit the required fee for a reissued license.

009. RENEWAL . The applicant must meet the requirements set out in 172 NAC 9 and these regulations. All massage therapy establishment and school licenses issued by the Department will expire on November 1 of each odd-numbered year.

010. REAPPLICATION . Establishments and schools that were previously licensed in Nebraska and seek the authority to return to operation must meet the requirements set out in 172 NAC 9.

011. FEES . Fees referred to in these regulations are set out in 172 NAC 2.

History

Effective 2021-06-07

Chapter 86 Behavior Analyst

Neb. Admin. Code tit. 172, ch. 86 Behavior Analyst {#sec-172-nac-86 omnilex-key=us-ne-regs-official--title-172--172 NAC 86}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 86 BEHAVIOR ANALYST

001. SCOPE AND AUTHORITY. These regulations govern the licensing of behavior analysts and related professions under the Behavior Analyst Practice Act, Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-4401 to 38-4414, and the Uniform Credentialing Act, Neb. Rev. Stat. §§ 38-101 to 38-1,148.

002. DEFINITIONS. The definitions contained in the Behavior Analyst Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and the following definitions apply to this chapter:

002.01 CLIENT. A direct recipient of behavior analysis services.

002.02 MULTIPLE RELATIONSHIPS. A business or close personal relationship between credential holder and a client, a client’s parent, a client’s guardian, or a stakeholder.

002.03 STAKEHOLDER. A person that is not the direct recipient of services but is impacted by and has a vested interest in the behavior analysis services received such as parent, guardian, caregiver, relative, legally authorized representative, employer, agency, institutional representatives, or third-party contractor for services.

002.04 BEHAVIOR ANALYSIS SERVICES. The provision of services that fall within the scope of practice for behavior analysts.

003. INITIAL LICENSE . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of the Behavior Analyst Practice Act, the Uniform Credentialing Act, 172 NAC 10, and this chapter.

003.01 LICENSED BEHAVIOR ANALYST INITIAL LICENSE. To obtain an initial license as a licensed behavior analyst, the applicant must submit:

(A) Proof of active certification from a certifying entity as defined by Neb. Rev. Stat. § 38-4405;

(B) A signed consent for the Department to check the applicant’s name against the Department’s abuse and neglect central registry;

(C) An attestation that the applicant is not listed as a perpetrator of abuse or neglect on an adult abuse and neglect registry or a child abuse and neglect registry from other states;

(D) An attestation listing any credential currently or previously held by the applicant and the state in which the credential was issued; and

(E) An attestation for any denial, refused renewal, suspension, revocation, or other disciplinary action taken against any credential.

003.01(i) DOCUMENTATION. If the applicant is or has been credentialed in another state and the credential has been denied, refused renewal, suspended, revoked, or had other disciplinary action taken against it, the applicant must request all documentation related to such action to be sent to the Department directly from the other state’s regulatory agency.

003.02 LICENSED ASSISTANT BEHAVIOR ANALYST INITIAL LICENSE. To obtain an initial license as a licensed assistant behavior analyst, the applicant must submit:

(A) Proof of active certification from a certifying entity, as defined by Neb. Rev. Stat. § 38-4405;

(B) A signed consent for the Department to check the applicant’s name against the Department’s abuse and neglect central registry;

(C) An attestation that the applicant is not listed as a perpetrator of abuse or neglect on an adult abuse and neglect registry or a child abuse and neglect registry from other states;

(D) An attestation listing any credential currently or previously held by the applicant and the state in which the credential was issued; and

(E) An attestation for any denial, refused renewal, suspension, revocation, or other disciplinary action taken against any credential.

003.02(i) DOCUMENTATION. If the applicant is or has been credentialed in another state and the credential has been denied, refused renewal, suspended, revoked, or had other disciplinary action taken against it, the applicant must request all documentation related to such action to be sent to the Department directly from the other state’s regulatory agency.

004. TEMPORARY LICENSE. To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of theBehavior Analyst Practice Act, the Uniform Credentialing Act, 172 NAC 10, and this chapter. A temporary license can be obtained by a behavior analyst or assistant behavior analyst who is licensed in another jurisdiction or certified by a certifying entity as defined by Neb. Rev. Stat. § 38-4405, to practice independently. The temporary license will allow the individual to provide applied behavior analysis services in Nebraska for 30 consecutive days. Individuals may be issued only one temporary license in a one-year period of time.

004.01 LICENSED BEHAVIOR ANALYST TEMPORARY LICENSE. To obtain a temporary license as a licensed behavior analyst, the applicant must meet all requirements to receive an initial license as a licensed behavior analyst and attest that the applicant will provide applied behavior analysis services for no more than 30 days in Nebraska.

004.02 LICENSED ASSISTANT BEHAVIOR ANALYST TEMPORARY LICENSE. To obtain a temporary license as a licensed assistant behavior analyst, the applicant must meet all requirements to receive an initial license as a licensed assistant behavior analyst and attest that the applicant will provide applied behavior analysis services for no more than 30 days in Nebraska.

005. RENEWAL. To renew a credential, a credential holder must, prior to the expiration date, submit a complete application for renewal provided by the Department demonstrating that the applicant meets the requirements of the Behavior Analyst Practice Act, the Uniform Credentialing Act, 172 NAC 10, and this chapter. All licensed behavior analyst and licensed assistant behavior analyst licenses issued by the Department expire on September 1st of each even-numbered year.

005.01 LICENSED BEHAVIOR ANALYST LICENSE RENEWAL. To renew a license as a licensed behavior analyst, the applicant must submit:

(A) Proof of active certification from a certifying entity, as defined as Neb. Rev. Stat. § 38-4405;

(B) A signed attestation that the applicant is not listed as a perpetrator on the Department’s abuse and neglect central registry;

(C) A signed attestation that the applicant is not listed as a perpetrator of abuse or neglect on an adult abuse and neglect registry or a child abuse and neglect registry from other states; and

(D) A signed attestation that the applicant’s credentials issued in other states are in good standing.

005.02 LICENSED ASSISTANT BEHAVIOR ANALYST LICENSE RENEWAL. To renew a license as a licensed assistant behavior analyst, the applicant must submit:

(A) Proof of active certification from a certifying entity, as defined by Neb. Rev. Stat. § 38-4405;

(B) A signed attestation that the applicant is not listed as a perpetrator on the Department’s abuse and neglect central registry;

(C) A signed attestation that the applicant is not listed as a perpetrator of abuse or neglect on an adult abuse and neglect registry or a child abuse and neglect registry from other states; and

(D) A signed attestation that the applicant’s credentials issued in other states are in good standing.

006. DENIAL AND DISCIPLINARY ACTION. An applicant or credential holder may be denied, refused renewal, suspended, revoked, or have other disciplinary action taken against the credential for failure to meet licensing requirements set forth in this chapter or for grounds specified in Neb. Rev. Stat. § 38-178, including for unprofessional conduct as set out in this chapter and in Neb. Rev. Stat. § 38-179.

006.01 REGISTRY CHECK DENIAL. Any applicant or credential holder listed as a perpetrator on any state’s adult abuse and neglect registry, or child abuse and neglect registry will be denied an initial license or may be refused renewal, suspended, revoked, or have other disciplinary action taken against the license.

007. INACTIVE STATUS . The credential holder must meet the requirements set out in 172 NAC 10 for the credential to be placed on inactive status. If a credential holder’s certification issued by a certifying entity, as defined by Neb. Rev. Stat. § 38-4405, becomes inactive, the credential holder must report the inactive status to the Department within 10 days.

008. CONTINUING EDUCATION REQUIREMENTS . Continuing education and competency requirements with a certifying entity, as defined by Neb. Rev. Stat. § 38-4405, must be maintained to be an active licensed behavior analyst or licensed assistant behavior analyst in the State of Nebraska.

009. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10 for reinstatement.

010. FEES . The following fees apply:

(A) The fee for initial behavior analyst licenses is $150.00;

(B) The fee for initial assistant behavior analyst licenses is $100.00; and

011. UNPROFESSIONAL CONDUCT . Unprofessional conduct includes acts set out in Neb. Rev. Stat. § 38-179 and acts set out in this chapter.

011.01 ETHICS CODE. It is unprofessional conduct for a credential holder to depart from or fail to conform to the ethics of the behavior analyst profession, found in the “Ethics Code for Behavior Analysts” as revised on January 1, 2022, and as published by the Behavior Analyst Certification Board.

011.02 COMPETENCE. It is unprofessional conduct for a credential holder to provide services for which he or she is not trained.

011.03 CLIENT CONFIDENTIALITY. It is unprofessional conduct for a credential holder to disclose any information they have acquired from a client, client’s parent or guardian, or stakeholder except:

(A) With the written consent of the client;

(B) With the written consent of the client’s parent or guardian if the client is unable to consent;

(D) When the client waives confidentiality by bringing charges against the credential holder.

011.04 NOTIFICATION. It is unprofessional conduct for a credential holder to fail to comply with the notification requirements in this section. A credential holder must inform each client; the client’s parent if the client is under the age of majority; and the client’s guardian, if one is appointed, of how to access these regulations and the right to file a complaint with the Department or certifying entity within 30 days of beginning services. For existing clients receiving services, a credential holder must inform each existing client; the client’s parent if the client is under the age of majority; and the client’s guardian, if one is appointed, of how to access these regulations and the right to file a complaint with the Department or certifying entity no later than 60 days after the effective date of these regulations. The credential holder must document completion of this notice in the client’s file.

011.05 DISCONTINUATION OF SERVICES. It is unprofessional conduct for a credential holder to fail to:

(A) Discontinue services when a client has achieved the discharge goals set out in the service plan;

(B) Discontinue services after it becomes evident the services are not effective or beneficial for the client and to take appropriate steps to transition the client to another provider;

(C) Create a written plan to transition the client to another provider if services are ended for reasons other than the client achieved the goals for which services were set out in the service plan or it becomes evident the services are not effective or beneficial for the client; or

(D) Make appropriate and timely efforts to facilitate the continuation of behavior analysis services in the event of an unplanned interruption in services caused by the credential holder or the credential holder’s employer.

011.06 DISCRIMINATION. It is unprofessional conduct for a credential holder to refuse to provide services or assistance to clients or stakeholders based on race, color, religion, sex, disability, marital status, national origin, age, familial status, and ancestry.

011.07 FAILURE TO COOPERATE WITH INVESTIGATIONS. Credential holders must provide information and documentation as requested during any investigation by the Department or other official entities. Refusal to cooperate or failing to furnish requested information and documentation during any investigation is considered unprofessional conduct.

011.08 FAILURE TO REPORT REGISTRY FINDING. It is unprofessional conduct for a credential holder to fail to report as required by this section. A credential holder must notify the Department within 10 days of being placed on any state’s adult abuse and neglect registry or child abuse and neglect registry.

011.09 CHARGES FOR SERVICES. It is unprofessional conduct for a credential holder to fail to comply with this section. A credential holder must provide accurate information regarding fees charged to clients or relevant stakeholders and provide accurate information on reports, bills, invoices, requests for reimbursements, and receipts.

011.10 MULTIPLE RELATIONSHIPS. Credential holders must make every effort to avoid multiple relationships that could impair professional judgment or increase the risk of exploitation. If a multiple relationship cannot be avoided, it is unprofessional conduct for a credential holder to:

(A) Not seek supervision or professional consultation to ensure judgment is not impaired and no exploitation occurs.

(B) Engage in any abuse of power or authority by coercing or exploiting the person over whom the credential holder has authority.

011.11 SEXUAL MISCONDUCT. It is unprofessional conduct for a credential holder to:

(A) Engage in romantic or sexual relationships with a client, a client’s parent, or a client’s

guardian;

(B) Engage in romantic or sexual relationships with former clients within two years from the date the professional relationship ended;

(C) Engage in romantic or sexual relationships with former supervisees or trainees until there is documentation that the professional relationship has ended;

(D) Supervise or train individuals with whom the credential holder has had a romantic or sexual relationship within the past six months; or

(E) Engage in sexual harassment.

011.12 PUBLIC STATEMENTS. It is unprofessional conduct for a credential holder to fail to protect the rights of their clients, stakeholders, trainees, and supervisees in all public statements by:

(A) Failing to protect a client’s confidentiality in public facing statements and media except when informed consent is obtained;

(B) Failing to make sure the statements about the credential holder’s professional activities are accurate and not misleading;

(C) Failing to take appropriate action to address untruthful, misleading, or inaccurate advertising or statements about the credential holder by the credential holder’s employer, marketers, clients, or stakeholders;

(D) Advertising nonbehavioral services as behavioral services;

(E) Soliciting testimonials from current clients for advertising purposes;

(F) Failing to comply with intellectual property laws;

(G) Posting confidential information on social media websites;

(H) Encouraging or promoting the practice of behavior analysis by untrained or unqualified persons; and

(I) Providing information in any form related to the practice of behavior analysis that is untruthful, intentionally misleading, or fraudulent.

011.13 RESEARCHWITH HUMAN PARTICIPANTS. It is unprofessional conduct for a credential holder to fail to respect the dignity and welfare of human research participants and conform with acceptable and prevailing standards in research. Unprofessional conduct includes:

(A) Unless it is considered minimal risk, a credential holder’s failure to establish an agreement that clarifies the obligations and responsibilities of the credential holder and the human research participant prior to the human research participant’s participation in a credential holder’s research;

(B) Except where the nature of the credential holder’s research precludes full disclosure, failure to inform human research participants of all aspects of the research that might be expected to influence willingness to participate, or failing to explain all aspects of the research about which a participant inquires. Where the nature of the research precludes full prior disclosure, or where the research is with children or with individuals with a legal guardian, failing to implement additional safeguards to protect the welfare and dignity of the human research participants;

(i) Failure to determine whether the use of the techniques are justified by the study’s prospective scientific, educational, or applied value before conducting the study; or

(ii) Failure to determine whether alternative procedures are available that do not use concealment or deception before conducting the study;

(D) Failure to grant a participant the right to decline to participate in or to withdraw from the credential holder’s research at any time without impacting other services received from the credential holder;

(E) Failure to inform the participant of undue physical and mental discomfort, harm, and danger that may arise from research procedures;

(F) Failure to inform the participant of the use of research procedures likely to cause serious or lasting harm to a participant unless fully informed and voluntary consent is obtained from the participant;

(G) Withholding information from participants about the nature of the study, after data has been collected, unless there is a scientific or humane value justifying the delay;

(H) Failure to make reasonable efforts to detect and remove or correct undesirable consequences for the individual participants;

(I) Knowingly publishing misleading or inaccurate research findings;

(J) Solicitation of research participants with false representations;

(K) Failure to obtain a parent or guardian’s consent to participate in research and, when appropriate, obtaining assent from the research participant; and

(L) Offering professional services as an inducement for participation.

011.14 PROFESSIONAL RECORDS. Failure to comply with the following is unprofessional conduct:

(A) Client records must be maintained a minimum of seven years following termination of services;

(B) Client records must be stored, safeguarded, and disposed of in ways that maintain confidentiality and in accordance with applicable laws and professional standards;

(C) Prior to the credential holder moving from the area or closing a practice, a credential holder must arrange for the storage, transfer, access to, or disposition of client records in ways that maintain confidentiality of the clients;

(D) Client records must include a signed and dated informed consent agreement outlining the credential holder’s confidentiality obligations, as well as the client’s rights and responsibilities;

(E) Client records must include documentation which reflect the services provided and include applicable releases of information and discussions with other professionals; and

(F) A credential holder must allow a client access to his or her records in accordance with Neb. Rev. Stat. §§ 71-8401 to 71-8407.

011.15 MINIMIZING CLIENT RISK. It is unprofessional conduct to fail to use the least restrictive and least intrusive measures in accordance with the client’s treatment plan.

011.15(i) PHYSICAL INTERVENTION. A credential holder must obtain informed consent and, when appropriate, client assent. A credential holder must document that they obtained informed consent, and document the occurrence and effectiveness of a restrictive or punishment-based procedure. Any physical management implemented must be communicated with the client’s parent, if the client is a minor, guardian if appointed, or stakeholder when used in an emergent situation.

011.16 SUPERVISION OF LICENSED ASSISTANT BEHAVIOR ANALYST BY A BEHAVIOR ANALYST. A licensed assistant behavior analyst must be supervised by a licensed behavior analyst holding a Nebraska credential. It is unprofessional conduct to fail to meet any of the following supervision criteria:

(A) Supervision by a behavior analyst with a Nebraska license; and

(B) Supervision consistent with the requirements of the certifying entity, as defined by Neb. Rev. Stat. § 38-4405.

011.17 SERVICE DELIVERY. It is unprofessional conduct for the licensed behavior analyst or licensed assistant behavior analyst to fail to do the following:

(A) Provide semi-annual client progress documentation to the client, the client’s parent if the client is under the age of majority, or the client’s guardian, if one is appointed;

(B) Provide notification to the client, the client’s parent if the client is under the age of majority, or the client’s guardian, if one is appointed, of any meetings with stakeholders;

(C) Attend, either in person or by video conference, an initial client meeting at the beginning of delivery of services; and

(D) Attend at least one meeting, either in person or by video conference, with the client, the client’s parent if the client is under the age of majority, or the client’s guardian, if one is appointed, every six months, to review and discuss the client’s progress and goals. If a higher meeting frequency is agreed upon by the client’s service delivery team, the licensed behavior analyst must attend at the agreed upon frequency.

011.17(i) CLIENT MEETING. If a licensed behavior analyst is providing services to a client at the effective date of these regulations, the licensed behavior analyst must meet with the client, the client’s parent if the client is under the age of majority, or the client’s guardian, if one is appointed, within 60 days. The licensed behavior analyst may include in the client’s file documentation of meeting with the client, the client’s parent, if the client is under the age of majority, or the client’s guardian, if one is appointed, within six months prior to the effective date of these regulations, to satisfy this requirement.

011.18 COLLABORATION WITH COLLEAGUES. It is unprofessional conduct for a credential holder to fail to make efforts to collaborate with colleagues from their own and other professions identified in the client’s service plan. The credential holder must document this collaboration or their efforts at collaboration.

History

Effective 2025-01-20
Adopted as an emergency regulation

Chapter 87 Licensure of Surgical First Assistant

Neb. Admin. Code tit. 172, ch. 87 Licensure of Surgical First Assistant {#sec-172-nac-87 omnilex-key=us-ne-regs-official--title-172--172 NAC 87}

001. AUTHORITY . These regulations govern the license of the practice as a Surgical First Assistant under the Surgical First Assistant Practice Act as provided in Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-3501 to 38-3517, the Uniform Credentialing Act (UCA), and Neb. Rev. Stat. §§ 38-101 to 38-1,142.

002. DEFINITIONS . Definitions are set out in the Uniform Credentialing Act, the Surgical First Assistant Practice Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 MODIFIED ANGOFF METHOD. A method of determining passing scores based on aggregate information obtained by having judges predict the probability that a hypothetical minimally competent candidate will correctly answer items in a test is the Angoff Method, a modified Angoff method has several review rounds.

002.02 APPROVED CERTIFYING BODIES. Approved certifying bodies include, National Board of Surgical Technology and Surgical Assisting, or a certifying body recognized by the Board of Medicine and Surgery.

002.03 APPROVED EDUCATION PROGRAMS. Programs who are accredited by the Commission on Accreditation of Allied Health Education Programs or approved as equivalent by the Board of Medicine and Surgery.

003. LICENSE REQUIREMENTS . To obtain a license to practice as a Surgical First Assistant, an individual must submit a completed application provided by the Department and provide documentation demonstrating the applicant meets the licensing requirements of Neb. Rev. Stat. § 38-3512, 172 NAC 10, and this chapter.

003.01 EDUCATION. The applicant must submit the following:

(A) Official transcripts sent from the issuing approved education program; and

(B) Copy of high school diploma or a diploma of high school equivalency issued by the Nebraska Commissioner of Education or a similar government official.

003.02 EXAMINATION. The individual must have sent directly to the Department from the issuing institution one of the following:

(A) Proof of having passed the National Board of Surgical Technology and Surgical Assisting (NBSTSA) examination with a passing score as determined using the modified Angoff method;

(B) Proof of having passed the National Commission for the Certification of Surgical Assistants (NCCSA) examination with a passing score as determined using the modified Angoff method;

(C) Proof of having passed the American Board of Surgical Assistants (ABSA) examination with a minimum score of 70% on the General Knowledge Section and 75% on the Specialty and Practical Skills Section or above; or

(D) Proof of having passed an equivalent nationally recognized Surgical First Assistant examination approved by the Board of Medicine and Surgery.

003.03 CERTIFICATION. Submit to the Department a copy of their certification from an approved certifying body.

(A) Possession of a current and valid credential as a Surgical First Assistant for at least one year in another state, a territory of the United States, or the District of Columbia;

(B) The education required to obtain the credential;

(C) The minimum work experience and clinical supervision requirements, if any, required for the credential and the applicant’s completion of the experience and clinical supervision;

(D) Passage of an examination for the credential, if required to obtain the credential in the other jurisdiction;

(E) That the credential has not been subject to revocation or any other disciplinary action or voluntarily surrendered while the applicant was under investigation for unprofessional conduct or any other conduct which would be subject to Neb. Rev. Stat. § 38-178 if the conduct occurred in Nebraska; and

(F) Information about any other credential the applicant has held and whether any disciplinary action has been taken against such credential. If disciplinary action has been taken documentation must be submitted showing the status of the action and whether the cause for the action has been corrected.

003.05 RESIDENCY. All applicants receiving a license pursuant to 172 NAC 87-003.04 must submit documentation of establishing residency in Nebraska as required by Neb. Rev. Stat. §38-129.02. Such documentation must be submitted within 30 days of establishment of residency and consist of a rental or lease agreement with the signature of the owner or landlord and the applicant, a deed or title to residential real property with the name of the applicant as an owner, or documents with the name and address of the applicant such as mortgage bills, home utility bills, medical or employee documents or similar documents that show the applicant residing in Nebraska.

004. RENEWAL . The individual must meet the requirements set out in 172 NAC 10. All licenses issued by the Department to Surgical First Assistants will expire on October 1 of each even-numbered year.

005. CONTINUING EDUCATION . On or before the license expiration date, each Surgical First Assistant holding an active license in the State of Nebraska must complete 40 hours of acceptable continuing education during the preceding 24 month period.

005.01 ACCEPTABLE CONTINUING EDUCATION. Attendance at an educational course provided by an approved continuing education provider.

005.02 APPROVED CONTINUING EDUCATION PROVIDERS.

(A) Category 1 continuing education from institutions accredited by the Accreditation Council for Continuing Medical Education (ACCME);

(B) Association of Surgical Technologist and Surgical First Assist (AST);

(D) The Association of Surgical Assistants (ASA); or

(E) A nationally recognized continuing education provider approved by the Board of Medicine and Surgery.

005.03 OTHER CONTINUING EDUCATION PROVIDERS. Other providers may be approved by the Board of Medicine and Surgery if using nationally recognized quality continuing education standards.

005.04 DOCUMENTATION. Evidence of acceptable continuing education may be demonstrated by documentation that the applicant has maintained certification through the Association of Surgical Technologists and Surgical First Assist, the Association of Surgical Assistants, and the National Surgical Assistant Association.

006. SUPERVISION . Supervision must be provided by a physician who is authorized to practice medicine and surgery in the state of Nebraska in accordance with Neb. Rev. Stat. § 38-3508.

006.01 SUPERVISION BY MORE THAN ONE PHYSICIAN. Nothing in these regulations will be construed to prohibit a Surgical First Assistant from being supervised by more than one physician at any time.

007. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179, 172 NAC 88 as applicable to the profession of surgical first assistant, and this chapter.

(A) Practicing as a Surgical First Assistant under a false or assumed name;

(B) Knowingly or unknowingly, perform functions requiring professional judgment and licensure that is not part of the scope of practice for a Surgical First Assistant;

(D) Claiming credit for any continuing education activities not actually participated in and earned.

008. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

009. FEES . Fees are set out in 172 NAC 2 and this chapter:

(A) Initial license is $150; and

(B) Renewal of a license is $110.

History

Effective 2022-07-10

Chapter 88 Licensure of Medicine and Surgery and Osteopathic Medicine and Surgery

Neb. Admin. Code tit. 172, ch. 88 Licensure of Medicine and Surgery and Osteopathic Medicine and Surgery {#sec-172-nac-88 omnilex-key=us-ne-regs-official--title-172--172 NAC 88}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of medicine and surgery under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-2001 to 38-2063 of the Medicine and Surgery Practice Act, the Interstate Medical Licensure Compact (IMLC), and the Uniform Credentialing Act (UCA).

002. DEFINITIONS . Definitions are set out in the Medicine and Surgery Practice Act, the Interstate Medical Licensure Compact, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 ACCREDITED SCHOOL OR COLLEGE OF MEDICINE. An accredited school or college of medicine is a United States or Canadian school or college which conforms to the standards required for accreditation by the Liaison Committee on Medical Education (LCME) sponsored by the Association of American Medical Colleges and the American Medical Association and is approved by the Department, upon recommendation of the Board.

002.02 ACCREDITED SCHOOL OR COLLEGE OF OSTEOPATHIC MEDICINE. An accredited school or college of osteopathic medicine is a school or college which conforms to the standards required for accreditation by the American Osteopathic Association Bureau of Professional Education and is approved by the Department, upon recommendation of the Board.

002.03 APPROVED GRADUATE MEDICAL EDUCATION. An approved graduate medical education is a program of graduate medical education, approved by the Board, that is accredited by the Accreditation Council for Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada, or has been deemed by the Board as comparable to the requirements of the Accreditation Council for Graduate Medical Education (ACGME).

002.04 APPROVED GRADUATE OSTEOPATHIC MEDICAL EDUCATION. An approved graduate osteopathic medical education is a program of graduate medical education approved by the Council on Postdoctoral Training (COPT) served in the United States, or has been deemed by the Board as comparable to the requirements of the Council on Postdoctoral Training (COPT).

002.05 COMPREHENSIVE OSTEOPATHIC MEDICAL LICENSING EXAMINATION OF THE UNITED STATES (COMLEX). The comprehensive osteopathic licensing examination of the United States is the examination made available by the National Board of Osteopathic Medical Examiners (NBOME).

002.06 FEDERATION CREDENTIALS VERIFICATION SERVICE (FCVS). The federation credentials verification service is the permanent, central repository of core credential documents that have been verified through primary sources administered by the Federation of State Medical Boards.

002.07 FEDERATION LICENSING EXAMINATION (FLEX) WEIGHTED AVERAGE. The federation licensing examination weighted average is the formula used to determine the examination score for the Federation Licensing Examination (FLEX) administered prior to 1985. Such formula is as follows: day 1 score multiplied by 1; day 2 score multiplied by 2; day 3 score multiplied by 3. The total of these 3 scores is divided by 6 which equals the Federation Licensing Examination (FLEX) Weighted Average.

002.08 FOREIGN MEDICAL GRADUATE. A foreign medical graduate is a graduate of a school or college of medicine not in the United States or Canada which is recognized by the appropriate government agency in the country where the medical school is located.

002.09 HEALTH PROFESSIONAL SHORTAGE AREA. A health professional shortage area is a geographic area designated a health profession shortage area by the Nebraska Rural Health Advisory Commission.

002.10 SPECIAL PURPOSE EXAMINATION (SPEX). The special purpose examination is an examination made available by the Federation of State Medical Boards.

002.11 STATE EXAMINATION. A state examination is an examination administered by a state, territory of the United States, or District of Columbia for purposes of determining eligibility for initial licensure of physicians or osteopathic physicians and surgeons.

003. LICENSE REQUIREMENTS FOR PHYSICIANS AND OSTEOPATHIC PHYSICIANS . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. §§ 38-2026 to 38-2028 for physicians, 38-2031 to 38-2033 for osteopathic physicians, 38-2034 to 38-2035, 38-131, 172 NAC 10, and this chapter.

003.01 EXAMINATION. Applicants must have score reports sent to the Department directly from the examining body.

(1) The Federation Licensing Examination (FLEX);

(2) The National Board of Medical Examiners (NBME);

(3) The United States Medical Licensing Examination (USMLE);

(4) The National Board of Osteopathic Medical Examiners (NBOME);

(5) The Comprehensive Osteopathic Medical Licensure Examination of the United States (COMLEX);

(6) The Licentiate of the Medical Council of Canada (LMCC); and,

(7) Any of the following combinations of examinations:

(i) Any 3-sequence examination combination of parts 1, 2 and 3 of the United States Medical Licensing Examination (USMLE), National Board of Medical Examiners (NBME), National Board of Osteopathic Medical Examiners (NBOME), or Comprehensive Osteopathic Medical Licensure Examination of the United States (COMLEX).

(ii) Federation Licensing Examination (FLEX) Component 1 can be combined with National Board of Medical Examiners (NBME) Part III, United States Medical Licensing Examination (USMLE) Step 3, National Board of Osteopathic Medical Examiners (NBOME) Part III or Comprehensive Osteopathic Medical Licensure Examination of the United States (COMLEX) Level 3.

(iii) Federation Licensing Examination (FLEX) Component 2 can be combined with National Board of Medical Examiners (NBME) Parts I and II, United States Medical Licensing Examination (USMLE) Steps 1 and 2, National Board of Osteopathic Medical Examiners (NBOME) Parts I and II or Comprehensive Osteopathic Medical Licensure Examination of the United States (COMLEX) Levels 1 and 2.

003.01(A) FEDERATION LICENSING EXAMINATION. If a Federation Licensing Examination (FLEX) is taken, a Federation Licensing Examination (FLEX) weighted average of 75 must be attained if examined prior to January 1, 1985. A grade of 75 is required in each component administered after January 1, 1985.

003.01(B) OPTIONAL DOCUMENTS. A completed profile from the Federation Credentials Verification Service may be submitted. The profile will be reviewed to determine if its components meet the documentation requirements for evidence of age, education, graduate medical education, examination, and equivalency, if applicable.

004. LICENSE REQUIREMENTS FOR RECIPROCITY THROUGH THE INTERSTATE MEDICAL LICENSURE COMPACT . Any applicant wishing to license through the compact must meet the requirements set out in Neb. Rev. Stat. §§ 38-3604 to 38-3608.

005. LICENSE REQUIREMENTS FOR TEMPORARY LICENSES . To obtain a permit, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. §§ 38-2036, 38-2038 to 38-2045, 38-129.01 and this chapter.

006. LICENSE REQUIREMENTS FOR LOCUM TENENS . The locum tenens may be issued by the Department based on criteria in Neb. Rev. Stat. 38-2036, and this chapter.

006.01 LOCUM TENENS CRITERIA. Circumstances for which a physician locum tenens permit may be issued include:

(A) The unavailability of a Nebraska physician due to vacation, sickness, hospitalization or other similar leaves of absence;

(B) A public health emergency in the State of Nebraska such as one arising from incidents of widespread disease, natural or manmade disaster or similar causes; or

007. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10. All physician and osteopathic physician licenses expire on October 1 of each even-numbered year. All temporary educational permits and visiting faculty permits expire on July 1 of each year.

008. CONTINUING COMPETENCY REQUIREMENTS . On or before the expiration date, individuals holding an active license in the State of Nebraska must complete required continuing competency for their specified profession.

008.01 REQUIREMENTS FOR PHYSICIANS AND OSTEOPATHIC PHYSICIANS. On or before the credential expiration date, individuals licensed to practice medicine and surgery and osteopathic medicine and surgery must earn one of the following:

(A) 50 hours of Category 1 continuing education approved as follows:

(i) Approved by the Accreditation Council for Continuing Medical Education (ACCME) or the American Osteopathic Association (AOA);

(ii) 1 year of participation in an approved graduate medical education program is approved as 50 hours of Category 1 continuing education; and

(iii) Hours are to be earned within the 24 months immediately preceding the date of expiration, except that a licensee who has earned more than the 50 hours required for license renewal for a 24-month renewal period is allowed to carry over up to 25 hours to the next 24-month renewal period; or

(B) The American Medical Association’s Physician’s Recognition Award or the American Osteopathic Association Continuing Medical Education Certification earned within the 24 months immediately preceding the date of expiration.

008.02 REQUIREMENTS FOR TEMPORARY PERMIT HOLDERS. On or before the expiration date, holders of temporary educational permits and visiting faculty permits must earn one of the following:

(A) 25 hours of Category 1 continuing education approved as follows:

(i) Approved by the Accreditation Council for Continuing Medical Education (ACCME) or the American Osteopathic Association (AOA);

(ii) 1 year of participation in an approved graduate medical education program is approved as 50 hours of Category 1 continuing education; and

(iii) Hours are to be earned within the 12 months immediately preceding the date of expiration; or

(B) The American Medical Association’s Physician’s Recognition Award or the American Osteopathic Association Continuing Medical Education Certification earned within the 12 months immediately preceding the date of expiration.

009. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179, 38-2021, 38-2062(1), and this chapter.

(A) Commission of any act of sexual abuse, misconduct, or exploitation related to the practice of the profession of the applicant or credential holder. Sexual misconduct in the practice of medicine means violation of the physician-patient relationship through which the physician uses said relationship to induce or attempt to induce the patient to engage, or to engage or attempt to engage the patient, in sexual activity; committing any act which may reasonably be interpreted as intended for the sexual arousal or gratification of the practitioner, the patient, or both;

(B) Failure to keep and maintain adequate records of treatment or service. Adequate records means legible medical records containing, at a minimum, sufficient information to identify the patient, support the diagnosis, justify the treatment, accurately document the results, indicate advice and cautionary warnings provided to the patient and provide sufficient information for another practitioner to assume continuity of the patient’s care at any point in the course of treatment, and, when investigative or unproven therapies are utilized, the records must include written informed patient consent;

(C) Disruptive physician behavior as manifested by a physician’s aberrant behavior which interferes with patient care or could reasonably be expected to interfere with patient care, including, but not limited to, the following:

(i) Outbursts of rage or violent behavior;

(ii) Repeated failure to respond to calls;

(iii) Throwing instruments, charts, or other objects;

(iv) Making insulting comments to a patient, patient’s family, physicians, or healthcare staff;

(v) Striking or assaulting a patient, patient’s family, physicians, or healthcare staff; and

(vi) Poor hygiene;

(D) A departure from or failure to conform to the ethics of the medical profession, found in the “Principles of Medical Ethics” as revised on June 2001 and as published by the American Medical Association;

(E) Refusal of applicants or credential holders to cooperate or failure to furnish requested information during any investigation by the Department;

(F) Providing treatment or consultation recommendations, including issuing a prescription, via electronic or other means, unless the physician has obtained a history and physical evaluation of the patient adequate to establish diagnosis and identify underlying conditions and contraindications to the treatment recommended or provided and that arrangements exist to insure availability of the physician or physician coverage for follow-up patient care;

(G) Practicing medicine under a false or assumed name;

(H) Allowing another person or organization to use his or her license to practice medicine;

(I) Except as otherwise permitted by law, prescribing, selling, administering, distributing, ordering, or giving to an addict or any person previously drug dependent, any drug legally classified as a controlled substance;

(J) Failure to transfer pertinent and necessary medical records to another physician in a timely fashion when requested to do so by the patient or by a designated representative of the patient;

(K) Use of any therapy, drug or device in a manner inconsistent with the federal Food, Drug and Cosmetic Act;

(L) Exercising influence on the patient in such a manner as to exploit the patient for the financial gain of the licensee or of a third party, which includes, but is not limited to, the promotion or sale of services, goods, appliances, or drugs;

(M) Refusing to provide professional service to a person because of such person’s race, creed, color, or national origin;

(N) Prescribing, selling, administering, or distributing, any drug legally classified as a prescription drug other than for proper medical purposes;

(O) Prescribing, dispensing or administering Schedule II controlled substances as defined in Neb. Rev. Stat. § 28-405(a) including amphetamines and similar Schedule II sympathomimetic drugs in the treatment of exogenous obesity for a period in excess of 30 days in any 1 year, or the non-therapeutic use of injectable amphetamines;

(P) Signing a blank, undated or predated prescription form;

(Q) Conduct or practice outside the normal standard of care in the State of Nebraska which is or might be harmful or dangerous to the health of the patient or the public, not to include a single act of ordinary negligence;

(R) Prescribing, dispensing or administering anabolic-androgenic steroids to a person for other than therapeutic purposes;(S) Lack of or inappropriate direction, collaboration or direct supervision of a licensed, certified or registered health care provider employed by, supervised by or assigned to the physician;

(S) Failure to comply with Neb. Rev. Stat. §§ 71-604 to 71-606 relating to the signing of birth and death certificates; and

(T) Refusal to undergo an examination defining competency as required by the Board.

010. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

011. FEES . Fees are set out in 172 NAC 2 and Neb. Rev. Stat. § 38-151.

History

Effective 2020-06-16

Chapter 89 Practice of Acupuncture

Neb. Admin. Code tit. 172, ch. 89 Practice of Acupuncture {#sec-172-nac-89 omnilex-key=us-ne-regs-official--title-172--172 NAC 89}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of acupuncturists under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-2001 to 38-2063 of the Medicine and Surgery Practice Act, and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions are set out in the Medicine and Surgery Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 APPROVED ACUPUNCTURE EXAMINATION. National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) Acupuncture Comprehensive Written Examination, which is a comprehensive written examination including acupuncture theory, diagnosis and treatment technique, and the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) Point Location Examination.

002.02 BOARD APPROVED SCHOOL. A formal, full-time acupuncture program at a university, college or school of acupuncture which includes at least 1,725 hours of entry-level acupuncture education consisting of a minimum of 1,000 didactic and 500 clinical hours, and is accredited or a candidate for accreditation by the Accreditation Commission for Acupuncture and Oriental Medicine, or is accredited by another accrediting body that is recognized as such by the United States Secretary of Education.

002.03 APPROVED CLEAN NEEDLE TECHNIQUE COURSE. A course in clean needle technique approved by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), or an equivalent course approved by the Board.

(A) Have graduated from, after having successfully completed the acupuncture curriculum requirements of an approved school;

(B) Have successfully passed an approved acupuncture examination;

(D) Submit to the Department:

(i) Official transcripts submitted to the Department by the issuing institution;

(ii) Official documentation of passing score obtained on the approved acupuncture examinations; and

(iii) Official documentation showing successful completion of an approved clean-needle technique course.

004. INFORMED CONSENT . The licensee must comply with Neb. Rev. Stat. § 38-2059 and present to each patient treated a voluntary and informed consent form. Each patient treated must sign and date the form stating that they have read and understood the information on the form and that they agree to acupuncture treatment. The voluntary and informed consent form must be retained in the each patient’s records for a period of at least 5 years after termination of the treatment.

005. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10. All acupuncture licenses expire on May 1 of each odd-numbered year.

006. CONTINUING COMPETENCY . On or before the expiration date, each acupuncturist who is licensed in the State of Nebraska must, as a condition for renewal of his or her license, earn one of the following in order to meet the continuing competency requirement:

(A) 50 hours of continuing education approved by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM);

(i) Hours are to be earned within the 24 months immediately preceding the date of expiration, except that a licensee who has earned more than the 50 hours required for license renewal for a 24-month renewal period is allowed to carry over up to 25 hours to the next 24-month renewal period; or

(B) 50 hours of Category 1 continuing education approved by the Accreditation Council for Continuing Medical Education (ACCME) or the American Osteopathic Association (AOA);

(C) Active certification or active recertification of diplomat status with the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) earned within the 24 months immediately preceding the date of expiration.

006.01 ATTESTATION. Each licensee must submit to the Department an attestation that he or she has met the continuing competency requirement for the 24 months immediately preceding the expiration date.

006.02 PROOF OF CONTINUING COMPETENCY. Each licensee is responsible for maintaining records verifying his or her attendance at continuing education programs or otherwise meeting the continuing competency requirement.

007. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179, 172 NAC 88 as applicable to the profession of acupuncture, and this chapter.

(A) Failure to obtain a voluntary and informed consent form as referenced in 172 NAC 89-004; and

(B) Failure to provide the same standard of care to patients as that provided by a person licensed under the Uniform Credentialing Act to practice medicine and surgery, or osteopathic medicine and surgery.

008. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

009. FEES . Fees are set out in 172 NAC 2.

History

Effective 2021-09-04

Chapter 90 Licensure and Supervision of Physician Assistants

Neb. Admin. Code tit. 172, ch. 90 Licensure and Supervision of Physician Assistants {#sec-172-nac-90 omnilex-key=us-ne-regs-official--title-172--172 NAC 90}

001. SCOPE AND AUTHORITY . These regulations govern the licensure and supervision of physician assistants under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-2001 to 38-2063 of the Medicine and Surgery Practice Act and the Uniform Credentialing Act (UCA).

002. DEFINITIONS . Definitions are set out in the Medicine and Surgery Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 BACKUP PHYSICIAN. A physician designated by the supervising physician to ensure supervision of the physician assistant in the supervising physician's absence. A backup physician is subject to the same requirements imposed upon the supervising physician when the backup physician is acting as a supervising physician.

002.02 PRIMARY PRACTICE SITE. Where the supervising physician maintains his or her primary practice.

002.03 SECONDARY PRACTICE SITES. A practice site which is not the primary practice site of the supervising physician or physicians.

003. LICENSE REQUIREMENTS . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements set out in Neb. Rev. Stat. §§ 38-2049, 38-131, 172 NAC 10, and this chapter.

003.01 EDUCATION. Submit an official transcript, sent directly from the issuing institution, verifying successful completion of an approved program for the education of physician assistants.

003.02 EXAMINATION. Submit proof of successful completion of the Physician Assistant National Certifying Examination.

003.03 TEMPORARY LICENSE. To receive a temporary license to practice as a physician assistant, an individual must have met the education requirements of this chapter but not yet passed the Physician Assistant National Certifying Examination; however, there must be no other grounds for denial of the license.

003.03(A) TEMPORARY PRACTICE. A physician assistant with a temporary credential may practice only when the supervising physician is actually present at the practice site.

004. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10 and this chapter.

004.01 PHYSICIAN ASSISTANT EXPIRATION. All physician assistant licenses expire on October 1 of each odd-numbered year.

004.02 TEMPORARY PHYSICIAN ASSISTANT TERM AND EXPIRATION. Temporary physician assistant licenses are only good for one year from date of issuance and may be extended at the discretion of the Department with the recommendation of the Board.

005. CONTINUING COMPETENCY REQUIREMENTS . On or before the expiration date, individuals holding an active license from the State of Nebraska must earn one of the following during the preceding 24-month period:

(A) 50 hours of Category 1 continuing education approved by the Accreditation Council for Continuing Medical Education (ACCME), the American Osteopathic Association (AOA), or the American Academy of Physician Assistants (AAPA); or

(B) Meet the National Commission on Certification of Physician Assistants (NCCPA) requirements within the previous 24-month period.

005.01 CONTINUING EDUCATION CARRY OVER. Hours are to be earned within the 24 months preceding the date of expiration, except that a licensee who has earned more than 50 hours required for renewal for a 24-month renewal period, is allowed to carry over up to 25 hours to the next 24-month renewal period.

005.02 ACCEPTABLE DOCUMENTATION. Acceptable documentation that the credential holder has met the continuing competency requirements include:

(A) Proof of current certification with the National Commission on Certification of Physician Assistants (NCCPA); or

(B) Documentation of completion of continuing education approved by the Accreditation Council for Continuing Medical Education (ACCME), the American Osteopathic Association (AOA), or the American Academy of Physician Assistants (AAPA).

006. REQUIREMENTS FOR SUPERVISION OF PHYSICIAN ASSISTANTS . Supervising physicians must meet the requirements of Neb. Rev. Stat. § 38-2050 and this chapter.

006.01 COLLABORATIVE AGREEMENT. A supervising physician or supervising podiatrist must define the scope of practice of the physician assistant as set forth in Neb. Rev. Stat. §38-2047, or Neb. Rev. Stat. §§ 38-3013 and 38-3014.

006.02 PHYSICIAN ASSISTANT SERVICES PERFORMED MINIMUM REQUIREMENTS. Physician assistants must meet the requirements set forth in Neb. Rev. Stat. § 38-2047.

006.03 PHYSICIAN ASSISTANT SUPERVISION WAIVER. The Board may consider a request for waiving the requirement that a supervising physician may supervise no more than 4 physician assistants at any time, as set forth in Neb. Rev. Stat. § 38-2050(4). In determining good cause, the factors considered by the Board include but are not limited to:

(A) The type of practice setting;

(B) The experience of the physician assistants;

(D) The general level of patient problem complexity.

007. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179, and 172 NAC 88 as applicable to physician assistants.

008. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

009. FEES . Fees are set out in 172 NAC 2, and Neb. Rev. Stat. § 38-151.

History

Effective 2021-12-14

Chapter 91 Licensure of Perfusionists

Neb. Admin. Code tit. 172, ch. 91 Licensure of Perfusionists {#sec-172-nac-91 omnilex-key=us-ne-regs-official--title-172--172 NAC 91}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of perfusionists under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-2701 to 38-2711 of the Perfusion Practice Act, and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions are set out in the Perfusion Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 ACCREDITED PERFUSION EDUCATION PROGRAM. A program which conforms to the standards established by the Accreditation Committee for Perfusion Education and accredited by the Commission on Accreditation of Allied Health Education Programs or a program with substantially equivalent education standards approved by the Board.

002.02 DIRECT SUPERVISION. Supervision requiring the immediate physical presence of a licensed perfusionist, overseeing the practice of a temporary perfusionist.

002.03 LICENSURE EXAMINATION. The certification examination offered by the American Board of Cardiovascular Perfusion (ABCP) that includes Part I, the Perfusion Basic Science Examination, and Part II, the Clinical Applications in Perfusion Examination, or a substantially equivalent examination approved by the Board.

003.01 DOCUMENTATION. The applicant must indicate and provide documentation for one of the following methods by which he or she is applying for licensure:

003.01(A) EDUCATION AND EXAMINATION. If applying for licensure based on meeting education and examination requirements, the applicant must:

(i) Submit an official transcript, sent directly from the issuing institution, verifying completion of an accredited perfusion education program; and

(ii) Submit an official document, sent directly from the American Board of Cardiovascular Perfusion (ABCP) or from a substantially equivalent examining entity, showing successful completion of the licensure examination.

003.01(B) CERTIFICATION AS A CERTIFIED CLINICAL PERFUSIONIST. If applying for licensure based on certification as a Certified Clinical Perfusionist, the applicant must:

(i) Hold current certification as a Certified Clinical Perfusionist issued by the American Board of Cardiovascular Perfusion; and

(ii) Submit a copy of the applicant’s certification as a Certified Clinical Perfusionist by the American Board of Cardiovascular Perfusion (ABCP).

003.01(C) PERFUSIONIST LICENSURE IN ANOTHER STATE. If applying for licensure based on perfusionist licensure in another state, the applicant must:

(i) Submit the standards and requirements for licensure, directly from the state regulatory authority from each state in which a license is held, for review by the Board in determining substantial equivalence;

(ii) Submit verification of licensure, directly from each state where the applicant is or has ever been licensed as a perfusionist; and

(iii) If the applicant’s perfusionist license in any state has been disciplined or restricted in any way, request that official documentation of the disciplinary action be submitted with the verification, including charges and disposition of the charges.

004. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10. All perfusionist licenses expire on October 1 of each odd-numbered year.

005. CONTINUING COMPETENCY REQUIREMENTS . On or before the credential expiration date, a perfusionist must comply with the continuing competency requirements unless the requirements are waived in accordance with 172 NAC 10. Each credentialed individual or temporary licensee is responsible for maintaining certificates or records of continuing competency activities.

005.01 PERFUSIONIST LICENSE. All licensed perfusionists must meet the following competency requirements:

(1) Perform a minimum of 80 clinical activities, as defined by American Board of Cardiovascular Perfusion (ABCP), of which no more than 30 clinical activities may be documented intraoperative pump standbys that must be documentable in an audit; and

(2) Earn 30 continuing education units (CEUs), as approved by the American Board of Cardiovascular Perfusion (ABCP), of which 10 CEUs must be earned in Category 1. Hours are to be earned within the 24 months immediately preceding the date of expiration, except that a licensee who has earned more than the 30 hours required for license renewal for a 24-month renewal period is allowed to carry over up to 15 hours to the next 24-month renewal period.

005.01(A) CLINICAL ACTIVITIES. Clinical activities include:

(i) Primary bypass;

(ii) Instructor for a primary bypass performed by a student;

(iii) Veno-venous bypass;

(iv) Pump assisted coronary or organ perfusion;

(v) Cardiopulmonary Support (CPS);

(vi) Extracorporeal Membrane Oxygenation (ECMO);

(vii) Ventricular Assist Device (VAD); and

(viii) Documented intraoperative pump standby.

005.02 TEMPORARY LICENSE. All temporary licensees must perform a minimum of 25 clinical activities as listed in 172 NAC 91-005.01(A), of which none may be documented intraoperative pump standbys.

006. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179, and 172 NAC 88 as applicable to the profession of perfusion.

007. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

008. FEES . Fees are set out in 172 NAC 2.

History

Effective 2021-08-10

Chapter 92 Licensure of Genetic Counselors

Neb. Admin. Code tit. 172, ch. 92 Licensure of Genetic Counselors {#sec-172-nac-92 omnilex-key=us-ne-regs-official--title-172--172 NAC 92}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of genetic counselors under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-3401 to 38-3425 of the Genetic Counseling Practice Act and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions are set out in the Genetic Counseling Practice Act, the Uniform Credentialing Act, and 172 Nebraska Administrative Code (NAC) 10.

004. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10 and this chapter. All genetic counseling licenses except for provisional licenses expire on October 1 of each even-numbered year.

004.01 CONTINUING COMPETENCY. The continuing competency requirement for genetic counselors is either:

(A) Recertification with the American Board of Genetic Counseling by examination or by continuing education; or

(B) Recertification with the American Board of Medical Genetics by participating in Maintenance of Certification.

004.02 PROVISIONAL LICENSE RENEWAL. An application for renewal of a provisional license must:

(A) Be signed by both the provisional license holder and a qualified supervisor; and

(B) Provide documentation of maintaining active candidate status with the national genetic counseling board or the national medical genetics board.

005. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179, and 172 NAC 88 as applicable to the profession of genetic counseling.

006. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

007. FEES . Fees are set out in 172 NAC 2 and this chapter.

007.01 LICENSE FEE. The fee for initial and provisional license is $150.

007.02 RENEWAL FEE. The fees for renewal of a full license is $110, and the renewal fee for a provisional license is $55.

History

Effective 2021-08-10

Chapter 93 Licensure of Persons Performing Medical Radiography

Neb. Admin. Code tit. 172, ch. 93 Licensure of Persons Performing Medical Radiography {#sec-172-nac-93 omnilex-key=us-ne-regs-official--title-172--172 NAC 93}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of medical radiographers, and limited radiographers under Nebraska Revised Statute (Neb. Rev. Stat.) §§38-1901 to 38-1920 of the Medical Radiography Practice Act, and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions are set out in the Medical Radiography Practice Act, the Radiation Control Act, Neb. Rev. Stat. §§ 71-3501 to 71-3520, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 ABDOMEN. Organs contained within the peritoneum.

002.02 ANKLE AND FOOT. Those body parts from the distal phalanges of the foot to the distal one-third of the fibula and tibia.

002.03 APPROVED EDUCATIONAL PROGRAM. An educational program for medical radiographers, provided by any accredited community college, university or hospital-based program approved by the board that awards a certificate of completion or an academic degree to its graduates, consisting of 24 months of instruction in radiography which includes radiographic procedures, imaging equipment, image production and evaluation, film processing, radiation physics, radiation protection, radiation biology, radiographic pathology, and quality assurance activities.

002.04 CHEST. The lung fields including the cardiac shadow, as well as the ribs and sternum.

002.05 EXTREMITIES. Extremities refers to:

(A) Upper extremities which are those body parts from the distal phalanges of the hand to the head of the humerus, including the clavicle and scapula; and

(B) Lower extremities which are those body parts from the distal phalanges of the foot to the head of the femur and its articulation with the pelvic girdle, including the hip.

002.06 SKULL AND SINUS. The cranium, including facial bones, the paranasal sinuses and the mandible.

002.07 SPINE. Cervical, thoracic, and lumbar vertebrae and their articulations, as well as the pelvis, sacrum, and coccyx.

002.08 USE OF CONTRAST MEDIA. The administration of contrast media by invasive procedures such as insertion of the enema tip, catheter, establishment of an intravenous line, or direct injection.

003.01 MEDICAL RADIOGRAPHER. An individual applying to practice as a medical radiographer must:

(A) Submit an official transcript, directly from the issuing institution, verifying completion of an approved educational program in radiography; and

(B) Submit a score report, directly from the issuing institution, showing the individual has passed a Department-approved examination with a score of 75 or above.

003.02 TEMPORARY MEDICAL RADIOGRAPHER. An individual applying to practice as a temporary medical radiographer must submit official documentation from an approved educational program in radiography indicating that at least 12 months of the program have been completed.

003.03 LIMITED RADIOGRAPHER. An individual applying to practice as a limited radiographer must submit proof that the individual has passed the Examination for the Limited Scope of Practice in Radiography given by the American Registry of Radiologic Technologists (ARRT) as follows:

(1) Achieve a passing score of 70 or above on the core section of the exam; and

(2) Achieve a passing score of 65% or above on each of the following sections of the exam for which a license is sought:

(i) Chest;

(ii) Extremities;

(iii) Skull and sinus;

(iv) Spine;

(v) Ankle and foot; or

(vi) Bone density.

003.03(A) ABDOMINAL RADIOGRAPHY. A limited radiographer applying to practice abdominal radiography must:

(i) Submit proof that the individual has passed the spine section of the Examination for the Limited Scope of Practice in Radiography given by the American Registry of Radiologic Technologists (ARRT).

003.03(B) ALTERNATIVE EXAMINATION. As an alternative to the Examination for the Limited Scope of Practice in Radiography given by the American Registry of Radiologic Technologists (ARRT), individuals applying to practice as a limited radiographer must take and achieve a passing score of 70 or above on the core section and a passing score of 65 or above on each of the anatomical categories for which a license is sought on an examination approved by the Board of Medical Radiography.

003.03(C) OUT-OF-STATE EXAMINATION. The individual must request that the Examination for the Limited Scope of Practice in Radiography scores be sent to the Department directly from the state board for which the examination was taken.

004. APPROVAL OF ALTERNATIVE EXAMINATIONS . To be approved as an alternative examination, the examination must be submitted to the Department for review by the Board of Medical Radiography and meet the requirements set out in Neb. Rev. Stat. § 38-1918.

005. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . An applicant for renewal must meet the requirements set out in 172 NAC 10. All medical radiography licenses expire on December 1 of even-numbered years.

006. CONTINUING COMPETENCY . On or before the expiration date, individuals holding an active credential must complete a minimum of 24 hours of continuing education during the preceding 24-month period.

006.01 CONTINUING EDUCATION PROGRAM REQUIREMENTS. To be accepted as continuing education for license renewal, continuing education programs must meet the following requirements:

006.01(A) GENERAL PROGRAM REQUIREMENTS. In addition to meeting the requirements of 172 NAC 93-006.01(H), the continuing education program must:

(i) Be at least 50 to 60 minutes in duration per continuing education unit (CEU) given;

(ii) Include topics or objectives related to medical radiography, including, mammography, magnetic resonance imaging (MRI), computed tomography (CT), cardiovascular technology, quality management, nuclear medicine, radiation therapy, ultrasound, and medical dosimetry; and

(iii) Be open to all medical radiographers and limited radiographers;

(1) Participation may be restricted if a level of knowledge is required to understand the subject matter presented.

006.01(B) NATIONALLY RECOGNIZED ORGANIZATIONS. Programs must meet the quality standards established by nationally recognized organizations or associations of radiography, such as the American Registry of Radiologic Technologists (ARRT) or the American Society of Radiologic Technologists (ASRT):

(i) Passing an advanced level examination in mammography, magnetic resonance imaging (MRI), computed tomography (CT), cardiovascular technology, quality management, nuclear medicine, radiation therapy or ultrasound during the biennial renewal period may be used to satisfy the 24-hour continuing education requirement.

006.01(C) RELATED TO THE PRACTICE OF MEDICAL RADIOGRAPHY. Learning experiences which are related to the practice of medical radiography, provided they are planned and conducted for individuals performing medical radiography.

006.01(D) ACADEMIC COURSES. Academic courses in an accredited post-secondary institution which are related to the specific knowledge and technical skills required for the practice of medical radiography.

006.01(E) TECHNICAL AND SCIENTIFIC KNOWLEDGE. Courses, lectures or offerings related to the technical and scientific knowledge for the practice of medical radiography which includes:

(i) Radiation protection;

(ii) Equipment maintenance and operation;

(iii) Image production and evaluation;

(iv) Patient care and management; and

(v) Quality assurance activities.

006.01(F) CARDIOPULMONARY RESUSCITATION (CPR). A course in cardiopulmonary resuscitation (CPR) which results in certification by the American Heart Association, the American Red Cross, or Health and Safety Institute. Such certification must be valid at the time of renewal:

(i) Only 4 credit hours of this type of course may be counted within the biennial renewal period; and

(ii) A copy of the current certification card will be documentation of completion.

006.01(G) HOME STUDY. If there is no testing mechanism or certificate of completion, the licensee must submit an abstract or summary of the material covered to the Department. The abstract or summary must only be written by the licensee and will be reviewed for approval by the Department. Only courses which have been assigned a specific number of continuing education credit hours by the home study provider will be approved.

006.01(H) OTHER CONTINUING EDUCATION PROGRAMS. Continuing education obtained to meet continuing competency requirements of a health care profession other than medical radiography licensed, certified, or registered by the Department may be acceptable if such continuing education has a rational connection to the practice of medical radiography; and no more than 4 hours of this type of continuing education may be counted within each year of the 24-month renewal period.

007. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179.

008. REINSTATEMENT . The individual must meet the requirements set out in 172 NAC 10.

009. FEES . Fees are set out in 172 NAC 2.

History

Effective 2021-11-01

001. SCOPE AND AUTHORITY . These regulations govern the licensing of independent mental health practitioners, mental health practitioners, and the associated certifications of social workers, master social workers, professional counselors, and marriage and family therapists set out in Nebraska Revised Statutes (Neb. Rev. Stat.) §§ 38-2101 to 38-2139 of the Mental Health Practice Act and the Uniform Credentialing Act. A person who provides mental health services, regardless of the how such services are delivered, to a client present in Nebraska at the time of service, must hold a current appropriate credential issued by the Department.

002. DEFINITIONS . Definitions set out in the Mental Health Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and the following apply to this chapter.

002.01 ASSESSMENT. The process of collecting pertinent data about client or client systems and their environment and appraising the data as a basis for making decisions regarding treatment and referral.

002.02 CLIENT OR PATIENT. A person who is a recipient of mental health services within the context of a professional relationship. An individual who provides collateral information about a client or patient is not considered a client or patient.

002.03 CLIENT SYSTEM. Individuals, agencies, or entities directly or indirectly involved with the client that supports, reinforces or otherwise affects the treatment process.

002.04 DIRECT CLIENT CONTACT. Contact between the practicum student or provisional licensed mental health practitioner and a client system while providing mental health services. Direct client contact does not include:

(A) Writing progress notes;

(B) Supervisory meetings;

(D) Video observation;

(E) Continuing education workshops or other similar workshops;

(F) Telephone supervision; or

(G) Similar activities.

002.05 MAJOR MENTAL DISORDER. Any clinically significant mental or emotional disorder in which symptoms, regardless of specific diagnoses or the nature of the presenting complaint, are associated with present distress or disability or present significantly increased risk of suffering, death, pain, disability, or an important loss of freedom. No diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association, nor any diagnosis from the International Classification of Diseases (ICD) published by the World Health Organization, of the edition or version used on the effective date of this chapter, is excluded from the category of Major Mental Disorder if the contemporary assessment indicates severe symptoms, as outlined in this section. This includes currently observed or assessed dysfunction or impairment that portends danger to self or others, a disabling deterioration of function that seriously impairs daily functioning to include food, clothing, and shelter, or an inability to establish or maintain a personal support system. Such disorders may take many forms and have varying causes but must be considered a manifestation of behavioral, psychological, or biological dysfunction in the person. Behavioral or psychological disorder symptoms include one or more of the following:

(A) Persistent or severe suicidal or homicidal thinking or behaviors injurious to self or others;

(B) Psychotic symptoms which include delusions, hallucinations, or formal thought disorders, including evidence of frequent substitution of fantasy for reality;

(C) Physical complaints or signs suggesting deterioration or anomaly in physiological, psychophysiological, or neuropsychological functioning;

(D) Feeling, mood or affect in which the emotion is clearly disruptive in its effects on other aspects of a person’s life. A marked change in mood, depression, or anxiety that incapacitates a person;

(E) Severe impairment in concentration and thinking, persistence, and pace. Frequent or consistently impaired thinking; and

(F) Consistent inability to maintain conduct within the limits prescribed by law, rules, and strong mores or disregard for safety of others or destructive to property.

002.06 MENTAL HEALTH. The relative state of emotional well-being, freedom from incapacitating conflicts, and the consistent ability to make and carry out rational decisions and cope with environmental stresses and internal pressures.

002.07 MENTAL HEALTH FOCUS OR THERAPEUTIC MENTAL HEALTH. An educational process consisting of mental health theories, techniques, practices, and methods necessary to prepare a mental health professional to identify, assess, and intervene with a client population for the primary purposes of providing or resulting in the clients optimal mental health.

002.08 MENTAL ILLNESS. Impaired psychosocial or cognitive functioning due to disturbances in any one or more of the following processes: biological, chemical, physiological, genetic, psychological, social, or environmental.

002.09 PSYCHOTHERAPY. A specialized formal interaction between a credential holder and a client or patient in which a therapeutic relationship is established to help to resolve symptoms of mental disorder, psychosocial stress, relationship problems, and difficulties in coping in the social environment. Some specific types of psychotherapy may include, but are not limited to, psychoanalysis, family therapy, group psychotherapy, supportive treatment, Gestalt therapy, experiential therapy, primal therapy, psychosocial therapy, psychodrama, behavioral therapy, clinical hypnosis, addiction therapy including drug and alcohol counseling and problem gambling, biofeedback, and cognitive therapy.

002.10 QUALIFIED PHYSICIAN. An individual with a current credential to practice medicine and surgery and who has specialized training in mental health treatment. Specialized training includes residency training in psychiatry or in family practice or fellowship training in behavioral medicine.

002.11 QUALIFIED SUPERVISOR. An individual who assumes the responsibility of supervision and who meets the requirements for being a supervisor.

002.12 SUPERVISED EXPERIENCE. The hours of experience obtained after receipt of the master's degree, under appropriate licensure and before an applicant is granted the desired credential or certification.

003. INITIAL LICENSE . To obtain a provisional or mental health practice license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. §§ 38-2122 or 38-2123, 172 NAC 10, and this chapter.

003.01 PROVISIONAL MENTAL HEALTH PRACTITIONER LICENSE. The applicant must submit an official transcript, submitted directly from the issuing institution, verifying completion of a master's degree, a doctoral degree, or the equivalent of a master's degree. The degree must have been completed at an approved educational program or from a program which meets the requirements in 172 NAC 94-007.

003.02 SECOND PROVISIONAL MENTAL HEALTH PRACTITIONER LICENSE. An individual who does not complete the required 3,000 hours of supervised experience in Nebraska may apply for another provisional license. No additional provisional licenses will be issued to an applicant after the issuance of a second provisional license.

003.03 MENTAL HEALTH PRACTITIONER LICENSE. To obtain an initial license as a mental health practitioner, the applicant must submit:

(A) Documentation of meeting the education requirements set out in 172 NAC 94-007.

(B) Documentation of meeting the requirements for supervised experience set out in Neb. Rev. Stat. § 38-2122. If the hours were earned in Nebraska the applicant must have held a provisional mental health practitioner license at the time.

(C) Submit documentation of successfully passing the examination set out in 172 NAC 94-010, directly to the Department from the examination entity or from another state licensing board or agency.

003.04 INDEPENDENT MENTAL HEALTH PRACTITIONER LICENSE. To obtain an initial license as an independent mental health practitioner, the applicant must have a provisional mental health practitioner license or a mental health license. Applicants must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. §§ 38-2124, 172 NAC 10, and this chapter. Documentation includes:

(A) Evidence of passing the appropriate examination identified in 172 NAC 94-010. Examination scores must be sent directly to the Department from testing vendor or from another state licensing board or agency.

(B) An affidavit signed by the supervisor verifying supervised experience set out in Neb. Rev. Stat. §38-2124.

003.05 CERTIFICATE AS A MARRIAGE AND FAMILY THERAPIST, PROFESSIONAL COUNSELOR, OR MASTER SOCIAL WORKER. An individual who is licensed or qualified to be licensed as an independent mental health practitioner or mental health practitioner may apply for an associated certification as a certified marriage and family therapist, certified professional counselor, or master social worker. To obtain an initial certificate, the applicant must submit a complete application as provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. §§ 38-2128 or 38-2132 or 38-2133, 172 NAC 10, and this chapter.

003.05(A) SUPERVISED EXPERIENCE. An individual applying for certification must submit documentation of having completed at least 3,000 hours of supervised experience applicable to the certificate being requested, under a qualified supervisor set out in 172 NAC 94-008, following receipt of the masters’ degree.

003.05(B) EXAMINATION. Submit documentation of successfully passing the examination set out in 172 NAC 94-010, directly to the Department from the examination entity or from another state licensing board or agency.

004. PROVISIONAL CERTIFICATE AS A MASTER SOCIAL WORKER . To obtain a provisional certificate, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the certification requirements of Neb. Rev. Stat. § 38-2129, 172 NAC 10, and this chapter.

004.01 EDUCATION. The applicant must submit an official transcript, submitted directly from the issuing institution, verifying completion of a masters’ degree in social work. The degree must have been completed at an approved educational program set out in 172 NAC 94-007.05.

004.02 SECOND PROVISIONAL. An individual who does not complete the required 3,000 hours of supervised experience in Nebraska may apply for another provisional certificate. No additional provisional certificates will be issued to an applicant after the issuance of a second provisional certificate.

005. CERTIFIED SOCIAL WORKER OR CERTIFIED MASTER SOCIAL WORKER . To obtain a certificate that is not in addition to the license as an independent mental health practitioner or mental health practitioner, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. § 38-2128, 172 NAC 10, and this chapter. The applicant must submit:

(A) An official transcript directly from the educational institution or through an acceptable electronic transcript service, showing proof of the required degree; and

(B) Evidence of meeting the education requirements set out in 172 NAC 94-007.05.

006. RECIPROCITY . To obtain a license or certification based on the applicant holding a credential in another jurisdiction, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the license or certification requirements of § 38-2125, 172 NAC 10, and this chapter. The applicant must submit:

(A) Documentation of meeting the licensing requirements set out in 172 NAC 94-003.03 or 172 NAC 94-003.04 for the license being requested.

(B) If applying for a certificate, documentation of meeting substantially equivalent standards to those set out in 172 NAC 94-003.05.

(C) If the applicant is applying for a license based on 5 years of active practice experience following initial licensure or certification in another jurisdiction, the applicant is not required to meet 172 NAC 94-006(A) or (B), but must submit evidence of successful completion of the Nebraska Jurisprudence Examination as set out in 172 NAC 94-

010.02(F) and the following:

(i) Documentation of having been in active practice under a similar credential following initial credentialing in another jurisdiction as set out in Neb. Rev. Stat. § 38-2125; and

(ii) Direct source verification of the credential the applicant holds in another jurisdiction.

007. EDUCATIONAL PROGRAMS . If the educational program is not accredited by one of the organizations set out in Neb. Rev. Stat. § 38-2104, the applicant must provide evidence that the program meets the following requirements:

007.01 MARRIAGE AND FAMILY THERAPY. A program that meets substantially equivalent educational requirements as adopted by Commission on Accreditation for Marriage and Family Therapy Education.

007.02 MENTAL HEALTH PRATICE. To be approved as equivalent to an approved mental health program, a program must meet the following:

(A) Be at least 60 graduate semester hours in duration. If the master’s degree is less than 60 semester hours, additional hours can be attained outside of the program to equal 60 semester hours. Any additional hours must be graduate hours and have a mental health focus to be considered as substantially equivalent.

(B) Have a mental health focused supervised practicum or internship that included a minimum of 300 clock hours of direct client contact under the supervision of a qualified supervisor as defined in 172 NAC 94-008 of these regulations. Any artificial situation where a person presents a problem, such as role playing, is not direct client contact. The program must have an emphasis on mental health practice and include coursework in theories and techniques, professional ethics, assessment techniques, human growth and development, and research and evaluation. Two years after the effective date of these regulations the coursework must also include social and cultural diversity. No course may be used to fulfill more than 1 coursework area. The coursework must meet the following requirements:

(i) A minimum of 6 semester hours or 9 quarter hours in theories and techniques. Two years after the effective date of these regulations, the coursework must include a minimum of at least 9 semester hours or 12 quarter hours in theories and techniques. The course must focus on therapeutic techniques and strategies for human behavioral intervention. Therapeutic techniques and strategies may include the study of major contributions of biological, behavioral, cognitive, and social sciences relevant to understanding assessment and treatment of a person and his or environment with an emphases on the social systems framework, personality theories, and development through the life cycle, and application of those during therapy.

(ii) A minimum of 3 semester hours or 4.5 quarter hours in professional ethics. The course must focus on the application of ethical and legal issues to the practice. Ethical and legal issues may include family law, codes of ethics, boundaries, peer review, record keeping, confidentiality, informed consent, and duty to warn.

(iii) A minimum of 3 semester hours or 4.5 quarter hours in assessment techniques. The course must focus on the process of collecting pertinent data about a client or client systems and their environment and appraising the data as a basis for making decisions regarding treatment or referral or both. Assessment techniques may include the ability to make a clinical diagnostic impression, knowledge of psychopathology, and assessment of substance abuse and other

addictions.

(iv) A minimum of 3 semester hours or 4.5 quarter hours in human growth and development. The course must focus on studies that provide an understanding of the nature and needs of individuals at all developmental levels. Human growth and development may include theories of individual and family development and transitions across the life-span; theories of learning and personality development; human behavior including an understanding of developmental crises, disability, exceptional behavior, addictive behavior, psychopathology, and situational and environmental factors that affect both normal and abnormal behavior; and strategies for facilitating optimum development over the life-span.

(v) A minimum of 3 semester hours or 4.5 quarter hours in research and evaluation. Research and evaluation includes statistics or research design and development of research, and demonstration proposals.

(vi) Two years after the effective date of these regulations, in addition to the above coursework, a minimum of 3 semester hours or 4.5 quarter hours in social and cultural diversity. The course must focus on studies that provide an understanding of the cultural context of relationships, and issues and trends in a multicultural and diverse society. Social and cultural diversity may include multicultural and pluralistic trends, including characteristics and concerns between and within diverse groups nationally and internationally; attitudes, beliefs, understandings, and acculturative experiences, including specific experiential learning activities; individual, couple, family, group, and community strategies for working with diverse populations and ethnic groups; counselors’ roles in social justice, advocacy and conflict resolution, cultural self-awareness, the nature of biases, prejudices, processes of intentional and unintentional oppression and discrimination, and other culturally supported behaviors that are detrimental to the growth of the human spirit, mind, or body; theories of multicultural counseling, theories of identity development, and multicultural competencies.

(C) Graduate programs accepting an undergraduate course as meeting the course criteria set out in 172 NAC 94-007.02(B)(i) through (vi) are acceptable if the course was used to meet the requirements for the master’s degree. The applicant must have the school submit a notarized letter, on institutional letterhead, from an authorized person stating the undergraduate course(s) was accepted to meet the educational requirement(s) of the master’s degree.

007.03 INDEPENDENT MENTAL HEALTH PRACTICE. A program that meets the educational requirements set out in Neb. Rev. Stat. § 38-2124.

007.04 PROFESSIONAL COUNSELING. A program that meets substantially equivalent educational requirements as adopted by the Council for Accreditation of Counseling and Related Educational Programs.

007.05 SOCIAL WORK. The following are acceptable programs:

007.05(A) BACCALAUREATE DEGREE. Undergraduate social work education and training approved by the Council on Social Work Education (CSWE).

007.05(B) MASTER’S DEGREE. Graduate social work education and training approved by the Council on Social Work Education (CSWE).

007.05(C) DOCTORAL DEGREE PROGRAMS. Recognized by the Groups for Advancement of Doctoral Education (GADE).

007.06 DEGREE OBTAINED IN A FOREIGN COUNTRY. A degree obtained in a foreign country must be evaluated by a foreign educational credential evaluation service that is a member of the National Association of Credential Evaluation Services (NACES) and be determined as equivalent to a degree issued from an approved program.

008. QUALIFIED SUPERVISOR . Supervisors must insure that their judgment is not impaired based on their personal relationship with the supervisee and that no exploitation of the supervisee occurs. The supervisor must:

(A) Hold a current active credential; and

(B) If the supervisor’s license or certificate has been disciplined, at least 1 year must have elapsed following completion of any disciplinary terms and conditions. If disciplinary action is taken by the Department during the supervisory agreement period, the supervisor must terminate the supervision immediately and notify the Department.

008.01 ADDITIONAL REQUIREMENTS. The following sets out additional supervisor requirements to obtain a license as an independent mental health practitioner, a certificate as a marriage and family therapist, a certificate as a master social worker, or a license as a mental health practitioner.

008.01(A) INDEPENDENT MENTAL HEALTH PRACTICE LICENSE. The supervisor must be a licensed physician, a licensed psychologist, a licensed independent mental health practitioner, or have a current similar credential or certification in another jurisdiction.

008.01(B) MARRIAGE AND FAMILY THERAPY CERTIFICATE. The supervisor must be a licensed independent mental health practitioner, licensed mental health practitioner, licensed psychologist, or licensed physician who meets either item (i) or (ii) below:

(i) Holds an approved supervisor designation issued by the American Association for Marriage and Family Therapy or an equivalent organization as approved by the Board; or

(ii) Is a certified marriage and family therapist or have a current similar credential or certification in another jurisdiction, who has practiced for five years and has completed, at a minimum, a five hour supervision course that is provided, endorsed, or approved by the American Association of Marriage and Family Therapy or an association which has substantially similar standards to those of the American Association of Marriage and Family Therapy, and has received supervision by an American Association of Marriage and Family Therapy approved supervisor at least one hour per month for at least one year after completion of the supervision course.

008.01(C) MASTER SOCIAL WORK CERTIFICATION. The supervisor must be a certified master social worker, or have a current similar credential or certification in another jurisdiction.

008.01(D) MENTAL HEALTH PRACTICE LICENSE. The supervisor must be a licensed physician, a licensed psychologist, a licensed independent mental health practitioner, a licensed mental health practitioner, or have a current similar credential or certification in another jurisdiction.

009. SUPERVISED EXPERIENCE . To count toward the required number of hours of supervised experience, all direct and in-direct client contact hours must take place while the applicant is being supervised by a qualified supervisor and supervised experience must meet the requirements set out below:

009.01 GENERAL SUPERVISION REQUIREMENTS. Supervision for all applicants must meet the following:

(A) Focus on raw data from the applicant's clinical work which is made directly available to the supervisor through such means as written clinical materials, direct observation, and video and audio recordings;

(B) Include a process which is distinguishable from personal psychotherapy, consultation, or didactic instruction; and

(i) The supervisee apprises the supervisor of the diagnosis and treatment of clients;

(ii) The clients' cases are discussed;

(iii) Ethical principles of the profession are discussed;

(iv) The supervisor provides the supervisee with oversight and guidance with the provision of service to clients;

(v) The supervisor must evaluate the supervisee’s performance by periodically evaluating the therapeutic process and determining if treatment goals are being met and if changes in direction or emphasis are needed; and

(vi) The supervisor cannot supervise more than 6 persons at 1 face-to-face supervisory meeting. Face to face supervision may include interactive visual imaging assisted communication which is secure and confidential.

009.02 MENTAL HEALTH PRACTICE SUPERVISION. Supervision must also include:

(A) Supervised experience, which is not considered direct client contact, and includes, but is not limited to, review of client records, case conferences, direct observation, or video observation; and

(B) Evaluative face-to-face contact for a minimum of 1 hour per week between the supervisee and supervisor. Face to face supervision may include interactive visual imaging assisted communication which is secure and confidential.

009.03 INDEPENDENT MENTAL HEALTH PRACTICE SUPERVISION. In addition to the requirements in 172 NAC 94-009.02 supervision must include:

(A) A review of the diagnostic criteria for clients diagnosed with major mental disorders;

(B) Evaluative face-to-face contact with a minimum cumulative ratio of 2 hours of face-to-face contact between the supervisee and a qualified supervisor per 15 hours of contact with clients diagnosed with major mental disorders, no more than 45 hours may be accumulated without such supervision. Face to face supervision may include interactive visual imaging assisted communication which is secure and confidential;

(C) Supervised experience, which is not considered direct client contact, includes, but is not limited to, review of client records, case conferences, direct observation, or video observation; and

(D) A licensed mental health practitioner seeking licensure as a licensed independent mental health practitioner must receive supervision of all direct client contact where the licensee is providing services to clients with major mental disorders. This supervision must last until the person receives the credential qualifying him or her for independent practice, not just during the period of time in which the specified number of hours is obtained.

009.04 MARRIAGE AND FAMILY THERAPY SUPERVISION. Supervision must include:

(A) At least 3,000 hours of supervised experience during the five years preceding application for certification. The 3,000 hours must include a minimum of 1,500 hours of direct client contact. During the course of completing the client-contact hours, there must be at least 100 hours of supervisor-supervisee contact hours with a qualified supervisor and supervision must be provided at least 1 hour per week or 2 hours every 2 weeks; and

(B) Supervised experience, which is not considered direct client contact, includes, but is not limited to, review of client records, case conferences, direct observation, or video observation.

009.05 MASTER SOCIAL WORK SUPERVISION. When a person wishes to apply for a mental health practice license and master social work certificate, supervision must be provided under a licensed independent clinical social worker or licensed clinical social worker and in accordance with this section. Supervision, when conducted pursuant to Neb. Rev. Stat. § 38-2129, must include:

(A) At least 3,000 hours of supervised experience;

(B) The written records of services or procedures are examined and evaluative interviews are conducted by a certified master social worker;

(D) Evaluative face-to-face contact for a minimum of 1 hour per week between the supervisee and supervisor.

010. EXAMINATIONS . Applicants must meet the examination requirements of this section.

010.01 ELIGIBILITY AND APPLICATION PROCESS. For an applicant who is not authorized to take the examination through his or educational institution, the applicant must apply for approval through the Department and must have received a master's, doctorate or equivalent degree from an approved program as set out in 172 NAC 94-007. The applicant must submit the following:

(A) An official transcript submitted directly from the educational institution or through an acceptable electronic transcript service, showing proof of the required degree.

(B) A completed application requesting approval to take the examination.

010.02 EXAMINATIONS REQUIRED. The following examinations are required as set out in this chapter.

010.02(A) MARRIAGE AND FAMILY THERAPY. For certification as a marriage and family therapist and licensure as a mental health practitioner or independent mental health practitioner, an applicant must pass the Association of Marital and Family Therapy Regulatory Boards (AMFTRB) examination.

010.02(B) PROFESSIONAL COUNSELING. For certification as a professional counselor and licensure as a mental health practitioner or independent mental health practitioner, an applicant must pass:

(i) The National Board of Certified Counselor's National Counselor Examination (NBCC/NCE) or The National Board of Certified Counselor’s National Clinical Mental Health Counselor Examination (NBCC/NCMHCE); or

(ii) The Commission on Rehabilitation Counselor Examination (CRC).

010.02(C) SOCIAL WORK. An applicant must pass the Association of Social Work Boards examination as identified below:

(i) If applying for the mental health practice license or independent mental health practice license and master social work certificate, the applicant must pass the Clinical Examination.

(ii) If applying for only the master social work certificate, the applicant must pass the Advanced Generalist Examination, Master Examination, or Clinical Examination.

010.02(D) MENTAL HEALTH PRACTITIONER OR INDEPENDENT MENTAL HEALTH PRACTITIONER. An applicant must pass the examination as follows:

(i) If the applicant’s degree is in marriage and family therapy or its equivalent, the applicant must pass the Association of Marital and Family Therapy Regulatory Boards examination (AMFTRB).

(ii) If the applicant’s degree is in social work or its equivalent, the applicant must pass the Association of Social Work Boards Clinical examination (ASWB).

(iii) If the applicant’s degree is a mental health related counseling degree, the applicant must pass:

(1) The National Board of Certified Counselor's National Counselor Examination (NBCC/NCE);

(2) The National Board of Certified Counselor’s National Clinical Mental Health Counselor Examination (NBCC/NCMHCE);

(3) The Commission on Rehabilitation Counselor Examination (CRC);

(4) The Examination for Professional Practice in Psychology (EPPP); or

(5) Any other examination determined by the Board to be equivalent.

010.02(E) EXAMINATION PASSING SCORES. The passing score on each of the examinations is set out as follows:

(i) The passing score on the National Board of Certified Counselor's National Examination is determined using the Angoff method for the National Clinical Mental Health Counselor examination and a modified Angoff method for the National Board of Certified Counselor’s National Counselor Examination.

(ii) The passing score on the Association of Marital and Family Therapy Regulatory Boards examination (AMFTRB) is determined by using a modified Angoff method.

(iii) The passing score on the Commission on Rehabilitation Counselor Examination (CRC) is determined using a conjunctive scoring model.

(iv) The passing score on the Association of Social Work Boards Examination is 75.

(v) The passing score on the Examination for Professional Practice in Psychology (EPPP) is a scaled score of 500.

010.02(F) RECIPROCITY. An applicant who is applying based on reciprocity and practice for at least 5 years following licensure, is required to pass the Nebraska jurisprudence examination with a score of at least 75%.

011. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10 and this chapter. All licenses and certifications issued by the Department expire on September 1st of each even-numbered year.

012. CONTINUING EDUCATION REQUIREMENTS . During the 24 months prior to the renewal date, individuals holding active licenses and certifications in the State of Nebraska must complete at least 32 hours of acceptable continuing education hours related to mental health practice during the preceding 24-month period.

012.01 GENERAL REQUIREMENTS. Applicants must meet the following continuing education requirements:

(A) All license and certificate holders must complete at least 4 hours of continuing education in ethics.

(B) All licensed independent mental health practitioners must complete at least 6 hours of continuing education relating to diagnosis and treatment of major mental disorders.

012.02 LICENSEES WHO HOLD AN ASSOCIATED CERTIFICATE. An individual who holds an independent mental health practice license or mental health practice license and an associated certificate(s) is not required to earn continuing education hours for each additional certificate.

012.03 TYPES OF ACCEPTABLE CONTINUING EDUCATION AND HOUR DETERMINATIONS. The following provides the types of continuing education that is considered acceptable for renewal and reinstatement and the hour determinations:

(A) Completing academic credit during the renewal period. Academic credit is determined as follows:

(i) 1 academic semester credit equals 15 continuing education credit hours and 1 credit audited equals 8 hours of continuing education.

(ii) 1 academic quarter credit equals 10 continuing education credit hours and 1 credit audited equals 5 hours of continuing education.

(iii) 1 academic trimester credit equals 14 continuing education credit hours and 1 credit audited equals 7 hours of continuing education.

(B) Hours for teaching an academic course or supervising a practicum or internship is determined the same as 172 NAC 012.03(A) above.

(D) Hours for completing home study or video programs, including those transmitted through electronic means, are determined by the provider of the program.

(E) Authoring a peer reviewed publication equals 16 hours.

(F) 60 minutes equals 1 continuing education hour when attending or participating workshops, lectures, or interactive webinars.

012.04 WORKSHOP PRESENTERS OR ACADEMIC INSTRUCTORS. An individual may receive credit for the initial presentation during a renewal period. Credit will not be given for subsequent presentations of the same program or course.

012.05 NON-ACCEPTABLE CONTINUING EDUCATION. Non-acceptable subject matter for continuing education credit includes, but is not limited to the following:

(A) Leadership training provided through associations;

(B) Business technology, business techniques, and management; and

013. UNPROFESSIONAL CONDUCT . Unprofessional conduct includes but is not limited to the acts set out in Neb. Rev. Stat. §38-179 and these regulations.

013.01 COMPETENCE. A credential holder must not provide services for which he or she is not trained or experienced, unless he or she associates with another credential holder with established competence in the service or obtains the knowledge through necessary study. A credential holder must not encourage or promote the practice of mental health services, social work, professional counseling, or marriage and family therapy by untrained or unqualified persons.

013.02 CONFIDENTIALITY. A credential holder must hold in confidence information received from a potential client with respect to the service requested, except in those unusual circumstances in which to do so would result in clear danger to the person or to others, or where otherwise required or permitted by law. A person who communicates information unilaterally to a credential holder without a reasonable expectation that the credential holder is willing to form a client-therapist relationship, is not a potential client.

013.03 DISCLOSURE OF CONFIDENTIAL INFORMATION. A person credentialed or certified pursuant to these regulations must not disclose any information he or she may have acquired from a client or patient, except:

(A) With the written consent of such person;

(B) In the case of death or disability when the client or patient is unable to consent, with the consent of a person legal authorized to consent on behalf of the decedent or client or patient;

(C) When more than one person in a family received therapy conjointly, each such family member who is legally competent to execute a waiver must agree to the waiver referred to in this section. Without such a waiver from each family member legally competent to execute a waiver, a practitioner must not disclose information received from any family member who received therapy conjointly for any therapy session where the non-consenting family member was present;

(D) As such privilege is limited by the laws of the state of Nebraska;

(E) When the person waives the privilege by bringing charges against the credential holder; and

(F) When there is a duty to warn under the limited circumstances set forth in Neb. Rev. Stat. § 38-2137.

013.04 DISCRIMINATION. Credential holders must provide professional assistance to clients or patients without discrimination on the basis of race, color, religion, sex, disability, marital status, national origin, age, familial status, and ancestry.

013.05 DUAL RELATIONSHIP. Credential holders must make every effort to avoid dual relationships with clients that could impair professional judgment or increase the risk of exploitation. When a dual relationship cannot be avoided, credential holders must take appropriate professional precautions, such as seeking supervision or professional consultation, to ensure judgment is not impaired and no exploitation occurs. Dual relationships include, but are not limited to, business or close personal relationships with a client.

013.05(A) SEXUAL INTIMACY OR CONTACT. Sexual intimacy or contact with a client during the provision of professional services, 5 years preceding the provision of professional services, or with a former client less than 5 years following the last professional contact is prohibited.

(i) Sexual Intimacy means any written, verbal, or physical behavior which a reasonable person would find to be sexually seductive or sexually demeaning. Sexual intimacy may or may not include sexual contact.

(ii) Sexual contact includes sexual intercourse, either genital or anal, cunnilingus, fellatio, sodomy or the handling of breasts, genital areas, buttocks, or thighs whether clothed or unclothed, initiated or consented to by the credential holder.

013.05(B) EXPLOITATION. In the therapeutic relationship, credential holders need to be aware of the intimacy and responsibilities inherent in the therapeutic relationship and must avoid actions that seek to meet their personal needs at the expense of clients. Credential holders must be aware of their influential positions with respect to clients, and they must avoid exploiting the trust and dependency of such persons. Credential holders, therefore, must make every effort to avoid conditions and multiple relationships with clients that could impair professional judgment or increase the risk of exploitation. Failure to comply with this standard is considered unprofessional conduct.

013.06 PROFESSIONAL RECORDS. Failure to comply with the following professional record requirements is unprofessional conduct:

(A) Client records must be maintained a minimum of 5 years following termination of services. Records or documentation of the actual fact of clinical record destruction must be maintained for an additional 5 years;

(B) Client records must be stored, safeguarded, and disposed of in ways that maintain confidentiality and in accord with applicable laws and professional standards;

(C) Prior to the credential holder moving from the area, closing a practice, or prior to the death of the credential holder, a credential holder must arrange for the storage, transfer, or access to, or dispose of client records in ways that maintain confidentiality and safeguard the welfare of clients;

(D) Client records must include a signed and dated informed consent agreement outlining confidentiality and the limitations of confidentiality, as well as the rights and responsibilities of the client in the client’s file;

(E) Client records must include documentation which reflect the services provided and include applicable release of information and discussions with other professionals; and

(F) A credential holder must allow a client access to his or her records in accordance with Neb. Rev. Stat. §71-8401 to 71-8407.

013.07 PROFESSIONAL RELATIONSHIPS. A credential holder must safeguard the welfare of clients or patients and maintain professional relationships with clients or patients. Commission of any of the following acts or behavior constitutes unprofessional conduct.

(A) Exploiting another person for one's own advantage;

(B) Performing or agreeing to perform mental health services, social work, professional counseling, or marriage and family therapy that have been requested when such services are known to be contraindicated or unjustified;

(C) Performing or agreeing to perform procedures that have been requested when such procedures are known to be outside of the mental health practice, social work, professional counseling, or marriage and family therapy scope of practice;

(D) Verbally or physically abusing clients or patients;

(E) Attempting to provide diagnostic or treatment information to patient(s) or client(s) that is beyond the credential holder’s level of education, training, and expertise;

(F) Failing to make a referral when a referral is in the patient’s or client’s best interest;

(G) Delegating to other personnel those client or patient related services for which the clinical skills and expertise of a credential holder are required;

(H) Failure to safeguard the patient's or client's dignity and right to privacy;

(I) Failure to take reasonable steps to clarify at the outset the following:

(i) Who is the client or patient; and

(ii) The relationship the practitioner will have with each person if there are multiple individuals present. This clarification includes the practitioner’s role, the probable services to be provided, and the probable uses of the information obtained; or

(J) Committing any act which endangers client or patient safety or welfare.

013.08 REFERRALS. If, for any reason, a credential holder is unable to provide therapeutic services to a client or patient, the credential holder must refer the client or patient to other credential holders. This may be done by directing the client or patient to specific credential holders or to a list or directory of credential holders who may be able to provide professional assistance. The referral must be documented in the client or patient’s record. Failure to comply with this standard is unprofessional conduct.

013.09 SEXUAL HARASSMENT. A credential holder must not under any circumstances engage in sexual harassment of clients or patients. Sexual harassment includes making unwelcome sexual advances, requesting sexual favors, and engaging in other verbal or physical conduct of a sexual nature which results in:

(A) Providing or denying care to a client or patient;

(B) Creating an intimidating, hostile, or offensive environment for the client or patient; or

013.10 STUDENTS AND SUPERVISEES. Failure to comply with the following is considered unprofessional conduct:

(A) A credential holder must not exploit the trust and dependency of students and supervisees.

(B) A credential holder must be aware of his or her influential positions with respect to students and supervisees, and they must avoid exploiting the trust and dependency of such persons. Credential holders, therefore, must make every effort to avoid conditions and multiple relationships that could impair professional objectivity or increase the risk of exploitation. When the risk of impairment or exploitation exists due to conditions or multiple roles, therapists must take appropriate precautions.

(D) A credential holder must not engage in sexual intimacy with students or supervisees during the evaluative or training relationship between the credential holder and students or supervisees.

(E) A credential holder must take reasonable measures to ensure that professional services provided by supervisees are within the supervisees training, level of experience, and competence.

(F) A credential holder must avoid accepting as supervisees or students those individuals with whom a prior or existing relationship could compromise the credential holder’s objectivity. When such situations cannot be avoided, credential holders must take appropriate precautions to maintain objectivity. Such relationships include, but are not limited to, those individuals with whom the credential holder has a current or prior sexual, close personal, immediate familial, or therapeutic relationship.

(G) A credential holder must not disclose information from a supervisee about a client or patient which is obtained as part of a professional relationship except with written authorization or waiver from or by the client or patient, or when mandated or permitted by law. In educational or training settings where there are multiple supervisors, disclosures are permitted only to other professional colleagues, administrators, or employers who share responsibility for training of the supervisee.

(H) A credential holder must sign-off as completed a supervisee’s hours of experience, when the hours have been completed.

013.11 FAILURE TO COOPERATE WITH INVESTIGATIONS. Refusal to cooperate or failure to furnish requested information during any investigation by the Department.

014. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

015. FEES . Fees are set out in 172 NAC 2.

History

Effective 2021-07-12

Chapter 95 Administration of Medications by Medication Aides and Medication Staff

Neb. Admin. Code tit. 172, ch. 95 Administration of Medications by Medication Aides and Medication Staff {#sec-172-nac-95 omnilex-key=us-ne-regs-official--title-172--172 NAC 95}

001. SCOPE AND AUTHORITY . These regulations govern the safe administration of medications by medication aides and medication staff under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 71-6718 to 71-6742.

002. DEFINITIONS . Definitions are found in Neb. Rev. Stat. § 71-6721 and this chapter.

002.01 CAPABILITY AND CAPACITY. An individual who has knowledge related to the purposes, desired effects, and potential side effects of the medication being administered and has knowledge of the consequences if the medication is not provided and received as prescribed or recommended is considered to have capability and capacity.

002.02 ENTITY. A facility, school, licensed child care facility, or any other business or individual utilizing a medication aide or medication staff.

002.03 MEDICATION STAFF. An individual who is licensed to operate a child care facility, or a staff member of a child care facility, or a staff member of a school and who has been determined to be competent to assist with the administration of medication.

002.04 REVIEWED PERIODICALLY. A review for which the time interval is determined by the caretaker or licensed health care professional based upon the health condition of the recipient, the nature of the additional activity, and the experience of the medication aide in the additional activity. The review should be conducted frequently enough to assure recipient safety.

003. ADMINISTRATION OF MEDICATION BY UNLICENSED INDIVIDUALS . Assistance with the administration of medication may only be performed by the following unlicensed individuals:

(A) Medication aides;

(B) Persons licensed to operate a child care facility or staff members of a child care facility; and

003.01 ADDITIONAL DUTIES THAT MAY BE PERFORMED DURING ADMINISTRATION OF MEDICATION BY UNLICENSED INDIVIDUALS. The persons identified in 172 NAC 95-003 may assist with the provision of medication, and with the documentation of the provision of the medication; and, under the specific conditions set forth in 172 NAC 95-007, these persons may also participate in observing and reporting.

004. MINIMUM COMPETENCY AREAS AND STANDARDS . Medication aides and medication staff must meet the following competency standards:

(A) Does not share confidential information except when it affects the recipient’s care and is shared with the appropriate person;

(B) Does not force recipients to take medication. Uses appropriate measures to encourage taking of medications when directed for recipients who are not competent;

(D) Accurately documents all medication provided including the name of the medication, dose, route, and time administered and any refusal of medication, and spoilage;

(E) Provides the right medication, to the right person, at the right time, in the right dose, and by the right route;

(F) Comprehends written or oral directions;

(G) Properly stores and handles all medication in accordance with entity policy;

(H) Intervenes when unsafe conditions of the medication indicate a medication should not be provided;

(I) Provides medication to recipients in accordance with their age and condition;

(J) Knows that they must:

(i) Be competent and have been assessed;

(ii) Always comply with the 5 rights of provision of medications;

(iii) Record all medication provided or refusals; and

(iv) Have additional competencies to provide additional activities;

(K) Identifies:

(i) Occurrences of possible abuse of a vulnerable adult and reports this information to the appropriate person or agency as required by the Adult Protective Services Act; and

(ii) Occurrences of possible abuse or neglect of a child and reports this information to the appropriate person or agency as required by Neb. Rev. Stat. §§ 28-710 to 28-727; and

(L) Does not misuse recipient property or cause physical harm, pain, or mental anguish to recipients.

004.01 COMPETENCY ASSESSMENT. Medication aides and medication staff must meet the standards set out in 172 NAC 95-004.01. The methods for assessment and those who may complete an assessment of medication aides or medication staff are set out in the following:

(A) 172 NAC 96 for medication aides;

(B) 92 NAC 59 for medication staff at schools; and

(C) 391 NAC 1 - 5 for licensees or medication staff at Family Child Care Homes, medication staff at Child Care Centers, and medication staff at Preschools.

005. PROVISION OF DIRECTION AND MONITORING . Medications may be provided by medication aides and medication staff only when direction and monitoring is provided and

documented.

005.01 DIRECTION AND MONITORING. Direction and monitoring must be provided by 1 of the following:

(A) A competent recipient;

(B) A caretaker; or

(C) A licensed health care professional. A licensed health care professional who provides direction and monitoring must do so within the prevailing practice standards of the profession. Licensed Practical Nurses must do so under direction and in accordance with the Nurse Practice Act.

005.02 MAY NOT PROVIDE DIRECTION AND MONITORING. A medication aide or medication staff may not provide direction and monitoring but may participate in observing and reporting as provided in 172 NAC 95-007.

005.03 DIRECTION AND MONITORING ACCEPTANCE BY COMPETENT RECIPIENTS. Acceptance of responsibility for direction and monitoring for a competent recipient may be provided by the recipient themselves, a caretaker, or a licensed health care professional.

005.04 DIRECTION AND MONITORING ACCEPTANCE FOR NON-COMPETENT RECIPIENTS. Acceptance of responsibility for direction and monitoring for recipients who are not competent may be provided by a caretaker or a licensed health care professional.

005.05 DIRECTION AND MONITORING ACCEPTANCE FOR NON-COMPETENT RECIPIENTS AND RECIPIENTS WITH NO CARETAKERS. For recipients who are not competent and for whom there are no caretakers, acceptance of responsibility for direction and monitoring must be provided by a licensed health care professional. Documentation may be accomplished by any of the following methods:

(A) When licensed health care professionals are employees, entities may identify on an individual basis or by title and job description or role delineation the licensed health care professional or the classifications of licensed health care professionals who are responsible to provide direction and monitoring. Written acceptance of responsibility is not required to be recipient-specific and can be through acceptance of title and job description or role delineation;

(B) When licensed health care professionals are not employees, entities must identify the licensed health care professional who is designated to provide direction and monitoring by name, profession, and license number. Written acceptance of responsibility must be recipient-specific; or

(C) A licensed health care professional who provides direction and monitoring directly to a recipient, rather than indirectly through employment by a facility or other entity, must have a documented professional relationship with the recipient, or with a responsible party on behalf of the recipient. The documentation must include the health care professional’s acceptance of the responsibility for direction and monitoring.

006. ACTIVITIES IN THE PROVISION OF MEDICATIONS . All medication aides and medication staff, when directed and monitored in accordance with 172 NAC 95-005, may provide routine medications by the following routes:

(A) Oral, which includes any medication given by mouth, including sublingual placing under the tongue, and buccal which is placing between the cheek and gum, and oral sprays;

(B) Inhalation, which includes inhalers and nebulizers. Oxygen may be given by inhalation;

(D) Instillation by drops, ointments, and sprays into the eyes, ears, and nose.

006.01 RECORD OF PROVISION OF MEDICATION. All medication aides and medication staff must make an accurate record of their provision of medication. The record of provision of medication must include:

(A) Identification of the recipient;

(B) Name of the medication given;

(D) Identification of the person who provided the medication; and

(E) Any refusal by the recipient to take or receive a medication.

006.02 MEDICATION RECORD RETENTION. The record must be given to the entity employing the medication aide or medication staff. The record must be kept and maintained as required by 172 NAC 95-011.

006.03 MEDICATION ERRORS. Any medication error must be reported to the person responsible for providing direction and monitoring immediately upon discovery of the error.

007. ADDITIONAL ACTIVITIES IN THE PROVISION OF MEDICATIONS . In addition to the activities specified in 172 NAC 95-006, medication aides and medication staff may provide optional additional activities in accordance with this chapter. Any additional activity must be done under the direction and monitoring required in 172 NAC 95-005. Before an additional activity may be provided, the following requirements must each be met:

(A) The specific medication aide or medication staff must be determined to be competent to perform the specific activity, and the determination must be documented as set out in 172 NAC 95-008.

(B) There must be written direction for each additional activity and for each recipient as described in 172 NAC 95-009.

(C) A licensed health care professional must determine that these activities can be done safely for the specific recipient, and the determination must be documented as set out in 172 NAC 95-010.

007.01 OPTIONAL ADDITIONAL ACTIVITIES. The optional additional activities which may be provided by a medication aide or a medication staff include:

(A) Provision of as needed (PRN) medications,

(B) Provision of medications by routes in addition to those identified in 172 NAC 95-006 but not including provision of medications or fluids intravenously. Acceptable additional routes may include gastrostomy tube; injections including subcutaneous, intradermal, and intramuscular; rectal; and vaginal; and

(C) Participation in direction and monitoring by observing for identified recipient responses and reporting these responses as directed.

007.02 ADDITIONAL ACTIVITIES RECORDKEEPING. All medication aides and medication staff must comply with the record keeping and reporting requirements of 172 NAC 95-006, including reporting of errors.

DETERMINATION OF COMPETENCY FOR A MEDICATION AIDE OR MEDICATION STAFF TO PERFORM AN ADDITIONAL ACTIVITY. Medication aides or medication staff may provide as needed (PRN) medication, provide medication by an additional route, or participate in monitoring if there is a written statement from a competent recipient, caretaker, or licensed health care professional that the medication aide or medication staff is competent to perform such duties. The following documentation is required:

(A) For competent recipients, a statement indicating informed determination that each medication aide or medication staff who provides the additional activity is competent. In the situation of a competent recipient who is making their own determination of need and

(B) effectiveness regarding medications, written documentation is not required for as needed PRN medication or for participation in monitoring.

(C) For recipients who are not competent but for whom there are caretakers, a statement from the caretaker indicating their determination that a medication aide or medication staff is competent to provide the additional activity. Competency determination of the medication aide or medication staff by the caretaker must be determined on a recipient-specific basis and the documentation must be on an individual-specific basis for each medication aide or medication staff and not by title or job description.

(D) For recipients who are not competent and for whom there are not caretakers, a statement from a licensed health care professional stating their determination that a medication aide or medication staff is competent to provide the additional activity. This requirement must be met in one of the following methods:

(i) An entity which employs licensed health care professionals may identify on an individual basis or by written title and job description both the licensed health care professional who has made the competency determination and those medication aides and medication staff who have been determined competent for each additional activity;

(ii) An entity which does not employ licensed health care professionals must identify by name, profession, and license number the licensed health care professional who has made the competency determination and those medication aides and medication staff who have been determined competent for each additional activity. Such persons may be identified on an individual basis or by written title and job description; or

(iii) A licensed health care professional who provides services directly to a recipient, rather than indirectly through entity employment or contract, must specify those medication aides and medication staff who have been determined competent to provide each additional activity. Such persons must be identified on an individual basis.

009. WRITTEN DIRECTION FOR AN ADDITIONAL ACTIVITY . There must be written direction whenever a medication aide or medication staff provides as needed (PRN) medication(s), provides medication by an additional route, or participates in observing and reporting. The written direction must be specific to each recipient, and provided by a caretaker or licensed health care professional. There is no requirement for written direction when direction and monitoring is provided by a competent recipient. Documentation may be accomplished by any of the following methods:

(A) Direction for as needed (PRN) medication must include instructions for the recipient-specific criteria under which a specific medication may be provided and the reporting requirements associated with the as needed (PRN) provision of said medication. The instructions must be for each as needed (PRN) medication provided and must be readily available for reference by and reviewed periodically with the medication aide or medication staff to assure continued safe provision of as needed (PRN) medications;

(B) Directions for an additional route must include instructions for the recipient-specific procedure and must be readily available at all times for reference and reviewed periodically with the medication aide or medication staff to assure continued safe provision of medication by an additional route; or

(C) Direction for participation in observing and reporting must include instructions for recipient-specific criteria for which the medication aide or medication staff is to observe and report. Instructions must include time lines for observing and reporting, and must identify the person to be notified. Instruction must be readily available for reference and be reviewed periodically with the medication aide or medication staff to assure continued safe monitoring.

010. WRITTEN DOCUMENTATION OF RECIPIENT SAFETY WHEN AN ADDITIONAL ACTIVITY IS PROVIDED . There must be a written statement by a licensed health care professional stating that it is safe for a medication aide or medication staff to provide as needed (PRN) medication, medication by an additional route, or participate in observing and reporting except when the medication is non-prescription and the monitoring is provided by a competent recipient for themselves or by a caretaker. The licensed health care professional making the decision of recipient safety must do so within their scope of practice. Licensed Practical Nurses must do so under direction and in accordance with the Nurse Practice Act. Documentation of safety may be accomplished by any of the following methods in this section.

010.01 COMPETENT RECIPIENTS. There must be a statement from a licensed health care professional as identified in 172 NAC 95-010 that it is safe for a medication aide or medication staff to provide as needed (PRN) prescription medication or to provide prescription medication by an additional route.

010.02 RECIPIENTS WHO ARE NOT COMPETENT BUT FOR WHOM THERE ARE CARETAKERS. There must be a written statement obtained from a licensed health care professional as identified in 172 NAC 95-010 indicating that it is safe for a medication aide or medication staff to provide an as needed (PRN) prescription medication, a prescription medication by an additional route, or to participate in observing and reporting for the identified recipient.

010.03 RECIPIENTS WHO ARE NOT COMPETENT AND FOR WHOM THERE ARE NO CARETAKERS. There must be documentation by a licensed health care professional as identified in 172 NAC 95-010 who has made recipient-specific determination that it is safe for a medication aide or medication staff to provide an as needed (PRN) medication, a medication by an additional route, or participate in observing and reporting for the identified recipient. This requirement must be met in one of the following methods:

(A) An entity which employs licensed health care professionals may identify on an individual basis or by written title and job description the licensed health care professional who has made the recipient-specific safety determination for each additional activity;

(B) An entity which does not employ licensed health care professionals must identify by name, profession, and license number of the licensed health care professional who has made the recipient-specific safety determination for each additional activity; or

(C) A licensed health care professional who provides services directly to a recipient may identify determination of recipient safety through the written records or plan of care for the recipient.

011. RECORD RETENTION FOR ENTITIES . All other entities, including licensed health care professionals providing services through contract, must establish policies for record maintenance and retention, and maintain the records for a minimum of two years after the service has been provided. This regulation does not affect the entity’s obligation to retain the records for any other purpose.

012. STORAGE AND HANDLING OF MEDICATION . Any entity responsible for administering or providing medication must ensure appropriate storage and handling of medications.

012.01 MEDICATION STORAGE AND PROTECTION. All medications that an entity is responsible for administering or providing must be:

(A) Protected from theft, tampering, and inappropriate use; and

(B) Stored in accordance with the manufacturers or dispensing pharmacist’s instructions.

012.02 ACCESS TO MEDICATION. Only authorized personnel who are designated by the entity responsible for administration or provision of medications may have access to the medications.

012.03 ENTITY NOT RESPONSIBLE FOR PROVISION OF MEDICATION. When the entity is not responsible for administering or providing medications, this chapter does not preclude an entity from allowing a recipient to possess and take the recipient’s own medications; however, the entity is not required to allow such possession. Examples include minor students in schools, minor children in child care facilities, and incompetent adults in assisted-living facilities.

012.04 HANDLING. The entity must ensure the proper handling of medications it is responsible for administering or providing.

012.05 MEDICATION INTEGRITY. Loss, waste, or spoilage of medication must be recorded according to entity policy.

012.06 TEMPORARY ABSENCE. Medications sent with a recipient for temporary absences must be in containers identified for the recipient with directions for the right dose, right time, and right route. The medication container must be given only to a competent recipient, to a resident-specific caretaker, or other designated responsible person.

History

Effective 2022-09-24

Chapter 96 Medication Aide Registry

Neb. Admin. Code tit. 172, ch. 96 Medication Aide Registry {#sec-172-nac-96 omnilex-key=us-ne-regs-official--title-172--172 NAC 96}

001. SCOPE AND AUTHORITY . These regulations apply to the establishment and maintenance of the Medication Aide Registry pursuant to the Medication Aide Act, Nebraska Revised Statute (Neb. Rev. Stat.) §§ 71-6718 to 71-6742.

002. DEFINITIONS . Definitions are found in Neb. Rev. Stat. § 71-6721 and this chapter.

002.01 ACTIVE STATUS. The individual has met all requirements for registration, reapplication or renewal and is eligible to administer medications in accordance with the Medication Aide Act.

002.02 ENTITY. As defined by 172 NAC 95.

002.03 MEDICATION AIDE-40 HOUR. A medication aide who has completed a 40-hour course and passed an examination identified in this chapter.

002.04 MEDICATION AIDE-20 HOUR. A medication aide who has, prior to January 1, 2003, completed a 20-hour course and passed an examination identified in this chapter.

002.05 MEDICATION STAFF. As defined by 172 NAC 95.

003. REQUIREMENTS FOR PLACEMENT ON THE MEDICATION AIDE REGISTRY . To qualify for placement on the Registry, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat § 71-6726 and this chapter.

(A) Competency in accordance with 172 Nebraska Administrative Code (NAC) 96-004 during the 6 months preceding the period for which the requested registration will become effective; and

(B) Must submit to the Department:

(i) Name, address, birth date, social security number;

(ii) Identification of any felony or misdemeanor conviction along with date of occurrence and county and state in which the conviction occurred;

(iii) Copies of all charges, amended charges, pleas, sentencing and probation orders for convictions;

(iv) An explanation of the events leading to the conviction, such as what, when, where, and why, and a summary of actions that the applicant has taken to address the behaviors or actions related to the conviction;

(v) A letter from the applicant’s probation officer addressing the terms and current status of the probation, if the applicant is currently on probation;

(vi) To aid in the evaluation of an applicant’s drug or alcohol related convictions, an applicant may submit evaluations and discharge summaries where drug or alcohol treatment was obtained or required. Evaluations and discharge summaries must be submitted by the provider directly to the Department;

(vii) All records, documents or information requested by the Department;

(viii) An official record documenting demonstration of competency as specified in 172 NAC 95; and

(ix) The required non-refundable fee as specified in 172 NAC 96-010.

003.01 INITIAL REGISTRATION FOR MEDICATION AIDE WAITING FOR PLACEMENT ON THE REGISTRY. An individual who has met all of the criteria for initial registration as identified in Neb. Rev. Stat. § 71-6726 and this chapter may provide medications in accordance with Neb. Rev. Stat. § 71-6726 and this chapter for a period not to exceed 30 days pending placement on the Registry.

004. COMPETENCY ASSESSMENT FOR PLACEMENT ON THE REGISTRY . The requirements for demonstration of competence and the required documentation are:

(A) Medication aides providing services in all settings except an assisted-living facility, intermediate care facility for individuals with intellectual disabilities (ICF/IID), or nursing home must successfully pass a competency assessment as identified in 172 NAC 96-005;

(B) Medication aides providing services in an assisted-living facility, intermediate care facility for individuals with intellectual disabilities (ICF/IID), or nursing home must:

(i) Successfully complete a competency assessment as identified in 172 NAC 96-005; and

(ii) Successfully complete a 40-hour course. The 40-hour course must be on the competency standards identified in 172 NAC 96-005.01. The 40-hour course may include the competency assessment identified in 172 NAC 96-005;

(1) A medication aide who has, prior to January 1, 2003, taken a 20-hour course and passed an examination administered by the Department, may complete an additional 20-hour course to meet the required 40-hour course;

(2) These course requirements may be met by a person enrolled in an approved program of nursing or other allied health program after the content required for the competencies identified in 172 NAC 96-005.01 have successfully been completed; and

(3) These course requirements may be met by a person who has taken a medication course in another state if the course consisted of the required 40 clock hours; and

(iii) Successfully pass the Department designated examination for Medication Aide-40 hour. The examination passing standard will be the criterion referenced using the Anghoff Method or equivalent method;

(C) Documentation of successful completion of competency assessment must be by copy of letter, certificate, or other official record from the professional who provided or directed the competency assessment;

(D) Documentation of successful course completion must be by copy of letter, certificate, or other official record from the professional or entity offering the 40-hour course, or the additional 20-hour course for those individuals who, prior to January 1, 2003, had completed a 20-hour course and the state written exam;

(E) Documentation of successful course completion by a student enrolled in an approved program of nursing may be met by a signed statement from a faculty member of the program who is also a licensed health care professional. The written statement must identify the name and Social Security Number of the student and a statement that the student has completed the course work covering the competencies identified in 172 NAC 96-005.01. For the purposes of the Medication Act and 172 NAC 96, this will meet the requirement of the 40-hour course; and

(F) Documentation of successful course completion by a person in another state who has completed a medication course may be met by submitting a copy of the certificate of completion or other official documentation from the course. The documentation must include the name of the individual who has completed the course, the date of course completion, and the number of hours contained in the course.

005. REQUIREMENTS FOR INDIVIDUALS AND ENTITIES OFFERING COMPETENCY ASSESSMENTS OR COURSES . Standards that are required to be met to show competency include the following in this section.

005.01 COMPETENCY ASSESSMENTS DEMONSTRATIONS. Competency assessments must include a demonstration of each of the following competency areas and standards:

(A) Maintaining confidentiality, which includes not sharing confidential information except when it affects the recipient’s care and is only shared with the appropriate person;

(B) Complying with a recipient’s right to refuse to take medication, including the use of appropriate measures to encourage taking of medications when directed for recipients who are not competent;

(C) Maintaining hygiene and current accepted standards for infection control, utilizing appropriate infection control principles when providing medications;

(D) Documenting accurately and completely the standard is to accurately document all medication provided including the name of the medication, dose, route, and time administered and any refusal of medication, and spoilage;

(E) Providing medications according to the 5 rights as outlined at Neb. Rev. Stat. § 71-6721(9); the standard is to provide the right medication, to the right person, at the right time, in the right dose, and by the right route;

(F) The ability to understand and follow instructions and to comprehend written or oral directions;

(G) Practicing safety in application of medication procedures which includes the ability to:

(i) Safely store and handle all medications in accordance with entity policy;

(ii) Intervene when unsafe conditions of the medication indicate a medication should not be provided; and

(iii) Provide medication to recipients in accordance with their age and condition;

(H) Complying with limitations and conditions under which a medication aide or medication staff may provide medications, which includes the standard is knowing that the medication aide or medication staff must:

(i) Be competent, have been assessed, and if applicable, be listed on the Medication Aide Registry with an active status;

(ii) Always comply with the 5 rights of provision of medications;

(iii) Record all medication provided or refused; and

(iv) Have additional competencies to provide additional activities;

(I) Having knowledge of abuse and neglect reporting requirements, the standard is to identify:

(i) Occurrences of possible abuse of a vulnerable adult and reports this information to the appropriate person or agency as required by the Adult Protective Services Act; and

(ii) Occurrences of possible abuse or neglect of a child and reports this information to the appropriate person or agency as required by Child Protection and Family Safety Act; and

(J) Complying with every recipient’s right to be free from physical and verbal abuse, neglect, and misappropriation or misuse of property; the standard is to not misuse recipient’s property or cause physical harm, pain, or mental anguish to recipients.

005.02 CONDUCTING COMPETENCY ASSESSMENTS. Competency assessments must be conducted by a licensed health care professional or a registered medication aide.

005.02(A) CONDUCTED BY A MEDICATION AIDE. If the competency assessment is conducted by a medication aide, the competency assessment must be designed, directed, and reviewed by a licensed health care professional.

005.02(B) CONDUCTED BY A LICENSED HEALTH CARE PROFESSIONAL. A licensed health care professional who has designed and is directing the competency assessment must review the competency assessment process no less than 1 time per year. The review must include, but is not limited to, a measurement of the desired outcomes of the competency assessment. The licensed health care professional must maintain a record of the review for no less than 3 years from the date the review was conducted.

005.03 COMPETENCY ASSESSMENT DOCUMENTATION. Persons offering competency assessments must provide the medication aide with documentation of successful completion of competency assessment. Documentation may be by letter, certificate, or other official record and must include:

(A) The name and social security number of the medication aide who successfully completed the competency assessment;

(B) The date the competency assessment was conducted; and

(C) The name, profession, and license number of the licensed health care professional who conducted or designed and directed the competency assessment.

005.04 40-HOUR COURSE REQUIREMENTS. The 40-hour course for an assisted-living facility, intermediate care facility for individuals with intellectual disabilities (ICF/IID), and nursing homes must be on the competencies identified in 172 NAC 96-005.01.

005.04(A) ASSESSMENT. The assessment must meet the requirements of 172 NAC 96-005.01.

005.04(B) DOCUMENTATION OF COURSE COMPLETION. Individuals or entities offering a 40- hour course or the additional 20-hour course for those individuals who, prior to January 1, 2003, had completed a 20-hour course and passed an examination administered by the Department, must provide the medication aide with documentation of successful course completion. Documentation must include:

(i) The name and social security number of the individual who successfully completed the course;

(ii) The number of hours in the course and whether the course was the 40-hour assisted-living, intermediate care facility for individuals with intellectual disabilities (ICF/IID), or nursing home course, or the additional 20-hour course;

(iii) The date the course was successfully completed;

(iv) The name of the person or entity responsible for providing the course and determining successful completion; and

(v) The criteria set forth in 172 NAC 96-005.03.

006. REVIEW OF ENTITIES CONDUCTING COMPETENCY ASSESSMENTS OR COURSES AND REVIEW OF MEDICATION AIDE ACTIVITIES . In order to ensure compliance with the Medication Aide Act and 172 NAC 96, the Department may:

(A) Conduct a review of any entity or person conducting competency assessments or a course;

(B) Review the activities of any applicant or medication aide; and

006.01 CONDITIONS FOR REVIEW. Conditions or environmental situations which may trigger a review include, but are not limited to:

(A) Receipt of a complaint against a facility or a medication aide;

(B) High failure rate on the examination for medication aides in an assisted-living facility, intermediate care facility for individuals with intellectual disabilities (ICF/IID), or nursing home;

(D) When there is cause for concern that a facility is not complying with the Act and 172 NAC 96;

(E) High rate of medication errors reported or found in a facility; and

(F) Information obtained through the facility survey process.

007. REGISTRATION RENEWAL OR REAPPLICATION . Registration as a medication aide shall be renewed biennially based on competency.

007.01 EXPIRATION OF REGISTRATION. All medication aide registrations expire 2 years after the date of registration. If an applicant meets the renewal requirements before the expiration date, their registration will be renewed. If an applicant fails to renew their registration by the expiration date, their registration will expire. An applicant whose registration has expired may reapply for registration.

007.02 REQUIREMENTS FOR REGISTRATION RENEWAL OR REAPPLICATION. Before an applicant’s registration will be renewed or in order to reapply for registration, an applicant must meet the following requirements:

(A) For renewal or reapplication, and applicant must:

(i) Have completed a competency assessment in accordance with 172 NAC 96-005 during the six months preceding the period for which the requested registration will become effective; and

(ii) Pay the non-refundable renewal or reapplication fee; and

(B) For reapplication only, the applicant must:

(i) Attest to the following:

(1) That the applicant has not provided services in Nebraska since they last held an active registration; or

(2) To the actual number of days the applicant provided services if the medication aide provided services in Nebraska since they last held an active registration.

007.03 PROCEDURES FOR RENEWAL OR REAPPLICATION. It is the responsibility of the applicant to renew or reapply to be active on the registry by following these procedures:

(A) Prior to the renewal period the applicant must notify the Department of any name or address changes;

(B) Any applicant who wishes to renew their registration or to reapply for registration must submit to the Department:

(i) The renewal notice or written application which:

(1) Is verified by the applicant’s oath; and

(2) Contains the following:

(a) Name;

(b) Address; and

(ii) Any revocations, suspensions, or other disciplinary actions against any health care professional credential held by the applicant during the time period since the credential was active;

(iii) Any disciplinary charges pending against any health care professional credential held by the applicant;

(iv) Copies of all charges, amended charges, pleas, sentencing and probation orders for convictions;

(v) A statement describing all felony or misdemeanor convictions during the time period since the registration was active;

(vi) A letter from the applicant’s probation officer addressing the terms and current status of the probation, if the applicant is currently on probation;

(vii) To aid in the evaluation of an applicant’s drug or alcohol related convictions, an applicant may submit evaluations and discharge summaries where drug or alcohol treatment was obtained or required. Evaluations and discharge summaries must be submitted by the provider directly to the Department;

(viii) All records, documents or information requested by the Department;

(ix) An official record documenting documentation of competency as specified in 172 NAC 96-004;

(x) The non-refundable renewal or reapplication fee and any other applicable fees and;

(i) A written attestation which states:

(1) That the applicant has not provided services in Nebraska since they last held an active registration; or

(2) To the actual number of days the applicant provided services if the applicant provided services in Nebraska since they last held an active registration.

007.04 REFUSAL TO RENEW REGISTRATION. The Department may refuse to renew a registration or deny reapplication for a registration for failure to meet the requirements specified in 172 NAC 96-007 or for falsification of any information submitted for renewal or reapplication of registration. Such refusal will be made pursuant to an informal conference as set forth in Neb. Rev. Stat. § 71-6731 or hearing in accordance with the Department’s Rules of Practice and Procedure.

008. GROUNDS AND PROCEDURES FOR DENIAL, REFUSAL OF RENEWAL OR REAPPLICATION, OR REMOVAL FROM THE REGISTRY . The Department may deny, refuse to renew or remove a medication aide from the registry if the medication aide does not meet the requirements set out in the Medication Aide Act and this chapter.

008.01 DENIAL OF APPLICATION. The Department will deny an application for placement on the registry as a medication aide when the applicant fails to meet the requirements specified in 172 NAC 96-003.

008.02 REFUSE RENEWAL OR REAPPLICATION. The Department will refuse renewal or reapplication for registration or remove registration if the medication aide fails to meet the requirements specified in 172 NAC 96-003.

008.03 REASON TO DENY, REFUSE RENEWAL OR REAPPLICATION OR REMOVE REGISTRATION. The Department may deny, refuse renewal or reapplication or remove registration for the following reasons:

(A) Failure to demonstrate competency as identified in 172 NAC 96-005;

(B) Failure to produce evidence of competency assessment performed or directed by a licensed health care provider;

(C) Conviction of a felony or misdemeanor if it relates to the competency standards in 172 NAC 96-005.01 or reflects on the moral character of the applicant or medication aide;

(D) Failure to comply with appropriate verbal and written direction given by a recipient with capability and capacity to make informed decision about medications, caretaker or licensed health care professional in the provision of medication;

(E) Falsification or failure to report any information on application for registration or renewal; and

(F) Providing medication aide services without an active medication aide registration.

008.04 INFORMAL CONFERENCE. If the Department denies, refuses renewal or reapplication of, or removes registration other than for non-payment of the renewal or reapplication fee, the applicant or registrant will be notified and given an opportunity for an informal conference as set forth in Neb. Rev. Stat. § 71-6731 and a hearing in accordance with the Department’s Rules of Practice and Procedure.

008.05 REAPPLICATION IF DENIED, REFUSED RENEWAL OR REAPPLICATION OR REMOVED FROM REGISTRY. When a registration as a medication aide has been denied, refused renewal or reapplication, or removed from the Registry, an applicant requesting registration must reapply for such registration as identified in 172 NAC 96-003, but may not reapply until one year has elapsed since the denial or refusal was effective.

009. REQUIREMENT TO REPORT . Entities shall report to the Department any adverse action taken against a medication aide. Adverse action includes termination of employment, suspension, demotion, or any other type of restriction or action adversely affecting a medication aide. The report must include:

(A) The name, address, and social security number of the medication aide;

(B) The date of the alleged incidents or incidents and date of adverse action;

(C) The name of the individual, if applicable, who was the recipient or intended recipient of the medications or medications during the acts or acts of the alleged incompetence;

(D) A description of the alleged acts or acts of incompetence and any supporting documents or records; and

(E) Any other related facts known to the Entity making the report.

010. INITIAL REGISTRATION, RENEWAL OR REAPPLICATION FEE . An applicant for initial registration, renewal, or reapplication to provide services as a medication aide must pay a fee of $18. This fee is non-refundable.

History

Effective 2022-09-24

Chapter 97 Approval of Basic Nursing Programs in Nebraska

Neb. Admin. Code tit. 172, ch. 97 Approval of Basic Nursing Programs in Nebraska {#sec-172-nac-97 omnilex-key=us-ne-regs-official--title-172--172 NAC 97}

001. SCOPE AND AUTHORITY . This chapter sets forth the standards for approval of registered and practical programs of nursing in Nebraska pursuant to Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-2232 to 38-2234 of the Nurse Practice Act.

002. DEFINITIONS . Definitions are set out in the Nurse Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 ACCREDITATION. A status bestowed by a national nursing accrediting agency recognized by the United States Department of Education.

002.02 ADJUNCT FACULTY. Persons who are employed by a program, but not on a full-time basis, or who are not employed by a program, who supervise and instruct students in a specific area of expertise. Adjunct faculty work under the supervision and guidance of faculty. Adjunct faculty must meet the educational qualifications of faculty. Adjunct faculty are to supplement and complement the nursing faculty. Staff Nurse Clinical Instructors working on Dedicated Education Units (DEUs) are exempt from faculty qualifications as outlined in 172 NAC 97-003.

002.03 ANNUAL REPORT. A document that each nursing program is to submit at the end of each calendar year to maintain ongoing program approval and to keep the Board informed of the status of the program’s administration and organization, clinical resources, curriculum, faculty and preceptors, program evaluation, students, and student services.

002.04 APPROVED. A program has been approved by the Board after it has met the requirements of Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-2232 to 38-2234 and the requirements of the Board as set out in this chapter.

002.05 ASSISTANT DIRECTOR. The registered nurse who is assistant to the director in administration of the educational program in nursing regardless of the official title in any specific institution. The assistant director has the administrative responsibility for a specific program or site and must meet the same qualifications as those specified in this chapter for the director.

002.06 CLINICAL EXPERIENCE. Faculty-planned and guided learning activities designed to assist students to meet the stated program and course outcomes. Learning activities should be designed to assist students to safely apply knowledge and skills to clients across the lifespan and must be appropriate to the expectations of the graduates according to the program type.

002.07 CONTROLLING INSTITUTION. An established organization or institution which applies for approval and actually administers and controls the program of registered or practical nursing in its entirety after approval is received from the Board.

002.08 COURSE. An instructional unit of the curriculum with defined objectives and methods of evaluation.

002.09 CURRICULUM. The total learning experiences of the program organized in a systematic manner.

002.10 DEBRIEFING. An activity that follows a clinical lab, classroom or simulation experience, is led by a facilitator, encourages participants’ reflective thinking, and provides feedback regarding participants’ performance.

002.11 DEDICATED EDUCATION UNIT (DEU). Nursing units in which designated staff nurses become the clinical instructors to the students. Staff nurse clinical instructors work closely with nursing faculty and have received education about teaching, learning and evaluation in clinical nursing education.

002.12 DIPLOMA, DEGREE OR CERTIFICATE. The formal document showing that the student has completed the prescribed program.

002.13 DIRECTOR. The registered nurse administratively in charge of an educational program in nursing regardless of the official title in any specific institution.

002.14 DISTANCE LEARNING. A mode of delivering education and instruction to students who are not physically present in the same location.

002.15 GOVERNING BODY. The body of a controlling institution that sets the policies for the institution.

002.16 INNOVATIVE APPROACH. A creative nursing education strategy that departs from the current rule structure and requires Board approval for implementation.

002.17 NURSING FACULTY. Individuals employed full- or part-time by an academic institution who drive nursing education based on national standards, reflect the parent institution’s mission, and facilitate the development of clinical judgment necessary for safe and effective practice.

002.18 OBSERVATIONAL EXPERIENCE. An assignment to a facility or unit where students observe the role of the facility and the role of nursing within the facility, but where students do not participate in direct patient or client care. Direct faculty or preceptor supervision is not required for an observational experience outside the clinical facility. Observational experiences may be used to supplement, but not replace direct patient care experiences.

002.19 PRECEPTOR. An experienced registered nurse who provides direct supervision of a formal student clinical learning experience at a clinical agency where the preceptor is employed. A preceptor acts as a facilitator of student learning and serves as a teacher, mentor, role model or supervisor who is immediately available in a clinical setting. Preceptors are employed by the agency where the student is placed for clinical experience.

002.20 PRELICENSURE NURSING EDUCATION PROGRAM. An educational program approved by the Board which prepares the registered or practical nursing graduates to qualify for the license of registered nurse or licensed practical nurse upon passing the required licensing examination, and meeting other licensure requirements.

002.21 PROGRAM STATUS. A designation assigned to a nursing education program by the Board which may include approval, warning, suspension or revocation.

002.22 PURPOSE. A statement which identifies the reason for the existence of a program.

002.23 RECOMMENDATIONS. Advice of what must be done to ensure that the entire program or program components have met the requirements of the law and the requirements of the Board as set out in this rule. All recommendations must be considered and implemented by the program and the program must keep the Board informed of the implementation of the recommendations.

002.24 SIMULATION. A technique to replace and amplify patient care experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.

002.25 STAFF NURSE SUPPORTED EXPERIENCE. A clinical experience, which is 3 days or less, where a student is assigned 1:1 to a staff nurse in a specialty setting for a hands on clinical experience at the direction of the staff nurse. Faculty should provide indirect supervision for the experience as defined in 172 NAC 99.

002.26 STAFF NURSE CLINICAL INSTRUCTOR. A registered nurse with 12 months or more experience who receives orientation and training from nursing programs and is employed in a clinical setting at sites using the Dedicated Education Unit (DEU) model of clinical instruction. A staff nurse instructor will supervise no more than 2 students at 1 time and is exempt from faculty qualifications as outlined in 172 NAC 97-007.03.

002.27 SUGGESTIONS. Proposals for the program to consider that may enhance the program or program components. Suggestions are to be considered by the program, but may be accepted and implemented, modified and implemented, or rejected and not implemented. No follow-up communication with the Board is required.

002.28 SUPPORT COURSE. A non-nursing course in the areas of the biological, physical, or behavioral sciences, for which the content is essential to the application of nursing knowledge.

002.29 WAIVER. A provisional document that allows temporary suspension of 1 element of this chapter, such as faculty education or preceptor education.

003. CLASSIFICATION OF PRELICENSURE PROGRAMS IN NURSING EDUCATION . The nursing education program shall be an integral part of a governing academic institution that is accredited by an accrediting agency that is recognized by the United States Department of Education. There are 2 types of prelicensure programs for registered nurses and one type for licensed practical nurses.

003.01 BACCALAUREATE DEGREE PROGRAM. A prelicensure program for registered nurses conducted by a university or college and leads to a baccalaureate degree in nursing;

003.02 ASSOCIATE DEGREE PROGRAM. A prelicensure program for registered nurses conducted by a community college, college or university and leads to an associate degree in nursing; and

003.03 PRACTICAL DIPLOMA PROGRAM. A prelicensure educational program for practical nurses of at least 1 academic year conducted by a community college or educational agency.

004. PRELICENSURE NURSING EDUCATION PROGRAM STANDARDS . Prelicensure nursing education programs must meet the following program standards. A program shall provide evidence to the Board that these standards have been met on an annual basis.

(A) Obtain national or specialized nursing program accreditation within 10 years of adoption of these regulations;

(B) Maintain national or specialized nursing program accreditation;

(C) Implement and maintain a comprehensive, systematic plan for ongoing evaluation based on program outcomes and incorporates continuous improvement;

(D) National Council Licensure Exam pass rates at 80% per year or a 3 year average consistent with the national average;

(E) At a minimum, 35% of the total faculty (including all clinical adjunct, part-time, or other faculty) are employed at the institution as full-time faculty;

(F) Retention of faculty and administration above the state average;

(G) No significant change in completion or attrition rates;

(H) Student faculty ratio that does not exceed ratios defined in 172 NAC 97-007.02;

(I) No significant loss of clinical contracts or lack of meeting requirements for clinical experiences;

(J) Provides annual report data and complies with curriculum revision or review or site visit requirements;

(K) Track and share complaints to Board of Nursing or other Nursing Regulatory Body from students, faculty, clinical sites or the public;

(L) Have less than three program directors in a five year period; and

(M) Frequent faculty reductions or frequent turnover in number of faculty.

005. ADMINISTRATION AND ORGANIZATION . The administrative control for the program must be vested in the governing body of the controlling institution. The governing body of the controlling institution must:

(A) Provide an organizational chart showing the relationship of the nursing program to the controlling institution, to other departments, institutions, and agencies and the channels of authority and communication;

(B) Provide an organizational chart showing relationships of individuals or groups within the nursing program;

(D) Provide for an adequate number of qualified faculty as set forth in 172 NAC 97-007-03;

(E) Provide for adequate educational facilities and clinical resources as set forth in 172 NAC 97-010 and 011;

(F) Provide for written agreements with all cooperating agencies that delineate the methods of communication and areas of responsibilities of each party;

(G) Provide for a financial base that is sufficient to ensure adequate financial resources to maintain a qualified faculty, adequate facilities including classrooms and laboratories, and simulation, to be able to provide students with adequate education from admission to completion;

(H) Provide in writing the conditions of employment and the policies for faculty; and

(I) Provide in writing the educational philosophy of the controlling institution.

006. PHILOSOPHY AND OUTCOMES . The program must have in writing a clearly defined statement of philosophy, organizing framework and program outcomes which serve as a basis for the development of the total nursing education program.

(A) The statement of philosophy must include the beliefs of the faculty about:

(i) Human beings;

(ii) Nursing;

(iii) Education;

(iv) Nursing education;

(v) Health; and

(vi) Must be in accord with those of the controlling institution.

(B) The organizing framework must reflect the concepts or theories that serve as the foundation of the curriculum.

(C) Program outcomes must reflect the stated philosophy and must be based on the concept of preparing a practitioner who gives safe and competent care and who functions within the legally defined scope of practice of a registered or licensed practical nurse.

(D) The program outcomes must be measurable and attainable within the timeframe of the program of instruction.

(E) The philosophy and program outcomes must be defined and approved by the faculty and shared with the students.

007. FACULTY . The program must hire and retain a qualified program director and faculty.

007.01 DIRECTOR. The director of the nursing education program must be a registered nurse, hold an unencumbered license to practice in Nebraska, and is academically and experientially qualified to direct the program preparing graduates for the safe and effective practice of nursing. The director is accountable for the administration, planning, implementation and evaluation of the nursing education program.

007.01(A) PRELICENSURE PRACTICAL NURSING PROGRAM. Any person appointed director of a prelicensure practical nursing program must have:

(i) A minimum of a graduate degree in nursing;

(ii) 3 years of clinical experience; and

(iii) 3 years of nursing education experience.

007.01(B) PRELICENSURE REGISTERED NURSING PROGRAM. Any person appointed director of a prelicensure registered nursing program must have:

(i) A minimum of a graduate degree in nursing;

(ii) 3 years of clinical experience; and

(iii) 3 years of nursing education experience.

007.02 FACULTY RATIOS. There must be sufficient faculty with educational preparation and nursing expertise to meet the objectives and purposes of the nursing education program. Factors which determine the number and qualifications of faculty include the type and length of program, number of students enrolled, number of students assigned to a clinical area, frequency of admissions, total responsibilities of the faculty, and number and location of clinical facilities.

(A) There must be a sufficient core of full-time faculty as set forth in 172 NAC 97-004(E), to assure consistent presentation of the curriculum, consistent application of policies, and consistent supervision of the clinical experiences;

(B) There must be no more than 10 students per faculty member, a 1:10 faculty-to-student ratio, in the clinical area. The clinical facility may require a lower number of students per faculty. A 1:8 faculty-to-student ratio is preferred; and

(C) For Dedicated Education Units (DEU’s), 1 nursing faculty member may supervise up to 16 students in the clinical setting. Staff nurse clinical instructors must supervise no more than 2 students at a time.

007.03 FACULTY QUALIFICATIONS. There must be written position descriptions of all faculty members, their qualifications, and their responsibility in the educational program.

007.03(A) TYPE OF NURSING PROGRAM. Qualifications for nursing faculty are outlined by program.

007.03(A)(i) PRACTICAL NURSING PROGRAM. Nursing faculty who teach in a program leading to licensure as a practical nurse must:

(1) Have an unencumbered registered nursing license to practice in Nebraska;

(2) Have a minimum of a baccalaureate degree in nursing. Faculty, except for adjunct clinical faculty, must have a minimum of a graduate degree in nursing or be making annual progress toward a graduate degree in nursing and complete it within 6 years of faculty appointment; and

(3) Have 2 years of clinical experience.

007.03(A)(ii) REGISTERED NURSING PROGRAM. Nursing faculty who teach in programs leading to licensure as a registered nurse must:

(1) Have an unencumbered registered nurse license to practice nursing in Nebraska;

(2) Have a minimum of a graduate degree in nursing or make annual progress toward a graduate degree in nursing and complete a degree within 6 years of faculty appointment; and

(3) Have 2 years of clinical experience.

007.03(B) OTHER FACULTY REQUIREMENTS. Other requirements for faculty in nursing programs include the following:

(i) All nursing faculty including clinical, full-time and adjunct, must complete a planned orientation;

(ii) Faculty teaching non-clinical nursing courses shall have advanced preparation and experience appropriate for the content being taught; and

(iii) If for any emergency reason a program employs a faculty member on a temporary basis who does not meet the requirements, the program must request a waiver of faculty qualifications for that specific situation. The waiver request must include the reason for the request, the time frame for the request, and what steps were taken to prevent the need for the waiver.

007.04 DIRECTOR AND FACULTY RESPONSIBILITIES. Responsibilities and functions of the director and faculty of a nursing program include the following:

(A) Develop, implement, evaluate, and update the purpose, philosophy, organizational framework and program outcomes;

(B) Design, implement and evaluate the curriculum using a written plan;

(C) Develop, evaluate, and revise student admission, progression, retention, and graduation policies within the policies of the institution;

(D) Participate in academic advising and guidance of students;

(E) Provide theoretical instruction and clinical or practicum experiences;

(F) Supervise the instruction provided by preceptors;

(G) Assure that observational experiences comprise no more than 20% of the clinical experiences of any course;

(H) Evaluate student achievement of curricular outcomes related to nursing knowledge and practice;

(I) Provide for student evaluation of teaching effectiveness;

(J) Provide an orientation for new faculty; and

(K) Participate in activities which facilitate maintaining the faculty members’ own nursing competence and professional expertise in the area of teaching responsibility and maintaining clinical competence through clinical experience, workshops, and in-service education.

007.05 POLICIES AND PROCEDURES. Faculty policies and procedures must be available in writing and must include qualifications, rights and responsibilities of faculty members, the criteria for evaluation of performance, and promotion and tenure policies.

007.06 RECORDS AND REPORTS. Written records of faculty decisions and committee reports must be maintained and available to all faculty.

007.07 RESOURCES. The program must have clerical staff and other resources sufficient to meet the needs of the faculty and administration.

008. PRECEPTORS . The program may use preceptors in direct supervision of student learning experiences in the clinical agency where the preceptor is employed.

008.01 PRECEPTOR GUIDELINES. These guidelines apply when a faculty member has assigned responsibility for direct supervision of student clinical learning experiences to a preceptor, at the preceptor's employing agency, and when the faculty member may not be physically present within the clinical agency or clinical setting.

(A) Preceptor supervision is not appropriate for the beginning student. Clinical preceptors may be used to enhance clinical learning experiences, after a student has received clinical and didactic instruction in all basic areas of nursing or within a course after students have received clinical and didactic instruction in all basic areas for that course or specific learning experience.

(B) While learning with the preceptor, the student role expectations must not exceed the level of practice for which the student is being prepared.

(C) Direct supervision by a preceptor means that the preceptor is present in the clinical setting and available to the student at all times.

(D) Preceptors may be responsible for no more than one student at a time.

(E) The responsibility for student learning rests with the faculty member, preceptor and student.

(i) The faculty member primarily coordinates the learning experience of the student, provides direction for the preceptor and student, and evaluates the student's achievement of the course objectives.

(ii) The preceptor retains his or her nursing staff responsibility for client care while considering the individual student's capabilities in making assignments.

(iii) The student must be directed to accept only those responsibilities which the preceptor believes can be safely managed. Students are expected to maintain practice within the safe limits which have previously been taught. Recognizing their own strengths and limitations, students are required to request help and supervision as needed.

008.02 PRECEPTOR QUALIFICATIONS. Qualifications for a clinical preceptor include:

(A) An unencumbered license to practice nursing in the jurisdiction where students are precepted;

(B) The educational level of the preceptor must be at or above the level for which the student is being prepared;

(D) Competence related to the area of assigned clinical teaching responsibilities; and

(E) Designated by manager and peers as a collaborator and leader among nurses.

009. CURRICULUM – CORE EDUCATIONAL REQUIREMENTS . The program must have a curriculum that enables students to develop the nursing knowledge, skills and abilities necessary for the level of licensure. An organized pattern, developed by the nurse faculty for the continuity and sequence of courses and related concurrent clinical instruction, must provide for progression of knowledge, skills, abilities, and attitudes of nursing students. Curricula will be revised as necessary to maintain a program that reflects advances in health care and its delivery.

009.01 STANDARDS. The curriculum, as defined by nursing education, professional and practice standards, must include:

(A) Experiences that promote the development and subsequent demonstration of evidence-based clinical judgment, skill in clinical management, and the professional commitment to collaborate in continuously improving the quality and safety of the healthcare system for patients.

(B) Evidence–based learning experiences and methods of instruction, including distance education methods, consistent with the written curriculum plan.

(i) Content in the biological, physical, social and behavioral sciences to provide a foundation for safe and effective nursing practice;

(ii) Content regarding professional responsibilities, scope of practice, legal and ethical issues, history and trends in nursing and health care; and

(iii) Didactic content and supervised clinical experience in the prevention of illness and the promotion, restoration, and maintenance of health in patients across the lifespan and from diverse cultural, ethnic, social and economic backgrounds. Patient experiences must occur in a variety of clinical settings and must include:

(1) Integrating patient safety principles throughout the didactic and clinical coursework;

(2) Using information technology to communicate and manage knowledge, mitigate error, and support decision making;

(3) Employing evidence-based practice to integrate best research with clinical expertise and client values for optimal care, including skills to identify and apply best practices to nursing care;

(4) Providing client-centered, culturally competent care by:

(a) Respecting client differences, values, preferences and expressed needs;

(b) Involving clients in decision-making and care management;

(d) Explaining appropriate and accessible interventions to patients and populations that may positively affect their ability to achieve healthy lifestyles;

(5) Collaborating with interdisciplinary teams to foster open communication, mutual respect, and shared decision making in order to achieve quality patient care; and

(6) Participating in quality improvement processes to measure client outcomes, identify hazards and errors, and develop changes in processes of client care.

009.02 ADDITIONAL CURRICULUM REQUIREMENTS. All nursing programs must meet the following additional curriculum requirements:

(A) Experiences which promote the development of leadership and management skills and professional socialization consistent with the level of licensure; and

(B) Delivery of instruction by distance education methods must be consistent with the program curriculum plan and enable students to meet the goals, competencies and objectives of the educational program and standards of the Board.

009.03 LEARNING EXPERIENCES. The curriculum must provide for learning experiences that prepare the student to identify and intervene in actual or potential health problems of individuals, families, or groups. Nursing actions must be directed toward maintaining or improving health status, based on the nursing assessment and through the execution of nursing care or therapeutic regimens prescribed by any person lawfully authorized to prescribe. Learning experiences, methods of instruction, and evaluation of student accomplishment will:

(A) Be planned, implemented and evaluated by the faculty with provisions for student input;

(B) Reflect the organizing framework and objectives of the nursing education program;

(D) Provide supervised clinical experience to prepare the student for the safe practice of nursing and will include development of skills in direct patient care; making clinical judgments; care and management of both individuals and groups of patients across the lifespan and delegation to and supervision of, as appropriate to level of education, other healthcare providers;

(E) Provide clinical hours comparable to those provided by an approved program of equivalent size and program type or, in the case of no equivalent program, clinical hours scaled relative to an approved program;

(F) Provide clinical experiences such as observation, simulation, staff nurse supported, dedicated education unit, adjunct or preceptor, that are supervised by qualified faculty;

(G) Measure the students’ competencies based on the students’ demonstration of care management and decision making skills when providing patient care in a variety of clinical situations and care settings; and

(H) Be comprised of sufficient hours to meet these standards, be supervised by educationally and clinically qualified faculty, and ensure students’ ability to practice at an entry level.

009.04 SYLLABI. Current syllabi must be available at the educational institution.

009.05 CHALLENGE PROCEDURE. Programs permitting students to challenge selected courses for credit must have written policies governing the challenge procedure.

009.06 CURRICULUM REVISIONS. Consultation from the Board is available when curriculum revisions are being considered. Plans for major curriculum revisions must be submitted to the Board for approval 3 months before they are implemented and must include the rationale and indicate the present plan as well as the proposed change and expected outcome. Major curriculum changes include:

(A) Changes in program outcomes which alter the present curriculum;

(B) Changes in the length of the program;

(D) Reorganization of the entire curriculum; and

(E) Additions, deletions, and substitutions of support courses or nursing electives.

010. CLINICAL RESOURCES . There must be clinical resources available and adequate for the number of students and faculty and the outcomes of the program.

010.01 CLINICAL FACILITIES. Clinical facilities must be available with a sufficient number and variety of clients to provide learning experiences essential to achievement of the stated objectives of the curriculum and for the number of students enrolled.

010.02 APPROVAL. The program must identify on the annual report all clinical facilities utilized by the program.

011. EDUCATIONAL FACILITIES . Adequate classrooms, offices, laboratories, conference rooms, and a library to meet the objectives of the program and to provide the needs of the students and faculty must be available.

012. STUDENTS . Students must be provided the opportunity to acquire and demonstrate the knowledge, skills and abilities for safe and effective nursing practice in theory and clinical experience through faculty supervision. The following requirements related to students will be in place:

(A) All institutional policies relevant to applicants and students are available in writing.

(B) Written policies will be developed by faculty for selection, admission, readmission, progression, graduation, transfer, dismissal or withdrawal of nursing students.

(D) Requirements for graduation are stated in the program brochure or catalog.

(E) The date of completion of the nursing program is specified on the transcript.

(F) Students are required to meet the health standards and criminal background checks as required by the clinical agencies and the nursing program.

(G) Students are to be accountable for the integrity of their work.

(H) The program will hold students accountable for professional behavior, including honesty and integrity, while enrolled in their program of study.

013. RECORDS . The controlling institution must maintain a record system with provision for the protection of records against loss, destruction, and unauthorized use. Such record system will meet the following requirements:

(A) Student records are to be available to the faculty;

(B) No part of the student's record may be released without the written consent of the student;

(C) Official records will be maintained for current students enrolled, including admission data, transcripts, and evaluations;

(D) Transcripts for students who have withdrawn or graduated will be kept on file;

(E) Records for transfer students, at the time of admission into a nursing program, will include a transcript of the previous nursing or college program and a written program of studies required to be completed by the transfer student prior to graduation; and

(F) Faculty records demonstrating educational and experiential qualifications will be maintained, including official educational transcripts.

014. REPORTS TO THE BOARD . An annual report, accreditation reports, and accreditation updates or reports must be submitted to the Board by the program, and the program will:

(A) Notify the Board in writing of administrative changes relating to and affecting the program; and

(B) Cooperate in submitting data to the Board for purposes of research and planning activities.

015. PROMOTIONAL MATERIALS . The program brochure, catalog, website, or other materials must be current and give an accurate description of the program.

016. EVALUATION . The faculty must develop a systematic evaluation plan for the total program and provide for periodic evaluation of all aspects of the program including: philosophy and outcomes, organization and administration, faculty, curriculum, students, facilities, follow-up study of graduates, records, and reports, and demonstrate how the evaluation data are used for program improvement.

017. SURVEY VISITS TO NURSING PROGRAMS . The Board will conduct survey visits to each of the nursing programs to verify compliance with all of the preceding regulations.

017.01 FREQUENCY. The frequency of survey visits will be based on an annual evaluation of the following criteria:

(A) The stability of the nursing administrative structure and personnel;

(B) The stability and retention of the faculty;

(D) The annual reports for the last 4 years; and

(E) The graduates from the program having demonstrated a pass rate on the National Council Licensure Examination each year for the last 4 years that meets or exceeds the national pass rate.

017.02 BOARD DIRECTED SURVEY. The Board may direct that a survey visit be conducted more frequently if it determines that a survey is indicated based on, but not limited to, the following:

(A) Frequent nursing department administrative changes or faculty turnover;

(B) Complaints received from faculty, students, parents, or the general public;

(D) Student retention and attrition.

018. INNOVATIVE APPROACHES TO PRE-LICENSURE PROGRAMS . A nursing education program may apply to implement an innovative approach by complying with provisions of this section. Nursing education programs approved to implement innovative approaches will continue to provide quality nursing education that prepares graduates to practice safely, competently and ethically within the scope of practice as defined in the Nurse Practice Act.

018.01 PURPOSE. A nursing program applying to implement an innovative approach must explain the purpose for creating innovation in curriculum or educational design, which must include:

(A) To foster innovative models of nursing education to address the changing needs in health care;

(B) To assure that innovative approaches are conducted in a manner consistent with the Board’s role in protection of the public; and

(C) To assure that innovative approaches conform to the quality outcome standards and core education criteria established by the Board.

018.02 ELIGIBILITY. In order for a nursing program to be eligible to submit an innovative approach to nursing education, the nursing program must:

(A) Hold full Board approval without conditions;

(B) Have no substantiated complaints in the past 2 years; and

018.03 APPLICATION. The following information must be provided by the nursing program to the Board at least 90 days prior to a Board meeting:

(A) Executive summary of the project;

(B) Identifying information including name of nursing program, address, responsible party, and contact information;

(D) Identification of the regulation or regulations affected by the proposed innovative approach;

(E) Length of time for which the innovative approach is requested;

(F) Description of the innovative approach, including objectives;

(G) Brief explanation of why the program wants to implement an innovative approach at this time;

(H) Explanation of how the proposed innovation differs from approaches in the current program;

(I) Rationale with available evidence supporting the innovative approach;

(J) Identification of resources that support the proposed innovative approach;

(K) Expected impact innovative approach will have on the program, including administration, students, faculty, and other program resources;

(L) Plan for implementation, including timeline;

(M) Plan for evaluation of the proposed innovation, including measurable criteria and outcomes, method of evaluation, and frequency of evaluation; and

(N) Additional application information as requested by the Board.

018.04 STANDARDS FOR APPROVAL. Approval is based on the following criteria:

(A) Eligibility and application criteria in 172 NAC 97-018.02 and 172 NAC 97-018.03 met;

(B) The innovative approach will not compromise the quality of education or safe practice of students;

(D) Rationale with available evidence supports the implementation of the innovative approach;

(E) Implementation plan is reasonable to achieve the desired outcomes of the innovative approach;

(F) Timeline provides for sufficient period to implement and evaluate the innovative approach; and

(G) Plan for periodic evaluation is comprehensive and supported by appropriate methodology.

018.05 BOARD REVIEW OF APPLICATION. Annually, the Board may establish the number of innovative approach applications it will accept, based on available Board resources. The Board will evaluate innovative approach applications to determine if eligibility criteria in 172 NAC 97-018.02 are met and if the standards from 172 NAC 97-018.04 are established.

018.05(A) APPROVAL. If the application meets the eligibility criteria and standards, the Board will:

(i) Approve the application; or

(ii) Approve the application with modifications as agreed between the Board and the nursing education program.

018.05(B) DENIAL. If the application does not meet the eligibility criteria and standards, the Board will deny approval of the innovative approach or may request additional information.

018.05(C) RESCIND APPROVAL. The Board may rescind the approval or require the program to make modifications in the innovative approach if:

(i) The Board receives substantiated evidence indicating adverse impact; or

(ii) The nursing education program fails to implement the innovative approach as presented and approved.

018.06 PERIODIC EVALUATION. Periodic evaluation of the innovative approach to nursing education requires the following:

(A) The educational program must submit progress reports conforming to the evaluation plan annually or as requested by the Board;

(B) The final evaluation report must conform to the evaluation plan, detailing and analyzing the outcomes data;

(C) If any report indicates that students were adversely impacted by the innovation, the nursing program must provide documentation of corrective measures and their effectiveness; and

(D) The educational program must maintain eligibility criteria in 172 NAC 97-018.02.

018.07 CONTINUATION. Requests for the innovative approach to continue and become an ongoing part of the education program must be submitted 30 days prior to a regularly scheduled Board meeting. Continuation of the innovative approach to nursing education may be granted by the Board if:

(A) The final evaluation has been submitted;

(B) The innovative approach has achieved the desired outcomes;

(D) The innovative approach is consistent with core nursing education criteria.

019. APPROVAL OF NEW PRELICENSURE EDUCATION PROGRAMS . An institution seeking Board approval to conduct a new prelicensure program in registered or practical nursing must submit an application provided by the Department at least 1 year prior to the anticipated opening of the new program. The application must include the following:

(A) Results of a needs assessment, including identification of potential and available students and employment opportunities for program graduates;

(B) Identification of sufficient financial and other resources;

(D) A description of the readiness that has been identified of the community to support the proposed program;

(E) Type of educational program proposed;

(F) Evidence of the institution meeting state requirements, and regional or national accreditation by an accredited agency recognized by the U.S. Department of Education;

(G) Evidence of the nursing program actively seeking accreditation from a U.S. Department of Education recognized national nursing accrediting agency;

(H) A description of the provision for educational facilities including classroom, laboratories, library, conference rooms and offices;

(I) A description of the provision for clinical opportunities and available resources;

(J) A description of the availability of qualified faculty;

(K) A description of the general education and nursing content of the curriculum including proposed course descriptions;

(L) Proposed timeline for initiating and expanding the program;

(M) If the controlling institution is a private organization, a copy of its articles of incorporation and of the resolution of its governing body authorizing it to establish a program of registered or practical nursing must be attached;

(N) If the controlling institution is a public body, a copy of its statutory authority to establish a program of registered or practical nursing must be attached, along with a copy of the resolution of its governing body authorizing it to establish a program of registered or practical nursing must be attached; and

(O) The application must be signed by the head of the governing body of the controlling institution making the application.

019.01 EMPLOYMENT OF DIRECTOR AND FACULTY. The applying institution must employ a director at least 12 months prior to the anticipated opening of the program. Sufficient, qualified faculty must be in place 6 months prior to the beginning of any course for the purpose of course development.

019.02 INITIAL APPROVAL FOR ADMISSION OF STUDENTS. The proposed program must provide the Board with verification that the following program components and processes have been completed:

(1) Overview of the total curriculum;

(2) Content;

(3) Schedule, including course sequence;

(4) Course descriptions;

(5) Contracts for clinical sites;

(6) Program evaluation plan;

(7) Course syllabi for first year with identified timeline for submission of syllabi for subsequent years; and

(8) Establishment of student policies for admission, progression, retention and graduation.

019.02(A) INITIAL APPROVAL. When the Board determines that all components and processes are complete and in place, the Board will authorize the program to admit students. The Board may or may not require a site visit to make this determination.

019.02(B) DENIAL. The Board will deny initial approval if it determines that a proposed nursing education program is unable to meet the standards for nursing education.

019.03 FULL PROGRAM APPROVAL. The Board may request periodic reports from a new program regarding initial program operations before granting full program approval. The Board will fully approve the program upon:

(A) Successful completion of a Board survey visit of the program concurrent with graduation of first class eligibility for the National Council Licensure Examination;

(B) Submission of the nursing program’s ongoing systematic evaluation plan;

(C) Satisfactory completion of survey report that verifies that the program is in compliance with the Board’s Nursing Education Standards in 172 NAC 97-004; and

(D) Accreditation approval or application status update.

019.04 CONTINUING APPROVAL. Approval is continued for those programs which continue to meet the requirements of the Board as determined by survey visits, annual reports, and such reports as may be required by the Board. Approval may be continued with or without Board recommendations or suggestions.

019.04(A) ONGOING EVALUATION. Nursing education programs will be reevaluated every 4 to 5 years with a site visit, upon request of the nursing education program, or at the discretion of the Board, to ensure continuing compliance with the regulations.

019.04(B) ANNUAL REPORT. Programs must submit an annual report.

020. BOARD ACTIONS . Failure to meet the standards put forward in this chapter may result in disciplinary action by the Board. The Board may recommend one of the following actions:

(A) Warning;

(B) Suspension; or

020.01 WARNING. If the Board determines that any controlling institution having a program in registered or practical nursing approved by the Board is not maintaining the standards required by the statutes and by this chapter, the controlling institution will be warned. Notice will be given in writing to the controlling institution, specifying the deficiency or deficiencies.

020.01(A) CORRECTION OF DEFICIENCIES. The controlling institution will be given 12 months in which to correct the deficiency or deficiencies in its program.

020.01(B) POSSIBLE WITHDRAWAL OF APPROVAL. If the requirements for approval have not been met within 12 months after receipt of a warning, the controlling institution will be given 6 months’ notice of possible withdrawal of approval.

020.01(C) FAILURE TO CORRECT DEFICIENCIES. If the deficiency or deficiencies have not been corrected within 6 months after the controlling institution has been given notice of possible withdrawal of approval, a hearing before the Department will be scheduled to determine whether the approval from the Board will be suspended or revoked.

021. TRANSFERRING A PROGRAM . In the event that the transfer of the controlling institutional ownership or control of a program in registered or practical nursing is to take place, the new ownership or new controlling institution must comply with the same requirements as for the establishment of a new program in Section 019 of this chapter.

022. CLOSING A PROGRAM . A nursing education program anticipating closure of its program is subject to the following requirements:

(A) A controlling institution terminating its program must notify the Board at least 1 year in advance of such intended termination, and must submit to the Board the plan for completion of students currently enrolled and the disposition of records. All Board requirements for approval must be maintained until the program is closed.

(B) The program must be officially closed on the date the last nursing student completes the program or is transferred to another approved program under the plan for termination of the program or voluntarily withdraws from the program. The controlling institution which has operated the program is responsible for the permanent preservation of records and issuance of transcripts of graduates, and must notify the Board of the custody of the records.

History

Effective 2021-08-10

Chapter 98 Advanced Practice Registered Nurse Licensure

Neb. Admin. Code tit. 172, ch. 98 Advanced Practice Registered Nurse Licensure {#sec-172-nac-98 omnilex-key=us-ne-regs-official--title-172--172 NAC 98}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of advanced practice registered nurses in the State of Nebraska. Statutory authority for these regulations is in the Advanced Practice Registered Nurse Licensure Act, the Certified Nurse Midwifery Practice Act, the Clinical Nurse Specialist Practice Act, the Certified Registered Nurse Anesthetist Practice Act, the Nurse Practitioner Act and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions are set out in the Certified Nurse Midwifery Practice Act, the Clinical Nurse Specialist Practice Act, the Certified Registered Nurse Anesthetist Practice Act, the Nurse Practitioner Act, the Uniform Credentialing Act, 172 Nebraska Administration Code (NAC) 10, and this chapter.

002.01 ADVANCED PRACTICE REGISTERED NURSE (APRN). A registered nurse who holds a current advanced practice registered nurse license as a certified nurse midwife, certified registered nurse anesthetist, clinical nurse specialist, or nurse practitioner.

002.02 ADVANCED PRACTICE REGISTERED NURSE – CERTIFIED NURSE MIDWIFE (APRN-CNM). A registered nurse who holds a current advanced practice registered nurse license as a certified nurse midwife and as defined in Nebraska Revised Statute (Neb. Rev. Stat.) § 38-606.

002.03 ADVANCED PRACTICE REGISTERED NURSE – CLINICAL NURSE SPECIALIST (APRN-CNS). A registered nurse who holds a current advanced practice registered nurse license as a clinical nurse specialist and as defined in Neb. Rev. Stat. § 38-905.

002.04 ADVANCED PRACTICE REGISTERED NURSE – CERTIFIED REGISTERED NURSE ANESTHETIST (APRN-CRNA). A registered nurse who holds a current advanced practice registered nurse license as a certified registered nurse anesthetist and as defined in Neb. Rev. Stat. § 38-704.

002.05 ADVANCED PRACTICE REGISTERED NURSE – NURSE PRACTITIONER (APRN-NP). A registered nurse who holds a current advanced practice registered nurse license as a nurse practitioner and as defined in Neb. Rev. Stat. § 38-2312.

002.06 APPROVED ADVANCED PRACTICE REGISTERED NURSE EDUCATION PROGRAM. A graduate-level program for advanced practice nursing accredited by a national accrediting body recognized by the United States Department of Education.

002.07 APPROVED CERTIFYING BODY. An approved certifying body is a national certification organization which certifies qualified registered nurses in advanced practice for a role with 1 or more population foci which determines and sets certification requirements and provides testing.

002.08 CERTIFICATION. A status granted, initially by examination, by an approved certifying body for an advanced practice registered nurse role with 1 or more population foci.

002.09 NURSYS™. The national database for verification of nurse licensure, discipline and practice privileges for registered nurses, licensed practical nurses licensed in participating jurisdictions, including all states in the Nurse Licensure Compact.

002.10 REENTRY PROGRAM. A board approved program that provides an organized approach to learning that results in current knowledge applicable to an advanced practice nursing role. The program must include a didactic component with education in pharmacotherapeutics and advanced assessments, as well as supervised clinical practice.

003. LICENSURE . Requirements for licensure as an advanced practice registered nurse include requirements found in 172 NAC 10, and the following:

(A) Apply for state licensure as a registered nurse or hold a valid multi-state privilege from another compact state;

(B) Submit an official transcript documenting completion of an approved advanced practice registered nursing education program;

(D) Complete a NURSYS™ verification for all current and prior licenses or request verifications from state licensing boards not participating in NURSYS™;

(E) For initial licensure as an advanced practice registered nurse – nurse practitioner, an attestation of existence of a transition to practice agreement as defined in Neb. Rev. Stat. § 38-2322; and

(F) For initial licensure as an advanced practice registered nurse – certified nurse midwife, a written practice agreement with a collaborating licensed practitioner as defined in Neb. Rev. Stat. § 38-609 must be on file with the Department.

004. TEMPORARY LICENSE . The temporary advanced practice registered nurse license will be issued for 60 days or until the expiration date of the current nursing license in the other state, whichever occurs first. The temporary license becomes null and void when the regular license is issued or when a final decision is made to deny the regular license.

004.01 ACTIVE LICENSE OR COMPACT PRIVILEGE REQUIREMENT. A temporary advanced practice registered nurse license cannot be issued unless the applicant has an active Nebraska registered nursing license or compact privilege to practice in this state.

004.02 REENTRY PROGRAM. A temporary advanced practice registered nurse license may be issued for the purposes of completing a reentry program in advanced practice nursing, for the length of time it takes to complete the course.

005. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10. All advanced practice registered nurse licenses expire on October 31 of each even-numbered year.

006. CONTINUING COMPETENCY . Each person holding an active advanced practice registered nursing license in the State of Nebraska must, on or before the date of expiration of the license, comply with the continuing competency requirements as noted in Neb. Rev. Stats. §§ 38-616, 38-709, 38-909, and 38-2319, unless the requirements are waived in accordance with 172 NAC 10. Evidence of continuing competency for the advanced practice registered nurse includes:

006.01 CERTIFICATION. Requirements for initial and ongoing certification are specified by the certifying body; and

006.02 PRACTICE. Advanced practice registered nurse – nurse practitioners must attest to 2,080 hours of practice over the 5 years preceding renewal as specified in Neb. Rev. Stat. § 38-2319.

007. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

008. FEES . Fees are set out in 172 NAC 2.

History

Effective 2020-09-19

Chapter 99 Provision of Nursing Care

Neb. Admin. Code tit. 172, ch. 99 Provision of Nursing Care {#sec-172-nac-99 omnilex-key=us-ne-regs-official--title-172--172 NAC 99}

001. SCOPE AND AUTHORITY . This chapter provides for the minimum standards for the provision, administration, and management of nursing care by licensed nurses and by unlicensed persons providing auxiliary service in support of nursing services under the Nurse Practice Act, Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-2216.

002. DEFINITIONS . Definitions are set out in the Nurse Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 ACCOUNTABILITY. The licensed nurse is responsible and answerable for decisions and action or inaction of self or others, and for the resultant consumer outcomes related to decisions and action or inaction.

002.01(A) UNLICENSED PERSON ACCOUNTABILITY. The unlicensed person is responsible and answerable for the action or inaction of self.

002.02 ASSESSMENT. A systematic evaluation of the consumer’s condition and response to the therapy.

002.03 ASSIGNMENT. A licensed nurse appoints or designates another person the responsibility for performance of nursing interventions. Assignments are made to individuals who already have authority to provide nursing interventions either through licensure as a nurse or through delegation from a registered nurse. Assignment is not the transfer authority.

002.04 ASSIST. To provide aid or support in the performance of an activity.

002.05 AUTHORITY. The legal authority to provide nursing care granted through licensure as a registered nurse, licensure as a practical nurse, or through delegation from a registered nurse.

002.06 AUXILIARY PATIENT CARE SERVICES. Care provided by persons authorized, assigned or directed by licensed nurses or licensed practitioners in support of that professional’s practice.

002.07 COMPETENCE. A state or quality of being competent or capable as a result of having the required knowledge, skills, and ability.

002.07(A) LICENSED NURSE COMPETENCE. The ability of the nurse to apply interpersonal, technical and decision-making skills at the level of knowledge consistent with the prevailing standard for the nurse’s current nursing practice role.

002.07(B) UNLICENSED PERSONCOMPETENCE. The ability of the unlicensed person to:

(i) Utilize effective communication;

(ii) Collect basic objective and subjective data;

(iii) Perform selected non-complex nursing interventions safely, accurately, and according to standard procedures; and

(iv) Seek guidance and direction when appropriate.

002.08 COUNSELING. The process of helping a consumer to recognize and cope with stressful psychological or social problems, to develop improved interpersonal relationships, and to promote personal growth. Counseling includes analysis of a situation, synthesis of information and experiences, and evaluation of the progress and productivity of consumers.

002.09 DELEGATION. The transference of authority, responsibility, and accountability to perform nursing interventions from one individual to another.

002.09(A) DELEGATION BY A REGISTERED NURSE. The transference of authority, responsibility, and accountability from a registered nurse to the unlicensed person to provide select non-complex nursing interventions on behalf of a registered nurse.

002.09(B) DELEGATION DECISION. Includes determining which nursing interventions may be delegated, selecting which unlicensed persons may provide the delegated interventions, determining the degree of detail and method to be used to communicate the delegation plan, and selecting a method of evaluation and supervision.

002.10 DIRECTION. The provision of guidance and supervision by a licensed nurse or licensed practitioner who is responsible to manage the provision of nursing interventions by another licensed or unlicensed person.

002.11 EMPLOYER GUIDELINES. Organizational policies or procedures that clearly delineate standards of care, job or role descriptions, and other work or care related guidelines.

002.12 LICENSED HEALTH CARE PROFESSIONAL. An individual who holds an active license to practice a defined scope of practice.

002.13 NURSING CARE. The application of the nursing process to individuals, families, and groups which results in the performance of any act expressing judgment or skill based upon principles of the biological, physical, behavioral, and nursing sciences as defined through rules promulgated by the Board of Nursing in accordance with Neb. Rev. Stat. § 38-2216.

002.14 NURSING INTERVENTION. The initiation and completion of consumer focused actions necessary to accomplish the goals defined in the plan of care.

002.14(A) COMPLEX NURSING INTERVENTIONS. Nursing interventions that require nursing judgment to safely alter standard procedures in accordance with the needs of the individual; or require nursing judgment to determine how to proceed from one step to the next; or require the multi-dimensional application of the nursing process.

002.14(B) NON-COMPLEX NURSING INTERVENTIONS. Nursing interventions which can be safely performed according to exact directions, do not require alternation of the standard procedure, and for which the results and consumer responses are predictable.

002.15 NURSING PROCESS. A scientific method used by licensed nurses to ensure the quality of consumer care which includes assessment, nursing diagnosis, planning, implementation and evaluation.

002.16 PROTOCOL.Awritten, step by step process or algorithm that is created and approved by a registered nurse or licensed practitioner that guides subjective and objective data collection, and defines interventions based upon collected data.

002.17 STABLE ORPREDICTABLE. A situation where the individual’s clinical and behavioral status and nursing care needs are determined by a registered nurse or licensed practitioner to be non-fluctuating and consistent or where the fluctuations are expected and the interventions are planned, including those individuals whose deteriorating condition is expected.

002.18 SUPERVISION. The provision of oversight, which includes maintaining accountability to determine whether or not nursing care is adequate and delivered appropriately.

002.18(A) DIRECT SUPERVISION. The responsible licensed nurse or licensed practitioner is physically present in the clinical area and is available to assess, evaluate or respond immediately.

002.18(B) INDIRECT SUPERVISION. The responsible licensed nurse or licensed practitioner is available through telecommunication or periodically for direct inspection and evaluation for direction, consultation and collaboration.

002.19 UNLICENSED PERSON. A person who does not have a license to practice nursing and who functions in an assistant or subordinate role to the licensed nurse. Unlicensed persons receive authority to provide selected non-complex nursing interventions through delegation from a registered nurse.

MINIMUM STANDARDS FOR NURSING CARE. For purposes of this chapter, the following minimum standards apply:

003.01 REGISTERED NURSE. Based on independent, dependent, and interdependent functions, a registered nurse conducts and documents nursing assessments, utilizes all data to identify and document responses to actual or potential health conditions and make a nursing diagnosis, develops and implements a plan of care, and evaluates responses to that plan of care.

003.02 LICENSED PRACTICAL NURSE. At the direction of a registered nurse or licensed practitioner, a licensed practical nurse contributes to the nursing assessment and nursing diagnosis, participates in the development and implementation of the plan of care, and contributes to the evaluation of responses of care or the nursing care plan.

003.03 UNLICENSED PERSON. As assigned, delegated, or directed by a registered nurse or as assigned and directed by a licensed practical nurse, the unlicensed person contributes to the assessment, planning, implementation and evaluation of the plan of care.

004. STANDARDS FOR DELEGATION . Registered nurses may delegate nursing interventions or tasks to be performed by unlicensed persons. A registered nurse retains accountability for the application of the nursing process and outcomes of care in making a delegation decision.

004.01 DELEGATION PROCESS. Registered nurses must use a systematic delegation decision making process based upon nursing education, a body of nursing knowledge, and nursing judgment to delegate in a manner that allows for safe, accountable, and responsible provision for nursing care.

004.01(A) REGISTERED NURSE RESPONSIBILITIES. A registered nurse must:

(i) Determine the consumer’s needs and when to delegate;

(ii) Determine the competency of unlicensed person or delegatee selected to complete the task;

(iii) Determine the method of supervision;

(iv) Communicate the plan to the delegatee;

(v) Retain accountability for the individual delegation decision, the delegation plan, and evaluation of the delegation outcomes.

004.01(B) UNLICENSED PERSON RESPONSIBILITIES. An unlicensed person must:

(i) Accept activities based on his or her own competence level;

(ii) Maintain competence for the delegated responsibility;

(iii) Maintain accountability for the delegated activity or task;

(iv) Communicate with a registered nurse regarding competence, variations in care, and data gathered from the task.

004.01(C) NURSING SERVICE ADMINISTRATOR RESPONSIBILITIES. A nursing services administrator must:

(i) Determine nursing responsibilities that can be delegated, including to whom and under what circumstances;

(ii) Develop delegation guidelines such as employer guidelines; and

(iii) Provide adequate resources for delegation to occur.

004.02 DELEGATION PLAN. A registered nurse develops, implements and retains accountability for evaluation of delegation plan outcomes. The delegation plan includes:

004.02(A) ASSESSMENT. A registered nurse must assess the consumer’s health status, analyze the data, and identify the consumer’s specific goals, nursing care needs, and necessary interventions. This must include assessment of:

(i) Stability of the consumer’s condition;

(ii) Experience and competency of the unlicensed persons providing nursing interventions;

(iii) Level of nursing judgment required for the delegated nursing interventions; and

(iv) Willingness and ability of the consumer to be involved in the management of his or her own care.

004.02(B) PLANNING. A registered nurse must develop and communicate a plan that includes delegation of the right task, the right circumstance, right person, right directions and communication, and the right supervision and evaluation.

004.02(C) INTERVENTIONS. A registered nurse must select and identify nursing interventions or tasks which may be delegated. Selected interventions must:

(i) Frequently occuror reoccur in the daily care of a consumeror group of consumers;

(ii) Not require the unlicensed person to exercise independent nursing judgment;

(iii) Not require complex or multi-dimensional application of the nursing process;

(iv) Be those for which the results of the intervention are predictable and the potential risk is minimal; and

(v) Utilize a standard and unchanging procedure.

004.02(D) EVALUATION. A registered nurse is responsible and accountable to evaluate consumer’s responses as well as outcomes of the delegated nursing interventions. Evaluation methods include:

(i) Obtaining feedback from unlicensed persons;

(ii) Providing feedback to unlicensed persons;

(iii) Measuring consumer response and goal attainment related to the delegated interventions; and

(iv) Altering the delegation plan as indicated by consumer responses.

004.03 COMMUNICATION. Implementing the delegation plan must include communication regarding competency and comfort of the unlicensed person regarding performing the task, exact directions, conditions for feedback and reporting, as well as the method of supervision. This may include:

004.03(A) INSTRUCTION OR VERIFICATION. A registered nurse must instruct and assess, verify, and identify the unlicensed person’s:

(i) Competency for the task on an individual and consumer specific needs basis;

(ii) Understanding of the delegation plan, including specific parameters, signs and symptoms of problems or issues to report, and method of supervision; and

(iii) Feedback on if the task was completed with consumer response.

004.04 SUPERVISION OF THE DELEGATEE. A registered nurse must determine the method of supervision on an individual basis and identify any other licensed nurses who have been assigned the responsibility of supervision. Registered nurses may utilize both direct and indirect methods of supervision. Registered nurses may assign the responsibility of supervision within the delegation plan to other licensed nurses only if the conditions of the supervision have been defined and communicated within the plan.

STANDARDS FOR DIRECTION. Registered nurses, licensed practical nurses, and licensed practitioners may provide direction in the provision and management of consumer care. The method and degree of direction may vary based upon consumer condition, the interventions to be applied, and the qualification and competency of the person providing the interventions.

005.01 REGISTERED NURSES. Registered nurses can provide direction to the following:

(A) Licensed practical nurses;

(B) Care teams which may include other licensed health care professionals; and

005.02 LICENSED PRACTICAL NURSES. Licensed practical nurses provide direction to unlicensed persons providing auxiliary patient care services.

005.03 STANDARDS FOR DIRECTION TO A LICENSED PRACTICAL NURSE. A licensed practical nurse receives direction from either a registered nurse or licensed practitioner, based on the following standards:

005.03(A) INSTRUCTION OR GUIDANCE. Direction must be sufficient to assure the provision of safe nursing care can be provided, meeting consumer needs;

005.03(B) ASSESSMENT. Direction may include identification of any specific assessment data to be collected relative to consumer condition, consumer diagnosis, and presenting signs and symptoms of the consumer;

005.03(C) INTERVENTIONS. Direction may include identification of specific interventions to be applied based upon the collected assessment data and consumer response to interventions; and

005.03(D) SUPERVISION. Direction must include the provision of supervision to a licensed practical nurse. Supervision may include direct, indirect, or a combination of both methods. Indirect supervision can be provided through protocols.

005.04 LICENSED PRACTICAL NURSE REQUIREMENTS. A licensed practical nurse must practice nursing only under circumstances inwhich direction is provided by a registered nurse or licensed practitioner.

005.04(A) COMPETENCE. A license practical nurse must exercise competence in providing and directing nursing interventions;

005.04(B) CONSULTATION OR COLLABORATION. A licensed practical nurse must initiate consultation or collaboration according to observed signs and symptoms of deviations from normal health status, and according to the directions specified by a registered nurse or licensed practitioner; and

005.04(C) DIRECTION. A licensed practical nurse must provide nursing interventions according to the direction and instructions identified by a registered nurse or licensed practitioner. Direction can be provided by protocols.

006. STANDARDS FOR ASSIGNMENT . Licensed nurses may assign the responsibility for performance of nursing interventions to other persons in the provision and management of nursing care. Licensed nurses may also have nursing interventions assigned to them by other licensed nurses or licensed practitioners.

006.01 ASSIGNMENT BY LICENSED NURSES TO OTHER LICENSED NURSES. Registered nurses and licensed practical nurses are responsible for maintaining their competence for the practice role. Competence may be assessed or evaluated by the employer, nursing service administrator, or another licensed nurse, but is ultimately the responsibility of the licensed nurse. The nurse assigning care is responsible to assess the competence of the nurse accepting the care assignment. Nurses must:

(A) Assign only those nursing interventions authorized by the level of nursing for which the nurse receiving the assignment is licensed; and

(B) Assign only those nursing interventions for which the nurse making the assignment has reason to believe the nurse receiving the assignment is competent to provide.

006.02 LICENSED NURSES ACCEPTING ASSIGNMENT. Registered nurses and licensed practical nurses must:

(A) Accept only those assignments authorized by the level of nursing for which the nurse receiving the assignment is licensed;

(B) Accept only those assignment for which he or she has the required knowledge, skills, and abilities;

(C) Acknowledge personal limitations in knowledge and skills, and communicate the need for specialized instruction prior to accepting any assignments; and

(D) Give sufficient notice of intent to refuse an assignment so as to allow the nurse making the assignment to make alternative arrangements for the assignment.

006.03 LICENSED NURSES PROVIDING ASSIGNMENT TO UNLICENSED PERSONS. Registered nurses and licensed practical nurses must:

(A) Make assignments only to those unlicensed persons authorized by registered nurse delegation; and

(B) Determine assignments within the framework of the delegation plan as described in Section 004 of this chapter. Registered nurses and licensed practical nurses may limit assignments according to competency of the unlicensed person and the current nursing care needs of the consumer condition.

007. STANDARDS FOR SUPERVISION . Registered nurses, licensed practical nurses, and licensed practitioners all provide some degree of supervision in the provision and management of nursing care.

007.01 REGISTERED NURSES. Registered nurses can provide supervision to the following:

(A) Licensed practical nurses;

(B) Care teams which may include other licensed health care professionals; and

007.02 DIRECT VERSUS INDIRECT SUPERVISION. The method and degree of supervision may vary based upon consumer condition, the interventions to be applied, and the qualification and competency of the person providing the interventions.

007.02(A) DIRECT SUPERVISION. Appropriate circumstances for direct supervision are when consumer conditions and responses to interventions are not stable or predictable, and when the consumer is not competent to make informed decisions or provide necessary information thereby requiring frequent assessment by a registered nurse or licensed practitioner.

(i) Licensed practical nurses must provide direction to unlicensed persons only through direct supervision.

007.02(B) INDIRECT SUPERVISION. If protocols are used to provide direction to a licensed practical nurse, indirect supervision by a registered nurse or licensed practitioner is required. This must include:

(i) Periodic inspection and evaluation, the frequency of which must be determined by a registered nurse or licensed practitioner; and

(ii) Availability of a registered nurse or licensed practitioner, or appropriate substitute, to a licensed practical nurse by telecommunication for consultation and collaboration.

History

Effective 2020-10-05

Chapter 101 Practice of Nursing

Neb. Admin. Code tit. 172, ch. 101 Practice of Nursing {#sec-172-nac-101 omnilex-key=us-ne-regs-official--title-172--172 NAC 101}

001. SCOPE AND AUTHORITY . These regulations govern the practice of nursing in the State of Nebraska. Statutory authority for this chapter is Nebraska Revised Statute (Neb. Rev. Stat.) §38-2216 of the Nurse Practice Act and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions are set out in the Nurse Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 APPROVED PROGRAM OF PRACTICAL NURSING. A nursing program that meets the requirements for a practical nursing program set forth in 172 NAC 97.

002.02 APPROVED PROGRAM OF REGISTERED NURSING. A nursing program that meets the requirements for a registered nursing program set forth in 172 NAC 97.

002.03 APPROVED PROVIDER. Nationally recognized, accredited status given to a provider regarding their capacity to award contact hours for continuing education activities, planned, implemented and evaluated by the provider.

002.04 CREDENTIALING EVALUATION SERVICES. A Board-approved service that evaluates foreign nursing education program credentials compared to United States nursing education standards and determines equivalency of language, content, credit hours, and a U.S. nursing degree.

002.05 CONTINUING COMPETENCY. The demonstration of specified levels of knowledge, skills, or ability, not only at the time of initial licensure, but throughout an individual’s professional career.

002.06 CONTINUING EDUCATION. Planned, organized, systematic, and evaluative educational experiences designed to maintain or enhance the knowledge, skills, and attitudes of nurses for nursing practice, education, administration, or research for the purpose of improving health care to the public. Continuing education includes a variety of forms of learning experiences, such as lectures, conferences, academic studies, institutes, seminars, workshops, extension studies, and independent study programs which may or may not be formally peer reviewed and approved. Continuing education does not include orientation, in-service education or on-the-job training.

002.07 CONTINUING EDUCATION OFFERING. A single continuing education activity that may be presented once, or repeated.

002.08 INSERVICE EDUCATION. Activities intended to help nurses acquire, maintain, and increase the level of competence in fulfilling his or her assigned responsibilities specific to the expectations of the employer.

002.09 LICENSED BY ENDORSEMENT. The granting of active status and the authority to practice to an individual who has been licensed in another jurisdiction and who meets the Nebraska licensure requirements.

002.10 LICENSED BY EXAMINATION. The authority to practice based on having passed the licensing National Council Licensure Exam (NCLEX).

002.11 THE NATIONAL COUNCIL LICENSURE EXAMINATION FOR PRACTICAL NURSES (NCLEX-PN®). The accepted examination for practical nursing licensure in Nebraska.

002.12 THE NATIONAL COUNCIL LICENSURE EXAMINATION FOR REGISTERED NURSES (NCLEX-RN®). The accepted examination for registered nursing licensure in Nebraska.

002.13 NURSYS™. The national database for verification of nurse licensure, discipline and practice privileges for registered nurses and licensed practical nurses licensed in participating jurisdictions, including all states in the Nurse Licensure Compact.

002.14 ON-THE-JOB-TRAINING. Informal instruction given by an employer to acquaint an employee with performance expectations related to a given task.

002.15 ORIENTATION. The method by which nursing staff are introduced to the philosophy, goals, policies, procedures, role expectations, and other factors needed to function in a specific work setting.

002.16 PEER REVIEWED AND APPROVED. Continuing education programs, offerings, or independent studies that are either provided by an approved or accredited provider or approved by an approved or accredited approver.

002.17 REFRESHER COURSE.A planned program of study which provides a review of basic knowledge and skills. The focus of a refresher course is the enhancement of clinical competency.

002.18 STATE BOARD TEST POOL EXAMINATION (SBTPE). The nationally accepted licensure examination for nurses that was the basis for registered nurse licensure in Nebraska between 1953 and 1981 and licensed practical nurse licensure between 1956 and 1981.

003. REQUIREMENTS FOR ISSUANCE OF LICENSE . To obtain a license to practice nursing in Nebraska, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of the Uniform Credentialing Act, 172 NAC 10, 172 NAC 2, and this chapter

003.01 LICENSURE BY EXAMINATION. General requirements for licensure as a practical nurse or a registered nurse by examination include requirements found in the Uniform Credential Act, 172 NAC 10, and the following:

(A) Submit an official transcript documenting completion of the basic curriculum in an approved program of practical nursing or registered nursing; or a military program approved by the Board pursuant to Neb. Rev. Stat. § 38-1,141;

(B) Graduates from non-English speaking practical nursing or registered nursing education programs must present evidence of successful completion of one of the following:

(i) Test of English as a Foreign Language (TOEFL®) paper version with a minimum score of 560;

(ii) Test of English as a Foreign Language (TOEFL®) computer version with a minimum score of 220;

(iii) Test of English as a Foreign Language Internet-Based Test (TOEFL® iBT) with a minimum score of 84 and a minimum speaking score of 26;

(iv) International English Language Testing System (IELTS) academic version with an overall score of 6.5 and a minimum score of 6.0 on all modules;

(v) Test of English for International Communication (TOEIC) with a minimum score of 780;

(vi) Michigan English Language Assessment Battery (MELAB) with a passing standard of 81 and speaking section score of 3; or

(vii) Pearson Test of English Academic (PTE Academic) 55 overall with no sub scores lower than 50 in each scored part;

(C) Graduates of foreign nursing education programs taught in English should be directed to take an NCLEX preparatory review course;

(D) Graduates of foreign nursing education programs will be required to have a transcript evaluation by a Board-approved credentialing review program; and

(E) Pass the National Council Licensure Exam for Practical Nurses (NCLEX-PN®) or the National Council Licensure Examination for Registered Nurses (NCLEX-RN®).

003.02 LICENSURE BY ENDORSEMENT. General requirements for licensure as a practical nurse or a registered nurse by endorsement include requirements found in 172 NAC 10, and the following:

(A) Be licensed in another state or jurisdiction;

(B) Meet one of the following practice requirements for continuing competency:

(i) Graduated from an approved nursing program within the previous 5 years;

(ii) Practiced nursing for a minimum of 500 hours within the previous 5 years;

(iii) Completed a Board-approved review course of study within the previous 5 years;

(D) Submit individual state licensure verifications from states not participating in NURSYS™;

(E) Licensees from non-English speaking jurisdictions must present evidence of successful completion of one of the following if they have been working in a non-English speaking setting in the past 2 years:

(i) Test of English as a Foreign Language (TOEFL®) paper version with a minimum score of 560;

(ii) Test of English as a Foreign Language (TOEFL®) computer version with a minimum score of 220;

(iii) Test of English as a Foreign Language Internet-Based Test (TOEFL® iBT) with a minimum score of 84 and a minimum speaking score of 26;

(iv) International English Language Testing System (IELTS) academic version with an overall score of 6.5 and a minimum score of 6.0 on all modules;

(v) Test of English for International Communication (TOEIC) with a minimum score of 780;

(vi) Michigan English Language Assessment Battery (MELAB) with a passing standard of 81 and speaking section score of 3; or

(vii) Pearson Test of English Academic (PTE Academic) 55 overall with no sub scores lower than 50 in each scored part;

(F) Graduates of foreign nursing education programs may be required to have a transcript evaluation by a Board-approved credentialing review program; and

(G) Graduates of Canadian registered nursing programs must have passed the English version of the Canadian Nurses Association licensure examination prior to 2015 or the National Council Licensure Exam for Registered Nurses (NCLEX-RN®).

003.03 TEMPORARY LICENSE. A temporary license will be issued for 60 days or until the expiration date of the current license in the other state, whichever occurs first. The temporary license may be extended by the Department. The temporary license becomes null and void if the regular license is issued or a final decision is made to deny the regular license.

003.03(A) DOCUMENTATION. The Department will accept as documentation of a current license in another state:

(i) An official certification record from the other state or jurisdiction; or

(ii) Certification or verification of licensure obtained through NURSYS™.

003.03(B) DESIGNATION. Persons holding valid temporary licenses pursuant to this section are entitled to use the designation registered nurse (RN) or licensed practical nurse (LPN).

003.02(C) TEMPORARY LICENSE FOR REFRESHER COURSE. Persons currently or previously licensed in another state or jurisdiction who have not graduated or practiced nursing for at least 500 hours within the past 5 years immediately preceding the date of application and who wish to enroll in a review course of study approved by the Board in order to obtain licensure pursuant to Neb. Rev. Stat. § 38-2225 and who meet all the other requirements for licensure in Nebraska maybe issued a temporary license after submitting the following to the Department:

(i) A completed application;

(ii) Written validation from the institution conducting the review course of study of the duration of the course and that the individual has applied and been accepted for the course. For an individually designed review course, written validation of the dates of the clinical practice may be submitted from the supervising or collaborating nurse; and

(iii) Documentation of current or previous licensure in another state or jurisdiction. Acceptable documentation consists of:

(1) An official certification record from the other state or jurisdiction; or

(2) Certification or verification of licensure obtained through NURSYS™;

(iv) The temporary license issued pursuant to this section:

(1) Is valid only for clinical practice undertaken as part of the approved course;

(2) Requires such practice to be supervised by a licensed registered nurse; and

(3) Entitles the holder to use the designation registered nurse or licensed practical nurse.

004. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10. All registered nurse licenses expire on October 31 of each even-numbered year. All practical nurse licenses expire on October 31 of each odd-numbered year.

005. CONTINUING COMPETENCY REQUIREMENTS . Each person holding an active nursing license in the State of Nebraska must, on or before the date of expiration of the license, comply with the continuing competency requirements for his or her profession, unless the requirements are waived in accordance with 172 NAC 10.

005.01 DOCUMENTATION. For purposes of license renewal, the applicant must document continuing competency by having:

(A) Graduated from an approved nursing program within the previous 2 years;

(B) Graduated from an approved nursing program in more than 2 but less than 5 years and have completed 20 contact hours of nursing continuing education from an approved provider within the last 2 years;

(C) Practiced nursing for a minimum of 500 hours within the last 5 years and have completed 20 contact hours of nursing continuing education from an approved provider within the last 2 years;

(D) Completed a Board-approved refresher course of study consisting of a minimum of 75 contact hours approved by the Board within the last 5 years;

(E) Obtained and maintained current certification in a nursing specialty granted by a nationally recognized certifying organization for nursing; or

(F) Developed and maintained a portfolio that includes the licensee’s current continuing competency goals and evidence or verification of professional activities to meet those goals. Such evidence may include, but not be limited to, specialized training or experiences, continuing education, employer performance evaluation, or other evidence of demonstrated competency.

005.02 CONTINUING EDUCATION. 20 hours of nursing continuing education from an approved provider are required for renewal of a nursing license. The Board does not pre- approve continuing education offerings, but may accept as continuing education for reinstatement of a license or license renewal, the following learning experiences:

(A) Academic courses in an accredited post-secondary institution that are related to the specific knowledge or technical skills required for the nursing practice role;

(B) Courses or offerings related to the scientific knowledge for the practice of nursing including basic and advanced courses in the physical, social, and behavioral sciences; and

006. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179 and this chapter as follows:

(1) Failure to utilize appropriate judgment in administering safe nursing practice based upon the level of nursing for which the individual is licensed;

(2) Failure to exercise technical competence based upon the level of nursing for which the individual is licensed in carrying out nursing care;

(3) Failure to follow policies or procedures implemented in the practice situation to safeguard patient care;

(4) Failure to safeguard a patient's dignity or right to privacy;

(5) Violating the confidentiality of information or knowledge concerning a patient;

(6) Verbally or physically abusing patients;

(7) Falsification or intentional unauthorized destruction of patient records;

(8) Failure to maintain an accurate patient record;

(9) Misappropriating medications, supplies or personal items of a patient or agency;

(10) Committing any act which endangers patient safety or welfare;

(11) Delegating or assigning nursing interventions contrary to the standards set in 172 NAC 99;

(12) Failure to exercise supervision as set in 172 NAC 99 over persons who are authorized to practice only under the direction of the licensed nurse or licensed practitioner;

(13) Leaving a patient care nursing assignment without notifying personnel so that reasonable arrangements for continuation of care can be made;

(14) Failure to seek consultation, collaboration, or direction from another licensed health care provider when warranted by patient condition;

(15) Accepting an assignment when the licensed nurse does not have the competence to safely perform the intervention required by the assignment;

(16) Practice of the profession without a current active license or temporary license;

(17) Failure of a licensee, who is the subject of a disciplinary investigation, to furnish the Department or its investigator with requested information or requested documents;

(18) Falsification or misrepresentation of material facts in attempting to obtain nursing employment;

(19) Altering a license or temporary license by changing the expiration date, license number or any other information appearing on the license;

(20) Intentional falsification of material facts in a material document connected with the practice of nursing;

(21) Violating any term of probation, condition, or limitation imposed on the licensee by the Department;

(22) Kissing, fondling, touching or engaging in any other activities of a sexual nature with a patient;

(23) Crossing the professional boundaries of the nurse-patient relationship, to include patients’ family members, including the nurse’s use of social media;

(24) Failure to meet the repayment provisions for a loan received under the Nursing Student Loan Act; and

(25) Failure to meet the repayment provisions for a loan received under the Nursing Faculty Student Loan Act.

007. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

008. FEES . Fees are set out in 172 NAC 2.

History

Effective 2020-10-05

Chapter 105 Paid Dining Assistants

Neb. Admin. Code tit. 172, ch. 105 Paid Dining Assistants {#sec-172-nac-105 omnilex-key=us-ne-regs-official--title-172--172 NAC 105}

001. SCOPE AND AUTHORITY . These regulations implement Nebraska Revised Statute (Neb. Rev. Stat.) §§ 71-6038 to 71-6042 that govern registration of paid dining assistants and identify the circumstances and conditions under which paid dining assistants may feed residents in nursing homes.

002. DEFINITIONS . Definitions are found in Neb. Rev. Stat. § 71-6038 and this chapter.

002.01 CURRICULUM. A detailed outline of the course content including specific content areas.

002.02 IMMEDIATELY AVAILABLE. The registered or licensed practical nurse is available to respond at any time in person or by electronic communication, including pagers, intercom or call light systems, telephone and cell phones.

002.03 SUPERVISION. The provision of oversight to a paid dining assistant by a registered or licensed practical nurse who is on duty, physically present in the nursing home, and immediately available.

002.04 SUPERVISOR. Any person employed by the nursing home in a supervisory nursing capacity and who would be available for the paid dining assistant to notify in an emergency situation related to feeding residents.

003. ROLE OF THE PAID DINING ASSISTANT . Paid dining assistants must not perform nursing or nursing-related services. Paid dining assistants are only to supplement and not to substitute for licensed, registered, or practical nurses or nurse aides.

004. COURSE CURRICULUM AND TRAINING REQUIREMENTS FOR PAID DINING ASSISTANTS . Paid dining assistant courses must be approved by the Department and be taught by a single entity or person who meets the requirements of this chapter.

004.01 COURSE APPLICATION. The course provider must submit a completed application provided by the Department that includes the following:

(A) Name of the entity or person providing the course;

(B) Course curriculum, including all course materials that will be utilized to meet the content areas;

(C) A detailed description of methods used to determine competency of each paid dining assistant, including copies of exams and procedures;

(D) Name and license number of the registered nurse administering the course; and

(E) Signature of the registered nurse administering the course.

004.02 COURSE CONTENT. The course must contain the following elements:

(A) At least 8 documented hours of classroom and clinical instruction;

(B) Be administered by a licensed registered nurse who has authority to practice in the State of Nebraska; and

(i) Feeding techniques, including levels of assistance, cueing, proper positioning, and use of assistive devices as appropriate;

(ii) Assistance with feeding and hydration, including basic nutrition, age-related changes related to feeding and nutrition, dehydration, weight loss, therapeutic diets and dining preparation;

(iii) Communication and interpersonal skills, including basic communication skills including verbal and non-verbal communication, and barriers to communication;

(iv) Appropriate responses to resident behavior, including identification of common behavior problems and suggested management approaches;

(v) Safety and emergency procedures including abdominal thrusts, general safety procedures when feeding residents, fire and disaster procedures, and basic emergency care including falls, scalds and burns, seizures, chest pain, shortness of breath and reporting procedures;

(vi) Infection control, including personal hygiene, hand washing, proper handling of food, and standard precautions;

(vii) Resident rights, including resident rights as set forth in 175 Nebraska Administrative Code (NAC) 12;

(viii) Recognizing changes in residents that are inconsistent with their normal behavior and the importance of reporting these changes to the supervisory nurse including objective and subjective observations, what to report, to whom to report changes and the time frame of reporting;

(ix) Special needs of residents in relation to feeding who may have additional medical conditions including stroke, dementia, physical limitations, or mental illness; and

(x) Abuse and neglect including the definitions of such terms and the responsibility to report suspected abuse or neglect as required by Neb. Rev. Stat. §§ 28-372 and 28-711.

004.03 COMPETENCY. Persons completing a paid dining assistant training course must demonstrate the minimum acceptable competency in performing tasks or duties connected with each content area listed in 172 NAC 105-004.02. Minimum competency must be determined by a registered nurse.

004.04 CURRICULUM CHANGES. Any changes to the approved curriculum or the licensed registered nurse administering the paid dining assistant course must be submitted in writing to the Department for prior approval.

004.05 DEPARTMENT REQUIRED COURSE ADMINISTRATION DOCUMENTATION. Course providers must submit to the Department within 30 days of completion the following information for each individual who has successfully completed the paid dining assistant course and competency evaluation. This information must include the following about the individual:

(A) Name;

(B) Address;

(D) Date of course completion and competency evaluation.

004.06 COURSE ATTENDANCE RECORDS. Course providers must maintain, for a minimum of 2 years, course attendance records for each paid dining assistant course taught that include the following:

(A) Name and title of the instructor of each course topic;

(B) Names of individuals completing the course; and

005. PAID DINING ASSISTANT REGISTRY . The Department will maintain a registry of persons who successfully complete an approved paid dining assistant course and competency evaluation. The registry will include the following about the individual:

(A) Name;

(B) Address;

(D) Date of course completion and competency evaluation.

006. NURSING HOME REQUIREMENTS . Each nursing home must maintain the following:

(A) A listing of all paid dining assistants employed at the facility and the number of hours worked; and

(B) Verification of successful completion of an approved paid dining assistant training course and competency evaluation for each individual paid dining assistant.

006.01 POLICIES AND PROCEDURES. Facilities utilizing paid dining assistants must have policies and procedures that address how supervision of paid dining assistants will occur and how paid dining assistants will be identified as single-task workers for the purposes of this chapter.

History

Effective 2021-07-13

Chapter 106 Nursing Home Administrators

Neb. Admin. Code tit. 172, ch. 106 Nursing Home Administrators {#sec-172-nac-106 omnilex-key=us-ne-regs-official--title-172--172 NAC 106}

001. SCOPE AND AUTHORITY . This chapter govern the credentialing of Nursing Home Administrators as defined by Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-2401 to 38-2425 and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions are found in the Nursing Home Administrator Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and the following apply to this chapter.

002.01 DEGREE. A degree is an academic title conferred by universities and colleges as an indication of the completion of a course of study from an accredited institution, or approved as equivalent to a U.S. degree by a foreign educational credential evaluation service that is a member of the National Association of Credential Evaluation Services (NACES).

002.02 TRAINEE. A trainee is a person in a learner role who is in an administrator-in-training or mentoring program and is supervised by a Nebraska certified preceptor.

002.03 WRITTEN EXAMINATION. The written examination is the National Association of Long Term Care Administrator Boards (NAB) licensing examination.

003. NURSING HOME ADMINISTRATOR LICENSE . Applicants for licensure must meet the following requirements.

003.01 INITIAL LICENSE. To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. § 38-2419, 172 NAC 10, and this chapter.

003.01(A) EDUCATION. An applicant must submit an official transcript verifying the degree received by the applicant.

003.01(B) APPLICATION METHODS. An applicant may apply based on one of the following:

(i) An associate degree and core education set out in 172 NAC 106-007.

(ii) An associate degree, core education set out in 172 NAC 106-007, and previous work experience defined in Neb. Rev. Stat. § 38-2415.

(iii) A degree or an advanced degree as defined in Neb. Rev. Stat. § 38-2409.

(iv) A nursing degree as defined in Neb. Rev. Stat. § 38-2413 and previous work experience in health care administration as defined in Neb. Rev. Stat. § 38-2416.

(v) A degree or an advanced degree in health care as defined in Neb. Rev. Stat. §38-2410 and previous work experience in health care administration as defined in Neb. Rev. Stat. § 38-2416.

(vi) A degree from a program accredited by the National Association of Long Term Care Administrator Boards for Nursing Home Administrators meets the requirements of (i) through (v).

003.01(C) CORE EDUCATION. If applicable, documentation of completion of the core education set out in 172 NAC 106-007 must be submitted. Evidence of core education must include:

(i) Name of the course and course number or continuing education provider;

(ii) Number of hours completed;

(iii) Course syllabus or continuing education course description or similar documentation; and

(iv) Documentation of completing the education.

003.01(D) ADMINISTRATOR-IN-TRAINING PROGRAM OR MENTORING PROGRAM. If applicable, documentation of completion of an administrator-in-training or mentoring training program.

003.01(E) PREVIOUS WORK EXPERIENCE. If applicable, documentation of previous work experience as defined in Neb. Rev. Stat. §§ 38-2415 or 38-2416 must be submitted. Documentation must include:

(i) Name of employer and name of facility;

(ii) Address of facility;

(iii) Position held by applicant;

(iv) Dates of employment; and

(v) Brief statement of experience.

003.01(F) EXAMINATION. Evidence of receiving a scaled score of at least 113 on the written examination must be submitted. If the written examination was taken in a state other than Nebraska, an official score report must be sent directly from the testing agency or state in which the examination was administered.

003.02. RECIPROCITY. To obtain a license by reciprocity, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. § 38-2421, 172 NAC 10, and this chapter, as applicable.

004. ADMINISTRATOR FOR A FACILITY CARING FOR PERSONS WITH HEAD INJURIES AND ASSOCIATED DISORDERS . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. § 38-2426, 172 NAC 10, and this chapter.

004.01 LICENSE REQUIREMENTS AND DOCUMENTATION. Applicants must submit:

004.01(A) EXPERIENCE. Documentation verifying at least 4 years of experience working with persons with head injuries or severe physical disabilities, and at least 2 years must be spent in an administrative capacity. The documentation must include:

(i) A brief description of the experience received working with persons with head injuries or severe physical disabilities and experience in an administrative capacity;

(ii) Name of facility or institution in which experience was completed; and

(iii) Duration of Experience.

004.01(B) LICENSE, CERTIFICATE, EDUCATION, OR ADDITIONAL EXPERIENCE. In addition to meeting the requirements of 004.01(A), documentation of one of the following:

(i) A current license as a psychologist, physician, mental health practitioner, independent mental health practitioner, physical therapist, occupational therapist, or speech pathologist;

(ii) A current certificate as a social worker or master social worker;

(iii) An educator with at least a master's degree in education from an accredited college or university. An official transcript must be submitted as verification;

(iv) An administrator or executive of a health care facility as defined in Neb. Rev. Stat. § 71-413 who is a member in good standing with an organization that offers voluntary certification for the purpose of demonstrating managerial knowledge and experience for health care managers; or

(v) Have at least 8 years of experience working with persons with head injuries or severe physical disabilities, at least 5 spent in an administrative capacity in a facility operated primarily for caring for persons with head injuries or severe physical disabilities.

005. ADMINISTRATOR RESPONSIBLE FOR OVERSEEING MORE THAN ONE FACILITY . To obtain approval to oversee the operation of more than one facility, a nursing home administration must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. § 38-2419 and this chapter. The combined total number of beds for the facilities cannot exceed 200, the travel time and distance between the two facilities the farthest apart cannot exceed two hours by motor vehicle and 150 miles.

006. ADMINISTRATOR-IN-TRAINING PROGRAM AND MENTORING PROGRAM . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. § 38-2420, 172 NAC 10, and this chapter.

006.01 DIPLOMA OR DEGREE. The applicant must provide an official transcript verifying the date of the diploma or degree awarded or to be awarded.

006.02 CORE EDUCATION. Documentation of college or university course work or continuing education verifying completion of at least 3 coursework hours in 50% of the core educational areas set out in 172 NAC 106-008 or a degree from a program accredited by the National Association of Long Term Care Administrator Boards for Nursing Home Administrators.

006.03 TRAINING AGREEMENT. Documentation of the agreement between the certified preceptor and the applicant for at least 640 hours of training and experience, to be gained in not less than 4 months, and not less than 20 hours per week. If completed in less than 40 hours per week, but not less than 20 hours per week, the applicant must submit a proposed schedule of training to meet the administrator-in-training or mentoring period.

006.04 SUPERVISION. The training must occur in a Nebraska licensed nursing home or home for the aged or infirm, under the direct supervision of a Nebraska certified preceptor. If the applicant is completing a mentoring program, the certified preceptor is not required to be at the same facility during the period of supervision but must be available to assist with questions or issues as needed. The supervisor must meet with the mentoring trainee at least 1 time per month at the facility where the training is occurring.

007. CORE EDUCATION . If applicable, applicants must complete the following core educational requirements either through a college or university or as continuing education:

007.01 PATIENT CARE AND SERVICES. Coursework may include one of the following:

(A) Aging;

(B) Ancillary health services;

(D) Disease process;

(E) End of life care;

(F) Environmental health and safety;

(G) Food management;

(H) Geriatrics or gerontology;

(I) Health care delivery systems;

(J) Medical terminology;

(K) Nursing;

(L) Nutrition;

(M) Pharmacology;

(N) Therapeutic recreation; or

(O) Similar coursework to those listed above.

007.02 SOCIAL SERVICES. Coursework may include one of the following:

(A) Case management;

(B) Death and dying;

(D) Mental health;

(E) Psychology relating to aging;

(F) Social gerontology, such as theories of aging, social aspects of aging, multi-cultural issues;

(G) Social services, including Medicaid or Medicare;

(H) Social work;

(I) Sociology;

(J) Spirituality, human development, or lifespan;

(K) Therapeutic recreation; or

(L) Similar coursework to those listed above.

007.03 FINANCIAL MANAGEMENT. Coursework may include one of the following:

(A) Accounting, such as payroll, taxes, or general ledger;

(B) Business management;

(D) Health care finance;

(E) Management;

(F) Office management or statistics; or

(G) Similar course work to those listed above.

007.04 ADMINISTRATION, LEADERSHIP AND MANAGEMENT. Coursework may include one of the following:

(A) Communication skills;

(B) Health care information technology;

(D) Leadership skills;

(E) Legal aspects of aging;

(F) Marketing or public relations;

(G) Management or organizational theory;

(H) Organizational analysis;

(I) Organizational development;

(J) Personnel, human resources, or labor relations;

(K) Purchasing or inventory control;

(L) Quality management / quality improvement;

(M) Strategic or financial planning; or

(N) Similar coursework to those listed above.

007.05 RULES, REGULATIONS, AND ENVIRONMENTAL STANDARDS RELATING TO THE OPERATION OF A HEALTH CARE FACILITY. Coursework may include one of the following:

(A) Ethics;

(B) Health care regulations;

(D) Law;

(E) Life or safety code;

(F) National fire protection association and fire safety evaluation system;

(G) Nursing home administrator regulations;

(H) Nursing facility standards;

(I) Occupational safety and health administration; or

(J) Similar coursework to those listed above.

007.06 CORE EDUCATIONAL HOURS. Hours are calculated as follows:

(A) 1 semester hour equals 1 coursework hour;

(B) 1.5 quarter hour equals 1 coursework hour; and

008. ADMINISTRATOR-IN-TRAINING OR MENTORING TRAINING REQUIREMENTS . Applicants who are in an administrator-in-training or mentoring training program must meet the following training requirements.

008.01 TRAINING AREAS. The applicant must provide verification, on a form provided by the Department, showing completion of training in the following areas:

(A) Leadership and Management;

(B) Nutritional Services;

(D) Nursing and Restorative Services;

(E) Medical and Allied Health;

(F) Medical Records and Health Information Systems;

(G) Activities;

(H) Social Services and Admissions;

(I) Therapy Services;

(J) Human Resources;

(K) Financial Management; and

(L) Rules, Regulations, and Standards.

008.02 CHANGE IN PRECEPTOR OR FACILITY. If the trainee has a change in preceptor or facility, the trainee must submit a complete application provided by the Department.

008.03 TRAINING COMPLETED IN ANOTHER STATE. Applicants who have completed a training program in another state must meet the same training areas set out in 172 NAC 106-008.01.

009. PROVISIONAL LICENSE AS A NURSING HOME ADMINISTRATOR . To obtain a provisional license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the credentialing requirements of Neb. Rev. Stat. § 38-2423, 172 NAC 10, and this chapter.

009.01 APPLICATION. The applicant must provide the following:

(A) Name of facility to be employed;

(B) Address of facility;

(D) Signed affidavit of designation of a provisional license, completed by the owner, governing body, or other appropriate authority of the nursing home or home for the aged or infirm which includes:

(i) Name of chairperson, governing body, or similar authority of the nursing home;

(ii) Name of applicant requesting a provisional license;

(iii) Name of previous administrator;

(iv) Proposed starting date; and

(v) Reason for request, such as death of previous administrator, medical emergency, unexpected resignation of the licensed administrator.

009.02 MENTORING TRAINEE AND PROVISIONAL LICENSEE. A person in a mentoring program may serve as the provisional licensee while completing the mentoring training program.

010. CERTIFIED PRECEPTOR . To obtain a preceptor certificate, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the credentialing requirements of Neb. Rev. Stat. §§ 38-2420, 172 NAC 10, and this chapter.

010.01 REQUIREMENTS AND DOCUMENTATION. Applicants must submit:

010.01(A) LICENSE. Evidence of holding a current active Nebraska Nursing Home Administrators license.

010.01(B) EXPERIENCE. Documentation of having at least 3 years of experience as a Nursing Home Administrator in the 5 years immediately preceding the application.

010.01(C) TRAINING. Documentation of having completed a preceptor training course as set out in 172 NAC 011. This training must have been completed within 12 months immediately prior to the application.

010.01(D) DISCIPLINARY ACTION. Verification that the applicant has not had his or her nursing home administrator license disciplined, limited, suspended, or placed on probation during the 1 year immediately prior to the application for a preceptor certification. At least 1 year must have elapsed following completion of any disciplinary terms and conditions. If any of these actions are taken by the Department during the trainee supervisory period, the preceptor must terminate the supervision immediately and notify the Department.

011. PRECEPTOR INITIAL TRAINING PROGRAM REQUIREMENTS . An approved preceptor training course must be at least 5 hours in duration. The following are acceptable training programs:

(A) The National Association of Long Term Care Administrator Boards’ preceptor on-line training course; or

(B) A training program, which includes the following training areas:

(i) At least 1 hour in preceptor expectations and administrator licensing regulations; and

(ii) At least 1 hour in 4 of the following areas:

(1) Leadership and team building;

(2) Communication;

(3) Generational learning styles;

(4) Adult learning;

(5) Coaching and mentoring; or

(6) Fostering professionalism.

012. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10 and this chapter. Licenses expire as follows:

(A) Nursing home administrator license’s expire December 31 of each even-numbered year.

(B) Preceptor certification’s expire December 31 of every 4th even-numbered year.

013. CONTINUING EDUCATION . The following continuing education requirements apply to certified preceptors and nursing home administrators.

013.01 CERTIFIED PRECEPTOR. Individuals holding an active preceptor certificate in the State of Nebraska, must complete at least 5 hours of approved continuing education, with at least 1 hour in 5 of the 6 topic areas set out in 172 NAC 106-011(B)(ii)(1-6) during the 48-month period prior to the expiration date.

013.01(A) SUPERVISING A TRAINEE. Certified preceptors who supervise a trainee may obtain continuing education as follows:

(i) If a preceptor supervises 1 trainee during the renewal period, this supervision meets the training requirements set out in 172 NAC 106-013.01 and 8 hours can be applied towards the renewal of the individual’s nursing home administrator license; and

(ii) If a preceptor supervises 2 trainees during the renewal period, 16 hours of continuing education can be applied towards the renewal of the individual’s nursing home administrator license.

013.02 NURSING HOME ADMINISTRATOR. Individuals holding an active nursing home administrator license in the State of Nebraska, must complete 50 hours of acceptable continuing education hours during the 24-month period prior to the expiration date.

013.02(A) CONTINUING EDUCATION HOUR CALCULATIONS. The following provides the hour calculations.

013.02(A)(i) ACADEMIC CREDIT. A maximum of 25 hours of continuing education may be obtained through academic credit; hours are calculated as follows: 6

(1) 1 semester hour of academic credit equals 5 continuing education hours; and

(2) 1 quarter hour of academic credit equals 3 continuing education hours.

013.02(A)(ii) HOME STUDY. A maximum of 25 hours of continuing education may be obtained through home study programs.

013.02(A)(iii) PRESENTER HOURS. A presenter may receive credit for only the initial presentation during a renewal period. Credit will not be given for subsequent presentations of the same program.

013.02(A)(iv) CONTINUING EDUCATION PROGRAMS. 60 minutes of participation equals 1 continuing education hour.

013.02(B) ACCEPTABLE CONTINUING EDUCATION TOPIC AREAS. In order for a continuing education program to be accepted, the program must include one or a combination of the following topic areas:

(i) Patient care and services;

(ii) Social services;

(iii) Financial management;

(iv) Leadership and management; and

(v) Rules, regulations, and environmental standards.

014. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179 and includes the following:

(A) Failure to utilize appropriate judgment in administering safe nursing home practices.

(B) Failure to exercise competence in carrying out nursing home administration.

(C) Failure to follow policies or procedures implemented in the practice situation to safeguard patient or resident care.

(D) Failure to safeguard the patient’s or resident’s dignity and right to privacy.

(E) Violating the confidentiality of information or knowledge concerning the patient or resident.

(F) Falsifying patient or resident records.

(G) Misappropriation of medications, supplies or personal items of the patient or resident or facility.

(H) Committing any act which endangers patient or resident welfare or safety.

(I) Failure to exercise appropriate supervision over persons who are authorized to practice only under the supervision of the licensed professional.

(J) Leaving employment, without notice or making arrangements for coverage, when a resident of the employing facility is at risk for harm.

015. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

016. FEES . Fees are set out in 172 NAC 2.

History

Effective 2020-09-21

Chapter 108 Approval of Training Programs and Qualifications for Nurse Aides in Nursing Homes

Neb. Admin. Code tit. 172, ch. 108 Approval of Training Programs and Qualifications for Nurse Aides in Nursing Homes {#sec-172-nac-108 omnilex-key=us-ne-regs-official--title-172--172 NAC 108}

001. SCOPE AND AUTHORITY . These regulations govern the qualifications and training requirements for nurse aides employed in nursing homes. Statutory authority for this chapter is Nebraska Revised Statutes (Neb. Rev. Stat.) §§ 71-6038, 71-6039, and 71-6040 to 71-6042. These regulations are consistent with federal requirements at 42 CFR § 483, Subpart D, as it existed on the effective date of these regulations.

002. DEFINITIONS . Definitions are found in Neb. Rev. Stat. § 71-6038 and this chapter.

002.01 ADMINISTRATOR. The operating officer for the health care facility, regardless of whether titled as administrator, manager, superintendent, director, or with a similar designation. The administrator of a licensed intermediate care facility, nursing facility, skilled nursing facility, or intermediate care facility for individuals with intellectual disabilities must be licensed by the State of Nebraska.

002.02 CURRICULUM. A detailed outline, description, or syllabus submitted to the Department as part of the course approval process by an association, hospital, nursing home, educational institution, or health care facility sponsoring a nurse aide training program.

002.03 NURSE AIDE REGISTRY. The central data bank of individuals eligible to function as nurse aides in certified facilities established by 471 Nebraska Administrative Code (NAC) 12.

002.04 PROGRAM OR COURSE. The terms program and course are used synonymously in these regulations. The Nurse Aide Training Program consists of one course.

002.05 RESIDENT. Any person domiciled, residing, or receiving care and treatment, for a period in excess of 24 hours, in a nursing home.

003. NURSE AIDE REQUIREMENTS .

003.01 PRACTICE. To act as a nurse aide, individuals must meet the requirements of Neb. Rev. Stat. § 71-6039 and the following:

(A) Successfully complete a Department-approved training program;

(B) Demonstrate at least the minimum acceptable proficiency in tasks or duties connected with each skill in the curriculum prescribed in 172 NAC 108-004, as determined by the registered nurse administering the course and the course instructor; and

003.02 FINDINGS OF CONVICTION. The Department will document convictions of crimes involving moral turpitude rationally related to the practice of a nurse aide by placing a finding of conviction on the Nurse Aide Registry.

003.02(A) WRITTEN NOTICE. Nurse aides will be notified in writing of a finding of conviction.

003.02(B) DISCIPLINARY ACTION. A nursing home is subject to disciplinary action against its license under Neb. Rev. Stat. § 71-6042 or this chapter.

004. NURSE AIDE TRAINING PROGRAMS .

004.01 NURSING HOME NURSE AIDE TRAINING PROGRAM. Courses of training for all facility types outlined in Neb. Rev. Stat. § 71-6039 except Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) must be given by a single sponsor or organization and include, at a minimum, 75 clock hours of instruction, including at least 16 hours of supervised practical training. In addition, the course must include at least 1 hour of instruction on the responsibility of each nurse aide to report suspected abuse or neglect at a minimum, the curriculum must include:

(A) At least 16 hours of training in the following areas prior to any direct contact with residents:

(i) Communication and interpersonal skills;

(ii) Infection control;

(iii) Safety and emergency procedures, including emergency measures for choking;

(iv) Promoting residents’ independence;

(v) Respecting residents’ rights;

(B) Basic nursing skills:

(i) Taking and recording vital signs;

(ii) Measuring and recording height and weight;

(iii) Caring for residents’ environment;

(iv) Recognizing abnormal changes in body functioning and the importance of reporting changes to supervisors;

(v) Caring for residents when death is imminent;

(i) Bathing;

(ii) Grooming, including mouth care;

(iii) Dressing;

(iv) Toileting;

(v) Assisting with eating and hydration;

(vi) Proper feeding techniques;

(vii) Skin care;

(viii) Transfers, positioning, and turning;

(D) Mental health and social service needs:

(i) Modifying behavior in response to residents’ behavior;

(ii) Awareness of developmental tasks associated with the aging process;

(iii) Responding to resident behavior;

(iv) Allowing residents to make personal choices, providing and reinforcing other behavior consistent with residents’ dignity;

(v) Using residents’ family as a source of emotional support;

(E) Care of cognitively impaired residents:

(i) Techniques for addressing unique needs and behaviors of residents with dementia, Alzheimer’s and other diseases affecting cognitive functioning;

(ii) Communicating with cognitively impaired residents;

(iii) Understanding behavior of cognitively impaired residents;

(iv) Appropriate responses to behavior of cognitively impaired residents;

(v) Methods of reducing effects of cognitive impairments;

(F) Basic restorative services:

(i) Training residents in self-care according to their abilities;

(ii) Use of assistive devices in transferring, ambulation, eating and dressing;

(iii) Maintaining range of motion;

(iv) Proper turning and positioning in bed and chair;

(v) Bowel and bladder training;

(vi) Care and use of prosthetic and orthotic devices;

(G) Residents’ rights:

(i) Providing privacy and maintaining confidentiality;

(ii) Promoting the residents’ right to make personal choices to accommodate their

needs;

(iii) Assisting in resolving grievances and disputes;

(iv) Providing assistance in getting to and participating in resident and family groups and activities;

(v) Maintaining care and security of personal possessions;

(vi) Promoting residents’ right to be free from abuse, mistreatment, and neglect and reporting of such treatment to appropriate facility staff; and

(vii) Avoiding restraints in accordance with current professional standards.

004.02 INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES NURSE AIDE TRAINING PROGRAM. Courses of training for nurse aides employed by intermediate care facilities for individuals with intellectual disabilities (ICF/IID) must be given by a single sponsor or organization and include, at a minimum, 15 hours of classroom instruction in basic personal care and 5 hours of classroom instruction in basic therapeutic and emergency procedures. In addition, the course must include at least 1 hour of instruction on the responsibility of each nurse aide to report suspected abuse or neglect. At a minimum, the curriculum must include:

(A) At least 15 hours of basic personal care training in the following areas:

(i) Personal care:

(1) Bathing;

(2) Oral hygiene;

(3) Backrubs;

(4) Nail care;

(5) Shaving;

(6) Hair care;

(7) Dressing;

(8) Bed-making, (both occupied and unoccupied);

(ii) Active range of motion:

(1) Ambulation;

(2) Positioning;

(3) Transfer techniques;

(4) Use of physical restraints;

(iii) Foods and fluids:

(1) Basic nutrition;

(2) Diet descriptions;

(3) Preparation of residents for meals;

(4) Feeding techniques;

(5) Reporting intake and output;

(6) Weighing techniques;

(iv) Elimination:

(1) Appropriate use of urinal and bedpan;

(2) Bowel and bladder retraining;

(3) Incontinent care;

(4) Enemas;

(v) Safety and accident prevention:

(1) Lighting;

(2) Siderails;

(3) Call lights;

(4) Wheelchairs;

(5) Smoking;

(vi) Infection prevention techniques:

(1) Handwashing and gloving;

(2) Care of linen and equipment;

(3) Introduction to isolation techniques;

(vii) Aging process:

(1) Basic principles;

(2) Psychosocial needs;

(3) Communication skills;

(B) At least 5 hours of therapeutic and emergency procedures training in at least the following areas:

(i) Fire and disaster safety and procedures;

(ii) Basic emergency care:

(1) Recognition of signs and symptoms of emergencies including bleeding, burns, convulsions, fainting, falls, and choking;

(2) Procedures for reporting;

(iii) Measuring vital signs:

(1) Temperature;

(2) Pulse;

(3) Respirations;

(4) Blood pressure;

(i) The requirements of the Adult Protective Services Act and the Child Protection and Family Safety Act; and

(ii) Resident rights as set forth in 175 NAC 12 and 175 NAC 17.

004.03 PROGRAM ADMINISTRATION. Courses must be administered by registered nurses who hold a current license to practice as such in Nebraska or have the authority to practice as such in Nebraska under the provisions of the Nurse Licensure Compact.

004.04 COURSE ADMINISTRATION DOCUMENTATION. A registered nurse administering a nurse aide course must document an individual's successful completion of the course in a document, the original of which must be given to the individual, containing the following information:

(A) Individual's name;

(B) Individual's date of birth;

(D) Course sponsor; and

(E) Course instructor.

004.05 REQUIRED DOCUMENTATION. The information required by 172 NAC 108-004.04 must also be submitted to the Department in a document signed by the administrator that also includes the individual’s social security number.

005. APPROVAL OF NURSE AIDE TRAINING PROGRAMS . Any association, educational institution, skilled nursing facility, nursing facility, intermediate care facility, or intermediate care facilities for individuals with intellectual disabilities (ICF/IID) may apply for approval to conduct a training course for nurse aides.

005.01 APPLICATION FORM AND CONTENT. Applications must be made on a form provided by the Department and submitted with the curriculum for the course as defined in 172 NAC 108-004. The application must include the following:

(A) Course title;

(B) Sponsor's name;

(C) Title, author, publisher, and edition of any textbook to be used or, if no textbook is to be used, a list of written materials to be used and the source of such materials;

(D) Specific objectives for the course;

(E) Units to be covered in the course, as determined by the components required by 172 NAC 108-004.01, items A-G, and 172 NAC 108-004.02, items A-C, and the hours to be spent on each unit;

(F) Methods of instruction for each unit listed in 172 NAC 108-004, such as lecture, demonstration, simulation, slide presentation, or other electronic methods;

(G) Description of the practical training to be provided for each unit;

(H) Reading assignments in the text or in other materials for each unit;

(I) Evaluation method for each unit, such as written examination, student presentation or demonstration, or competency check-off;

(J) Timing of evaluations, such as after each unit or comprehensively at the end of the course;

(K) Grading system to be used; and

(L) Tasks and duties that students will be evaluated for competency on for each unit and the examinations to be used, including, at a minimum:

(i) Procedures for administering examinations;

(ii) Procedures for ensuring the security of examinations, during administration and otherwise, including the number of times particular examinations will be used;

(iii) Procedures for validating that examinations measure competency in the unit being tested; and

(iv) Procedures for reporting grades to the sponsor and Department.

005.02 APPLICATION SUBMISSION. The administrator for the entity conducting the course must submit the application at least 30 days prior to the date when the course is to be given.

005.03 COMPLETE APPLICATIONS. Only complete applications will be considered. Applications must include:

(A) All information requested on the application;

(B) A complete curriculum as defined in this chapter; and

005.04 CONTINUING APPROVAL. Once an application for approval has been granted, reapproval is not required for each occasion on which the course is administered so long as the course is not changed or the course requirements are not changed by law. If the course or any portion thereof is changed, reapplication must be made in accordance with this chapter. When only a portion of a course is changed, the applicant may submit only documentation and information regarding the changes made, but must clearly identify those portions that are unchanged by so stating on the application.

005.05 APPLICATIONS TO CONDUCT APPROVED COURSES DEVELOPED BY OTHERS. Associations, educational institutions, skilled nursing facilities, nursing facilities, intermediate care facilities, and intermediate care facilities for individuals with intellectual disabilities (ICF/IID) may, with the consent of the developer, conduct nurse aide training courses developed by others that have been approved by the Department. Such facilities must apply for approval in accordance with this chapter, but need not submit curriculum materials required by this chapter except to the extent that the course will vary in any manner from the approved course. Applicants must indicate on the application the title of the approved course to be used, name of the entity whose approved course will be used, and the date on which such course was approved.

005.06 CHANGES TO APPROVED COURSES. Any changes in approved courses must be submitted to the Department for approval.

005.07 ONSITE INSPECTION. All nurse aide training courses are subject to periodic on-site review by the Department. Sponsors of approved courses must give the Department at least 5 working days’ written notice of the date when a course will be held and the location of the course.

005.08 ATTENDANCE RECORDS. The sponsor must maintain attendance records for courses for a minimum of 2 years from the date of completion. Attendance records are subject to review by the Department upon request.

005.09 DENIAL, SUSPENSION, OR REVOCATION OF APPROVAL. The Department may deny, suspend, or revoke approval of a nurse aide training course for failure to meet the requirements of Neb. Rev. Stat. §§ 71-6038 to 71-6042 and this chapter.

006. COMPETENCY EVALUATIONS . The Department may administer and evaluate competency evaluations; contract for the administration and evaluation of competency evaluations; or request applications for approval to administer and evaluate competency evaluations. Skilled nursing facilities that participate in Medicare and nursing facilities that participate in Medicaid are not eligible to administer and evaluate competency evaluations. A nurse aide course instructor cannot teach a student in the nurse aide course and administer the competency evaluation to the same student. Any applications for approval must include a copy of the evaluation plan and procedures and assurances that the requirements of this section will be met.

006.01 CONTENT. A competency evaluation must contain a written or oral portion and a skills demonstration portion.

006.01(A) WRITTEN PORTION. The written or oral portion must:

(i) Address each course requirement listed in section 004 of these regulations;

(ii) Be developed from a pool of questions, only a portion of which is used in any one examination;

(iii) Use a system that prevents disclosure of both the question pool and the individual competency evaluations;

(iv) If oral, be read from a prepared text in a neutral manner;

(v) Be tested for reliability and validity using nationally recognized standards; and

(vi) Meet all other requirements set forth in 42 CFR § 483, Subpart D.

006.01(B) SKILLS DEMONSTRATION. The skills demonstration portion must:

(i) Address each personal care skill listed in section 004 of these regulations;

(ii) Consist of demonstration of randomly selected items drawn from a pool of tasks generally performed by nurse aides;

(iii) Be performed in a setting comparable to the setting in which the nurse aide will operate and be administered and evaluated by a registered nurse with at least one year’s experience in providing care for the elderly or the chronically ill of any age; and

(iv) Meet all other requirements set forth in 42 CFR § 483, Subpart D.

006.02 NOTIFICATION. Persons taking the competency evaluation will be advised in advance that a record of the successful completion of the examination will be included in the state’s nurse aide registry.

006.03 SUCCESSFUL COMPLETION. A score of PASS must be achieved for both the written, oral, and skills demonstration parts of the test. The competency testing entity will inform the nurse aide of the test score within 5 calendar days of the completion of the test and will inform the nurse aide registry of the nurse aide’s scores within 14 calendar days after the test is completed.

006.04 UNSUCCESSFUL COMPLETION. Any person who does not complete the evaluation satisfactorily will be advised in writing within 5 calendar days after the test is scored of the areas which the person did not pass and that the person has 3 opportunities to take the evaluation. The competency testing entity will inform the nurse aide registry of the nurse aide’s scores within 14 calendar days after the test is completed.

006.05 STORAGE OF EVALUATION INSTRUMENT. Evaluation instruments must be securely stored when they are not being administered or processed.

006.06 DATA MANAGEMENT AND TRANSMISSION. Any contractor or provider of competency evaluations must meet state and federal requirements for nurse aide certification testing. This includes a secure system for data management and transmission of data to the Department, as well as the maintenance and security of questions in the written and skills examination pool.

006.06(A) QUALITY ASSURANCE. Any contractor or provider of competency evaluations shall conduct a standard quality assurance program measuring elements of structure, process, and outcomes of all components of the nurse aide competency evaluation. Written and skills exams must be linked to the nurse aide job analysis and supported by psychometric data determining the validity of all testing items on an ongoing basis.

006.06(B) DATA COLLECTION AND REPORTING. Data collection and reporting shall include the following reports as requested by the Department:

(i) Pass and fail rates by program or contract;

(ii) Psychometric analysis of exam items;

(iii) Candidate satisfaction rates;

(iv) Americans with Disabilities Act (ADA) accommodations provided;

(v) Quality assurance data; and

(vi) Data that supports intra- and inter rater-reliability of the nurse aide tester.

History

Effective 2022-09-24

Chapter 114 Licensure of Occupational Therapy

Neb. Admin. Code tit. 172, ch. 114 Licensure of Occupational Therapy {#sec-172-nac-114 omnilex-key=us-ne-regs-official--title-172--172 NAC 114}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of occupational therapists and occupational therapy assistants under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-2501 to 38-2531 of the Occupational Therapy Practice Act and the Uniform Credentialing Act (UCA).

002. DEFINITIONS . Definitions are set out in the Occupational Therapy Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 ACTIVE LICENSE. The license of a person who is acting, practicing, functioning and working in compliance with the requirements of a license.

002.02 APPROVED SUPERVISED FIELD WORK EXPERIENCE. A period of supervised field work experience at an educational institution approved by the Department and where the occupational therapists or occupational therapy assistant's academic work was successfully completed or which was part of a training program approved by the educational institution. A minimum of 6 months of supervised field work experience will be required for an occupational therapist and a minimum of 2 months of supervised field work experience is required for an occupational therapy assistant.

002.03 ASSOCIATION. A recognized national or state association for occupational therapy.

002.04 BASIC EDUCATIONAL PROGRAM AND EDUCATIONAL PROGRAM:

(A) A program for the education of occupational therapists which is recognized by the Department and accredited by the Accreditation Council for Occupational Therapy Education of the American Occupational Therapy Association, the World Federation of Occupational Therapists, or predecessor organizations.

(B) A program for the education of occupational therapy assistants which is recognized by the Department and accredited by the Accreditation Council for Occupational Therapy Education of the American Occupational Therapy Association, the World Federation of Occupational Therapists or predecessor organizations.

002.05 CERTIFICATION EXAMINATION. The Nebraska Physical Agent Modalities Testing Service Examination administered by the Physical Agent Modalities Practitioner Credentialing Agency (PAMPCA).

002.06 CERTIFIED OCCUPATIONAL THERAPY ASSISTANT. A person who is certified pursuant to guidelines established by the National Board for Certification in Occupational Therapy (NBCOT).

002.07 CONSULTATION OR IN ASSOCIATION WITH. Providing professional advice.

002.08 CONTINUING EDUCATION. Planned, organized learning activities designed to maintain, improve, or expand a licensee’s knowledge and skills in order for the licensee to develop new knowledge and skills relevant to the enhancement of practice, education, or theory development to improve the safety and welfare of the public.

002.09 CONTINUING EDUCATION ACTIVITY. The various methods in which a licensee can obtain the necessary continuing education for license renewal.

002.10 HOUR AS IT RELATES TO CONTINUING EDUCATION. At least 60 minutes of participation in an organized learning experience otherwise known as a contact hour.

(A) One academic semester hour is equal to 15 contact hours. An approved three credit hour course provides 45 contact hours of continuing education credit.

(B) One academic quarter hour is equal to 10 contact hours. An approved 3 credit hour course would provide 30 contact hours of continuing education credit.

002.11 LASER. A mechanism for emitting electromagnetic radiation using heat via the process of stimulated emission. This does not include a method where light is applied to tissue in order to influence cell or tissue functions with such low light that heating is negligible.

002.12 LICENSURE EXAMINATION. The National Board for Certification in Occupational Therapy (NBCOT) Examination administered by the Professional Examination Service.

002.13 NATIONAL ASSOCIATION. The American Occupational Therapy Association or equivalent organization.

002.14 OCCUPATIONAL THERAPIST REGISTERED. A person who is registered under guidelines established by the National Board for Certification in Occupational Therapy (NBCOT).

002.15 ONSITE. The location where the occupational therapy assistant is providing occupational therapy services.

002.16 ONSITE SUPERVISION. The occupational therapist or occupational therapy assistant must be physically present at the practice site to direct all actions when occupational therapy services are being provided.

002.17 SUPERVISION. The process by which the quantity and quality of work of an occupational therapy assistant is monitored. Supervision means the directing of the authorized activities of an occupational therapy assistant by a licensed occupational therapist and will not be construed to require the physical presence of the supervisor when carrying out assigned duties.

002.18 TREATMENT PLAN. A written statement setting forth the goals, method of treatment, and time frame for goal achievement.

003. LICENSURE REQUIREMENTS . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. §§ 38-2501, 38-2531, 172 NAC 10, and this chapter.

003.01 DOCUMENTATION. The following documentation must be provided to the Department.

003.01(A) EDUCATION. An official transcript, sent directly from the issuing institution, verifying successful completion of an educational program in occupational therapy for an occupational therapist or occupational therapy assistant.

003.01(B) EXAMINATION. Documentation of passing the licensure examination sent directly to the Department from the National Board of Certification in Occupational Therapy. An applicant who passed the examination more than 3 years prior to the date of application and who is not practicing at the time of application for licensure must provide documentation to the Department of obtaining 50 hours of continuing education within the 3 years immediately preceding the date of application. The 50 hours of continuing education must show 30 hours related to the clinical practice of occupational therapy and 20 hours related to the practice of occupational therapy.

003.01(C) FIELD EXPERIENCE. Provide documentation of successful completion of a supervised fieldwork experience for an occupational therapy or for an occupational therapy assistant.

003.01(D) OTHER PROOF OF COMPETENCY. An applicant who holds an occupational therapy license in another jurisdiction and who is not currently practicing must provide documentation to the Department of having obtained 50 hours of continuing education within the 3 years immediately preceding the date of application. The 50 hours of continuing education must show 30 hours related to the clinical practice of occupational therapy and 20 hours related to the practice of occupational therapy.

003.02 TEMPORARY LICENSE. A temporary license may be issued to an applicant who has submitted documentation of meeting the educational and experience requirements for licensure under this chapter, except passing or failing the licensure examination. A temporary license allows the applicant to practice only in association with a licensed occupational therapist and is valid until the date the results of the licensure examination are available to the Department. A temporary license can be extended if the licensee was unable to take the licensure examination and can provide proof of good cause. A temporary license may not be extended beyond 1 year or if the licensee has taken the licensure examination. Documentation showing good cause, includes but is not limited to:

(A) Military Service: An applicant who has served in the regular armed forces of the United States during part of the credentialing period immediately or is actively engaged in military service as defined in 172 NAC 114-002. The applicant must document their military service by submitting to the Department:

(i) Military identification proving that they are in active service;

(ii) Military orders; or

(iii) A letter from the licensee’s commanding officer indicating that they are on active duty;

(B) Illness: These circumstances may include proof that the credential holder was suffering from a serious or disabling illness or physical disability. The applicant must document their illness by submitting to the Department a statement from the treating physician stating that the individual was injured or ill, the duration of the illness or injury and of the recovery period; or

(C) Other circumstances: An applicant who suffered from circumstances beyond their control must submit documentation of the circumstances.

003.03 REQUIREMENTS FOR CERTIFICATION TO APPLY PHYSICAL AGENT MODALITIES. In order to apply physical agent modalities, a licensed occupational therapist or licensed occupational therapy assistant must be certified by the Department. Any person who wishes to administer the modalities must obtain certification under Neb. Rev. Stat. § 38-2530. Physical agent modalities may be used by occupational therapy practitioners when used as an adjunct to, or in preparation for purposeful activity to enhance occupational therapy performance. Occupational therapy practitioners must have documented evidence of possessing the theoretical background and technical skills for safe and competent use.

003.03(A) SUPERFICIAL THERMAL AGENT MODALITIES DOCUMENTATION. The following documentation must be provided to the Department.

003.03(A)(i) BOARD APPROVED TRAINING. Provide a transcript or certification showing successful completion of a minimum of 6 hours of Board approved training or its equivalent and passing an end-of-course written or computer-based examination approved by the Board which tests competency in the use of superficial thermal agent modalities. The training must include the following:

(1) Biophysical and bio-physiological changes which occur with cryotherapy;

(2) Indications, contraindications and precautions for the application of cold agents;

(3) Clinical reasoning involved in the application of cold agents;

(4) Commonly used types of cold agents;

(5) Application procedures for each cold modality;

(6) Definition of the term superficial thermal agent;

(7) Differentiation between the two commonly used methods of heat transfer: conduction and convection;

(8) The four biophysical effects of heat;

(9) The physiologic response to tissue secondary to temperature elevation;

(10) Differentiation between mild, moderate and vigorous dosages of heat;

(11) Indications, precautions, and contraindications that should be considered when using superficial thermal agents;

(12) Proper clinical applications for hot packs, paraffin bath, fluidotherapy, whirlpool, and contrast bath;

(13) Guidelines for educating the client and family in the purpose, benefits and potential risks of the modality; and

(14) Universal precautions, sterile techniques, infection control, and the use of modalities; or

003.03(A)(ii) HAND THERAPY CERTIFICATION. Provide documentation of being certified as a hand therapist by the Hand Therapy Certification Commission or other equivalent entity recognized by the Board. Any occupational therapist who bases their certificate on their hand therapist certification will receive certification for all 3 levels of physical agent modalities; or

003.03 (A)(iii) EXPERIENCE. Provide documentation showing a minimum of 5 years of experience in the use of the superficial thermal agent modalities and documentation of passing the Nebraska Physical Agent Modalities Testing Service Examination titled Superficial Thermal Agents Test sent directly to the Department; or

003.03(A)(iv) BASIC EDUCATIONAL PROGRAM. Submit an application provided by the Department as documentation of successfully completing education during a basic educational program which includes demonstration of competencies for application of the superficial thermal agent modalities.

003.03(B) DEEP THERMAL AGENT MODALITIES DOCUMENTATION. The following documentation must be provided to the Department.

003.03(B)(i) BOARD APPROVED TRAINING. Provide a transcript or certification showing successful completion of a minimum of 12 hours of Board approved training or its equivalent and passing an end-of-course written or computer-based examination and a practical examination approved by the Board which tests competency in the use of deep thermal agent modalities. The training must include the following:

(1) Theory and rationale for the application of therapeutic ultrasound;

(2) Differentiation between the parameters for therapeutic ultrasound;

(3) Current research trends in the utilization of ultrasound;

(4) Clinical decision making in the determination of the appropriate treatment parameters for ultrasound;

(5) Clinical procedures for the application of ultrasound;

(6) Safe use of ultrasound, contraindications and precautions for treatment; and

(7) Methods for maximizing therapeutic effect in the use of phonophoresis as a physical agent modality; or

003.03(B)(ii) HAND THERAPY CERTIFICATION. Provide documentation of being certified as a hand therapist by the Hand Therapy Certification Commission or other equivalent entity recognized by the Board. Any occupational therapist who bases their certificate on their hand therapist certification will receive certification for all 3 levels of physical agent modalities; or

003.03(B)(iii) EXPERIENCE. Provide documentation showing a minimum of 5 years of experience in the use of the deep thermal agent modalities and documentation of passing the Nebraska Physical Agent Modalities Testing Service Examination titled Deep Thermal Agents sent directly to the Department; or

003.03(B)(iv) BASIC EDUCATIONAL PROGRAM. Submit an application provided by the Department as documentation of successfully completing education during a basic educational program which includes demonstration of competencies for application of the deep thermal agent modalities.

003.03(C) ELECTROTHERAPEUTIC AGENT MODALITIES DOCUMENTATION. The following documentation must be provided to the Department.

003.03(C)(i) BOARD APPROVED TRAINING. Provide a transcript or certification showing successful completion of a minimum of 22 hours of Board approved training or its equivalent and passing an end-of-course written or computer-based examination and a practical examination approved by the Board which tests competency in the use of electrotherapeutic agent modalities. The training must include the following:

(1) Available parameters of electrical stimulation devices and the principles and concepts of electricity;

(2) Physiological effects of electrical stimulation;

(3) Therapeutic goals of electrical therapy;

(4) Physiological events associated with electrical stimulation;

(5) Distinguishing characteristic and indications and contraindications of electrical stimulation;

(6) Physiological effects of various parameters of electrical stimulation, such as voltage, type, dosage, or duty cycle;

(7) Therapeutic relationship of electrotherapy with other therapeutic procedures;

(8) Clinical application of electrical stimulation in rehabilitation;

(9) Clinical reasoning process used to determine selection of Neuromuscular Electrical Stimulation (NMES) and appropriate parameters;

(10) Parameters of therapeutic electrical currents;

(11) Bio physiological responses to electrical currents;

(12) Indications and contraindications for neuromuscular electrical stimulation use;

(13) Appropriate electrode placement for treatment protocols;

(14) Clinical applications for iontophoresis;

(15) Definition and differentiation of the clinical application of iontophoresis from phonophoresis;

(16) Bio physiology and mechanism related to transdermal delivery of medication;

(17) Common medications used in iontophoresis and their pharmacology;

(18) Clinical decision making regarding iontophoresis, indications and precautions;

(19) The processes in pharmacokinetics: absorption, distribution, and metabolism;

(20) The processes of pharmacodynamics as it pertains to routine drugs used in phonophoresis and iontophoresis;

(21) Effects of physical agents, exercise, and manual techniques on pharmacokinetics;

(22) The aging process as it relates to pharmacokinetics; and

(23) Other nationally recognized commercially available technologies; or

003.03(C)(ii) HAND THERAPY CERTIFICATION. Provide documentation of being certified as a hand therapist by the Hand Therapy Certification Commission or other equivalent entity recognized by the Board. Any occupational therapist who bases their certificate on their hand therapist certification will receive certification for all 3 levels of physical agent modalities; or

003.03(C)(iii) EXPERIENCE. Provide documentation showing a minimum of 5 years of experience in the use of the electrotherapeutic agent modalities and documentation of passing the Nebraska Physical Agent Modalities Testing Service Examination titled Electrotherapeutic Agents Test sent directly to the Department; or

003.03(C)(iv) BASIC EDUCATION PROGRAM. Submit an application provided by the Department as documentation of successfully completing education during a basic educational program which includes demonstration of competencies for application of the electrotherapeutic agent modalities.

004. APPROVAL OF PHYSICAL AGENT MODALITY COURSES . To have a physical agent modality training course approved by the Board, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the training course meets the requirements of Neb. Rev. Stat. § 38-2530 and this chapter.

004.01 ACCESS. Approved courses must be open to all licensees.

004.02 AUDIT ACCESS. Providers must allow employees of the Department or its designees, to audit classroom course instruction, course materials, instructors’ presentations, course records, and records of examination, attendance rosters and other aspects of instruction. These auditors must not be hindered, obstructed, delayed, prevented or interfered with while conducting or attempting to conduct an audit. Audits will be conducted with a minimum of disruptions. Providers agree that auditors may attend any Board-approved course offered for the purpose of the audit without paying any fee. Providers must grant the Department or its designees the right to audit records at the premises of the provider or at the physical location of the records.

004.03 RECORD KEEPING. Providers must keep all records of attendance, records of examination, course records and requests for duplicate course completion certificates on file for 5 years. These records must be available to the Department upon request.

004.04 REAPPLICATION. Once approved, a course may not be substantially altered without a new application being submitted to the Board. A substantial alteration is any change that would modify the content or time allocations would change any of the course topics or a change in instructors. If there is a change in instructors, the provider must request approval of the instructor by submitting a curriculum vitae for the new instructor. The Board will evaluate the curriculum vitae and reaffirm or deny the physical agent modality course approval.

004.05 ADVERTISEMENT. A course may not be advertised or otherwise promoted as appropriate for Nebraska physical agent modality certification until the course has been approved by the Board. Advertising a course as being offered for physical agent modality certification before approval of the course is grounds for disqualification of the course.

004.06 APPROVAL REVOCATION. The approval of a physical agent modality course will be revoked if a provider of the course is found to have issued a certificate of course completion to an individual who did not complete the course.

005. REQUIREMENTS FOR CONSULTING WITH OR SUPERVISING AN OCCUPATIONAL THERAPY ASSISTANT . An occupational therapy assistant may assist in the practice of occupational therapy under the supervision of or in consultation with an occupational therapist.

005.01 STANDARDS. An occupational therapist that is supervising or consulting with an occupational therapy assistant must meet the following standards:

(A) Evaluate each patient prior to treatment by the occupational therapy assistant;

(B) Develop a treatment plan outlining which elements have been delegated to the occupational therapy assistant;

(D) Approve any change in the occupational therapy treatment plan;

(E) Ensure that the occupational therapy assistant is assigned only to duties and responsibilities for which he or she has been specifically trained and is qualified to perform;

(F) Review all documentation written by the occupational therapy assistant;

(G) Interpret the results of tests which are administered by the occupational therapy assistant; and

(H) Evaluate the treatment plan and determine termination of treatment.

005.02 REQUIREMENTS. An occupational therapist supervising an occupational therapy assistant must meet the following requirements:

(A) A minimum of 4 hours per month of on-site supervision if an occupational therapy assistant has more than 1 year satisfactory work experience as an occupational therapy assistant; or

(B) A minimum of 8 hours per month of on-site supervision if an occupational therapy assistant has less than 1 year satisfactory work experience as an occupational therapy assistant.

006. SUPERVISION OF AIDES IN OCCUPATIONAL THERAPY . An aide, as used in occupational therapy practice, is an individual who provides supportive services to the occupational therapist and the occupational therapy assistant. Aides are not primary service providers of occupational therapy in any practice setting. Aides do not provide skilled occupational therapy services. An aide is trained by an occupational therapist or an occupational therapy assistant to perform specifically delegated tasks. The occupational therapist is responsible for the overall use and actions of the aide. An aide first must demonstrate competency to be able to perform the assigned, delegated client and non-client-related tasks.

(A) The occupational therapist must oversee the development, documentation, and implementation of a plan to supervise and routinely assess the ability of the occupational therapy aide to carry out client and non-client-related tasks. The occupational therapy assistant may contribute to the development and documentation of this plan.

(B) The occupational therapy assistant may supervise the aide.

(D) Client-related tasks are routine tasks during which the aide may interact with the client but does not act as a primary service provider of occupational therapy services. Onsite supervision of an aide is required by an occupational therapist or an occupational therapy assistant when an aide is performing all client-related tasks. Onsite supervision of an aide means that the occupational therapist or occupational therapy assistant must be physically present at the practice site to direct all actions when occupational therapy services are being provided.

006.01 DELEGATION FACTORS. The following factors must be present when an occupational therapist or occupational therapy assistant delegates a selected client-related task to the aide:

(A) The outcome anticipated for the delegated task is predictable;

(B) The situation of the client and the environment is stable and will not require that judgment, interpretations, or adaptations be made by the aide;

(D) The task routine and process have been clearly established.

006.02 TRAINING REQUIREMENTS. When performing delegated client-related tasks, the supervisor must ensure that the aide:

(A) Is trained and able to demonstrate competency in carrying out the selected task and using equipment, if appropriate;

(B) Has been instructed on how to specifically carry out the delegated task with the specific client; and

(C) Knows the precautions, signs, and symptoms for the particular client that would indicate the need to seek assistance from the occupational therapist or occupational therapy assistant.

006.03 REQUIRED DOCUMENTATION. The supervision of the aide must be documented and include:

(A) Information about frequency and methods of supervision used;

(B) The content of the supervision; and

006.04 PROHIBITED TASKS. An occupational therapy aide may not perform evaluation, reevaluation, treatment planning or establish treatment goals.

007. RENEWAL WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in Neb. Rev. Stat. § 38-2521 and 172 NAC 10. All occupational therapist and occupational therapy assistant licenses expire on August 1st of each even-numbered year.

008. CONTINUING EDUCATION . On or before August 1st of each even-numbered year, individuals holding an active license in the State of Nebraska must complete at least 20 hours of acceptable continuing education if an occupational therapist and 15 hours of acceptable continuing education if an occupational therapy assistant. Continuing education hours must be obtained during the preceding 24-month period.

008.01 CONTINUING EDUCATION HOUR CALCULATIONS. The following provides the hour calculations for acceptable continuing education.

008.01(A) PROGRAMS AT STATE AND NATIONAL ASSOCIATION MEETINGS. Includes, but is not limited to, a meeting of the Nebraska or other state occupational therapy associations or the American Occupational Therapy Association. Must relate directly to the theory of Occupational Therapy. Documentation must include a certificate of attendance and a program outline or objectives. One hour for each hour of attendance.

008.01(B) WORKSHOPS, SEMINARS, WEBINARS AND CONFERENCES. The content of the continuing education activity must relate to occupational therapy whether the subject is research, treatment, documentation, or education management, and includes monitored videotapes, and in-service programs. Documentation must include a certificate of attendance and a program outline or objectives. One hour for each hour of attendance.

008.01(C) UNIVERSITY OR COLLEGE SPONSORED COURSES. The content of the course must relate to occupational therapy whether the subject is research, treatment, documentation, education, or management. Documentation must include an official transcript and a program outline or objectives.

008.01(D) FORMAL SELF-STUDY. The content of the self-study activity must relate to occupational therapy whether the subject is research, treatment, documentation, education, or management. The self-study program must have a testing mechanism. Documentation must include a certificate of completion and a program outline or objectives. One hour for each hour of attendance.

008.01(E) MANAGEMENT COURSES. Must pertain to the practice of occupational therapy. An occupational therapist may complete a maximum of 10 hours of continuing education utilizing management courses each 24-month renewal period. An occupational therapy assistant may complete a maximum of 7.5 hours of continuing education utilizing management courses each 24-month renewal period. Documentation must include a certificate of attendance and a program outline or objectives. One hour for each hour of attendance.

008.01(F) SUPERVISION. Student supervision by an occupational therapist or occupational therapy assistant. One contact hour is earned for being a primary direct clinical supervisor for each student’s entire level II fieldwork experience. Licensee may receive a maximum of 2 contact hours of continuing education by supervising a student each 24-month renewal period. Documentation must include a copy of the signature page of the completed fieldwork evaluation form for each supervised student.

008.01(G) RESEARCH. Participation in research or other scholarly activities that result in professional publication or acceptance for publication that relate to occupational therapy. Four contact hours will be received for each publication. Licensees may earn up to a maximum of 10 contact hours of continuing education each 24-month renewal period for authorship, editorship, co-authorship, co-editorship, or all of these, of a juried publication relating to occupational therapy. Documentation must include a copy of the final publication or verification of publication.

008.01(H) INFORMAL SELF-STUDY. A licensee may earn up to a maximum of 2 contact hours of continuing education each 24-month renewal period for completion of the following activities or a combination of such activities:

(1) Reading related to occupational therapy practice;

(2) Observing other occupational therapists;

(3) Viewing videotapes without a supervisor; and

(4) Quality assurance or peer review studies.

008.01(H)(i) DOCUMENTATION. Documentation when reading or viewing videotapes must include the name of the article, book or videotape and a brief synopsis of what was learned. Documentation, when observing other therapists and participating in quality assurance and peer review studies, must include a statement from the licensee explaining what was learned.

008.01(I) NATIONALLY RECOGNIZED SPECIALTY CERTIFICATION EXAMINATIONS. A licensee will earn 20 contact hours of continuing education each 24-month renewal period for successful completion of a nationally recognized specialty certification examination related to an area of advanced practice in the field of occupational therapy. Documentation must include a copy of the certification.

008.01(J) PRESENTATIONS. One hour credit will be awarded for each hour of scientific presentation by a licensee at workshops, seminars, in-service training, conferences, or guest lectures which relate to the practice of occupational therapy. A licensee may receive continuing education credit for only the initial presentation during a renewal period. Credit will not be given for subsequent presentations of the same program. A licensee may complete a maximum of 4 hours of continuing education credit for presentations in a 24-month renewal period. A licensee’s documentation must include the presentation outline, course objectives, date, location, time, and type of audience.

008.01(K) NON-ACCEPTABLE CONTINUING EDUCATION. Continuing education credit will not be awarded for programs where the content does not relate to occupational therapy whether the subject is research, treatment, documentation, education, or management, including but not limited to:

(i) Medical terminology courses;

(ii) Occupational therapy on-the-job training;

(iii) Occupational therapy orientation programs, including orientation to new policies, procedures, equipment, forms, responsibilities, services, etc.; or

(iv) Cardiopulmonary resuscitation or other related training.

009. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179 and this chapter and includes:

009.01 REPRESENTATION. Failing to accurately represent the licensee’s skills to a patient or client;

009.02 DELEGATION. Delegating to other personnel those patient or client related services when the clinical skills and expertise of an occupational therapist is required;

009.03 PROVIDE SERVICES. Declining to provide occupational therapy services that have been requested when such services are believed to be contraindicated or unjustified;

009.04 SAFETY. Committing any act which endangers patient or client safety or welfare;

009.05 POLICIES AND PROCEDURES. Failing to follow policies or procedures implemented in the practice situation to safeguard patient care;

009.06 PATIENT DIGNITY. Failing to safeguard the patient's dignity and right to privacy; violating the confidentiality of information or knowledge concerning the patient;

009.07 RECORDS. Failing to accurately record and report information or falsification or unauthorized destruction of patient records;

009.08 SUPPLIES. Misappropriating supplies or personal items of a patient or client or agency;

009.09 SUPERVISION. Failing to exercise appropriate supervision over persons who are authorized to practice only under the supervision of the licensed professional;

009.10 ABUSE. Verbally or physically abusing patients;

009.11 SEXUAL RELATIONSHIP. Engaging in sexual relationships, whether consensual or nonconsensual, with any patient while a physical therapist or physical therapist assistant -patient relationship exists.

009.12 SEXUAL HARASSMENT. Engaging in sexual harassment of patients. Sexual harassment includes making unwelcome sexual advances, requesting sexual favors, and engaging in other verbal or physical conduct of a sexual nature as a condition of: The provision or denial of occupational therapy to a patient; or

(A) For the purpose or effect of creating an intimidating, hostile, or offensive environment for the patient or unreasonably interfering with a patient's ability to recover.

009.13 COMPETENCE. Providing services for which they are not trained or experienced.

009.14 PRACTICE. Practicing the profession of occupational therapy while the license, certificate or registration is suspended or is guilty of practicing such profession while their license to do so is suspended or is guilty of practicing such profession while violating any limitation placed upon their license, certificate, or registration; or

009.15 COMPLY WITH DEPARTMENT INVESTIGATION. Failure of an applicant or credential holder who is the subject of a pre-licensure or disciplinary investigation to furnish the Board, the Department, or its investigator with requested information or requested documents.

010. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

011. FEES . Fees are set out in 172 NAC 2.

History

Effective 2020-06-20

Chapter 120 Licensure of Optometrists

Neb. Admin. Code tit. 172, ch. 120 Licensure of Optometrists {#sec-172-nac-120 omnilex-key=us-ne-regs-official--title-172--172 NAC 120}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of optometrists under the Optometry Practice Act, Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-2601 to 38-2623 and the Uniform Credentialing Act (UCA).

002. DEFINITIONS . Definitions are set out in the Optometry Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 ACCREDITED SCHOOL OR COLLEGE OF OPTOMETRY. A school or college which is accredited by a regional or professional accrediting organization that is recognized by the Council of Postsecondary Accreditation of the United States Department of Education and is approved by the Board of Optometry.

002.02 APPROVED EXAMINATION. An examination which is approved by the Board of Optometry.

002.03 CLINICAL TRAINING. Training of an applicant for certification to use pharmaceutical agents for diagnostic purposes or for diagnostic and therapeutic purposes offered by a school or college approved by the Department.

002.04 CONTINUING EDUCATION. The offering of instruction or information to licensees for the purpose of maintaining skills necessary to the safe and competent practice of optometry. The continuing education may be offered under such names as "scientific school", "clinic", "forum", "lecture", "course of study" or "educational seminar". In order for continuing education to be recognized for licensure renewal, it must be approved by the Board of Optometry.

002.05 COURSE OF STUDY. A program of instruction necessary to obtain a credential meeting the requirements set out for each profession in the appropriate practice act and rules and regulations and includes a college, a professional school, a vocational school, hours of training, or a program of instruction with a similar designation.

002.06 DIRECT SUPERVISION. Direct supervision is the physical presence and immediate availability of the optometrist.

002.07 DRUG UTILIZATION REVIEW (DUR). An authorized, structured, ongoing program that collects, analyzes, and interprets drug use patterns to improve the quality of pharmacotherapy and patient outcomes.

002.08 HOUR. A period of 50 minutes of formal instruction, otherwise known as a "contact hour."

002.09 LABEL. All legible written information provided by the optometrist to the patient that is affixed to the packaging provided to the patient.

002.10 MEDICATED CONTACT LENSES. Contact lenses containing an ocular pharmaceutical agent.

002.11 PACKAGING. The container provided by an optometrist to the patient.

002.12 PRACTICE MANAGEMENT. The study of management of the business affairs of optometric practice. This includes the concepts of managed care and operations management, courses designed to help market practices, to educate office staff, to improve billing efficiency and coding skills, to improve clinical recordkeeping and to enhance fiscal efficiency. This does not include courses that are intended for personal enhancement or investment prowess.

002.13 PRESCRIPTION FILE. A file of drugs, devices, or medicated contact lens prescriptions dispensed that is separate and distinct from the patient record, and that require a dispensing practitioner license.

002.14 PRESCRIPTION LABEL. A label that provides the patient all of the information required by section 009. The information required of a prescription label may be found either on a writing affixed to the packaging by the optometrist, or on the packaging (e.g., manufacturer's container), or a combination or the packaging and a writing affixed to the packaging.

002.15 RECORD. Information that is inscribed on a tangible medium or that is stored in an electronic or other medium and is retrievable in perceivable form. Record includes a hard copy and record includes an "electronic medical record" (EMR).

002.16 RECORDKEEPING. Creating, maintaining, and securing records necessary for drug utilization review and prescription files.

002.17 STORAGE. Securing and preserving drug, device, or biological in accordance with the requirements of federal laws, such as Food and Drug Administration label specifications and the requirements of Nebraska's laws and this chapter.

002.18. SUPERVISION. Supervision is the availability of an optometrist on the premises or by telecommunications.

003. INITIAL CREDENTIAL . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the individual meets the requirements of Neb. Rev. Stat. §§ 38-2608, 38-131, 172 NAC 10, and this chapter.

003.01 LICENSURE BY EXAMINATION. Individuals applying for licensure by examination must:

(A) Request that an official transcript from an accredited school or college of optometry which shows the date the degree was conferred be sent directly to the Department by the issuing institution;

(B) Request that a detailed score report showing successful passage of Part I, Part II and Part III of the examination given by the National Board of Examiners in Optometry

(NBEO) be sent directly to the Department by the issuing institution; and

(C) Pass a jurisprudence examination that relates to the statutes and regulations that govern optometry with a minimum score of 60 or above.

003.02 LICENSURE BASED ON LICENSURE IN ANOTHER STATE. Individuals applying for licensure based on licensure in another state must:

(A) Request that an official transcript from an accredited school or college of Optometry which shows the date the degree was conferred be sent directly to the Department by the issuing institution;

(B) Have been actively engaged in the practice of optometry in another jurisdiction for at least two of the last three years, and be credentialed in that jurisdiction at the highest level available and is equivalent to the current scope of practice in Nebraska as determined by the board; and

(C) Pass a jurisprudence examination that relates to the statutes and regulations that govern optometry with a minimum score of 60 or above.

003.03 RECIPROCITY. To obtain a license based on reciprocity, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of § 38-129.02, 172 NAC 10, and this chapter. Applicants must provide documentation of the following:

(A) Possession of a current and valid credential as a (license type), for at least one year in another state, a territory of the United States, or the District of Columbia;

(B) The education required to obtain the credential;

(C) The minimum work experience and clinical supervision requirements, if any, required for the credential and the applicant’s completion of the experience and clinical supervision;

(D) Passage of an examination for the credential, if required to obtain the credential in the other jurisdiction;

003.04 RESIDENCY. All applicants receiving a license pursuant to 172 NAC 120-003.03 must submit documentation of establishing residency in Nebraska as required by Neb. Rev. Stat. § 38-129.02. Such documentation must be submitted within 30 days of establishment of residency and consist of a rental or lease agreement with the signature of the owner or landlord and the applicant, a deed or title to residential real property with the name of the applicant as an owner, or documents with the name and address of the applicant such as mortgage bills, home utility bills, medical or employee documents or similar documents that show the applicant residing in Nebraska.

004. RENEWAL, WAIVER OF CONTINUING EDUCATION AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10. All optometrist licenses expire on August 1 of each even-numbered year.

005. CONTINUING COMPETENCY . During the 24 months prior to the license renewal date, each licensed optometrist must complete 44 hours of approved continuing education. Each credentialed individual is responsible for maintaining certificates or records of continuing competency activities. Subject matter acceptable for continuing education credit is described as follows.

005.01 STATE AND NATIONAL MEETINGS. For attendance at state and national meetings, such as meetings of the Nebraska Optometric Association or the American Optometric Association, licensees may earn credit for only the portion of the meeting which meets the definition of continuing education can be accepted for credit.

005.02 FORMAL EDUCATION. For attendance at formal education courses which relate directly to the practice of optometry, licensees may earn credit for each hour of attendance.

005.03 OPTOMETRIC COLLEGE-SPONSORED COURSES. For attendance at optometric college-sponsored courses in continuing education in optometry, licensees may earn credit for each hour of attendance.

005.04 HOME STUDY. For completion of home study continuing education with a testing mechanism, licensees may earn credit with a maximum of 8 hours of continuing education by home study during the 24-month renewal period. If there is not a testing mechanism or certificate of completion, the licensee must submit an abstract or summary of the material covered to the Board. Such abstract or summary must be written by only the licensee and will be reviewed by members of the Board.

005.04(A) EXAMPLES OF HOME STUDY. Examples of home study courses include, but are not limited to, professional journal articles, profession related Internet courses, online web courses, or other digital media. For purposes of this section web based meetings that are live and interactive count as live in person continuing education and do not count towards the home study limits.

005.05 CARDIOPULMONARY RESUSCITATION (CPR). For completion of initial CPR certification or for the re-certification, licensees may earn 1 hour credit for each hour of training, with a maximum of 2 credit hours of this type of continuing education during the 24-month renewal period.

005.06 PRACTICE MANAGEMENT. For attendance at practice management courses, licensees may earn 1 credit hour for each hour of practice management, with a maximum of 4 credit hours of this type of continuing education during the 24-month renewal period.

005.07 UNACCEPTABLE SUBJECT MATTER. Examples of unacceptable subject matter include, but are not limited to, education provided by a business entity for the purpose of promotion of their products or services.

006. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179, and this chapter:

(A) Making a false or misleading statement regarding his or her skill as an optometrist or the efficacy or value of the medicine, device, treatment, or remedy prescribed by him or her or used at his or her direction in the practice of optometry;

(B) Prescribing, selling, administering, or distributing, any drug legally classified as a prescription drug, other than with proper certification;

(C) Knowingly giving to an addict any drug legally classified as a controlled substance or recognized as an addictive or dangerous drug;

(D) Failure to furnish the Department, its investigators or representatives, information requested by the Department;

(E) To advertise in a manner that deceives, misleads, or defrauds the public. The following advertising practices will be considered to be deceptive:

(i) To advertise or promote any optometric service as free or below the advertiser's or promoter's own cost without revealing in the advertising or promotion the minimum expenditure the consumer must incur in order to receive the service. If the consumer need not incur any expense to obtain the service, then the advertising or promotion must state that there is no minimum purchase required;

(ii) To fail to advertise the names of all licensed optometrists who are providing optometric service who are addressed by the advertisement; and

(iii) To advertise or promote any optometric service with statements that cannot be verified, substantiated or measured;

(F) Failure of a licensed optometrist who administers or prescribes pharmaceutical agents for examination or for treatment to provide the same standard of care to patients as that provided by a physician licensed in this state to practice medicine and surgery utilizing the same pharmaceutical agents for examination or treatment;

(G) Any departure from or failure to conform to the ethics of the optometric profession, which ethics are found in the American Optometric Association’s An Optometrist’s Guide to Clinical Ethics;

(H) Misrepresenting one’s credentials in an application submitted to a healthcare facility, insurance company, or prospective employer;

(I) Providing treatment or consultation recommendations via electronic or other means, including issuing a prescription, unless the optometrist has obtained a history and evaluation of the patient adequate to establish diagnosis and identify underlying conditions and contraindications to the treatment recommended or provided and that arrangements exist to insure availability of the optometrist or optometrist coverage for follow-up patient care.

007. CERTIFICATION TO USE PHARMACEUTICAL AGENTS . In order to use pharmaceutical agents for diagnostic or therapeutic purposes, a licensee must be certified by the Department. The criteria for issuance of certification to use pharmaceutical agents for diagnostic or therapeutic purposes and the documentation required by the Department and the Board are set forth below.

007.01 CERTIFICATION TO USE PHARMACEUTICAL AGENTS FOR DIAGNOSTIC PURPOSES. Applicants for certification to use pharmaceutical agents for diagnostic purposes must submit a completed application provided by the Department, have a current Nebraska license to practice optometry, and meet the following:

(A) Satisfactorily complete an approved course in pharmacology provided by an accredited school or college of optometry;

(i) An approved course in pharmacology for a certification to use pharmaceutical agents for diagnostic purposes must meet the following criteria:

(1) Include a study of ocular anesthetics, mydriatics, cycloplegics, ocular toxicity of pharmaceutical agents, ocular allergies of ocular agents, and pharmacologic effects of ocular drug substances;

(2) Include the consideration of the mechanism of action of anesthetics, cycloplegics, and mydriatics in human beings and the uses of the substances in the diagnosis of occurring ocular disorders; and

(3) Correlate the utilization of pharmaceutical agents and optical instrumentation and procedures; and

(B) Meet one of the following:

(i) Pass an approved examination which covers ocular pharmacology for the use of pharmaceutical agents for diagnostic purposes pursuant to 172 NAC 120 administered by the National Board of Examiners in Optometry (NBEO) with a passing score;

(ii) Pass an examination which covers ocular pharmacology pursuant to 172 NAC-120 administered by an accredited school or college of optometry with a passing score; or

(iii) Be credentialed in another U.S. jurisdiction at the highest level required for optometrist licensure in the U.S. jurisdiction where the applicant is currently licensed and such level is determined by the Board to be at least equivalent to the current scope of practice in Nebraska; and

(i) An official transcript sent to the Department directly from an accredited school or college of optometry showing successful completion of the course of study for use of pharmaceutical agents for diagnostic purposes completed by the applicant which meets the requirements of this chapter;

(ii) A detailed score report showing the passing the approved examination; or

(iii) Certification of having a credentialed in another U.S. jurisdiction at the highest level required to practice optometry in the U.S. jurisdiction where the applicant is currently credentialed; and

(iv) The required certification fee.

007.02 CERTIFICATION TO USE PHARMACEUTICAL AGENTS FOR THERAPEUTIC PURPOSES. Applicants for certification to use pharmaceutical agents for therapeutic purposes must submit a completed application provided by the Department, have a current Nebraska license to practice optometry, and meet the following:

(A) Have been certified by the Department upon the recommendation of the Board to use pharmaceutical agents for diagnostic purposes and meet the following criteria:

(i) Satisfactorily complete the following educational requirements:

(1) Classroom didactic education concerning the use of pharmaceutical agents for therapeutic purposes provided by an accredited school or college of optometry; and

(2) Clinical training as it applies to optometry with particular emphasis on the examination, diagnosis and treatment of the eye, ocular adnexa, and visual system provided by an accredited school or college of optometry that includes, but is not limited to, case histories, diagnosis, treatment and management regimens, special instrumentation and grand rounds; and

(ii) Meet one of the following:

(1) Pass an approved examination which covers the treatment and management of ocular disease administered by the NBEO with a passing score; or

(2) Pass Part II of the examination administered by the NBEO after 1992 with a passing score; or

(3) Pass an examination that is approved by the Board as equivalent to the examination given by the NBEO; or

(4) Be credentialed in another U.S. jurisdiction at the highest level required for optometrist licensure in the U.S. jurisdiction where the applicant is currently licensed and such level is determined by the Board to be at least equivalent to the current scope of practice in Nebraska; and

(iii) Submit to the Department:

(1) An official transcript sent directly to the Department from an accredited school or college of optometry of successful completion of the didactic education and clinical training completed by the applicant; and

(2) A detailed score report showing successful passage of the approved examination;

(3) Certification of having a credential at the highest level required to practice optometry in the U.S. jurisdiction where the applicant is currently credentialed sent to the Department from that U.S. jurisdiction; and

(4) The required fee.

008. PRESCRIBING AND APPLICATION OF CONTACT LENSES . Optometrists and persons licensed to practice medicine and surgery are authorized to prescribe and apply and fit contact lenses as set out in Neb. Rev. Stat. §§ 38-2601 and 38-2607. Each contact lens prescription is valid for the duration of the prescription as indicated by the optometrist or physician or for a period of twelve months from the date of issuance, whichever period expires first. Merchants or dealers may sell contact lenses from a prescription but are not authorized to prescribe, apply or fit the lenses. The prescribing and application or fitting of contact lenses includes, but is not limited to, the following:

(A) Assessment of the eyes to assure their suitability for contact lens wear;

(B) Evaluation and measurement of the physical characteristics of the eye and lid;

(D) Determination of a preliminary contact lens prescription including all the parameters needed to describe the lens so that it can be correctly provided to the patient and can be precisely duplicated in the future. These parameters can include lens material, power, base curve, overall diameter, color, manufacturer, series, optical zone, peripheral curve radii, widths and blends and edge treatment;

(E) Patient instruction in care and usage of the lenses;

(F) Monitoring of the patient during adaptation to contact lens wear; and

(G) Determination of the final contact lens prescription.

009. DISPENSING MEDICATED CONTACT LENSES . Prior to dispensing a contact lens containing a pharmaceutical agent, the optometrist must assure that a legible prescription label is affixed to the container. Such prescription label shall contain the following information:

(A) Name, address, and telephone number of the doctor’s office;

(B) Serial number of the prescription;

(D) Strength of the pharmaceutical agent contained in the contact lens, if applicable;

(E) Directions for use;

(F) Quantity of contact lens containing a pharmaceutical agent in the container;

(G) Any cautionary statements contained in the prescription;

(H) Name of the patient;

(I) Name of the prescriber; and

(J) Dosage form of the pharmaceutical agent.

009.01 STORAGE OF CONTACT LENSES WITH A PHARMACEUTICAL AGENT. The optometrist shall provide equipment for the storage of contact lenses containing a pharmaceutical agent in a manner that meets the manufacturer’s labeled requirements or in the absence of manufacturer’s requirements in accordance with those listed in this chapter.

(A) Those requiring a freezer must be stored between -4 and +14 degrees Fahrenheit;

(B) Those requiring refrigeration must be stored between 36 and 46 degrees Fahrenheit;

(C) Those requiring storage in a cool place must be stored between 46 and 59 degrees Fahrenheit, or under refrigeration, between 36 and 46 degrees Fahrenheit, unless otherwise specified; and

(i) For drugs, devices, or biologicals requiring a storage temp under -4 degrees Fahrenheit the temperature of the storage location must be within plus or minus 10 degrees;

(D) Those requiring storage at controlled room temperature must be stored between 59 and 86 degrees Fahrenheit;

(E) Other labeled storage instruction for contact lenses containing a pharmaceutical agent must be followed; and

(F) Contact lenses containing a pharmaceutical agent stored in refrigerator must be kept in a compartment separate from staff food or beverages.

010. RECORDKEEPING AND INVENTORY . Drugs and devices including medicated contact lenses inventories which require a dispensing practitioner license must meet recordkeeping requirements as set out in this chapter.

010.01 INVENTORY. The prescription inventory and prescription records must be maintained in a secure location when there is no optometrist on the premises. Loss of prescription inventory or prescription records due to theft or any other cause resulting from failure to secure the inventory or records are grounds for disciplinary action.

010.02 INVENTORY SECURITY. The optometrist must not have in his or her dispensable inventory any contact lenses containing a pharmaceutical agent which are misbranded or adulterated.

010.03 DRUG UTILIZATION REVIEW (DUR). The prescribing optometrist shall choose and implement a systematic approach for DUR. The DUR is part of the optometrist's record keeping duties.

010.04 MEDICATED CONTACT LENSES. The prescribing optometrist shall make notation of the prescription for medicated contact lenses in the patient record which is a part of the optometrist's record keeping duties.

010.05 MEDICATED CONTACT LENS PRESCRIPTIONS. A prescription for medicated contact lenses shall contain the following information:

(A) Patient’s name;

(B) Date of the order;

(D) Strength of the pharmaceutical agent contained in the contact lens, if applicable,

(E) Directions for administration to the patient, including the dose to be given, and the number of authorized refills; and

(F) Prescriber’s name.

010.06 PRESCRIPTION FILE. The dispensing optometrist's record keeping duties include a prescription file. The prescription file as defined in 002 shall contain the original record of all dispensed prescriptions which must:

(A) Be filed, in numeric order, in a file system that excludes, as per statute, any prescription filled for Schedule II-V controlled substances or other prescription drug product that are not within Nebraska scope of practice to be dispensed in the optometrists office;

(B) Include the following information:

(i) All information required for prescriptions as set forth in 013.03(C);

(ii) Prescription serial number;

(iii) Date of initial filling;

(iv) Quantity dispensed; and

010.07 PATIENT CONSULTATION. The prescribing optometrist who also is dispensing the contact lens containing a pharmaceutical agent shall take steps to insure adequate doctor-patient consultation on drug utilization instructions related to medicated contact lenses. The optometrist shall make a verbal offer to counsel to the patient or to counsel the patient’s caregiver. Patient counseling shall occur, unless one of the following is documented:

(A) The contact lens containing a pharmaceutical agent is being administered by a health care professional credentialed by the Department to a resident of a hospital or a long term care facility;

(B) Patient or caregiver refuses to be counseled; or

011. DELEGATION TO OPTOMETRIC ASSISTANTS . Under Neb. Rev. Stat. §§ 38-2607 and 38-2618, any licensed optometrist may employ optometric assistants and may delegate the performance of certain duties to optometric assistants under supervision. A licensed optometrist who chooses to delegate duties to optometric assistants must:

(A) Ensure that optometric assistants have received the appropriate level of training necessary to satisfactorily complete the delegated duties;

(B) Conduct the qualitative assessment of the data collected by the optometric assistant and make any appropriate diagnosis;

(C) Accept legal responsibility and liability for the accuracy of the results, as well as any consequences of the testing procedure; and

(D) Authenticate and direct, by full signature, the entire examination and treatment provided to the patient.

011.01 AUTHORIZED DUTIES. Optometric assistants, under the supervision or direct supervision of a licensed optometrist, may perform the following duties:

011.01(A) UNDER SUPERVISION. These services can be done under supervision of a licensed optometrist:

(i) Gather clinical information, which includes subjective and objective data (example – initial refraction and visual field testing); and

(ii) Provide educational information as instructed by the supervising optometrist.

011.01(B) UNDER DIRECT SUPERVISION. These services can be done under direct supervision of a licensed optometrist:

(i) Perform Goldmann contact tonometry; and

(ii) Instill medication as instructed by the supervising optometrist.

Each optometric assistant involved in the data collection must sign the chart indicating their participation.

011.02 PROHIBITED DUTIES. A licensed optometrist may not delegate the following:

(A) Ophthalmoscopy;

(B) Gonioscopy;

(D) Final refraction;

(E) Final nervous system assessment;

(F) Determination of any prescription, education or treatment plans;

(G) Removal of superficial eyelid, conjunctival, and corneal foreign bodies; and

(H) Ordering procedures and laboratory tests rational to the diagnosis of conditions or diseases of the human eye, ocular adnexa, or visual system.

012. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

013. FEES . Fees are set out in 172 NAC 2.

History

Effective 2022-03-21

Chapter 128 Practice of Pharmacy and Credentialing of Pharmacy Personnel

Neb. Admin. Code tit. 172, ch. 128 Practice of Pharmacy and Credentialing of Pharmacy Personnel {#sec-172-nac-128 omnilex-key=us-ne-regs-official--title-172--172 NAC 128}

001. SCOPE AND AUTHORITY . These regulations govern the credentialing of pharmacists, pharmacist interns, pharmacy technicians, and the practice of pharmacy under the Pharmacy Practice Act, Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-2801 to 38-28,116; the Uniform Controlled Substances Act, Neb. Rev. Stat. §§ 28-401 to 28-456.01; 28-458 to 28-475; and the Uniform Credentialing Act (UCA), Neb. Rev. Stat. §§ 38-101 to 38-1,145.

002. DEFINITIONS . Definitions set out in the Pharmacy Practice Act, the Uniform Controlled Substances Act, the Uniform Credentialing Act, and 172 Nebraska Administrative Code (NAC) 10 apply to this chapter.

003. CREDENTIALING REQUIREMENTS . To obtain a credential, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the statutory requirements, the requirements in 172 NAC 10, and the requirements in this chapter.

003.01 PHARMACIST LICENSURE. To obtain a pharmacist license an applicant must meet the requirements of Neb. Rev. Stat. § 38-2851 and this chapter.

003.01(A) EDUCATION. Applicants must have sent to the Department directly from the issuing organization an official transcript showing graduation from an accredited pharmacy program; or the Foreign Pharmacy Graduate Examination Committee (FPGEC) Certification given by the National Association of Boards of Pharmacy (NABP).

003.01(B) EXAMINATION. Applicants must have sent to the Department directly from the issuing organization a detailed score report showing successful completion of the following:

(i) Pass the North American Pharmacist Licensure Examination (NAPLEX) or its predecessor exam given by the National Association of Boards of Pharmacy (NABP) with a score of 75 or above; and

(ii) Pass the Multistate Pharmacy Jurisprudence Examination (MPJE) for Nebraska given by National Association of Boards of Pharmacy (NABP) with a score of 75 or above.

003.01(C) ADDITIONAL REQUIREMENTS. Applicants must submit to the Department proof of having met one of the following requirements to demonstrate his or her current competency if the applicant has not within the last three years passed the North American Pharmacist Licensure Examination (NAPLEX):

(i) Has been licensed and in the active practice of the profession of pharmacy in another state, territory, or the District of Columbia for at least 1 year within the 3 years immediately preceding the application for licensure; or

(ii) Has become board certified in a specialty recognized by the Board of Pharmacy Specialties or its successor within 7 years immediately preceding the application for licensure; or

(iii) Is licensed as a pharmacist in some other state, territory, or the District of Columbia; or

(iv) Has completed continuing competency in pharmacy that is approved by the Board of Pharmacy.

003.02 PHARMACIST INTERN REGISTRATION. To obtain a pharmacist intern registration an applicant must meet the requirements of Neb. Rev. Stat. § 38-2854 and submit one of the following:

(A) Documents from an educational institution showing current enrollment in an accredited pharmacy program;

(B) Official transcript from an accredited pharmacy program; or

(C) Copy of the Foreign Pharmacy Graduate Examination Committee (FPGEC) Certification given by National Association of Boards of Pharmacy (NABP).

003.03 PHARMACY TECHNICIAN REGISTRATION. To obtain a pharmacy technician registration an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. § 38-2890.

004. RENEWAL . The individual must meet the requirements set out in 172 NAC 10 and this chapter.

004.01 CREDENTIAL EXPIRATION DATES. All pharmacist licenses issued by the Department expire on January 1 of each even-numbered year. All pharmacy technician registrations issued by the Department expire on January 1 of each odd-numbered year. Pharmacist intern registrations are not renewable and expire as set out in Neb. Rev. Stat. § 38-2854.

005. CONTINUING COMPETENCY . During the 24 months prior to the license renewal date, individuals holding an active pharmacist license must complete 30 of continuing education hours from an approved continuing education provider, or have obtained or maintained an approved certification as listed in this chapter.

005.01 APPROVED CONTINUING EDUCATION PROVIDERS. The following are approved continuing education providers:

(A) The Accreditation Council for Pharmacy Education (ACPE);

(B) The Nebraska Pharmacist Association;

(D) Other providers demonstrating the same quality continuing education standards as those established in the Criteria for Quality of Accreditation Council for Pharmacy Education (ACPE) and approved by the Board of Pharmacy.

005.02 PHARMACY SPECIALTY CERTIFICATION. Certification in a specialty through the Board of Pharmacy Specialties which is obtained or maintained during the renewal period meets the requirement for continuing competency.

005.03 DIABETES EDUCATOR CERTIFICATION. Certification through the National Certification Board of Diabetes Educators (NCBDE) which is obtained or maintained during the renewal period meets the requirement for continuing competency.

006. IDENTIFICATION REQUIREMENTS . Each individual must be properly identified as set out in Neb. Rev. Stat. § 38-124, and this chapter.

006.01 PHARMACIST. Each pharmacist must be identified as a pharmacist while performing the duties of a pharmacist within a facility licensed under the Health Care Facility Licensure Act.

006.02 PHARMACIST INTERN. Each pharmacist intern must be identified as a pharmacist intern while performing the duties of a pharmacist intern.

006.03 PHARMACY TECHNICIAN. Each pharmacy technician must be identified as a pharmacy technician while performing the duties of a pharmacy technician.

007. SUPERVISION OF PHARMACIST INTERN . A pharmacist intern must be supervised as set out in Neb. Rev. Stat. §§ 38-2854 and 38-2866.01. This supervision must be provided by a pharmacist who possesses a Nebraska pharmacist license which is free from disciplinary measures at the time of supervision unless the pharmacist intern is receiving experiential training directed by the accredited pharmacy program in which he or she is enrolled.

007.01 ONE OR MORE SUPERVISORS. Nothing in this chapter will be construed to prohibit 1 pharmacist intern or 1 pharmacy technician from being supervised by more than 1 pharmacist at any time.

007.02 PHARMACIST INTERN. A pharmacist intern must not supervise another pharmacist intern nor a pharmacy technician.

007.03 COMPLIANCE. In the case of a pharmacist intern, the result of failure to comply with any of these standards may be revocation of any credential issued on the basis of such pharmacist internship.

008. UNPROFESSIONAL CONDUCT . Unprofessional conduct includes those acts set out in Neb. Rev. Stat. § 38-179 and this chapter.

(A) Refusal to cooperate or furnish requested information during a licensing or discipline;

(B) Any departure from or failure to conform to the ethics of the pharmacy profession, which code of ethics were adopted by the membership of the American Pharmacists Association on October 27, 1994 by a pharmacist;

(C) Misrepresenting one’s credentials in an application submitted to a healthcare facility, insurance company, or prospective employer;

(D) Refusal to provide professional service to a person because of such person’s race, color, religion, sex, ancestry, age, familial status, disability, or national origin;

(E) Refusal to undergo a competency evaluation as required by the Board of Pharmacy pursuant to Neb. Rev. Stat. § 38-1,112;

(F) Failure by a pharmacist to ensure a verbal offer to counsel is made, unless specifically exempt as provided in Neb. Rev. Stat. § 38-2869(2)(e);

(G) Willfully or negligently violating the confidentiality between pharmacy personnel and a patient, except as allowed by law;

(H) Except as otherwise permitted by law, dispensing, selling, administering, distributing, ordering, or giving to a person, known by the pharmacist to be an addict or any person previously drug dependent, any drug legally classified as a controlled substance;

(I) Exercising undue influence on the patient in such a manner as to exploit the patient for the financial gain of the pharmacist or of a third party, which includes, but is not limited to, the promotion or sale of services, goods, drugs, devices, or biologicals;

(J) Refusal to allow access to the records appropriate to practice pharmacy in a facility and required to be kept as set out in 175 NAC 8;

(K) Return of dispensed drugs or devices to saleable stock, unless specifically allowed by law;

(L) Dispensing, selling, or administering anabolic steroids to a person for other than therapeutic purposes;

(M) Practicing pharmacy under a false or assumed name;

(N) Lack of appropriate direction, collaboration, or supervision of any person employed by, supervised by or assigned to the pharmacist;

(O) Claiming credit for any continuing competency activities not actually participated in and earned; or

(P) Any false or misleading statement on a pharmacy self-inspection form.

009. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

010. FEES . Fees are set out in 172 NAC 2.

History

Effective 2020-11-03

Chapter 130 Mail Service Pharmacy Licensure

Neb. Admin. Code tit. 172, ch. 130 Mail Service Pharmacy Licensure {#sec-172-nac-130 omnilex-key=us-ne-regs-official--title-172--172 NAC 130}

001. SCOPE AND AUTHORITY . These regulations govern the credentialing of mail service pharmacies and the practice of pharmacy under the Mail Service Pharmacy Licensure Act, Nebraska Revised Statute (Neb. Rev. Stat.) §§ 71-2406 to 71-2409; the Pharmacy Practice Act, Neb. Rev. Stat. §§ 38-2801 to 38-28,116; the Health Care Facility Licensure Act, Neb. Rev. Stat. §§ 71-401 to 71-475; and the Uniform Controlled Substances Act, Neb. Rev. Stat. §§ 28-401 to 28-456.01 and 28-458 to 28-475.

002. DEFINITIONS . Definitions set out in the Pharmacy Practice Act, the Health Care Facility Licensure Act, the Uniform Controlled Substances Act, the Uniform Credentialing Act, and 175 Nebraska Administrative Code (NAC) 8 apply to this chapter.

003. MAIL SERVICE PHARMACY LICENSE REQUIREMENTS . To receive a license, an applicant must submit a complete application provided by the Department, meet the requirements of Neb. Rev. Stat. § 71-2407, 175 NAC 8-005 and 175 NAC 8-006, and provide the following:

(A) A copy of the current active pharmacy license, including all disciplinary action taken on that license;

(B) A copy of all disciplinary action taken against the pharmacy in any other jurisdiction in which the pharmacy is licensed;

(D) A declaration that designates the Secretary of State as the Agent for Service of Process

in this state;

(E) The name and license number of at least one designated pharmacist who holds a current

unrestricted Nebraska pharmacist license; and

(F) A copy of the two most recent inspection reports.

004. RENEWAL . All mail service pharmacy licenses expire annually on July 1. To renew, a licensee must submit a completed application provided by the Department and provide documentation demonstrating that the licensee continues to meet the requirements of 172 NAC 130-003.

005. REINSTATEMENT . An applicant requesting reinstatement of an expired license must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of 172 NAC 130-003.

005.01 REINSTATEMENT FROM DISCIPLINE . An applicant requesting reinstatement after discipline must submit a complete application provided by the Department and the following:

(A) The reinstatement fee listed in 172 NAC 130-006.02;

(B) An explanation of the events the led to discipline;

(D) A copy of all inspections since the discipline and all correspondence from the appropriate jurisdiction addressing such issues; and

(E) Documents showing the applicant meets the requirements set out in 172 NAC 130-005.

006. FEES . Fees are set out in this chapter.

006.01 INITIAL AND RENEWAL FEE. The initial and renewal fees are set at $625.00.

006.02 REINSTATEMENT FEE. The reinstatement fee is set at $35.00 plus the renewal fee.

History

Effective 2020-11-03

Chapter 131 Wholesale Drug Distributors

Neb. Admin. Code tit. 172, ch. 131 Wholesale Drug Distributors {#sec-172-nac-131 omnilex-key=us-ne-regs-official--title-172--172 NAC 131}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 131 WHOLESALE DRUG DISTRIBUTORS

001. SCOPE AND AUTHORITY . These regulations govern the licensure of wholesale drug distributors under Nebraska Revised Statutes (Neb. Rev. Stat.) §§ 71-7427 to 71-7463 of the Wholesale Drug Distributor Licensing Act.

002. DEFINITIONS . Definitions set out in the Wholesale Drug Distributor Licensing Act, 21 Code of Federal Regulations (CFR) Part 205, and the following apply to this chapter.

002.01 ATTEST OR ATTESTATION. An affirmation that the individual declares that all statements on the application are true and complete.

002.02 AUTHENTICATE. To affirmatively verify that each transaction listed on the pedigree and any other accompanying documentation has occurred.

002.03 CO-LICENSEE. A pharmaceutical manufacturer that has entered into an agreement with another pharmaceutical manufacturer to engage in a business activity or occupation related to the manufacture or distribution of a prescription drug.

002.04 COMMON CARRIER. An entity that provides transportation or delivery of prescription drugs without storing, warehousing, or taking legal ownership of such drugs.

002.05 DESIGNATED REPRESENTATIVE. An individual designated by the wholesale drug distributor who will serve as the responsible individual of the daily operations of the wholesale drug distributor.

002.06 DROP SHIPMENT. The sale, by a manufacturer, that manufacturer’s co-licensee, that manufacturer’s third party logistics provider, or that manufacturer’s exclusive distributor of the manufacturer’s prescription drug, to a wholesale drug distributor whereby the wholesale drug distributor takes title to but not possession of such prescription drug and the wholesale drug distributor invoices the pharmacy, the chain pharmacy warehouse, or other designated persons authorized by law to dispense, administer or distribute such drug and the pharmacy, chain pharmacy warehouse, or other designated persons authorized by law to dispense, administer or distribute such drug, receives delivery of the prescription drug directly from the manufacturer, that manufacturer’s co-licensee, that manufacturer’s third party logistics provider, or that manufacturer’s exclusive distributor, of such prescription drug. Drop shipments must be part of the “normal distribution chain”.

002.07 EXCLUSIVE DISTRIBUTOR. An entity that:

(A) Contracts with a manufacturer to provide or coordinate warehousing, wholesale drug distribution, or other services on behalf of a manufacturer and who takes title to that manufacturer’s prescription drug, but who does not have general responsibility to direct the sale or disposition of the manufacturer’s prescription drug; and

(B) Is licensed as a wholesale drug distributor under this chapter.

002.08 NATIONALLY RECOGNIZED ACCREDITATION PROGRAM. An accreditation program that conforms to the standards required for accreditation by the Verified-Accredited Wholesale Distributors (VAWD) program, established and operated by the National Association of Boards of Pharmacy (NABP), and is approved by the Board.

002.09 NORMAL DISTRIBUTION CHAIN. Defined by Neb. Rev. Stat. § 71-7439 and this chapter.

(A) From a manufacturer or co-licensee to a wholesale drug distributor, to a pharmacy buying cooperative warehouse, to a pharmacy that is a member or member owner of such pharmacy buying cooperative warehouse, and then to a patient or a patient’s agent;

(B) From a manufacturer or co-licensee to a pharmacy buying cooperative warehouse, to a pharmacy that is a member or member owner of such pharmacy buying cooperative warehouse, and then to a patient or a patient’s agent;

(C) From a manufacturer or co-licensee to a third party logistics provider or an exclusive distributor, to a wholesale drug distributor, to a pharmacy, and then to a patient or a patient’s agent;

(D) From a manufacturer or co-licensee to a third party logistics provider or an exclusive distributor, to a wholesale drug distributor, to a pharmacy, to a health care practitioner, health care practitioner facility, or hospital, and then to a patient or a patient’s agent;

(E) From a manufacturer or co-licensee to a third party logistics provider or an exclusive distributor, to a pharmacy, to a health care practitioner, health care practitioner facility, or hospital, and then to a patient or a patient’s agent;

(F) From a manufacturer or co-licensee to a third party logistics provider or an exclusive distributor, to a wholesale drug distributor, to a chain pharmacy warehouse, to a pharmacy affiliated with the chain pharmacy warehouse, and then to a patient or a patient’s agent;

(G) From a manufacturer or co-licensee to a third party logistics provider or an exclusive distributor, to a chain pharmacy warehouse, to a pharmacy affiliated with the chain pharmacy warehouse, and then to a patient or a patient’s agent; or

(H) From a manufacturer or co-licensee either through drop shipment or directly to a pharmacy, health care practitioner, health care practitioner facility, hospital, chain pharmacy warehouse, or other designated persons authorized by law to dispense, administer or distribute such drug, and then to a patient or a patient’s agent.

002.10 PHARMACY BUYING COOPERATIVE WAREHOUSE. A permanent physical location that acts as a central warehouse for prescription drugs and from which sales of such drugs are made to an exclusive group of pharmacies that are members or member owners of the buying cooperative operating the warehouse and must be licensed as a wholesaler.

002.11 REVERSE DISTRIBUTOR. A person whose primary function is to act as an agent for a pharmacy, wholesaler, manufacturer, or other entity by receiving, inventorying, and managing the disposition of outdated, expired, or otherwise non-saleable medications.

002.12 THIRD PARTY LOGISTICS PROVIDER. An entity that:

(A) Provides or coordinates warehousing, drug distribution, or other services on behalf of a manufacturer, but does not take title to the prescription drug or have general responsibility to direct the prescription drug’s sale or disposition.

002.13 WHOLESALE DRUG DISTRIBUTION. Wholesale drug distribution is defined in Neb. Rev. Stat. § 71-7444 and also to exclude the sale, transfer, merger, or consolidation of all or part of the business of a retail pharmacy or pharmacies from or with another retail pharmacy or pharmacies, whether accomplished as a purchase and sale of stock or business assets, in accordance with this chapter.

003. LICENSE REQUIREMENTS . To obtain a license, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. §§ 71-7448, 71-7452, and this chapter.

003.01 APPLICATION. All applications submitted to the Department must contain the information required by 21 CFR § 205.5, Neb. Rev. Stat. § 71-7448, and the following:

(A) Drug Enforcement Administration (DEA) Controlled Substances Registration number, if applicable; and

(B) Business hours.

003.02 INSPECTION REPORT. An inspection report of an inspection conducted of the applicant within the 6 months prior to the date of application which meets the requirements of 172 Nebraska Administrative Code (NAC) 131-004.

003.03 CRIMINAL BACKGROUND CHECK. Submit to the Nebraska State Patrol complete fingerprint cards under Neb. Rev. Stat. § 71-7448 and this chapter:

(A) In the section of the fingerprint cards marked “Reason Fingerprinted”, print “Wholesale Drug § 71-7448” or an acceptable equivalent; and

(B) Submit the completed fingerprint cards and payment for the criminal background check to the Nebraska State Patrol, CID Division, P.O. Box 94907, Lincoln, NE 68509.

004. INSPECTIONS . Inspections must meet the requirements set out in Neb. Rev. Stat. §§ 71-7453 to 71-7456, and this chapter.

004.01 TRIENNIAL INSPECTION. On a triennial basis after initial licensure, all wholesale drug distributor facilities must be inspected. The licensee must ensure that:

(1) The designated representative is present at the facility at the time of inspection;

(2) All records which describe the wholesale drug distribution activities for the triennium are accessible during the inspection, including drug analysis; and

(3) Any required fees for conducting the inspection are paid.

004.01(A) INSPECTION BY OTHER ENTITY. If the inspection is performed by a nationally recognized accreditation program approved by the Board or by another state or federal regulatory agency approved by the Board, the inspection must meet the requirements in this chapter, including standards for:

(i) Personnel;

(ii) Facility;

(iii) Pedigrees;

(iv) Policies and procedures; and

(v) Records.

004.02 INSPECTION FOR CAUSE. The Department may inspect a wholesale drug distributor to determine violations when any 1 or more of the following conditions or circumstances occur:

(A) An accident or natural disaster resulting in damage to the facility or interruption of utility services which could result in adverse effects to the potency, efficacy, safety, or security of the prescription drugs;

(B) A complaint alleging violation of the Wholesale Drug Distributor Licensing Act or these regulations;

(D) Change of scope or type of services offered, management or location;

(E) Change in the designated representative; and

(F) Any other event that raises concerns about the maintenance, operation, or management of the facility.

004.03 SUCCESSFUL COMPLETION OF INSPECTION. Each applicant for a wholesale drug distributor license must successfully complete an inspection to receive a wholesale drug distributor license and to retain such license by demonstrating compliance with the standards found in Section 005 of this chapter.

004.04 FAILED INITIAL INSPECTION. When an applicant of a wholesale drug distributor license does not meet all of the inspection standards and receives a rating of "Fail" on the initial inspection, the applicant:

(A) Must not open the wholesale drug distribution facility;

(B) Must pay the re-inspection fee; and

(C) Must be subject to a re-inspection within 90 days after failing the initial inspection to determine if the applicant meets the requirements.

004.05 FAILED TRIENNIAL INSPECTION. When a licensee does not meet all of the inspection standards and receives a rating of "Fail" on a triennial inspection, the licensee:

(A) Will be granted up to 90 days from the date of the triennial inspection to meet the requirements;

(B) Must pay the re-inspection fee; and

(C) Must be subject to a re-inspection within 90 days after failing the triennial inspection to determine if the licensee meets the requirements.

005. STANDARDS FOR ENGAGING IN WHOLESALE DRUG DISTRIBUTION . All wholesale drug distributors must meet the requirements in 21 CFR Part 205 and the following standards for engaging in wholesale drug distribution.

005.01 PERSONNEL. A wholesale drug distributor must employ staff to operate the wholesale drug distribution facility under this chapter and must designate a representative to be in charge of wholesale drug distribution and the storage and handling of all drugs. Such designated representative must:

(A) Have knowledge of federal and state statutes applicable to wholesale drug distribution;

(B) Have had no convictions under any federal, state, or local laws relating to drug samples, wholesale or retail drug distribution, or distribution of controlled substances;

(C) Have a minimum of 2 years of verifiable full-time managerial or supervisory experience in a pharmacy or wholesale drug distributor licensed in this state or another state, where the designated representative’s responsibilities included but were not limited to recordkeeping, storage, and shipment of prescription drugs; and

(D) Be actively involved in and aware of the actual daily operations of the wholesale drug distributor, including the following:

(i) Employed full-time in a managerial position by the wholesale drug distributor;

(ii) Physically present at the wholesale drug distributor during normal business hours, except for time periods when absent due to illness, family illness or death, scheduled vacation, or other authorized absence; and

(iii) Aware of, and knowledgeable about, all policies and procedures pertaining to the operations of the wholesale drug distributor.

005.02 FACILITY. All Wholesale Drug Distributor facilities at which prescription drugs are received, stored, warehoused, handled, held, offered, marketed, displayed, or transported from must meet the requirements of 21 CFR § 205.50 and the following:

(A) Be a commercial location and not a personal dwelling or residence;

(B) Provide for the secure and confidential storage of information with restricted access and policies and procedures to protect the integrity and confidentiality of the information;

(C) Provide and maintain appropriate inventory controls in order to detect and document any theft, counterfeiting, or diversion of prescription drugs; and

(D) Provide to another wholesale drug distributor or pharmacy pedigrees for prescription drugs that leave the normal distribution chain before wholesale drug distribution to such other wholesale drug distributor or pharmacy in accordance with this chapter.

005.03 PEDIGREES. Each licensee must meet the requirements of Neb. Rev. Stat. § 71-7456 and 21 CFR § 205.50.

005.04 RECORDS. Each licensee must meet the requirements of Neb. Rev. Stat. §§ 71-7455 to 71-7456, 21 CFR § 205.50, and the following:

(A) Wholesale drug distributors and manufacturers must maintain an ongoing list of persons with whom they do business to sell or purchase prescription drugs;

(B) All facilities must establish and maintain procedures for reporting counterfeit and contraband, or suspected counterfeit and contraband drugs or counterfeiting and contraband or suspected counterfeiting and contraband activities to the Department and Food and Drug Administration (FDA);

(C) Wholesale drug distributors must maintain a system for the mandatory reporting of significant shortages or losses of prescription drugs where it is known or suspected that diversion is occurring to the Department and the Food and Drug Administration (FDA), and, where applicable, to the Drug Enforcement Administration (DEA);

(D) Records must be maintained by the wholesale drug distributor to document all purchases, sales, destruction, transfer, loss, and return of drugs; and

(E) Records may be kept manually or by electronic or automated means. When an automated recordkeeping system is used, there must be a complete back-up system every 7 days that is verifiable to prevent loss of records.

006. AMENDING A WHOLESALE DRUG DISTRIBUTOR APPLICATION OR LICENSE . A license is issued only for the premises and persons named in the application and is not transferable or assignable. Change of ownership or change of premises terminates the license. The owner or owners must apply for a new wholesale drug distributor license.

006.01 AMENDMENT. An applicant or licensee must notify the Department when there is a change in the designated representative or the information required by 21 CFR § 205.5(a). The applicant or licensee is responsible for meeting the requirements of this chapter and may amend the wholesale drug distributor application or license by submitting the required information to the Department.

007. RENEWAL . To renew a license, applicants must meet the requirements of Neb. Rev. Stat. § 71-7448, §§ 71-7451 to 71-7453, and this chapter, including the following:

(A) Respond whether, since initial license or renewal, has any license of the facility in another state been revoked, suspended, limited, or disciplined in any manner;

(B) Pass any inspection that has been conducted prior to the renewal of the license;

(C) If any misdemeanor or felony convictions of the designated representative, the supervisor of the designated representative and each owner of the licensee or any disciplinary action was taken against the licensee by another state, submit to the Department an official copy of the disciplinary action or court records, including charges and disposition; and

(D) Attest that the information provided is true and correct to the best of their knowledge.

008. REINSTATEMENT . To reinstate a license, applicants must submit an application provided by the Department that contains the information in 172 NAC 131-003 and the following:

(A) The license number;

(B) The expiration date;

(D) The licensee’s last known address of record.

008.01 REINSTATEMENT AFTER EXPIRATION. If more than 30 days has passed since a license expired an applicant must apply to reinstate the license.

008.01(A) NOTICE OF DISCIPLINE OR ACTION TAKEN IN ANOTHER JURISDICTION. All applicants for reinstatement after expiration must include the following related to the time period since the last renewal or since the initial issuance of the license if the applicant has not previously renewed:

(i) Submit to the Department an official copy of the disciplinary action or court records if the designated representative of the licensee been convicted of a misdemeanor or felony; and

(ii) Submit to the Department an official copy of the disciplinary action if any license of the designated representative of the licensee or any other license held by the licensee in any profession in another state has been revoked, suspended, limited, or disciplined in any manner.

008.02 REINSTATEMENT AFTER DISCIPLINARY ACTION. A wholesale drug distributor license that has been suspended or revoked as set out in Neb. Rev. Stat. § 71-7457 may be reinstated by the Department upon the recommendation of the Board of Pharmacy. Applicants must reapply on an application provided by the Department that contains the information in 172 NAC 131-003.

009. GROUNDS ON WHICH THE DEPARTMENT MAY DENY, REFUSE RENEWAL OF, OR DISCIPLINE A WHOLESALE DRUG DISTRIBUTOR LICENSE . Grounds are set out in Neb. Rev. Stat. § 38-178, § 38-179, § 71-7461 and this chapter.

(A) Unprofessional conduct which includes:

(i) Misrepresentation or fraud in the conduct of a wholesale drug distribution facility; or

(ii) Knowingly purchasing or receiving prescription drugs from any source other than a person or entity licensed or exempt from licensure pursuant to the Wholesale Drug Distributor Licensing Act, except transfers for emergency medical reasons. This will not apply to returns or recalls, misshipments, misorders, or damaged goods;

(B) Failure of the licensee to maintain and make available to the Department or to Federal, State, or local law enforcement officials, records required by this chapter;

(D) The purchase or receipt of a prescription drug from a person that is not licensed to wholesale distribute prescription drugs to that purchaser or recipient;

(E) The sale or transfer of a prescription drug to a person who is not legally authorized to receive a prescription drug;

(F) The failure to obtain, authenticate, or pass on a pedigree when required under these rules;

(G) The receipt of a prescription drug pursuant to a wholesale drug distribution without first receiving a pedigree, when required, that was attested to as accurate and complete by the wholesale drug distributor; or

(H) The distributing or wholesale drug distributing of a prescription drug that was previously dispensed by a pharmacy or distributed by a practitioner.

010. SCHEDULE OF FEES . The following fees have been set by the Department as set out in Neb. Rev. Stat. § 71-7450 and this chapter.

010.01 INITIAL LICENSE FEE. The fee for initial licensure as a wholesale drug distributor is set at $550.

010.02 INSPECTION FEE. The fee for issuance or renewal of a wholesale drug distributor license who requests an inspection to be conducted by a pharmacy inspector of the Department, is set at $3,000 in addition to actual costs for transportation, lodging and meals of the pharmacy inspector who conducts the inspection.

010.03 RE-INSPECTION FEE. The fee for issuance or renewal of a wholesale drug distributor license who requests a re-inspection to be conducted by a pharmacy inspector of the Department is set at $750 in addition to actual costs for transportation, lodging and meals of the pharmacy inspector who conducts the re-inspection.

010.04 RENEWAL FEE. The fee for renewal on an annual basis of a credential is set at $550.

010.05 RENEWAL LATE FEE. The fee for renewal on an annual basis of a credential, who fails to pay the renewal fee on or before the expiration date of the credential is set at $100.

010.06 REINSTATEMENT FROM EXPIRED OR LAPSED STATUS. The fee for reinstatement of a lapsed or expired credential is set at $50 in addition to renewal fee.

010.07 REINSTATEMENT FEE AFTER DISCIPLINE. For reinstatement of a wholesale drug distributor credential following suspension, limitation, or revocation for disciplinary reasons, the fee of $100.

History

Effective 2023-09-20

Chapter 134 Delegated Dispensing Permits

Neb. Admin. Code tit. 172, ch. 134 Delegated Dispensing Permits {#sec-172-nac-134 omnilex-key=us-ne-regs-official--title-172--172 NAC 134}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 134 DELEGATED DISPENSING PERMITS

001. SCOPE OF AUTHORITY . These regulations govern the issuance of delegated dispensing permits under the Pharmacy Practice Act, Nebraska Revised Statutes (Neb. Rev. Stat.) §§ 38-2801 to 38-28,116, and the Uniform Credentialing Act (UCA).

002. DEFINITIONS . Definitions set out in the Pharmacy Practice Act, the Prescription Drug Safety Act, the Uniform Credentialing Act, and 172 Nebraska Administrative Code (NAC) 10.

002.01 APPROVED FORMULARY. A formulary as recommended by the Board and approved by the Director as set out in Neb. Rev. Stat. § 38-2881.

003. PERMIT REQUIREMENTS . To obtain a delegated dispensing permit, an applicant must submit a completed application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. § 38-2873 and this chapter. An applicant must pass an initial inspection before a permit may be issued.

004. INSPECTIONS . An applicant for a delegated dispensing permit must meet the requirements of Neb. Rev. Stat. § 38-2874 and this chapter and may be inspected as determined by the Department. A follow-up inspection may be conducted by the Department under Neb. Rev. Stat. § 38-2875.

004.01 CLOSING. When a delegated dispensing permit holder anticipates closing for business, the Department must be notified in writing within 15 days of the closing date. Documentation must be provided to the Department which verifies that the delegated dispensing permit holder has completed a closing inventory and has distributed all legend drugs and devices to an authorized recipient and disposed of all expired legend drugs and devices.

005. STAFFING REQUIREMENTS FOR A DELEGATED DISPENSING PERMIT . An individual working as a public health clinic worker in a delegated dispensing site must meet the requirements of Neb. Rev. Stat. §§ 38-2884 to 38-2889, and this chapter.

005.01 TRAINING. Training required for licensed health care workers and public health clinic workers prior to staff dispensing drugs and devices under a delegated dispensing permit. The training is required to include the following:

(A) Procedures for dispensing initial prescriptions and authorized refills of contraceptives;

(B) Procedures for dispensing approved drugs and devices;

(D) Proper labeling of contraceptives and approved drugs and devices;

(E) Proper record keeping of initial and refilled prescriptions;

(F) Proper pharmacist referral;

(G) Procedures for reaching the delegating or the on-call pharmacist;

(H) Storage and security of approved formulary drugs and devices; and

(I) Patient information.

005.02 DOCUMENTATION OF TRAINING. Documentation of successful completion of all training must be maintained in the employee's personnel file and in the delegated dispensing permit holder’s policy and procedure manual. The delegating pharmacist must provide the training before staff dispense any drugs and devices and the permit holder must ensure that documentation of training has been completed.

005.03 PROFICIENCY DEMONSTRATION. Following training, public health clinic workers must be supervised by a licensed health care professionals trained to dispense drugs for the first month the public health clinic worker dispenses authorized refills of contraceptives, and that the worker demonstrate proficiency to the delegating pharmacist at least annually or as requested by the delegating pharmacist.

005.03(A) PROFICIENCY STANDARDS. Demonstrate to the delegating pharmacist the ability to follow the procedures outlined in 172 NAC 134-005.01.

005.03(B) PROFICIENCY DOCUMENTATION. Completed proficiency demonstrations must be documented in the employee's personnel file and in the delegated dispensing permit holder’s policy and procedure manual.

006. STANDARDS FOR DISPENSING LEGEND DRUGS AND DEVICES . The requirements for dispensing drugs are set out in the Pharmacy Practice Act, and this chapter.

006.01 DELEGATING PHARMACIST. The delegating pharmacist must meet the requirements of Neb. Rev. Stat. § 38-2882 and must report any significant discrepancies in the inventory of the delegated dispensing site to the Board and the administrator of the delegated dispensing site.

006.02 PRESCRIPTION REFILL. Refills under Neb. Rev. Stat § 38-2884(3) for contraceptives cannot be authorized for greater than 1 year from the date of issuance of the original prescription.

006.03 DISPENSING. Drugs must be dispensed in accordance with Neb. Rev. Stat. § 38-2884.

006.04 PACKAGING. All drugs or devices dispensed under a delegated dispensing permit are to be prepackaged by the manufacturer or a pharmacist on-site into the quantity to be prescribed and dispensed at the delegated dispensing site.

006.05 CONTAINERS. All new and refilled prescriptions must be packaged in new sanitary containers before they are dispensed; original unopened containers as received from the manufacturer, distributor, or packer may be utilized provided the pharmacist ensures all labeling requirements of this chapter are met.

006.06 PRESCRIPTION AND PRESCRIBED MEDICAL ARTICLES RETURNS. A delegated dispensing permit holder is prohibited from accepting for any purpose any dispensed prescriptions.

006.07 INVENTORY. A pharmacist must ensure that the inventory of all drugs and devices in the delegated dispensing site have affixed to them the original label of the manufacturer, distributor, or packer. Information contained on all labels and packages must be complete and accurate. A pharmacist must ensure that the inventory of all drugs in the drug dispensing area have affixed to them a label with the information set out in Neb. Rev. Stat. § 38-2884. Drugs stored in the drug dispensing area or dispensed to patients are deemed misbranded if they are not labeled as specified in Neb. Rev. Stat. § 38-2884 or as set out in Neb. Rev. Stat. § 71-2470.

006.08 STORAGE AND ENVIRONMENT. The site, furnishings, and equipment must be maintained in a clean, orderly, and sanitary manner at all times. All drugs and devices must be stored in a manner that meets the recommended storage requirements of the manufacturer or those listed in 175 NAC 8-006.02.

006.09 RECORDKEEPING. The delegating pharmacist is responsible for recordkeeping as set out in Neb. Rev. Stat. § 38-2882 and the following:

(A) A delegated dispensing permit holder must maintain a single file of the prescription information;

(B) The delegated dispensing permit holder must maintain records of all drugs and devices dispensed for 5 years;

(C) When an electronic recordkeeping system is used and it becomes inoperable, dispensing transactions occurring during this period of inoperability must be entered into the system when the system becomes operable;

(D) Dispensing records must be readily retrievable;

(E) Appropriate reference material for the practice of pharmacy must be kept; and

(F) A manual of current policies and procedures must be kept and includes the following:

(i) Labeling requirements;

(ii) Storage and security of drugs and devices;

(iii) Proper patient instruction;

(iv) Formulary;

(v) Library resources;

(vi) Record keeping, to include the medical chart;

(vii) Drug recall procedures;

(viii) Policies for licensed or certified health care staff; and

(ix) Policies for public health clinic workers.

006.10 REQUIRED SIGNAGE. Each site must display a Poison Control Center phone number in a conspicuous location. Each permit holder must display the permit in a conspicuous manner in the drug dispensing area.

007. RENEWAL . All delegated dispensing permits expire on July 1. The applicant must meet the requirements set out in 172 NAC 10 and this chapter.

008. REINSTATEMENT . The applicant must meet the reinstatement requirements set out in 172 NAC 10.

009. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179, and this chapter.

(A) Misrepresentation or fraud in the conduct of a delegated dispensing site;

(B) Dispensing without a prescription of a drug or device which under state or federal law or regulation is prohibited from being dispensed without a prescription or the renewal of such a prescription without the authorization of the prescriber; and

(C) Dispensing a different drug or device in place of the drug or device ordered or prescribed without the express permission of the person ordering or prescribing the same.

History

Effective 2023-09-20

Chapter 137 Licensure of Physical Therapy

Neb. Admin. Code tit. 172, ch. 137 Licensure of Physical Therapy {#sec-172-nac-137 omnilex-key=us-ne-regs-official--title-172--172 NAC 137}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of physical therapists and physical therapist assistants under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-2901 to 38-2929 of the Physical Therapy Practice Act and the Uniform Credentialing Act (UCA).

002. DEFINITIONS . Definitions are set out in the Physical Therapy Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 ADEQUATE PATIENT RECORDS. Legible records that contain at a minimum:

(A) Sufficient information to identify the patient;

(B) An evaluation of objective findings;

(D) A plan of care;

(E) A treatment record; and

(F) A discharge plan.

002.02 APPROVED EDUCATION PROGRAM. A program for the education and training of physical therapists or physical therapist assistants accredited by the Commission on Accreditation in Physical Therapy Education of the American Physical Therapy Association or by equivalent standards established by the Board.

002.03 AUDIT. The selection of licensees or certificate holders for verification of satisfactory completion of continuing competency requirements during a specified time period.

002.04 CERTIFICATION EXAMINATION. The National Physical Therapist Assistant Examination and Jurisprudence (NE LAW) Examination approved by the Department upon the recommendation of the Board.

002.05 CONTINUING COMPETENCY ACTIVITIES. Continuing competency activities are those appropriate learning experiences physical therapists and physical therapist assistants undertake to expand their scope of knowledge beyond the initial preparation for the profession of physical therapy.

002.06 HOUR. As it relates to continuing education, an hour is at least 60 minutes of participation in an organized learning experience otherwise known as a “contact hour.”

(A) 1 academic semester hour is equal to 15 contact hours. An approved 3 credit hour course provides 45 contact hours of continuing education credit; and

(B) 1 academic quarter hour is equal to 10 contact hours. An approved 3 credit hour course provides 30 contact hours of continuing education credit.

002.07 INTERVENTION. A therapeutic procedure defined by the Current Procedural Terminology (CPT) manual of the American Medical Association.

002.08 JURISPRUDENCE (NE LAW) EXAMINATION. The Nebraska Physical Therapy Law Examination covering the laws governing the practice of physical therapy in Nebraska. This examination covers the regulations relating to the licensure of physical therapy, 172 NAC 137; the Physical Therapy Practice Act, Neb. Rev. Stat. §§ 38-2901 to 38-2929; the regulations relating to the Uniform Credentialing Act, 172 NAC 10; the Uniform Credentialing Act, Neb. Rev. Stat. §§ 38-101 to 38-1,142; and the statutes relating to medical records, Neb. Rev. Stat. §§ 71-8401 to 71-8407.

002.09 LICENSURE EXAMINATION. The National Physical Therapist Examination and Jurisprudence (NE LAW) Examination approved by the Department on the recommendation of the Board.

002.10 PLAN OF CARE. A plan of therapeutic intervention utilizing current standards of care.

002.11 PRACTICE SITE. The location where the physical therapist provides physical therapy services.

002.12 SATELLITE OFFICE. A practice site operating without the presence of a physical therapist.

002.13 SEMESTER CREDIT HOUR. A semester credit hour must include at a minimum:

(A) 15 hours of lecture;

(B) 30 hours of laboratory; or

002.14 SUPERVISORY VISIT. An on-site visit by the supervising physical therapist in consultation with the physical therapist assistant. The on-site visit may occur in any clinical setting where the supervising physical therapist renders patient care.

002.15 TELECOMMUNICATIONS. Telecommunications includes a phone, pager, video teleconference or any similar teleconferencing that will allow immediate response time.

003. LICENSE REQUIREMENTS FOR A PHYSICAL THERAPIST . To obtain a license as a physical therapist, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. §§ 38-2901-38-2929, 172 NAC 10, and this chapter.

003.01 DOCUMENTATION. The following documentation must be provided to the Department.

003.01(A) EDUCATION. Submit an official transcript sent directly from the issuing institution, verifying completion of an approved physical therapist educational program.

003.01(B) EXAMINATION. Submit proof of passing the licensure examination with a scaled score that is greater than or equal to 600 on the National Physical Therapist Examination and pass the Jurisprudence (NE LAW) Examination with a scaled score that is greater than or equal to 600.

003.01(C) LICENSED IN ANOTHER JURISDICTION CURRENTLY PRACTICING. Applicants must meet requirements outlined in 172 NAC 10 and in 172 NAC 137-003.01(A) and 172 NAC 137-003.01(B).

003.01(D) LICENSED IN ANOTHER JURISDICTION AND HAS NOT PRACTICED WITHIN THE 3 YEARS PRECEDING THE APPLICATION. Applicants must meet requirements outlined in 172 NAC 10 and in 172 NAC 137-003.01(A) and 172 NAC 137-003.01(B) and must provide documentation of obtaining 50 hours of acceptable continuing education for a physical therapist within the 3 years immediately preceding the date of application.

003.01(E) PASSED LICENSURE EXAMINATION BUT NOT PRACTICING. Applicants that have met the license requirements outlined in 172 NAC 10, 172 NAC 137-003.01(A) and 172 NAC 137-003.01(B), who passed the licensure examination more than 3 years prior to the time of application must provide documentation of obtaining 50 hours of acceptable continuing education for a physical therapist within the 3 years immediately preceding the date of application.

004. LICENSE REQUIREMENTS FOR A PHYSICAL THERAPIST BASED ON TRAINING IN A FOREIGN COUNTRY . To obtain a license based on training as a physical therapist in a foreign country, applicants must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the licensing requirements of Neb. Rev. Stat. §§ 38-2901 – 38-2929, 172 NAC 10, and this chapter.

004.01 DOCUMENTATION. The following documentation must be provided to the Department.

004.01(A) EDUCATION. An applicant who graduates from a physical therapy education program located outside of the United States must show that the education program is substantially equivalent to an approved physical therapy program. The applicant must provide:

(1) An official transcript that shows graduation from a physical therapy education program that prepares the applicant to engage without restriction in the practice of physical therapy;

(2) Documentation that shows that the applicant’s school of physical therapy is recognized by its own ministry of education or other appropriate recognition agency recommended by the Board and approved by the Department;

(3) Documentation that shows completion of a credential evaluation through the Foreign Credentialing Commission on Physical Therapy (FCCPT), the Commission on Graduates of Foreign Nursing Schools (CGFNS) or other similar credential review agency that uses the Federation of State Boards of Physical Therapy Coursework Tool approved by the Board that determines that the applicant has met uniform criteria for educational requirements sent directly to the Department from the evaluating agency;

(a) Applicants that do not hold a license in another jurisdiction of the United States, must have completed the most current Coursework Tool evaluation; and

(b) Applicants that hold a license in another jurisdiction of the United States and who are actively practicing, must have completed the Coursework Tool evaluation based on graduation date or more recent, and

(4) Documentation of proficiency of the English language by obtaining the following:

(a) Test of English as a Foreign Language (TOEFL) internet based test (IBT) total minimum score of 89 which includes: Reading with a minimum score of 21; Listening with a minimum score of 18; Writing with a minimum score of 24; and Speaking with a minimum score of 26; or

(b) Hold an official United States Citizenship and Immigration Services’ Health Care Worker Certification issued no more than five years immediately preceding the date of the application by the Foreign Credentialing Commission of Physical Therapy (FCCPT) or Commission on Graduates of Foreign Nursing Schools (CGFNS); or

(c) Applicants of physical therapy programs from Australia, Canada, with the exception of Quebec, Ireland, New Zealand, the United Kingdom, and the United States are deemed to be proficient in the English language.

004.01(A)(i) SUBSTANTIAL EQUIVALENCY. Graduation outside the United States from an approved education program as defined in this chapter constitutes evidence of substantial equivalency.

004.01(B) EXAMINATION. Documentation of passing the licensure examination sent directly to the Department by the examining entity.

005. CERTIFICATION REQUIREMENTS FOR A PHYSICAL THERAPIST ASSISTANT . To obtain a certification, applicants must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the certification requirements of Neb. Rev. Stat. §§ 38-2901 – 39-2929, 172 NAC 10, and this chapter.

005.01 DOCUMENTATION. The following documentation must be provided to the Department:

005.01(A) EDUCATION. Submit an official transcript, sent directly from the issuing institution, verifying completion of an approved physical therapist assistant educational program.

005.01(B) EXAMINATION. Documentation of passing the certification examination with a scaled score that is greater than or equal to 600 on the National Physical Therapist Assistant Examination; and documentation of passing the Jurisprudence (NE LAW) Examination with a scaled score that is greater than or equal to 600.

005.01(C) CREDENTIALED IN ANOTHER JURISDICTION AND CURRENTLY PRACTICING. Applicants must meet requirements for a credential as outlined in 172 NAC 10, 172 NAC 137-005.01(A) and 172 NAC 137-005.01(B).

005.01(D) CREDENTIALED IN ANOTHER JURISDICTION AND HAS NOT PRACTICED WITHIN THE 3 YEARS PRECEDING THE APPLICATION. Applicants must meet requirements for a credential as outlined in 172 NAC 10, 172 NAC 137-005.01(A) and 172 NAC 137-005.01(B) and must provide documentation of obtaining 15 hours of acceptable continuing education for a physical therapist assistant within the 3 years immediately preceding the date of application.

005.01(E) PASSED THE CERTIFICATION EXAMINATION MORE THAN 3 YEARS AGO BUT NOT PRACTICING. Applicants that have met the credentialing requirements outlined in 172 NAC 10, 172 NAC 137-005.01(A) and 172 NAC 137-005.01(B), who passed the certification examination more than 3 years prior to the time of application must provide documentation of obtaining 15 hours of acceptable continuing education for a physical therapist assistant within the 3 years immediately preceding the date of application.

006. FINE-WIRE ELECTROMYOGRAPHY OR DRY NEEDLING . A physical therapist who wishes to perform tissue penetration for the purpose of fine-wire electromyography or dry needling must meet one of the following requirements:

(A) Completion of a pre-service or in-service training. The pre-service or in-service training must include:

(i) Pertinent anatomy and physiology;

(ii) Choice and operation of equipment;

(iii) Knowledge of test indications;

(iv) Proper technique of tissue penetration;

(v) Sterile methods, hazards, and complications;

(vi) Post-test care;

(vii) Knowledge in test interpretation; and

(viii) For the purposes of fine-wire electromyography, documentation of 10 kinesiology electromyography examinations in an educational environment or, for the purposes of dry-needling, tissue palpation; or

(B) Authorization from another state to perform fine-wire electromyography or dry-needling with substantially equivalent requirements; or

(C) For the purpose of fine-wire electromyography, certification from the American Board of Physical Therapy Specialties in the area of Clinical Electrophysiology.

007. REQUIREMENTS TO PERFORM PHYSICAL THERAPY SERVICES AS A CERTIFIED PHYSICAL THERAPIST ASSISTANT . A physical therapist assistant may perform physical therapy services under supervision by a licensed physical therapist under the following conditions.

007.01 GENERAL SUPERVISION. A physical therapist assistant being directed to perform physical therapy services:

(A) Must notify the supervising physical therapist of any change from routine responses that occur during or prior to treatment warranting a reevaluation of or a change in the patient treatment plan;

(B) May document physical therapy services provided by the physical therapist assistant without the signature of the supervising physical therapist;

(D) May assign the supervision of the physical therapist assistant student to another physical therapist assistant or physical therapist during the scheduled or non-scheduled periods of absence from the clinical setting.

007.02 PHYSICAL THERAPIST ASSISTANT STUDENT. All patient care services delivered by a physical therapist assistant student, working under the clinical instruction of a physical therapist assistant must be rendered under the direct supervision of a supervising physical therapist or physical therapist assistant.

007.03 PROHIBITED SERVICES. Prohibited services can be found in Neb. Rev. Stat. § 38-2927(1).

008. REQUIREMENTS FOR SUPERVISION OF PHYSICAL THERAPIST ASSISTANTS . A physical therapist supervising a physical therapist assistant must meet the following requirements of supervision:

(A) A physical therapist may provide general supervision for no more than 2 physical therapist assistants at any point in time during the physical therapist’s work day;

(B) All physical therapy services performed by a physical therapist assistant under the general supervision of a supervising physical therapist:

(i) All telecommunications must be documented in the medical records of patients under care of the supervising physical therapist; and

(ii) When the supervising physical therapist is unavailable, they must transfer responsibility of all patient care to another qualified physical therapist who will assume responsibility for all patient care including those being rendered by the physical therapist assistant under general supervision; and

(C) The supervising physical therapist maintains primary responsibility for all patient care services including those rendered by a physical therapist assistant under general supervision;

(D) A supervising physical therapist must re-evaluate or re-examine each patient and the plan of care of the patient receiving physical therapy services from a physical therapist assistant a minimum of least 1 time every 30 calendar days under general supervision. More frequent re-evaluations or re-examinations by the supervising physical therapist may be warranted, dependent upon the following parameters:

(i) Patient complexity and acuity;

(ii) Upon request by the physical therapist assistant;

(iii) When a change in treatment plan is warranted;

(iv) Any significant change in the medical status of the patient; and

(v) Upon request by the patient; and

(E) The supervising physical therapist must provide final documentation for discharge of patient care being rendered by a physical therapist assistant under general supervision, including patient response to treatment at the time of discharge; and

(F) The physical therapist assistant may participate in the discharge process for patient care by providing subjective and objective patient information to the supervising physical therapist.

008.01 GENERAL SUPERVISION OF THE PHYSICAL THERAPIST ASSISTANT IN SATELLITE CLINICS. A physical therapist may supervise a physical therapist assistant in a satellite clinic under general supervision. Satellite clinics include but are not limited to:

(1) Rehabilitation facilities;

(2) Acute care facilities;

(3) Skilled nursing facilities;

(4) Nursing homes;

(5) Schools-based settings;

(6) Outpatient clinics;

(7) Home health; and

(8) Client preventative facilities.

008.01(A) SUPERVISION OF A PHYSICAL THERAPIST ASSISTANT IN A SATELLITE CLINIC. When a physical therapist assistant is rendering physical therapy services in a satellite clinic, the following requirements apply as well as 172 NAC 137-009, items 1-6:

(i) A supervisory visit with the physical therapist will be made every 30 days or at a higher frequency if warranted. More frequent re-evaluations or re-examinations by the supervising physical therapist may be warranted, dependent upon the following parameters:

(1) Patient complexity and acuity;

(2) Upon request by the physical therapist assistant;

(3) When a change in treatment plan is warranted;

(4) Any significant change in the medical status of the patient; and

(5) Upon request by the patient; and

(ii) A supervisory visit as defined in 172 NAC 137-002 may occur in any clinical setting where the supervising physical therapist renders patient care. The on-site visit must include:

(1) Direct patient contact for the purpose of reevaluation or re-examination of patient status;

(2) A review of the plan of care with revision and or termination of treatment as warranted; and

(3) A re-assessment for utilization of outside resources for physical therapy services; and

(iii) The supervising physical therapist must provide final documentation for discharge of patient care being rendered by a physical therapist assistant in a satellite clinic under general supervision, including patient response to treatment at the time of discharge. The physical therapist assistant may participate in the discharge process for patient care by providing subjective and objective patient information to the supervising physical therapist; and

(iv) A physical therapist is not authorized to establish a satellite clinic for the purpose of rendering physical therapy services staffed solely by a physical therapist assistant.

008.02 REQUIREMENTS FOR THE ASSIGNMENT OF SERVICES TO PHYSICAL THERAPIST ASSISTANTS. It is the responsibility of the supervising physical therapist to determine which tasks require the clinical reasoning expertise of the physical therapist and which tasks can be safely assigned to the physical therapist assistant under general supervision.

008.02(A) ASSIGNMENT OF SERVICES, PATIENT OR CLIENT MANAGEMENT. Assignment of services related to patient or client management is dependent upon the clinical practice setting in addition to patient complexity and acuity. Clinical practice settings include but are not limited to:

(i) Rehabilitation facilities;

(ii) Acute care facilities;

(iii) Skilled nursing facilities;

(iv) Nursing homes;

(v) School-based settings;

(vi) Out-patient clinics;

(vii) Home health;

(viii) Industrial rehabilitation facilities; and

(ix) Client preventative services.

008.02(B) ASSIGNMENT OF PATIENT OR CLIENT SERVICES TO A PHYSICAL THERAPIST ASSISTANT. Patient complexity and acuity must also be considered when a physical therapist assigns patient or client services to a physical therapist assistant. The supervising physical therapist must exercise professional judgment when determining what services can or cannot be assigned to the physical therapist assistant.

008.02(B)(i) FACTORS IN DIRECT PATIENT CARE. The following factors inherent in direct patient care must be considered by the supervising physical therapist when assigning services, and must be commensurate with the education, training, and experience of the physical therapist assistant under general supervision. These factors apply to all clinical settings where physical therapy services are rendered by a physical therapist assistant under general supervision:

(1) Predictability of action - How confident is the physical therapist assistant in predicting consequences of action related to patient care?

(2) Stability of the environment - How confident is the physical therapist assistant in clinical problem solving issues related to change in patient status?

(3) Observability of patient status – How easy is it to observe or perceive relevant clinical indicators of patient status?

(4) Ambiguity of patient status – How difficult is it to interpret phenomena related to change in relevant clinical indicators? and

(5) Criticality of patient treatment – What consequences exist for a poor choice in patient intervention?

008.03 RESPONSIBILITY OF THE SUPERVISING PHYSICAL THERAPIST. For each patient under their care, a physical therapist must:

(A) Be responsible for managing all aspects of physical therapy services provided to the patient and assume legal liability for physical therapy and related services provided under their supervision;

(B) Provide initial evaluation and documentation of the evaluation;

(D) Provide documentation for discharge, including the patient’s response to therapeutic intervention at the time of discharge;

(E) Be responsible for accurate documentation and billing for services provided; and

(F) On each date physical therapy services are provided to a patient, a physical therapist must:

(i) Provide all therapeutic interventions that require the expertise of a physical therapist for example, sharp wound debridement and high velocity low amplitude manual therapy techniques; and

(ii) Determine the appropriate use of physical therapist assistants or physical therapy aides.

009. USE OF PHYSICAL THERAPY AIDES . A physical therapy aide trained under the direction of a physical therapist may perform non-treatment and treatment related tasks under the supervision of a physical therapist or a physical therapist assistant as specified below.

009.01 NON-TREATMENT RELATED TASKS - GENERAL SUPERVISION. Under the general supervision of a physical therapist or physical therapy assistant, a physical therapy aide may perform non-treatment related tasks under general supervision including clerical, housekeeping, facility maintenance or patient transportation services related to the practice of physical therapy such as:

(A) Transporting patients;

(B) Assisting a patient in preparation for treatment;

(D) Other non-treatment related tasks.

009.02 TREATMENT RELATED TASKS - DIRECT SUPERVISION. Under the direct supervision of a physical therapist or physical therapist assistant, a physical therapy aide may assist the physical therapist or physical therapist assistant with treatment related tasks. An aide may perform treatment related tasks when treatment is initiated by a physical therapist or physical therapist assistant and only under direct supervision. A physical therapy aide:

(A) Must not solely provide an intervention;

(B) Must receive training from a physical therapist for all treatment related tasks that the aide will perform;

(D) Must be knowledgeable of the preparation of equipment and accessories and all other operational activities relevant to equipment and accessories necessary for treatment.

010. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10 and this chapter. All physical therapist and physical therapist assistant licenses expire on November 1st of each odd-numbered year.

011. CONTINUING EDUCATION . On or before November 1 of each odd-numbered year, individuals holding an active license in the State of Nebraska must complete at least 20 hours of acceptable continuing education for a physical therapist and 10 hours of acceptable continuing education for a physical therapist assistant during the preceding 24-month period.

011.01 ACCEPTABLE SUBJECT MATTER. The Board does not approve continuing education programs or activities. In order for a continuing education activity or program to be accepted for renewal or reinstatement of a license, the activity or program must relate to physical therapy and may focus on research, treatment, documentation, management, or education.

011.02 CONTINUING EDUCATION HOUR CALCULATIONS. 1 hour of credit will be awarded for each hour of attendance. Credit will not be awarded for breaks or meals. The following provides the hour calculations for acceptable continuing education.

011.02(A) STATE AND NATIONAL MEETINGS. Programs at State and National meetings which relate to the theory or clinical application of theory pertaining to the practice of physical therapy.

011.02(B) FORMAL EDUCATION COURSES. The courses or presentations must be formally organized and planned instructional experiences in which the instructor has specialized experience or training to meet the objectives of the course and which have:

(i) A date;

(ii) Location;

(iii) Course title;

(iv) Number of contact hours;

(v) A signed certificate of attendance; and

(vi) Are open to all licensees and certificate holders.

011.02(C) HOME STUDY. The home study program must have a testing mechanism. A licensee or certificate holder may complete a maximum of 10 hours of continuing education by home study each 24-month renewal period.

011.02(D) MANAGEMENT COURSES. A licensee or certificate holder may complete a maximum of 4 hours of continuing education utilizing management courses each 24-month renewal period.

011.02(E) WEBINARS. A licensee or certificate holder may complete a maximum of 10 hours of continuing education utilizing webinars each 24-month renewal period. Webinars are continuing education activities that meet the following criteria:

(i) There is a sponsoring group or agency; and

(ii) Attendance is not self-monitored.

011.02(F) SCIENTIFIC REVIEW OF RESEARCH PAPERS. Completion and publication of a scientific review of a research paper for a professionally recognized database as approved by the Board. 1 contact hour will be awarded for each article published. A licensee or certificate holder will be awarded a maximum of 5 hours each 24-month period. Documentation must include a certificate of completion or a copy of the published review.

011.02(G) PUBLICATIONS. Participation in research or other scholarly activities that result in professional publication or acceptance for publication that relates to physical therapy and is intended for an audience of health care professionals. Licensees or certificate holders will be awarded a maximum of 10 hours each 24-month period. This includes:

(i) Authoring an article in a non-refereed journal. Earn 5 hours per article: Documentation required – a copy of the article;

(ii) Authoring an article in a refereed journal. Documentation required – a copy of the article; Earn 10 hours per article:

(iii) Authoring or being a contributing author of a published textbook. Earn 10 hours per book: Documentation required – A copy of the title page;

(iv) Authoring a poster presentation. 5 hours per presentation: Documentation required – Letter of acknowledgement; and

(v) Authoring a home study course. Earn 5 hours per course: Documentation - Letter of approval.

011.02(H) JURISPRUDENCE (NE LAW) EXAMINATION. 5 hours of continuing education will be awarded for passing the Jurisprudence (NE LAW) Examination with a scaled score that is greater than or equal to 600.

011.02(I) NEBRASKA LAW TUTORIAL. 1 hour of continuing education will be awarded for passing the Nebraska Law Tutorial with a score of 100%.

011.02(J) RESIDENCY OR FELLOWSHIP PROGRAM. A licensee or certificate holder will be awarded 1 hour for each month of participation for the completion of a residency or fellowship program approved by the American Board of Physical Therapy Residency and Fellowship Education. A letter verifying participation from the agency providing the program must be submitted. The dates of participation must be included in the letter.

011.02(K) SPECIALTY CERTIFICATION. Obtaining the initial Certified Strength and Conditioning Specialist (CSCS) certificate issued by the National Strength and Conditioning Association (NSCA). 4 hours of continuing education will be awarded for the Certified Strength and Conditioning Specialist (CSCS) certificate during the 24 months prior to the reinstatement application or license expiration date.

011.02(L) SUPERVISION. Direct supervision of students for clinical education:

(i) The physical therapist or physical therapist assistant who is supervising the student must be an American Physical Therapy Association Credentialed Clinical Instructor of record at the Basic Level;

(ii) The student being supervised must be from an accredited physical therapist or physical therapist assistant program and participating in a full-time clinical experience of varying length. Full-time is defined as clinical experiences with durations of approximately 40 hours per week ranging from 1-18 weeks;

(iii) 1 hour will be awarded for every 160 contact hours of supervision of full-time physical therapist student or physical therapist assistant student;

(iv) A maximum of 8 hours for physical therapist and 4 hours for physical therapist assistant per 24-month renewal period may be awarded to each individual for supervision of a physical therapist student or physical therapist assistant student; and

(v) The physical therapist or physical therapist assistant must have documentation from the accredited educational program indicating the number of hours spent supervising a student.

011.02(M) CARDIOPULMONARY RESUSCITATION CERTIFICATION. 2 hours of credit will be awarded for a current Cardiopulmonary Resuscitation for the Healthcare Provider (CPR) certificate.

011.02(N) PRESENTATION. 1 hour credit will be awarded for each hour of scientific presentation by a licensee or certificate holder acting as an essayist or lecturer to licensed physical therapists and physical therapist assistants if the program relates to the theory or clinical application of theory pertaining to physical therapy. A licensee or certificate holder may receive continuing education credit for only the initial presentation during a renewal period, with a maximum of 4 hours of continuing education for presentations in a 24-month renewal period.

011.03 NON-ACCEPTABLE CONTINUING EDUCATION. Continuing education credit will not be awarded for programs where the subject matter does not relate to the theory or clinical application of theory pertaining to the practice of physical therapy, including but not limited to:

(A) Business communications and operations;

(B) Medical terminology;

(D) Courses designed for lay persons;

(E) Teaching unlicensed or uncertified persons;

(F) Courses less than 60 minutes in duration;

(G) Physical therapy on-the-job training;

(H) Physical therapy orientation programs or staff meetings, including:

(i) Orientation to new policies;

(ii) Procedures;

(iii) Equipment;

(iv) Forms;

(v) Responsibilities; and

(vi) Services; and

(I) Presentations made by students.

012. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179 and this chapter.

012.01 COMPETENCE. A physical therapist or physical therapist assistant must not provide services for which they are not trained or experienced. Unprofessional conduct in the practice of physical therapy includes but is not limited to: Performing or agreeing to perform procedures when the procedures are known to be a departure from the standards of acceptable and prevailing practice in physical therapy. Unprofessional conduct does not include a single act of ordinary negligence.

012.02 CONFIDENTIALITY. Without the prior written consent of a patient, a physical therapist or physical therapist assistant must hold in confidence information obtained from a patient, except in those unusual circumstances in which to do so would result in clear danger to the person or to others, or where otherwise required by law.

012.03 PROFESSIONAL RELATIONSHIPS. A physical therapist or physical therapist assistant must safeguard the welfare of patients and maintain professional relationships with patients. Commission of any of the following acts or behavior will constitute unprofessional conduct:

(A) Exploiting another person for one's own advantage;

(B) Performing or agreeing to perform physical therapy services that have been requested when the services are known to be contraindicated or unjustified;

(C) Performing or agreeing to perform procedures that have been requested when the procedures are known to be outside of the physical therapist or physical therapist assistant's scope of practice;

(D) Verbally or physically abusing patients;

(E) Falsification or unauthorized destruction of patient’s records;

(F) Attempting to provide diagnostic or treatment information to a patient or patients that is beyond the physical therapist or physical therapist assistant's level of education, training and expertise;

(G) Delegating to other personnel those patient related services for which the clinical skills and expertise of a physical therapist or physical therapist assistant are required;

(H) Encouraging or promoting the practice of physical therapy by untrained or unqualified persons;

(I) Failure to safeguard the patient's dignity and right to privacy;

(J) Failure to maintain adequate patient records; and

(K) Delegating to a physical therapy assistant those patient related services for which the clinical skills and expertise of a physical therapist are required.

012.04 SEXUAL MISCONDUCT. A physical therapist or physical therapist assistant must not under any circumstances engage in sexual misconduct. Specifically with regard to patients, unprofessional conduct includes but is not limited to:

(A) Engaging in sexual relationships, whether consensual or nonconsensual, with any patient while a physical therapist or physical therapist assistant and patient relationship exists; and

(B) Engaging in sexual harassment of patients: Sexual harassment includes making unwelcome sexual advances, requesting sexual favors, and engaging in other verbal or physical conduct of a sexual nature which results in:

(i) Providing or denying physical therapy to a patient;

(ii) Creating an intimidating, hostile, or offensive environment for the patient; or

(iii) Interfering with a patient's ability to recover.

012.05 OTHER. Other unprofessional conduct includes but is not limited to:

(A) The violation of an assurance of compliance entered into under Neb. Rev. Stat. § 38-1,108 of the Uniform Credentialing Act;

(B) Failure to follow policies or procedures implemented in the practice situation to safeguard patient care;

(C) Failure to exercise appropriate supervision over persons who are authorized to practice only under the supervision of a physical therapist;

(D) Failure to obtain patient informed consent before treatment;

(E) Failure to take steps to transfer the continuum of care of the patient, as appropriate, to another health care provider in the event of elective termination of physical therapy services by the physical therapist;

(F) Engaging in conduct that subverts or undermines the integrity of the examination or the examination process including, but not limited to, utilizing in any manner recalled or memorized examination questions from or with a person or entity, failing to comply with all test center security procedures, communicating or attempting to communicate with other examinees during the test, or copying or sharing examination questions or portions of questions;

(G) Failure to complete continuing competency requirements as established by rules and regulations as specified in this chapter;

(H) Promoting any unnecessary device, treatment intervention or service resulting in the financial gain of the practitioner or of a third party; and

(I) Participating in underutilization or overutilization of physical therapy services for personal or institutional financial gain.

013. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

014. FEES . Fees are set out in 172 NAC 2.

History

Effective 2020-06-20

Chapter 143 Practice of Podiatry

Neb. Admin. Code tit. 172, ch. 143 Practice of Podiatry {#sec-172-nac-143 omnilex-key=us-ne-regs-official--title-172--172 NAC 143}

001. SCOPE AND AUTHORITY . These regulations apply to licensure of Podiatrists as defined by the Podiatry Practice Act, Nebraska Revised Statutes (Neb. Rev. Stat.) §§ 38-3001 to 38-3012; and the Uniform Credentialing Act, Neb. Rev. Stat. §§ 38-101 to 38-1,142.

002. DEFINITIONS . Definitions are set out in the Podiatry Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 ANGOFF METHOD. A method of determining passing scores based on aggregate information obtained by having judges predict the probability that a hypothetical minimally competent candidate will correctly answer items in a test is the Angoff Method.

002.02 APPROVED CLINICAL FACILITY. A clinical facility sponsored by an accredited college of podiatry is an approved clinical facility.

002.03 APPROVED CONTINUING COMPETENCY ACTIVITIES. Approved continuing competency activities are activities that ensure the maintenance of knowledge and skills necessary to competently practice podiatry; the utilization of new techniques based on scientific and clinical advances; and the promotion of research to assure expansive and comprehensive services to the public. The activities must meet the criteria for approval established by the Board to be recognized for licensure renewal.

002.04 HOUR. An hour is a period of 50 minutes of formal instruction, otherwise known as a "contact hour."

002.05 PROVIDER. A provider is an institution or individual that presents continuing education programs to licensees and requests approval from the Board of those programs.

002.06 ADVANCED POSTDOCTORAL SURGICAL RESIDENCY PROGRAM. An advanced postdoctoral surgical residency program is a surgical residency program approved by the Council on Podiatric Medical Education, or approved by another body that approves podiatric residency programs that maintains standards for approval that are equivalent to those of the Council on Podiatric Medical Education.

003. LICENSE REQUIREMENTS . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. § 38-3008, 172 NAC 10, and this chapter.

003.01 LICENSE BY EXAMINATION. An applicant applying by examination must submit the following:

(A) Have an Official Transcript submitted to the Department by the issuing institution.

(B) Request detailed score reports showing successful completion of one of the following:

(i) The Podiatric Medical Licensing Examination for States (PMLexis) given by the National Board of Podiatric Medical Examiners with a passing score as determined by using the Angoff Method or other comparable criterion referenced scoring method; or

(ii) The National Board of Podiatric Medical Examiners Examination Part III with a score of 75 or above; and

003.02 LICENSE BY RECIPROCITY. An applicant applying by reciprocity must meet the requirements of 172 NAC 143-003.01 and submit the following:

(A) Direct source verification of certification of a credential to practice podiatry submitted to Department by the jurisdiction; and

(B) Documentation that the applicant has been actively engaged in the practice of podiatry or in an accepted residency or graduate training program for at least 1 of the 3 years immediately preceding the date of the application for Nebraska licensure.

004. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10. All Podiatry licenses expire on April 1 of each even-numbered year.

005. CONTINUING COMPETENCY . Each podiatrist must meet the requirements of the Podiatry Practice Act, 172 NAC 10, and this chapter for continuing competency.

005.01 GENERAL REQUIREMENTS. On or before April 1 of each even-numbered year thereafter, each podiatrist who is in active practice in the state of Nebraska must complete 48 hours of continuing education approved by the Council of Podiatric Medical Education during the preceding 24 month period.

005.02 SUBJECT MATTER THAT IS NOT ACCEPTABLE. Practice management programs and education provided by a business entity for the purpose of promotion of its products or services and similar courses or training will not be accepted for continuing competency credit.

006. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179, this chapter which includes the following:

(A) Refusal to cooperate or failure to furnish requested information during a licensing or discipline investigation by the department;

(B) Misrepresenting one’s credentials in an application submitted to a healthcare facility, insurance company, or prospective employer;

(C) Refusal to provide professional service to a person because of such person’s race, color, religion, sex, national origin, ethnicity, disability or familial status;

(D) Refusal to undergo an examination for evaluation of competency as required by the board;

(E) Practicing podiatry under a false or assumed name;

(F) Advertising for health care services that does not provide accurate information on the type of credential(s) held or includes deceptive or misleading information pursuant to Neb. Rev. Stat. § 38-124;

(G) Advertising a fee for service that does not state a specific period of time the fee will be honored; if a time period is not specified it must be offered for a reasonable amount of time of at least 20 calendar days; or

(H) Advertising as a specialist without being certified by a specialty board as recognized by the Council on Podiatric Medical Education of the American Podiatric Medical Association, unless the practitioner has disclosed in the advertisement that they are not board certified.

007. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

008. FEES . Fees are set out in 172 NAC 2.

History

Effective 2021-12-26

Chapter 155 Psychology Licenses

Neb. Admin. Code tit. 172, ch. 155 Psychology Licenses {#sec-172-nac-155 omnilex-key=us-ne-regs-official--title-172--172 NAC 155}

TITLE 172 PROFESSIONAL AND OCCUPATIONAL LICENSURE

CHAPTER 155 PSYCHOLOGY LICENSES

001. SCOPE AND AUTHORITY . These regulations govern the credentialing of psychologists, psychological assistants, psychologist associates, provisional licensed psychologists, and special licensed psychologists as set out in Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-3101 to 38-3133 of the Psychology Practice Act and the Uniform Credentialing Act (UCA). Persons providing psychology services to clients located in Nebraska must be licensed as a psychologist in Nebraska unless exempt.

002. DEFINITIONS . Definitions are set out in the Psychology Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 BEHAVIORAL HEALTH PRACTITIONER. A licensed psychologist, special licensed psychologist, psychological assistant, psychologist associate, licensed independent mental health practitioner, licensed mental health practitioner, qualified physician, licensed alcohol and drug counselor, or other recognized profession who is licensed, certified, or regulated under the laws of this state, whose scope of practice includes mental health services or mental health service referrals.

002.02 CLIENT OR PATIENT. A recipient of psychological services within the context of a professional relationship. In the case of individuals with legal guardians, including minors and incompetent adults, the legal guardian will also be considered a client or patient for decision-making purposes relating to the minor or incompetent adult.

002.03 CONSULTATION. A professional collaborative relationship between a behavioral health practitioner or behavioral health entity and a consultant who is a licensed psychologist. The consulting psychologist must be qualified by license, training and experience to address the mental health problems of clients who are the subjects of consultation. When a mental health practitioner seeks consultation with a licensed psychologist for clients with major mental disorders, the consultation must be conducted in accordance with 172 NAC 94.

002.04 DIRECT SERVICE. A variety of activities, during the postdoctoral experience associated with a client system, including collateral contacts, for the purpose of providing psychological services.

002.04(A) DIRECT SERVICES. Includes, but are not limited to the following:

(i) Interviewing;

(ii) Therapy;

(iii) Case conferences;

(iv) Behavioral observations and management;

(v) Evaluations;

(vi) Treatment planning;

(vii) Testing;

(viii) Report writing;

(ix) Clinical supervision of graduate students in an American Psychological Association accredited clinical, counseling, or school psychology program;

(x) Consultations;

(xi) Biofeedback and neurofeedback;

(xii) Patient management, such as crisis management, triage, placement referrals, etc.;

(xiii) Classroom teaching of graduate psychology courses in an American Psychological Association accredited clinical, counseling, or school psychology programs that involve examination of psychopathology, psychological assessment, or psychological intervention; and

(xiv) Clinical research that involves examination of psychopathology, psychological assessment, or psychological intervention.

002.04(B) NON-DIRECT SERVICES. Includes, but are not limited to the following:

(i) Insurance or managed care reviews relating to payment;

(ii) Classroom teaching that is not for graduate courses in an American Psychological Association accredited clinical, counseling, or school psychology programs that involve examination of psychopathology, psychological assessment, or psychological intervention;

(iii) Receiving supervision;

(iv) Research that does not involve the examination of psychopathology, psychological assessment, or psychological intervention in clinical situations;

(v) Program evaluation;

(vi) Scheduling client appointments; and

(vii) Administrative tasks related to mental health facilities and programs.

002.05 MAJOR MENTAL DISORDER. Any clinically significant mental or emotional disorder in which symptoms, regardless of specific diagnoses or the nature of the presenting complaint, are associated with present distress or disability or present significantly increased risk of suffering, death, pain, disability, or an important loss of freedom. No diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association, nor any diagnosis from the International Classification of Diseases (ICD) published by the World Health Organization, of the edition or version used on the effective date of this chapter, is excluded from the category of Major Mental Disorder if the contemporary assessment indicates severe symptoms, as outlined in this section. These documents are available by contacting the publishing organizations. This includes currently observed or assessed dysfunction or impairment that portends danger to self or others, a disabling deterioration of function that seriously impairs daily functioning to include food, clothing, and shelter or an inability to establish or maintain a personal support system. Such disorders may take many forms and have varying causes but must be considered a manifestation of behavioral, psychological, or biological dysfunction in the person. Behavioral or psychological disorder symptoms include one or more of the following:

(A) Persistent or severe suicidal or homicidal thinking or behaviors injurious to self or others;

(B) Psychotic symptoms which include delusions, hallucinations, or formal thought disorders, including evidence of frequent substitution of fantasy for reality;

(C) Physical complaints or signs suggesting deterioration or anomaly in physiological, psychophysiological, or neuropsychological functioning;

(D) Feeling, mood or affect in which the emotion is clearly disruptive in its effects on other aspects of a person’s life. A marked change in mood, depression or anxiety that incapacitates a person;

(E) Severe impairment in concentration and thinking, persistence, and pace. Frequent or consistently impaired thinking; or

(F) Consistent inability to maintain conduct within the limits prescribed by law, rules, and strong mores or disregard for safety of others or destructive to property.

002.06 NATIONAL REGISTER. The National Register of Health Service Providers in Psychology (NRHSPP) is a credentials bank that verifies that the psychologist applying for licensure in Nebraska has previously submitted primary source documentation demonstrating completion of specific education and training, holds an active unrestricted license, and has maintained professional and ethical standards.

002.07 NATIONAL STANDARDIZED EXAMINATION. The Examination for Professional Practice in Psychology (EPPP) or the Enhanced Examination for Professional Practice in Psychology (EEPPP) developed by the Professional Examination Service (PES) or another examination that is substantially equivalent and approved by the Board.

002.08 NEBRASKA JURISPRUDENCE EXAMINATION. The examination relating to statutes and regulations governing psychology in Nebraska and relevant federal laws and ethical standards in psychology.

002.09 POSTDOCTORAL EXPERIENCE. Psychology experience or practice under the direct supervision of a licensed psychologist qualified to offer the services provided. To be postdoctoral, the experience must follow the formal awarding of the doctoral degree by an appropriate institution of higher education. Such experience must be compatible with knowledge and skills acquired during formal doctoral or postdoctoral education in accordance with professional requirements and relevant to the intended area of practice.

002.10 QUALIFIED PHYSICIAN. An individual with a current license to practice medicine and surgery and has specialized training in mental health treatment or is a Board Certified Psychiatrist.

002.11 REGULAR EMPLOYMENT. For purposes of Neb. Rev. Stat. § 38-3113, regular employment is:

(A) Work done in the context of an employer-employee relationship;

(B) That the school system directly pays the school psychologist for all services rendered; and

(C) That the agreed-upon school psychological services are provided in the context of a comprehensive service delivery system, are not limited to any specific type of service and include opportunities for follow-up and continuing consultation.

002.12 SUPERVISING LICENSED PSYCHOLOGIST. A Nebraska licensed psychologist, not a special licensed psychologist, who provides supervision.

003. CRIMINAL BACKGROUND CHECK . All applicants applying for a psychology license or provisional psychology license must submit a full set of fingerprints to the Nebraska State Patrol in compliance with Neb. Rev. Stat. § 38-131.

004. INITIAL PSYCHOLOGY LICENSE . To obtain a psychology license, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the credentialing requirements of Neb. Rev. Stat. §§ 38-131, 38-3114, 38-3115, 172 NAC 10, and this chapter. Applicants must submit the following:

004.01 EDUCATION. An official transcript, verifying completion of a doctoral degree from a program of graduate study in professional psychology, directly from the issuing institution, or the Association of State and Provincial Psychology Boards’ credentialing data bank, or the National Register. If the program is not accredited by the American Psychological Association, the applicant must submit the following to show the program meets the requirements of Neb. Rev. Stat. § 38-3114:

(A) Documentation, including syllabi or course descriptions, verifying that the applicant completed the following coursework:

(i) Scientific and professional ethics;

(ii) Research design and methodology;

(iii) Statistics and psychometics;

(iv) Biological bases of behavior;

(v) Cognitive and affective bases of behavior;

(vi) Social bases of behavior;

(vii) Individual behavior;

(viii) Assessment and evaluation; and

(ix) Treatment and intervention;

(B) Documentation that the program complies with the following:

(i) It was clearly identified and labeled as a psychology program and its intent was to educate and train psychologists;

(ii) Has a permanent and stable standing, including organizational structure, leadership and funding, within the academic setting;

(iii) Has clear authority and primary accountability for the academic program with an identifiable psychology faculty and has a psychologist who is responsible for the training program;

(iv) Was integrated and has an organized sequence of study, including core course work and profession-wide competencies;

(v) Has an identifiable body of students who are matriculated in the degree program; and

(vi) Has degree granting authority and was regionally accredited; and

(C) Documentation that the program required students to successfully complete the following years of study and residency:

(i) A minimum of 3 full-time academic years of graduate study, or equivalent, and an internship prior to receiving the doctoral degree;

(ii) Two of the 3 academic years, or equivalent, must be at the program from which the doctoral degree is granted; and

(iii) One year must be a full-time residency, or the equivalent, at the degree granting program. If the program is an on-line program, at least 600 hours must be live face-to-face in person interaction with faculty and students.

004.02 INTERNSHIP. Documentation of completion of an internship that was accredited by the American Psychological Association or if the internship is not accredited by the American Psychological Association, the applicant must submit:

(A) Verification that the internship was accredited by the Association of Psychology Postdoctoral and Internship Centers (APPIC); or

(B) Verification and documentation of the following:

(i) The official school, college or university transcript must show completion of practica prior to entering the internship;

(ii) A letter from the internship director or a copy of the internship brochure that verifies the purpose of the internship was to train psychologists for the independent provision of direct psychology services;

(iii) The internship was at least 12 months in duration and consisted of at least 1,500 hours in not more than 24 months. School psychology internships may be 10 months in duration;

(iv) The internship was directed by a licensed psychologist;

(v) The internship was sequentially organized with progressively increased levels of responsibility and skills;

(vi) The internship required 4 hours of supervision per week, 2 of the 4 hours were individual face-to-face. For part time internships, the supervision requirements must be proportional to these standards;

(vii) The internship had 2 or more supervising licensed psychologists on-site; and

(viii) The internship included positions for 2 or more psychology interns.

004.03 SUPERVISED POSTDOCTORAL EXPERIENCE. Documentation of completion of at least 1 year of supervised postdoctoral experience.

004.03(A) COMPLETED IN NEBRASKA. If the postdoctoral experience was completed in Nebraska, the applicant must provide documentation that the applicant:

(i) Holds or has held a provisional license as set out in 172 NAC 155-005; and

(ii) Has completed 1 year of supervised postdoctoral experience as follows:

(1) Met the standards of supervision as set out in 172 NAC 155-011;

(2) Included 1,500 or more hours in total duration, including 1,000 or more hours of direct service hours earned in not more than 48 months; and

(3) Compatible with the knowledge and skills acquired during formal doctoral or postdoctoral education in accordance with professional requirements and relevant to the intended area of practice.

004.03(B) COMPLETED OUTSIDE OF NEBRASKA. If the postdoctoral experience was completed outside of Nebraska, it must have been at least 1 year of supervised experience and have met the requirements of 172 NAC 155-004.03(A)(ii)(2).

004.04 EXAMINATION. Documentation of passing the national standardized examination with a minimum scaled score of 500 for all doctoral candidates and passing the Nebraska jurisprudence examination with a minimum score of 80%. The national standardized examination requirement is waived for applicants in the categories set out in Neb. Rev. Stat. § 38-3115.

005. PROVISIONAL PSYCHOLOGY LICENSE . To obtain a provisional license, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. §§ 38-131, 38-3122, 172 NAC 10, and this chapter.

005.01 LICENSE EXTENSION. The provisional license may be extended one time for an additional 2-year period upon approval by the Board and submission of a new application under this section.

006. TWENTY YEARS OF PSYCHOLOGY LICENSURE . To obtain a license based on 20 years of psychology licensure, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. § 38-3117, 172 NAC 10, and this chapter. Applicants must submit:

(A) An official transcript, verifying completion of a doctoral degree in psychology, directly from the issuing institution, or the Association of State and Provincial Psychology Boards’ credentialing data bank, or the National Register;

(B) Verification of holding a current license based on a doctoral degree in psychology;

(C) Verification of at least 20 years of licensed practice in psychology in the United States or a Canadian jurisdiction; and

(D) Documentation of successful passage of the Nebraska jurisprudence examination with a minimum score of 80%.

007. RECIPROCITY PSYCHOLOGY LICENSE . To obtain a license based on reciprocity, an applicant must have a current license in another jurisdiction, submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of 172 NAC 10, Neb. Rev. Stat. §§ 38-3118, 38-3121 or 38-129.02, and this chapter. Applicants applying under Neb. Rev. Stat. § 38-3121 must submit documentation of:

(A) A current Certification of Professional Qualification (CPQ) through the Association of State and Provincial Psychology Boards or a current credential at the doctoral level as a Health Service Provider by the National Register of Health Service Providers; or

(B) Meeting the requirements to obtain an initial license as set out in 172 NAC 155-004.

007.01 RESIDENCY. All applicants receiving a license pursuant to 172 NAC 155 must submit documentation of establishing residency in Nebraska as required by Neb. Rev. Stat. § 38-129.02. Such documentation must be submitted within 90 days of establishment of residency and consist of a rental or lease agreement with the signature of the owner or landlord and the applicant, a deed or title to residential real property with the name of the applicant as an owner, or documents with the name and address of the applicant such as mortgage bills, home utility bills, medical or employee documents or similar documents that show the applicant residing in Nebraska.

007.02 EXAMINATION. All applicants must submit documentation of passing the Nebraska jurisprudence examination with a minimum score of 80%.

007.03 TEMPORARY LICENSE. To obtain a temporary license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. §§ 38-129.01 or 38-3120, 172 NAC 10, and 172 NAC 155-007(A) and (B) of this chapter.

008. THIRTY DAYS PSYCHOLOGY PRACTICE WITHIN A ONE YEAR PERIOD . To obtain authority to practice for 30 days within a one year period, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. §§ 38-3119, 172 NAC 10, and this chapter. Applicants must submit documentation of:

(A) A current license in another jurisdiction; and

(B) An official transcript, verifying completion of a doctoral degree from a program of graduate study in professional psychology from an institution of higher education. The transcript must be submitted directly from the issuing institution, the Association of State and Provincial Psychology Boards’ credentialing data bank, or the National Register.

009. REGISTRATION . To obtain registration, an applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of 172 NAC 10, Neb. Rev. Stat. §§ 38-3113 and 38-3116 for applicants who hold a special license as a psychologist, Neb. Rev. Stat. §§ 38-3113 and 38-3122 for provisional licenses, Neb. Rev. Stat. § 38-3113 for assistants or associates, and this chapter.

009.01 PSYCHOLOGICAL ASSISTANTS OR PSYCHOLOGIST ASSOCIATES. Applicants must submit an official transcript, directly by the issuing institution, verifying completion of a masters’ degree in clinical psychology, counseling psychology, or educational psychology.

009.02 TERMINATION OF SUPERVISION. If a supervisor or registrant terminates supervision, he or she must notify the Department in writing immediately of the date of termination.

009.03 CHANGE OF OR ADDITIONAL SUPERVISOR. If a change in supervisor occurs or an additional supervisor is added, the registrant must submit an application as set out in 172 NAC 155-009.

010. SUPERVISING LICENSED PSYCHOLOGIST . The supervisor must:

(A) Hold an active license, which is currently not limited, suspended, or on probation. If disciplined by the Department during the supervisory period, the supervisor must terminate the supervision immediately and notify the Department of the termination;

(B) Not be a family member; and

011. SUPERVISION . Supervision applies to the following:

011.01 PROVISIONAL PSYCHOLOGY LICENSE. A professional relationship in which a licensed psychologist assumes legal and professional responsibility for the work of the provisional psychology licensee. The purpose of supervision is to provide training to assist the supervisee to achieve full licensure. The supervisor must:

(A) Review raw data from the applicant’s clinical work which is made directly available to the supervisor through such means as written clinical materials, direct observation, and video and audio recordings; and

(B) Meet with the provisional licensee at least twice per month for a minimum of 4 total hours. Such meeting may include face-to-face consultation, telephone, video, or other electronic means of communication and must ensure confidentiality of the conversation. The supervisor is responsible for documenting supervision meetings.

011.02 SPECIAL PSYCHOLOGY LICENSE. The supervisor will be responsible for determining the extent and character of supervision of a special psychology licensee, keeping in mind the education and experience of the supervisee. The supervisor assumes legal and professional responsibility for any work by the supervisee relating to major mental disorders. In all cases the supervisor must be competent to provide the services being supervised.

011.03 PROVISIONAL MENTAL HEALTH PRACTITIONER. A professional relationship in which a licensed psychologist has oversight responsibility for the mental health practice of the provisional mental health practitioner. The purpose of supervision is to provide training to assist the supervisee to achieve full licensure as a mental health practitioner. The supervisor must meet with the provisional licensee in accordance with 172 NAC 94.

011.04 SEEKING AN INDEPENDENT MENTAL HEALTH PRACTITIONER LICENSE. A professional relationship in which a licensed psychologist has oversight responsibility for the independent mental health practice of an individual seeking an independent mental health practitioner license. The purpose of supervision is to provide training to assist the supervisee to achieve full licensure as an independent mental health practitioner. The supervisor must meet with the applicant in accordance with 172 NAC 94.

011.05 PROVISIONAL ALCOHOL AND DRUG COUNSELOR. A professional relationship in which a licensed psychologist has oversight responsibility for the alcohol and drug clinical work of the provisional alcohol and drug counselor. The purpose of supervision is to enhance and promote the alcohol and drug clinical skills and competencies of the supervisee who is earning hours of clinical work experience to achieve full licensure as an alcohol and drug counselor. The supervisor must meet the requirements of 172 NAC 15.

011.06 PSYCHOLOGICAL ASSISTANT OR PSYCHOLOGIST ASSOCIATE. A professional relationship in which a licensed psychologist has oversight responsibility for the psychological work of an individual who administers and scores and may develop interpretations of psychological testing under the supervision of the licensed psychologist. Such individuals are deemed to be conducting their duties as an extension of the legal and professional authority of the supervising psychologist and must not independently provide interpretive information or treatment recommendations to clients or other health care professionals prior to obtaining appropriate supervision. The purpose of this supervision will be to provide oversight that insures competent and ethical practice in accordance with the statutes and Code of Conduct as promulgated by this Board. The supervisor must:

(A) Review raw data from the assistant or associates work which is made directly available to the supervisor through such means as written clinical materials, direct observation, and video and audio recordings; and

(B) Meet with the assistant or associate at least twice per month for a minimum of 4 total hours. Such meetings may include face-to-face consultation, telephone, video, or other electronic means of communication and must ensure confidentiality of the conversation. The supervisor is responsible for documenting supervision meetings.

012. TEST ADMINISTRATION BY UNLICENSED INDIVIDUALS . An individual who is trained by and is under the supervision of a licensed psychologist may administer and score tests which require no independent professional judgment and no interpretation of results. The individual must receive supervision, orders, and directions from a licensed psychologist. The supervisor must select the test to be administered and is ultimately responsible for the accuracy of the administration and scoring of the tests.

013. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The licensee must meet the requirements set out in 172 NAC 10 and this chapter. All psychology licenses, except a provisional license and temporary license, issued by the Department will expire on January 1 of each odd-numbered year.

014. CONTINUING EDUCATION . Psychologists holding an active license in the State of Nebraska must complete at least 24 hours of acceptable continuing education hours during the 24-month period prior to the expiration date. This section does not apply to individuals who hold a provisional license or temporary license.

014.01 REQUIRED HOURS. At least 3 of the 24 hours of continuing education must be in ethics relating to psychology.

014.02 CONTINUING EDUCATION ACTIVITIES. Continuing education must directly relate to the practice of psychology as defined in Neb. Rev. Stat. § 38-3108. Continuing education hours are determined as follows:

014.02(A) DEVELOPING AND TEACHING A GRADUATE ACADEMIC COURSE. Developing and teaching a graduate academic course in an institution accredited by a regional accrediting agency is an approved continuing education activity. Hours will be granted only for the first time the licensee teaches the course during the renewal period and cannot be used for subsequent renewal periods. 1 semester hour of graduate academic credit equals 15 hours of continuing education.

014.02(B) COMPLETING A GRADUATE LEVEL COURSE. Satisfactorily completing a graduate level course offered by an institution accredited by a regional accrediting agency is an approved continuing education activity. Hours will be granted only for the first time it is completed, and it must be completed during the renewal period for which it is submitted. 1 semester hour of graduate academic credit equals 15 hours of continuing education.

014.02(C) AUTHORING OR EDITING A PEER-REVIEWED PSYCHOLOGICAL PRACTICE ORIENTED PUBLICATION. Continuing education hours may be earned only in the year of publication or first distribution. Hours are granted as follows:

(i) Senior or 1st author of a peer-reviewed psychological practice oriented professional or scientific book equals 16 hours of continuing education;

(ii) Senior or 1st author of a peer-reviewed psychological practice oriented professional or scientific book chapter equals 8 hours of continuing education;

(iii) Senior or 1st author of a peer-reviewed psychological practice oriented professional journal article equals 8 hours of continuing education; and

(iv) Editor of a peer-reviewed psychological practice oriented professional or scientific book or journal equals 16 hours of continuing education.

014.02(D) PRESENTING, ATTENDING, OR COMPLETING PROGRAMS. Presenting or attending workshops, seminars, symposia, colloquia, invited speaker sessions, meetings of professional or scientific organizations, homestudy, or videos are acceptable continuing education activities.

014.02(D)(i) HOUR. 60 minutes of presentation or attendance equals 1 hour of continuing education.

014.02(D)(ii) APPROVED CONTINUING EDUCATION PROVIDERS. Only activities approved by the following organizations are acceptable for renewal or reinstatement:

(1) American Association of Marriage and Family Therapists (AAMFT) or its state Chapters;

(2) American Counselors Association (ACA) or its state chapters or National Board for Certified Counselors (NBCC);

(3) American Nurses Credentialing Center’s Commission on Accreditation (ANCCC);

(4) Nebraska Medical Association (NMA);

(5) Nebraska Nurses Association (NNA);

(6) National Association of Alcohol and Drug Abuse Counselors (NAADAC);

(7) National Association of Social Workers (NASW) or its state chapters;

(8) The Accreditation Council for Continuing Medical Education (ACCME);

(9) The American Medical Association (AMA) or its state chapters;

(10) The American Nurses Credentialing Center’s Commission on Accreditation (ANCCCA); and

(11) The American Psychological Association (APA) or its state chapters.

015. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

016. FEES . Fees are set out in 172 NAC 2.

017. PSYCHOLOGY INTERJURISDICATIONAL COMPACT . The applicant must meet the requirements set out in Neb. Rev. Stat. § 38-3901.

History

Effective 2023-06-14

Chapter 156 Regulations Defining Unprofessional Conduct by a Psychologist

Neb. Admin. Code tit. 172, ch. 156 Regulations Defining Unprofessional Conduct by a Psychologist {#sec-172-nac-156 omnilex-key=us-ne-regs-official--title-172--172 NAC 156}

001 SCOPE OF REGULATIONS . These regulations are intended to define and set forth what constitutes unprofessional conduct pursuant to the Uniform Licensure Law and Neb. Rev. Stat. 71-1,206 to 71-1,226.

002 DEFINITIONS .

002.01 Client means any person with whom the Psychologist has an agreement to provide psychological services.

002.02 Clinical Psychology means that branch of psychology concerned with the assessment, diagnosis, and treatment of mental, emotional and behavioral disorders.

002.03 Psychological services shall be the provision of services in the practice of psychology.

002.04 Unprofessional conduct is conduct which fails to conform to the accepted standards for the psychology profession and which could jeopardize the health safety and welfare of the client and shall include but not be limited to the conduct described in these regulations and Neb. Rev. Stat. 71-148.

003 INFORMED CONSENT . A psychologist shall obtain from a client or his or her legal representative informed and voluntary consent before providing or assisting in the care of treatment of the client. Failure to do so shall constitute unprofessional conduct. A client shall be deemed to have not given his or her informed and voluntary consent if the psychologist:

003.01 Fails to advise a client of a conflict of interest. A conflict of interest exists if the exercise of the psychologist’s professional judgment on behalf of the client will be or reasonably will be impaired or adversely affected by his or her own financial, business, property or personal interest.

003.02 Fails to clarify the nature of the relationship to all parties directly affected by the services.

003.03 Fails to advise a client of a known bias or prejudice which seriously affects the psychologist’s objectivity in dealing with the client.

004 COMPETENCE . A psychologist shall not provide services or use techniques for which he or she is not trained or experienced. Unprofessional conduct in the practice of psychology shall include but is not limited to:

004.01 Failure to consider a client as an individual and imposing on the client any stereotypes of behavior, values or roles related to age, gender, religion, race, disability, nationality or sexual orientation which would unreasonably interfere with the objectivity provision of psychological services to the client.

004.02 Making decisions involving clients based on test results for which the psychologist has made an interpretation in an area or areas where he or she is not trained or experienced.

004.03 Making decisions involving clients based on interpretations of test results by others whom the psychologist knows are not adequately trained or experienced.

004.04 Providing psychological services in which his or her serious personal problems may cause a competent psychologist to believe it will lead to inadequate performance or harm to a client, colleague, student, or research participant.

004.05 Willful or gross neglect of a client of record.

004.06 Terminating a relationship which a client without informing the client of such termination and providing the client with information regarding adequate alternatives for treatment.

004.07 Failing to take appropriate care when working with minors or other persons who are unable to give voluntary, informed consent, to protect their best interests.

005 PUBLIC STATEMENTS . A psychologist shall be accurate and objective when advertising regarding professional services or products. Unprofessional conduct includes but is not limited to:

005.01 Advertising of psychological products or services which contain: A) a false, fraudulent, misleading, deceptive statement; B) a testimonial from a patient which attests to performance of superior performance of professional service of psychologist’s services; C) a statement guaranteeing any professional services; D) a statement intended or likely to appeal to a client’s fears, anxieties, or emotions concerning the possible results of failure to obtain the offered services; E) a statement concerning the comparative desirability of offered services; F) a statement of direct solicitation of individual clients.

005.02 Giving anything of value to a representative of the press, radio, television, or other communication medium in anticipation of or in return for professional publicity in a news item.

005.03 Advertising for ”personal growth groups”, clinics, and agencies without a clear statement of purpose and a clear description of the services to be provided.

005.04 advertising for psychological devices, books or other products offered for commercial sale without making reasonable efforts to ensure presentation of nondeceptive, accurate, or nonmisleading statements.

005.05 Knowingly permitting others to misrepresent the psychologist’s professional qualifications or the psychologist’s affiliation with products or services for personal gain of the psychologist.

005.06 Providing individual formal diagnostic or formal therapeutic services outside the context of the psychologist/client relationship.

005.07 Making deceptive or misleading representations of the psychologist’s education, training, or experience.

006 CONFIDENTIALITY . A psychologist shall hold in confidence information obtained from a client, except in those unusual circumstances in which to do so would result in clear danger to the person or to others or where otherwise required by law. Failure to do so shall constitute unprofessional conduct.

007 PROFESSIONAL RELATIONSHIPS . A psychologist shall safeguard the welfare of clients and maintain appropriate professional relationships with clients and research participants. Unprofessional conduct includes but is not limited to:

007.01 Using skills of the psychologist to exploit clients.

007.02 Failure to terminate a clinical or consulting relationship with a client when the client is clearly and convincingly not benefiting from it.

007.03 Intentional failure to report to the Board of Examiners of Psychologists known unprofessional conduct by a psychologist. Information that becomes known to a psychologist in the course of psychotherapy and is otherwise subject to the protection of confidentiality is exempt from this provision.

007.04 Abandoning or neglecting a client with whom a professional relationship exists.

008 SEXUAL MISCONDUCT . A psychologist shall in no circumstances engage in sexual acts with clients, students who are under direct evaluative control of the psychologist, or with individuals who are currently participating in research conducted by or under the direction of the psychologist. Specifically with regard to the clients, such unprofessional conduct includes but is not limited to:

008.01 Engaging in sexual relationships with a client, regardless of the clients consent.

008.02 Soliciting a sexual relationship with a client.

008.03 Committing an act with a client punishable as a sexual or sexual related crime.

008.04 Engaging in any sexual act with a client or with a person who has been a client. Nothing in these regulations shall be construed to allow for a pre-arranged waiting period.

008.05 Engaging in sexual harassment of a client. Sexual harassment is defined as deliberate or repeated comments, gestures, or physical contacts of a sexual nature that are unnecessary in the professional relationship with a client.

009 FEES FOR SERVICES . A psychologist shall solicit or obtain fees for professional service in an appropriate manner consistent with the laws of the State of Nebraska. Unprofessional conduct includes but is not limited to:

009.01 Solicitation of professional patronage by agents or persons, popularly known as cappers or steerers, or profiting by the acts of those representing themselves to be agents of the psychologist.

009.02 Receipt of fees on the assurance that a manifestly incurable disease can be permanently cured.

009.03 Division of fees, or agreeing to split or divide the fees received for professional services with any person for bringing or referring a patient.

009.04 Ordering or utilizing tests, treatment, or use of treatment facilities not warranted by the condition of the patient.

009.05 Falsely or fraudulently claiming to have performed a professional service, charging for a service, or representing a service as the psychologist’s own when he or she has not rendered due service or substantially assumed responsibility for the service.

010 ASSESSMENT AND TREATMENT TECHNIQUES . A psychologist shall make reasonable efforts to preclude misuse in the development, publication and utilization of psychological assessment techniques for use with clients. Unprofessional conduct includes but is not limited to:

010.01 Failure, in reporting assessment results, to indicate any serious concerns or special circumstances that exist regarding validity or reliability because of the circumstances of the assessment or the inappropriateness of the norms for the person tested.

010.02 Failure to make reasonable efforts to avoid and prevent the misuse of obsolete psychological tests and instruments.

010.03 Offering scoring and interpretation services for which the validity of the programs and procedures used in arriving at interpretations cannot be supported by adequate evidence.

010.04 Encouraging or promoting the use of psychological assessment techniques by inadequately trained or otherwise unqualified persons through teaching, sponsorship, or supervision.

010.05 In presenting psychological information, failure to make reasonable efforts to present such information objectively, fully, and accurately.

011 RESEARCH WITH HUMAN PARTICIPANTS . A psychologist shall respect the dignity and welfare of human research participants, and shall comply with these regulations governing such psychological research. Unprofessional conduct includes but is not limited to:

011.01 Except in minimal risk research unless care and treatment is provided in such research, failure to establish an agreement with research participants, prior to their participation, that clarifies the obligations and responsibilities of the psychologist and of the participant. Except where the nature of the research precludes full disclosure, the failure to inform participants of all aspects of the research that might reasonably be expected to influence willingness to participate, or the failure to explain all aspects of the research about which a participant inquires, also constitute unprofessional conduct; where the nature of the research precludes full prior disclosure, or where the research is with children or with participants who have impairments, the failure to tax additional safeguards to protect the welfare and dignity of the research participants constitutes unprofessional conduct.

011.02 Where methodological requirements of a study make the use of concealment or deception necessary, unprofessional conduct includes failure of the investigator to:

A) Determine before conducting the study whether the use of the techniques is justified by the study’s prospective scientific, educational or applied value;

B) Determine before conducting the study whether alternative procedures are available that do not use concealment or deception; or

C) Provide the participants with an explanation as soon as possible.

011.03 Failure to grant a participant the right to decline to participate in or to withdraw from the research any time.

011.04 Failure to protect and or inform the participant of undue physical and mental discomfort, harm, and danger that may arise from research procedures; failure to inform participants of risks of such consequences; use of research procedures likely to cause serious or lasting harm to a participant unless the research has a potential benefit and fully informed and voluntary consent is obtained from the participant.

011.05 Except where scientific or humane values justify delaying or withholding information, the failure to provide participants, after data is collected, with information about the nature of the study or the failure to make reasonable efforts to remove any misconceptions that may have arisen constitute unprofessional conduct. Where scientific or humane values justify delaying or withholding this information, unprofessional conduct includes failure by the investigator to monitor the research and to ensure that there are no undue damaging consequences for participants.

011.06 Failure to make reasonable efforts to detect and remove or correct undesirable consequences for the individual participants, including long term effects.

011.07 Failure to make reasonable efforts to minimize the possibility that his or her research findings will be misleading.

011.08 Failure to make reasonable efforts to prevent distortion, misuse, or suppression of psychological findings by an institution or agency of which he or she is an employee.

011.09 Solicitation of research participants, when clinical services or other professional services are offered as an inducement for participation, without making clear the nature of the services as well as the costs and other obligations to be accepted by participants.

These Rules and Regulations recodify 172 NAC 36.6, Regulations Defining Unprofessional Conduct by a Psychologist.

History

Effective 1992-11-07

Chapter 157 Code of Professional Conduct for the Practice of Psychology

Neb. Admin. Code tit. 172, ch. 157 Code of Professional Conduct for the Practice of Psychology {#sec-172-nac-157 omnilex-key=us-ne-regs-official--title-172--172 NAC 157}

001 ADOPTION . The Board hereby adopts the Ethical Standards of Psychologists of the American Psychological Association as the Code of Professional Conduct for the practice of Psychology in Nebraska. Copies of the Ethical Standards of Psychologists are available from the Board or from the American Psychological Association, Inc., 1200 Seventeenth Street, N.W. Washington, D.C. 20036.

These Rules and Regulations recodify 172 NAC 156.5, Code of Professional Conduct for the Practice of

History

Effective 1992-08-15

Chapter 162 Respiratory Care Practitioners

Neb. Admin. Code tit. 172, ch. 162 Respiratory Care Practitioners {#sec-172-nac-162 omnilex-key=us-ne-regs-official--title-172--172 NAC 162}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of respiratory care practitioners under Nebraska Revised Statute (Neb. Rev. Stat.) §§ 38-3201 to 38-3216 of the Respiratory Care Practice Act and the Uniform Credentialing Act (UCA).

002. DEFINITIONS . Definitions are set out in the Respiratory Care Practice Act, the Uniform Credentialing Act, Title 172 Nebraska Administrative Code (NAC) 10, and this chapter.

002.01 APPROVED TRAINING PROGRAM. A respiratory therapy education program which is accredited by the Commission on Accreditation for Respiratory Care.

002.02 CONTINUING EDUCATION. The offering of instruction or information to license holders for the purpose of maintaining skills necessary to the safe and competent practice of respiratory care. Continuing education may be offered under such names as scientific school, clinic, forum, lecture, or educational seminar.

002.03 LICENSURE EXAMINATION. The Certified Respiratory Therapist (CRT) examination or the Registered Respiratory Therapist (RRT) examination offered by the National Board for Respiratory Care and approved by the Department on the recommendation of the Board.

002.04 PROVIDER. An individual or sponsoring organization that presents continuing education programs to license holders.

002.05 SCALED SCORE. A qualitative interpretive score which is a function of performance.

003.01 DOCUMENTATION. The following documentation must be provided to the Department.

003.01(A) EDUCATION. Submit an official transcript directly from the issuing institution, verifying completion of an approved training program.

003.01(B) EXAMINATION. Documentation of successful completion of the licensure examination developed by the National Board of Respiratory Care with a minimum score of 75 on a scaled score ranging from 1 to 99. An applicant who, on or before July 17,1986, passed the Certified Respiratory Therapy Technician or Registered Respiratory Therapist examination administered by the National Board for Respiratory Care or the appropriate accrediting agency acceptable to the Board, and meets the requirements as listed in 172 NAC 10, will be issued a license to perform respiratory care.

003.01(C) OTHER PROOF OF COMPETENCY. Applicants who have met the education and examination requirements as listed in 172 NAC 162-003.01(A) and (B) who passed the examination more than 3 years prior to the time of application and who are not practicing at the time of application, must within the 3 years immediately preceding the application, present proof of having at least 60 hours of acceptable continuing education in accordance with these regulations with a minimum of 15 hours in the each of the following categories:

(i) Pharmacology;

(ii) Mechanical ventilation;

(iii) Non-invasive ventilation support; and

(iv) Practice of respiratory care.

003.01(D) ACTIVE LICENSE IN ANOTHER JURISDICTION, NOT PRACTICING. Applicants who have an active license in another jurisdiction but who are not practicing at the time of application must meet the requirements listed in 172 NAC 162-003.01(A) and (B) and provide proof of having a minimum of 20 hours of acceptable continuing education in accordance with these regulations, obtained within the 3 years immediately preceding the date of application.

004. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10. All respiratory care practitioner licenses expire on June 1st of each even-numbered year.

005. CONTINUING EDUCATION . On or before June 1st of each even-numbered year, individuals holding an active license in the State of Nebraska must complete at least 20 hours of acceptable continuing education hours during the preceding 24-month period.

005.01 CONTINUING EDUCATION HOUR CALCULATIONS. The following provides the hour calculations for acceptable continuing education:

005.01(A) PROGRAMS AT STATE AND NATIONAL ASSOCIATION MEETINGS. Programs presented at state or national association meetings must relate to the theory or clinical application of theory pertaining to the practice of respiratory care. One hour for each hour of attendance;

005.01(B) FORMAL EDUCATION COURSES. Formal continuing education courses must be:

(i) Formally organized and planned instructional experiences;

(ii) Have a date, location, and course title, number of contact hours, signed certificate of attendance, and be open to all licensees;

(iii)Have objectives that relate to the theory or clinical application of theory pertaining to the practice of respiratory care; and

(iv) Be presented by an instructor that has specialized experience or training to meet the objectives of the course.

005.01(C) ACADEMIC COURSEWORK. Courses related to respiratory care practice taken either in person or online for college credit will be accepted for continuing education upon submission of a transcript by the college or university from which the course was taken. Continuing education hours will be awarded as follows:

(i) 1 semester hour of academic credit equals 15 continuing education hours; and

(ii) 1 quarter hour of academic credit equals 10 continuing education hours.

005.01(D) HOME STUDY. Home study will be accepted when the content of the home study activity relates to the theory or clinical application of theory pertaining to the practice of respiratory care, whether the subject is research, treatment, documentation, education, or management, for example, videotapes, internet courses, or correspondence courses. The program must have a testing mechanism scored by the named study provider. A licensee’s documentation must include a certificate of completion and a program outline or objectives.

005.01(E) MANAGEMENT COURSES. Management courses which relate to the theory or clinical application of theory pertaining to the practice of respiratory care will be accepted. A respiratory care practitioner may complete a maximum of 4 hours of continuing education utilizing management courses each 24-month renewal period. A licensee’s documentation must include a certificate of attendance and a program outline or objectives.

005.01(F) SPECIALTY CERTIFICATION EXAMINATIONS. A licensee will earn contact hours for successful completion of nationally recognized specialty certification examinations related to an area of specialty practice in the field of respiratory care each 24-month renewal period. A licensee’s documentation must include a copy of the certification that shows the date of the examination. Continuing education hours will be awarded as follows:

(i) Certified Pulmonary Function Technologist (CPFT), 10 hours;

(ii) Registered Polysomnographic Technologist (RPSGT), 10 hours;

(iii) Neonatal Pediatric Specialist (NPS), 10 hours;

(iv) Registered Pulmonary Function Technologist (RPFT), 10 hours; and

(v) Registered Respiratory Therapist (written and clinical simulation examinations), 15 hours.

005.01(G) CARDIOPULMONARY RESUCITATION CERTIFICATION. Basic or advanced cardiac life support for adults and pediatric or neonatal courses:

(i) Maximum of 1 hour credit for the basic cardiac life support course during each 24-month renewal period;

(ii) Maximum of 12 hours credit for initial advanced cardiac life support certification course or 6 hours credit for re-certification during each 24-month renewal period;

(iii) Maximum of 8 hours credit for initial neonatal advanced life support certification course or 4 hours credit for re-certification during each 24-month renewal period;

(iv) Maximum of 12 hours credit for pediatric advanced life support certification course or 6 hours credit for re-certification during each 24-month renewal period.

005.01(H) IN-SERVICES. In-services that meet the requirements for formal education that cover:

(i) Therapeutic respiratory care procedures; or

(ii) Respiratory care equipment.

005.01(I) PRESENTER OR LECTURER. One hour credit will be awarded for each hour of scientific presentation by a licensee acting as an essayist or lecturer to licensed respiratory care practitioners if the program relates to the theory or clinical application of theory pertaining to respiratory care. A licensee may receive continuing education credit for only the initial presentation during a renewal period, with a maximum of 4 hours of continuing education for presentations in a 24-month renewal period. Presenters may not receive any more hours of credit for a continuing education activity than an attendee could receive for the activity.

005.02 ACCEPTABLE PROGRAMS. The Board does not approve continuing education programs. In order for a continuing education program to be accepted for renewal or reinstatement of a license, the activity must include one or a combination of the following topic areas related to the practice of respiratory care therapy or clinical application:

(A) Research;

(B) Treatment;

(D) Management; or

(E) Education.

005.03 NON-ACCEPTABLE CONTINUING EDUCATION. Continuing education credit will not be awarded for programs that do not relate to the theory or clinical application of theory pertaining to the practice of respiratory care including:

(A) Business communications and operations;

(B) Medical terminology and language courses;

(D) Courses designed for lay persons;

(E) Teaching unlicensed or uncertified persons, conducting research, or publications, or any preparation for the same;

(F) Respiratory care on-the-job training;

(G) Respiratory care orientation programs or staff meetings, including orientation to new policies, non-therapeutic procedures, equipment, forms, responsibilities, or services;

(H) Presentation made by students; or

(I) Participation in or attendance at case conferences, grand rounds, or informal presentations.

006. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179 and this chapter and includes:

(A) Providing services for which they are not trained or experienced;

(B) Encouraging or promoting respiratory care by untrained or unqualified persons;

(D) Failure to maintain in confidence information obtained from a patient, except in those unusual circumstances in which to do so would result in clear danger to the person or to others, or where otherwise required by law;

(E) Failure to safeguard the welfare of patients and maintain appropriate professional relationships with patients;

(F) Improper use of another person for one’s own advantage;

(G) Failure to decline to carry out respiratory care services that have been requested when the services are known to be contraindicated or unjustified;

(H) Failure to decline to carry out procedures that have been requested when such services are known to be outside of the respiratory care practitioner’s scope of practice;

(I) Verbally or physically abusing patients;

(J) Falsification or unauthorized destruction of patient records;

(K) Attempting to provide diagnostic or treatment information to patients that is beyond the respiratory care practitioner’s level of training and expertise;

(L) Delegating to other personnel those patient related services when the clinical skills and expertise of a respiratory care practitioner is required.

(M) Engaging in sexual harassment of patients or co-workers. Sexual harassment includes making unwelcome sexual advances, requesting sexual favors, and engaging in other verbal or physical conduct of a sexual nature as a condition of:

(i) The provision or denial of respiratory care to a patient;

(ii) The provision or denial of employment or employment advances to a co-worker;

(iii) For the purpose or effect of creating an intimidating, hostile, or offensive environment for the patient or unreasonably interfering with a patient’s ability to recover; or

(iv) For the purpose or effect of creating an intimidating, hostile, or offensive working environment or unreasonably interfering with the co-worker’s ability to perform their work.

(N) Obtaining any fee for professional services by fraud, deceit, or misrepresentation;

(O) Violating an assurance of compliance entered into under Neb. Rev. Stat. § 38-1,108;

(P) Failure to follow policies or procedures implemented in the practice situation to safeguard patient care;

(Q) Failure to safeguard the patient's dignity and right to privacy;

(R) Failure to exercise appropriate supervision over persons who are authorized to practice only under the supervision of the licensed professional;

(S) Failure of a licensee who is the subject of a disciplinary investigation to furnish the Department or its investigator with requested information or requested documents.

007. REINSTATEMENT . The application must meet the requirements set out in 172 NAC 10.

008. FEES . Fees are set out in 172 NAC 2.

History

Effective 2020-05-17

Chapter 168 Certification of a Registered Environmental Health Specialist

Neb. Admin. Code tit. 172, ch. 168 Certification of a Registered Environmental Health Specialist {#sec-172-nac-168 omnilex-key=us-ne-regs-official--title-172--172 NAC 168}

001. SCOPE AND AUTHORITY . These regulations govern the certification of registered environmental health specialists under Nebraska Revised Statutes (Neb. Rev. Stat.) §§ 38-1301 to 38-1315 of the Registered Environmental Health Specialists Practice Act and the Uniform Credentialing Act (UCA).

002. DEFINITIONS . Definitions set out in the Registered Environmental Health Specialists Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10 and the following apply to this chapter.

002.01 ACCREDITED COLLEGE OR UNIVERSITY. An accredited college or university is a post-secondary school accredited by a regional accrediting institution.

002.02 CERTIFICATION EXAMINATION. The certification examination is The National Environmental Health Association’s Registered Environmental Health Specialist or Registered Sanitarian Examination.

002.03 PROVIDER. A provider is an individual or sponsoring organization that presents continuing education programs to certificate holders.

003. CERTIFICATION REQUIREMENTS . To obtain a certification, the applicant must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets the requirements of Neb. Rev. Stat. §§ 38-1301 to 38-1315, 172 NAC 10 and this chapter. All applicants must submit the following:

003.01 EDUCATION. An official transcript, directly from the issuing institution, verifying completion of a baccalaureate degree or higher from an accredited college or university.

003.02 EXAMINATION. Documentation of successful completion of the certification examination developed and administered by the National Environmental Health Association with a score of 68% or above.

003.03 EXPERIENCE. Documentation of successful completion of full-time employment as an environmental health specialist for a period of not less than 2 years with a baccalaureate degree or a period of not less than 1 year with a degree higher than a baccalaureate degree.

003.04 PASSED EXAMINATION BUT NOT PRACTICING. An applicant that passed the certification examination but is not currently practicing as an environmental health specialist must present documentation to the Department of completing 24 hours of continuing education as set out in this chapter, that were obtained within the 3 years immediately preceding the application for certification.

003.05 CREDENTIALIED IN ANOTHER JURSIDICTION BUT IS NOT PRACTICING. An applicant that has met the standards for certification under this chapter who holds a credential in another jurisdiction and who is not practicing at the time of application for certification must present documentation to the Department of completing 24 hours of continuing education as set out in this chapter, that were obtained within the three years immediately preceding the application for certification.

003.06 PROVISIONAL CREDENTIAL. An applicant who has met the education requirements outlined in 003.01, may be issued a provisional environmental health specialist credential.

004. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The certificate holder must meet the requirements set out in 172 NAC 10. Provisional environmental health specialist credentials will expire one year from the date of issuance and may be renewed for two one-year periods, not to exceed a three year period. A certificate expires on December 31st of each even-numbered year.

005. CONTINUING COMPETENCY REQUIREMENTS . On or before December 31st of each even-numbered year, individuals holding an active Registered Environmental Health Specialist certification in the State of Nebraska must complete at least 24 hours of acceptable continuing education hours during the preceding 24-month period.

005.01 ACCEPTABLE CONTINUING EDUCATION. The board does not pre-approve continuing education programs in advance. In order for continuing education programs or activities to be accepted for renewal or reinstatement of a certification, the continuing education programs or activities must relate to environmental health and it may focus on research, documentation, management, or education and must be open to all certificate holders.

005.01(A) CONTINUING EDUCATION HOUR CALCULATIONS. The following provides the hour calculations for acceptable continuing education. Each program must be at least 50 minutes in length. 1 hour of continuing education credit will be awarded for each 50 minutes of attendance. Credit will not be awarded for non-working breaks or meals.

005.01(A)(i) STATE AND NATIONAL ASSOCIATION MEETINGS. Attendance as State and National Association meetings is acceptable continuing education. This includes, but is not limited to, meetings of the Nebraska or other state environmental health associations or the National Environmental Health Association.

005.01(A)(ii) WORKSHOPS, SEMINARS, OR CONFERENCES. Attendance at workshops, seminars, or conferences is acceptable continuing education. This includes monitored videotapes and in-service programs where the content of the continuing education program or activity relates to environmental health.

005.01(A)(iii) UNIVERSITY OR COLLEGE SPONSORED COURSES. The credential holder must provide documentation of successfully completing the course. 1 semester hour is equivalent to 15 contact hours. 1 quarter hour is equivalent to 3.75 contact hours.

005.01(A)(iv) FORMAL SELF-STUDY. Formal self-study is acceptable continuing education and includes, but is not limited to, videotapes, internet courses, and correspondence courses. Certificate holders may complete a maximum of 12 hours of continuing education by formal self-study each renewal period. The formal self- study program must have a testing mechanism.

005.01(A)(v) MANAGEMENT COURSES. An environmental health specialist may complete a maximum of 6 hours of continuing education utilizing management courses each renewal period.

005.01(A)(vi) PROFESSIONAL DEVELOPMENT COURSES. Professional Development courses are acceptable continuing education if the course includes the topics of quality improvement and communication. An environmental health specialist may complete a maximum of 4 hours of continuing education utilizing professional development courses each renewal period.

005.01(A)(vii) NATIONALLY RECOGNIZED SPECIALTY CERTIFICATIONS OR REGISTRATION. A credential holder will earn 24 contact hours of continuing education each renewal period for successful completion of a nationally recognized specialty certification. These include Certified Food Safety Professional (CFSP), National Environmental Health Association’s (NEHA) Registered Environmental Health Specialist or Registered Sanitarian (REHS or RS), Registered Hazardous Substances Professional (RHSP), and Registered Hazardous Substances Specialist (RHSS). Documentation must include a copy of the credential holder’s current certification.

005.01(A)(viii) SCIENTIFIC PRESENTATION. A certificate holder acting as an essayist or a lecturer to certified environmental health specialists will be awarded 1 hour of continuing education credit for each continuing education hour of scientific presentation at workshops, seminars, in-service training, conferences, or guest lectures which relate to environmental health. A certificate holder may receive continuing education credit for only the initial presentation during a renewal period, with a maximum of 4 hours of continuing education credit for presentations in a renewal period.

005.02 NON-ACCEPTABLE CONTINUING EDUCATION. Continuing education credit will not be awarded for programs where the content does not relate to environmental health, including but not limited to:

(A) Stress management;

(B) Environmental health on-the-job training; and

(C) Environmental health orientation programs, including orientation to new policies, procedures, equipment, forms, responsibilities, services, etc.

006. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179 and this chapter.

006.01 PROFESSIONAL RELATIONSHIPS. Commission of any of the following acts constitutes unprofessional conduct:

(A) Exploiting a client for financial gain or sexual favors;

(B) Performing or agreeing to perform environmental health services that have been requested when the services are known to be contraindicated or unjustified;

(C) Performing or agreeing to perform procedures that are outside of the environmental health specialist’s scope of practice;

(D) Verbally or physically abusing clients;

(E) Falsification or unauthorized destruction of client records;

(F) Delegating to other personnel, who are not trained or qualified, those services for which the skills and expertise of a registered environmental health specialist are required;

(G) Filing a false report or record in the practice of environmental health. This includes but is not limited to collection or billing of a fee or other similar activity to obtain payment; and

(H) Providing services or promoting the sale of devices, appliances, or products to a person who cannot reasonably be expected to benefit from the services, devices, appliances, or products.

006.02 ENGAGING IN SEXUAL MISCONDUCT. Engaging in sexual harassment of clients is unprofessional conduct. Sexual harassment includes, but is not limited to, making unwelcome sexual advances, requesting sexual favors, and engaging in other verbal or physical conduct of a sexual nature which results in:

(A) Providing or denying service to a client;

(B) Creating an intimidating, hostile, or offensive environment for the client; and

006.04 SUPERVISION. Failure to exercise appropriate supervision over persons who are authorized to practice only under the supervision of a registered environmental health specialist constitutes unprofessional conduct.

006.05 COMPLY WITH DEPARTMENT INVESTIGATION. Failure of an applicant or certificate holder who is the subject of a pre-licensure or disciplinary investigation to furnish the Board or its investigator with requested information or requested documents constitutes unprofessional conduct.

007. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

008. FEES . Fees are set out in 172 NAC 2.

History

Effective 2020-05-23

Chapter 180 Practice of Veterinary Medicine and Surgery

Neb. Admin. Code tit. 172, ch. 180 Practice of Veterinary Medicine and Surgery {#sec-172-nac-180 omnilex-key=us-ne-regs-official--title-172--172 NAC 180}

001. SCOPE AND AUTHORITY . These regulations apply to licensure of veterinarians and veterinary technicians as defined by the Veterinary Medicine and Surgery Practice Act, Nebraska Revised Statutes (Neb. Rev. Stats.) §§ 38-3301 to 38-3335 and the Uniform Credentialing Act.

002. DEFINITIONS . Definitions set out in the Veterinary Medicine and Surgery Practice Act, the Uniform Credentialing Act, 172 Nebraska Administrative Code (NAC) 10, and the following apply to this chapter.

002.01 ADEQUATE RECORDS. Legible medical records containing, at a minimum, sufficient information to identify the patient, support the diagnosis, justify the treatment, accurately document the results, indicate advice and cautionary warnings provided to the patient and provide sufficient information for another practitioner to assume continuity of the patient’s care at any point in the course of treatment, and, when investigative or unproven therapies are utilized, the records must include written informed client consent.

002.02 ANGOFF METHOD. A method of determining passing scores based on aggregate information obtained by having judges predict the probability that a hypothetical minimally competent candidate will correctly answer items in a test.

002.03 APPROVED CONTINUING EDUCATION. Consists of courses, clinics, forums, lectures, training programs or seminars that pertain to veterinary medicine and surgery or veterinary technology and are approved by the Board.

002.04 APPROVED CONTINUING COMPETENCY. Activities that ensure the maintenance of knowledge and skills necessary to competently practice veterinary medicine and surgery; the utilization of new techniques based on scientific and clinical advances; and the promotion of research to assure expansive and comprehensive services to the public. The activities must meet the criteria for approval established by the Board to be recognized for licensure renewal.

002.05 APPROVED PROGRAM THAT DETERMINES EDUCATIONAL EQUIVALENCE. A program which issues certificates based on specific standards indicating that the holder of such a certificate has demonstrated knowledge and skill equivalent to that possessed by a graduate of an accredited college of veterinary medicine. Such programs include the American Veterinary Medical Association (AVMA), Education Commission for Foreign Veterinary Graduates (ECFVG), the American Association of Veterinary State Boards (AAVSB) Program for the Assessment of Veterinary Education Equivalence (PAVE); or another entity that maintains the same standards for determining educational equivalence as the American Veterinary Medical Association, Education Commission for Foreign Veterinary Graduates, or the American Association of Veterinary State Boards Program for the Assessment of Veterinary Education Equivalence.

002.06 HOUR. A period of 50 minutes of formal instruction, otherwise known as a "contact hour."

002.07 PROVIDER. An institution or individual that presents continuing education programs to licensees.

002.08 SURGERY. The treatment, through revision, destruction, incision, closure or other structural alteration of animal tissue.

003. LICENSE REQUIREMENTS . To obtain a license, an individual must submit a complete application provided by the Department and provide documentation demonstrating that the applicant meets all statutory requirements, 172 NAC 10, and this chapter.

003.01 VETERINARY LICENSURE BY EXAMINATION. An applicant for a license to practice veterinary medicine and surgery based on examination must have attained at least the age of 21, and:

(A) Submit an official transcript directly from the issuing institution verifying graduation from an accredited school of veterinary medicine or a certificate directly from an approved program that determines educational equivalence;

(B) Submit score reports directly from the issuing institutions showing:

(i) Passage of the National Board Examination with a converted score of at least 70 and the Clinical Competency Test with a converted score of at least 70 within the last 5 years, which are administered by the National Board of Veterinary Medical Examiners (NBVME); or pass the North American Veterinary Licensing Examination (NAVLE) given by the National Board of Veterinary Medical Examiners with a converted score of at least 70 within the last 5 years; and

(C) Pass the Nebraska Jurisprudence Examination, which relates to the statutes that govern veterinary medicine and surgery, with an average score of at least 70.

003.02 VETERINARY LICENSE BY RECIPROCITY. An applicant for a license to practice veterinary medicine and surgery based on reciprocity must have attained at least the age of 21, and:

(B) Submit score reports directly from the issuing institutions showing:

(i) Passage of the National Board Examination with a converted score of at least 70 and the Clinical Competency Test with a converted score of at least 70 within the last 5 years, which are administered by the NBVME; or pass the North American Veterinary Licensing Examination given by the National Board of Veterinary Medical Examiners with a converted score of at least 70 within the last 5 years; or

(ii) Passage of one of the following examinations administered by the NBVME:

(1) The National Board Examination with a converted score of at least 70; or

(2) The NAVLE with a converted score of at least 70;

(C) Pass the Nebraska Jurisprudence Examination, which relates to the statutes that govern veterinary medicine and surgery, with an average score of at least 70; and

(D) Submit direct source verification of the credential the applicant holds in another state or territory of the United States or the District of Columbia which maintains standards regulating the profession equal to those maintained in this State.

003.03 VETERINARY TECHNICIAN LICENSE. An applicant for licensure as a veterinary technician must:

(A) Submit an official transcript directly from the issuing institution verifying graduation from an American Veterinary Medical Association (AVMA) accredited veterinary technician program; and

(B) Submit score reports directly from the issuing institution showing passage of the Veterinary Technician National Examination (VTNE) with a passing score as determined by the Angoff Method or other comparable criterion referenced scoring method.

004. STANDARDS OF SUPERVISION . The following delegated tasks may be performed under the indicated level of veterinarian supervision.

004.01 LICENSED VETERINARY TECHNICHIANS. Veterinary technicians may perform the following tasks provided the supervising veterinarian makes a physical examination of the patient being treated.

004.01(A) TASKS WHICH REQUIRE IMMEDIATE SUPERVISION.

(i) Dental extraction not requiring sectioning of a tooth or the resectioning of bone; or

(ii) Assist veterinarian in surgery by tissue handling and instrument handling.

004.01(B) TASKS WHICH REQUIRE DIRECT SUPERVISION.

(i) Induction of anesthesia;

(ii) Euthanasia;

(iii) Blood or blood component collection, preparation and administration for blood transfusions; or

(iv) Dental procedures limited to the following procedures only:

(1) Removal of calculus, soft deposits, plaque, and stains;

(2) Smoothing, filing, and polishing of teeth; or

(3) Flotation or dressing of equine teeth.

004.01(C) TASKS WHICH REQUIRE INDIRECT SUPERVISION.

(i) Perform preliminary physical examination;

(ii) Obtain history regarding an animal patient;

(iii) Client education;

(iv) Administration and application of treatments, drugs, oxygen therapy, medications and immunological agents by parenteral and injectable routes (subcutaneous, intramuscular, intraperitoneal, and intravenous), except when in conflict with government regulations;

(v) Initiation of parenteral fluid administration;

(vi) Intravenous catheterizations;

(vii) Radiography including settings, positioning, processing and safety procedures;

(viii) Electrocardiogram (EKG);

(ix) Collection of urine by expression, cystocentesis, or catheterization;

(x) Collection and preparation of tissues, cellular, or microbiological samples by skin scraping, impressions, or other non-surgical methods, except when in conflict with government regulations;

(xi) Routine laboratory test procedures;

(xii) Supervision of the handling of biohazardous waste materials;

(xiii) Application of bandages and wound management; or

(xiv) Patient vital sign monitoring.

004.02 UNLICENSED VETERINARY ASSISTANTS. An unlicensed veterinary assistant may perform under the indicated level of supervision the following tasks provided the supervising veterinarian makes a physical examination of the patient being treated.

004.02(A) TASKS WHICH REQUIRE IMMEDIATE SUPERVISION.

(i) Assist veterinarian in surgery by tissue handling and instrument handling.

004.02(B) TASKS WHICH REQUIRE DIRECT SUPERVISION.

(i) Assist with the following radiology procedures:

(1) Patient positioning; or

(2) Operation of x-ray machine after obtaining training in radiation safety as required by 172 NAC 93.

(ii) Administer crystalloid fluid therapy through an established IV catheter;

(iii) Collection of blood specimens; or

(iv) Patient vital sign monitoring.

004.02(C) TASKS WHICH REQUIRE INDIRECT SUPERVISION.

(i) Collection of voided urine specimens;

(ii) Collection of fecal specimens;

(iii) Perform automated blood tests or commercial ELISA tests;

(iv) Obtain history regarding an animal patient;

(v) Perform preliminary physical examination;

(vi) Client education; or

(vii) Administration and application of treatment and drugs, medications and immunological agents by topical, oral, rectal, intramuscular and subcutaneous injectable routes, except when otherwise prohibited by law.

004.03 EMERGENCY AID OR TREATMENT. During an emergency a licensed veterinary technician or unlicensed veterinary assistant may render the following life-saving aid and treatment:

(A) Application of tourniquets or pressure bandages to control hemorrhage;

(B) Administration of pharmacological agents and parenteral fluids only when performed after direct communication with a licensed veterinarian and the veterinarian is either present or enroute to the location of the distressed animal;

(D) Application of temporary splints or bandages to prevent further injury to bones or soft tissues;

(E) Application of bandages, appropriate wound dressings and external supportive treatment in severe wound and burn cases; or

(F) External supportive treatment in heat prostration cases.

004.04 TASKS RESERVED FOR A VETERINARIAN. Licensed veterinary technicians or unlicensed veterinary assistants are not permitted to do any of the following:

(A) Make a diagnosis or prognosis;

(B) Prescribe any treatment, drugs, medications or appliances;

(D) Administer rabies vaccine.

005. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10. All licenses expire on April 1 of each even-numbered year.

006. CONTINUING COMPETENCY . On or before the expiration date, individuals holding an active license must complete the following number of hours for professional certification.

(A) Veterinarians – 32 hours of approved Continuous Competency.

(B) Veterinary Technicians –16 hours of approved Continuous Competency.

006.01 GENERAL REQUIREMENTS FOR LICENSEE. As a condition for renewal of license, each veterinarian and veterinary technician must complete one or a combination of the following continuing competency requirements within the renewal period immediately preceding the license renewal date:

006.01(A) INITIAL OR RE-CERTIFICATION. Initial Board Certification or Re-Certification by an AVMA recognized veterinary specialty organization, obtained during the renewal period immediately preceding the license renewal date, meets the entire requirement for continuing competency for that renewal period.

006.01(B) PROFESSIONAL CERTIFICATION. Professional Certification, as approved in advance by the Board, obtained during the renewal period immediately preceding the license renewal date. Professional certification meets the requirement for continuing competency according to the number of hours of classwork, study time, or other time required to be completed by the practitioner in order to obtain the certification, to be determined in advance by the Board.

006.01(C) REFRESHER COURSES. As approved in advance by the Board, meet the requirement for continuing competency according to the number of hours attended.

006.01(D) IN-SERVICE TRAINING. As approved in advance by the Board, meets the requirement for continuing competency according to the number of hours attended.

006.01(E) CLINICAL ROTATIONS. As approved in advance by the Board, meet the requirement for continuing competency according to the number of hours attended.

006.01(F) ACCEPTABLE CONTINUING EDUCATION PROGRAMS. Types of continuing education programs acceptable for continuing competency credit include, but are not limited to:

(i) State, National, and District meetings, i.e., a meeting of the Nebraska Veterinary Medical Association (NVMA) or a veterinary association in any other state, the Nebraska Veterinary Technician Association (NVTA), or a veterinary technician association in any other state, the Nebraska Academy of Veterinary Medicine (NAVM), the AVMA, the American Association of Bovine Practitioners (AABP), the American Association of Equine Practitioners (AAEP), the American Association of Swine Practitioners (AASP), the American Association of Laboratory Animal Practitioners (AALAP), the American Animal Hospital Association (AAHA), or any satellite organization related to any of the associations listed above.

(1) One hour credit for each hour of attendance, and only the portion of such meeting which is applicable to the credential holders practice of either veterinary medicine and surgery or veterinary technician, can be approved for credit.

(ii) Formal education courses which relate directly to the practice of veterinary medicine and surgery or veterinary technology.

(1) One hour credit for each hour of attendance.

(iii) Veterinary and veterinary technology continuing education courses sponsored by accredited colleges of veterinary medicine and surgery or veterinary technology:

(1) One hour credit for each hour of attendance.

(iv) Home study courses with a testing mechanism that is scored by the provider or their designee. Licensee will be given credit for home study courses for a maximum of one quarter of the total number of hours required for each renewal period.

(1) One hour credit for each hour of study; no more than one quarter of the total number of hours required for each renewal period.

(v) Programs approved by the American Association of Veterinary State Boards Registry of Approved Continuing Education (RACE) which are related to the practice of veterinary medicine and surgery or veterinary technology.

(1) One hour credit for each hour of attendance.

(vi) Practice management programs. Licensee will be given credit for practice management programs for a maximum of one quarter of the total number of hours required for each renewal period.

(1) One hour credit for each hour of attendance; no more than one quarter of the total number of hours required for each renewal period.

(vii) A presenter may receive credit for only the initial presentation during a renewal period. Credit will not be given for subsequent presentations of the same program.

006.02 APPROVAL OF CONTINUING COMPETENCY ACTIVITIES. Either a provider or a licensee may apply for approval of a continuing competency activity. The approval is granted by the Department and means that the activity has been determined by the Board to meet the criteria for acceptable continuing competency. Approval prior to the renewal date is optional for continuing education, but is provided by the Board as a service to providers and licensees who wish to determine if a program meets the criteria for acceptable continuing education. All continuing competency activities must include:

(1) The activity must be at least one hour in duration;

(2) The topic and/or objectives must relate directly to the practice of veterinary medicine and surgery or veterinary technology;

(3) The presenter of the activity must be qualified by education, experience or training; and

(4) Activities must be open to all veterinarians or veterinary technicians licensed in Nebraska.

006.02(A) REQUESTING APPROVAL. A provider or licensee may submit information about the continuing competency activity to the Board on an application provided by the Department. Only applications which are complete will be considered.

(i) The following information must be included in the application:

(1) A description of activity content and/or objectives;

(2) A general description of the qualifications of each presenter;

(3) The number of hours for which approval is requested, if applicable;

(4) The name, address, and telephone number of the provider's program planner;

(5) A description of the process the provider uses to verify attendance by the licensee;

(6) A sample copy of the documentation the provider issues to the licensee as proof of attendance at the activity;

(a) Certificates verifying attendance at approved activities must contain at least the following information:

(i) Name of the activity;

(ii) Name of the provider;

(iii) Name of the licensee who attended the course;

(iv) Number of credit hours earned (actually attended) by the licensee, if applicable; and

(v) Date(s) the course was attended by the licensee; and

(7) Location of program.

(ii) The provider may submit additional documents or information as considered relevant to the application and in compliance with the provisions of this chapter.

(iii) The provider must submit a complete application to the Department at least 45 days prior to the date on which the program is to be given to gain approval before the activity is presented.

(iv) Once a provider is granted approval for a continuing competency activity, re-approval is not required for each subsequent occasion on which the activity is administered so long as the program is not changed or the laws and regulations governing continuing competency are not changed. If any portion of the activity is changed, re-application must be made in accordance with this chapter if continued approval is desired.

(v) After being granted written approval of the application, the provider is entitled to state upon any publication which advertises or announces the program, the following statement: "This program is approved for ___ hours of continuing competency by the Nebraska Department of Health and Human Services, Division of Public Health.”

(vi) Post-Program Approval Applications for approval of a continuing education program may be made after the program has occurred. Activities that are not continuing education programs require approval prior to the completion of the activity.

006.02(B) DENIAL OF CONTINUING COMPETENCY ACTIVITIES. The Board may deny an application for approval of a continuing competency activity or suspend or revoke approval of a continuing competency activity on any of the following grounds:

(1) Fraud or misrepresentation of information in an application; or

(2) The program fails to meet the criteria for acceptable continuing competency set forth in this chapter.

006.02(B)(i) NOTICE OF DENIAL. An application for approval of continuing competency activities may be approved or denied. Should an application for a continuing competency activity be denied, the applicant will be sent a notice setting forth the reasons for the determination to the last address of record in the Department. Denial of an application will become final 15 days after the mailing of the notice unless the provider, within such 15-day period, will give written notice to the Board of a desire for hearing. The hearing will be conducted before the Board in accordance with the Administrative Procedure Act and 184 NAC 1 of the Rules of Practice and Procedure for the Department.

007. UNPROFESSIONAL CONDUCT . Unprofessional conduct includes but is not limited to the acts set out in Neb. Rev. Stat. § 38-179 and the following:

(A) Commission of any act of sexual abuse, misconduct, or exploitation related to the practice of the profession of the applicant or credential holder. Sexual misconduct in the practice of veterinary medicine means violation of the practitioner-client-patient relationship through which the applicant or credential holder uses said relationship to induce or attempt to induce the client-patient to engage or to attempt to engage the client or patient, in sexual activity; committing any act which may reasonably be interpreted as intended for the sexual arousal or gratification of the practitioner, the client or patient, or both;

(B) Failure to keep and maintain adequate records of treatment or service for 3 years after the veterinarian’s most recent contact with the client or patient;

(C) Disruptive veterinarian behavior as manifested by a veterinarian’s aberrant behavior which interferes with patient care or could reasonably be expected to interfere with patient care, including, but not limited to, the following:

(i) Outbursts of rage or violent behavior;

(ii) Repeated failure to respond to calls;

(iii) Throwing instruments, charts, or objects;

(iv) Insulting comments to a client, client’s family, veterinarians, or healthcare staff;

(v) Striking or assaulting a client, client’s family, patient, veterinarians, or healthcare staff; or

(vi) Poor hygiene;

(D) Making a false or misleading statement regarding his or her skill as a veterinarian, or as a veterinary technician;

(E) Making a false or misleading statement regarding the efficacy or value of the medicine, device, treatment, or remedy prescribed by the veterinarian or used at the veterinarians direction in the practice of veterinary medicine and surgery;

(F) Practice or other behavior that demonstrates a willful rendering of substandard care, either individually or as a part of a third-party reimbursement agreement or other agreement;

(G) The use of any false, fraudulent, deceptive or misleading statement in any document pertaining to the practice of veterinary medicine and surgery, or practice as a veterinary technician;

(H) Prescribing, selling, administering, or distributing, any drug legally classified as a controlled substance, other than with proper registration to prescribe controlled substances;

(I) Failure to furnish the Board, its investigators or representatives, information legally requested by the Board;

(J) To advertise in a manner that deceives, misleads, or defrauds the public. The following advertising practices will be considered to be deceptive:

(i) To advertise or promote any veterinary service as free or below the advertiser's or promoter's own cost without revealing in the advertising or promotion the minimum expenditure the consumer must incur in order to receive the service. If the consumer need not incur any expense to obtain the service, then the advertising or promotion must state that there is no minimum purchase required;

(ii) To fail to inform the consumer of any time schedule within which a fee is to be effective, if the fee applies to a particular service for a given time;

(iii) To fail to charge the same fee for a service as that which is advertised; or

(iv) To advertise or promote any veterinary service with statements that cannot be verified, substantiated or measured;

(K) Failure to properly supervise licensed veterinary technicians or unlicensed assistants; or

(L) Failure to comply with Neb. Rev. Stat. §§ 71-8401 to 71-8407 regarding access to medical records.

007. UNPROFESSIONAL CONDUCT . Unprofessional conduct includes but is not limited to the acts set out in Neb. Rev. Stat. § 38-179 and 172 NAC 10.

008. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

009. FEES . Fees are set out in 172 NAC 2.

History

Effective 2021-11-01

Chapter 182 Licensure of Animal Therapists

Neb. Admin. Code tit. 172, ch. 182 Licensure of Animal Therapists {#sec-172-nac-182 omnilex-key=us-ne-regs-official--title-172--172 NAC 182}

001. SCOPE AND AUTHORITY . These regulations govern the licensure of animal therapists under the Nebraska Revised Statutes (Neb. Rev. Stats.) §§ 38-3301 to 38-3334 of the Veterinary Medicine and Surgery Practice Act, and the Uniform Credentialing Act. These regulations do not apply to:

(A) Licensed veterinary technicians;

(B) Unlicensed assistants working in veterinary medicine;

(D) Persons who hold a valid credential under the Uniform Credentialing Act and who consult with a licensed veterinarian or perform collaborative animal health care tasks on a patient under the care of such veterinarian if all such tasks are performed under the immediate supervision of such veterinarian.

002.01 ADEQUATE RECORDS. Legible records in either written or electronic form which contain, at a minimum, the date, patient, client, diagnosis or service provided, products given, data from tests performed and documentation of any client or agent consent.

003.01 QUALIFICATIONS. To receive a credential to practice as an animal therapist, an individual must meet the following qualifications:

(A) Hold and maintain an undisciplined license under the Uniform Credentialing Act for a health care profession other than veterinary medicine and surgery. Any person who wishes to practice or represent himself or herself as an animal therapist must be licensed as an animal therapist.

(B) Successfully complete training, approved by the board, regarding the performance of the applicant’s specified health care profession on animals and have training in the human profession consistent with the therapy to be provided on animals. Training can be obtained from more than one program.

003.02 DOCUMENTATION. The applicant must submit to the Department proof of completing a training program that includes the following:

(A) The name of the training program completed;

(B) The location of the training program completed; and

004. TRAINING STANDARDS . All animal therapists must have a qualifying license to pursue an animal therapist license and meet the training standards in this chapter.

004.01 STANDARDS APPLICABLE TO ALL PROFESSIONS. In addition to meeting the requirements for the specified health care profession and this chapter, to be acceptable for licensure, a training program must be approved by the Board, meet the requirements for the specific professions listed in this chapter, and meet the following criteria:

(A) The topic or objectives must relate directly to the practice of animal therapy in the specified health care profession;

(B) The presenter of the activity must be qualified by education, experience or training;

(C) Activities must be open to all persons who hold a Nebraska license to practice the specified health care profession on humans;

(D) If the course involves the use of distance learning formats, including, but not limited to, archived video or audio programs, webcasts, telephone broadcasts, or simultaneous broadcasts, those persons not physically attending must have substantially the same opportunity for interaction with those teaching the course as they would if physically present at the same location; and

(E) Activities must include a competency assessment or evaluation which may consist of a test, case studies, or other type of competency assessment.

004.02 STANDARDS APPLICABLE TO SPECIFIC PROFESSIONS. Applicants must meet the requirements for all professions and the following specific to their profession as listed in this chapter.

004.02(A) ACUPUNCTURE. An applicant must:

(i) Have and maintain an undisciplined license as an acupuncturist, a chiropractor, a physician, an osteopathic physician, or a physician assistant under the Uniform Credentialing Act;

(ii) Complete a training program that consists of:

(1) At least 200 hours of instruction and training in veterinary acupuncture in the following areas:

(a) Comparative functional anatomy and physiology;

(b) Handling and restraint;

(d) Recordkeeping; and

(2) At least 50 hours of supervised clinical training; and

(iii) An Animal Therapist in Acupuncture is only allowed to use the following modalities:

(1) Dry needling;

(2) Electrostimulation;

(3) Moxibustion; and

(4) Laser therapy to stimulate acupuncture points.

004.02(B) CHIROPRACTIC OR VETERINARY ORTHOPEDIC MANIPULATION (VOM) A CHIROPRACTIC TECHNIQUE. An applicant must:

(i) Complete a training program that consists of:

(1) At least 210 hours of instruction or course work pertaining to animals in the following areas:

(a) Anatomy, including sacropelvic, thoracolumbar, cervical, and extremity;

(b) Anatomy laboratory;

(d) Biomechanics and gait;

(e) Chiropractic educational basics;

(f) Chiropractic adjusting technique, including lecture and laboratory:

(i) Cervical;

(ii) Thoracic;

(iii) Lumbosacral;

(iv) Pelvic; and

(v) Extremity;

(g) Case management and case studies;

(h) Chiropractic philosophy;

(i) Differential diagnosis of neuromusculoskeletal conditions;

(j) Ethics and legalities;

(k) Knowledge of breed anomalies;

(l) Motion palpation;

(m)Neurology, neuroanatomy, and neurological conditions;

(n) Pathology;

(o) Physiology;

(p) Radiology;

(q) Research in current chiropractic and veterinary topics;

(r) Restraint;

(s) Rehabilitation, current topics, evaluation, and assessment;

(t) Normal foot anatomy and normal foot care;

(u) Saddle fit and evaluation, lecture, and laboratory;

(v) Veterinary educational basics;

(w) Vertebral subluxation complex; and

(x) Zoonotic diseases; and

(2) At least 50 hours of supervised clinical training.

004.02(C) MASSAGE THERAPY. An applicant must:

(i) Complete a training program that consists of:

(1) At least 100 hours of instruction or course work pertaining to animals in the following areas:

(a) Anatomy and physiology;

(b) Pharmacology;

(d) Massage therapy techniques;

(e) Handling skills;

(f) Restraint; and

(g) Behavior; and

(2) At least 50 hours of in-class massage therapy clinics supervised by licensed veterinarians or licensed animal massage therapists.

004.02(D) PHYSICAL THERAPY OR OCCUPATIONAL THERAPY. An applicant must:

(i) Have and maintain an undisciplined license as either a physical therapist or an occupational therapist under the Uniform Credentialing Act;

(ii) Complete a training program that consists of:

(1) At least 100 hours of instruction or course work pertaining to animals in the following areas:

(a) Assessment and planning of treatment;

(b) Behavior;

(d) Common orthopedic and neurological conditions;

(e) Comparative anatomy and physiology;

(f) Restraint;

(g) Handling skills;

(h) Neurology; and

(i) Therapeutic modalities and exercises;

(2) At least 40 hours of supervised clinical training or internship; and

(3) A competency assessment or evaluation which may consist of a test, case studies, or other type of competency assessment.

(iii) The training program must be affiliated with an American Veterinary Medical Association accredited school or college of veterinary medicine or the American College of Veterinary Surgeons.

005. RENEWAL, WAIVER OF CONTINUING EDUCATION, AND INACTIVE STATUS . The applicant must meet the requirements set out in 172 NAC 10 and these regulations. All animal therapist licenses expire on April 1 of each even-numbered year.

006. CONTINUING COMPETENCY REQUIREMENTS . On or before April 1 of each even-numbered year all licensees must complete the appropriate number of continuing education hours, and maintain their human equivalent license according their profession. Each licensee is responsible for maintaining certificates or records of continuing education. Only continuing competency activities which pertain to animals within the licensee’s scope of practice are acceptable. The following continuing competency activities are limited to no more than 2 hours of each activity during each 2-year renewal period, and all other continuing competency activities have no limitation:

(A) Clinical observation with a Veterinarian or Licensed Animal Therapist;

(B) Home study hours with a testing mechanism;

(D) Publishing research in animal therapy; and

(E) Teaching animal therapy.

006.01 PROFESSIONS REQUIRING TEN HOURS OF CONTINUOUS COMPETENCY HOURS. As a condition of license renewal, the following professions must complete at least ten (10) hours of acceptable continuing competency activities.

(A) Acupuncture;

(B) Chiropractic; and

006.02 PROFESSION REQUIRING SIX HOURS OF CONTINUOUS COMPETENCY HOURS. As a condition of license renewal, the following professions must complete at least six (6) hours of acceptable continuing competency activities.

(A) Massage Therapy;

(B) Physical Therapy; and

007. PRACTICE REQUIREMENTS . A licensed animal therapist may perform health care therapy in accordance with Neb. Rev. Stat. § 38-3333 and the following:

(A) The health care therapy must be consistent with and limited to the veterinary medical diagnosis and evaluation that is included in the letter of referral;

(B) The licensed animal therapist keeps and maintains adequate records of treatment or service for three (3) years after the licensed animal therapist’s most recent contact with the client or patient.

008. UNPROFESSIONAL CONDUCT . Unprofessional conduct is set out in Neb. Rev. Stat. § 38-179, 172 NAC 10, and includes, additionally, refusal to cooperate or failure to furnish requested information during any investigation by the Department.

009. REINSTATEMENT . The applicant must meet the requirements set out in 172 NAC 10.

010. FEES . Fees referred to in these regulations are set out in 172 NAC 2, and these regulations.

010.01 INITIAL FEE. Initial Licensure Fee for Animal Therapist. By an applicant for a license as an animal therapist, the fee of $142.

010.02 RENEWAL FEE. Renewal Fee for Animal Therapist. By an applicant for renewal on a biennial basis of a license as an animal therapist, the fee of $142.

History

Effective 2021-11-01

Chapter

Neb. Admin. Code tit. 172, ch.