102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB4004

 

Introduced 1/21/2022, by Sen. Ann Gillespie

 

SYNOPSIS AS INTRODUCED:
 
20 ILCS 2310/2310-434 new
210 ILCS 9/77 new
210 ILCS 45/3-202.05
210 ILCS 45/3-613 new
210 ILCS 46/3-613 new
210 ILCS 47/3-613 new
305 ILCS 5/5-5.01b new

    Amends the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Requires the Department of Public Health to establish and implement a Certified Nursing Assistant Intern Program to address the increasing need for trained health care workers and makes conforming changes in the Department of Public Health Powers and Duties Law of the Civil Administrative Code of Illinois. Provides that upon successful completion of the Program, an individual may provide specified patient and resident care services. Contains requirements for the Program. Amends the Assisted Living and Shared Housing Act, the Nursing Home Care Act, the MC/DD Act, and the ID/DD Community Care Act. Requires a certified nursing assistant intern to report to the charge nurse or nursing supervisor and provides that a certified nursing assistant intern may only be assigned duties authorized under the Certified Nursing Assistant Intern Program by a supervising nurse. Provides that a facility or establishment shall notify its certified and licensed staff members, in writing, that a certified nursing assistant intern may only provide the services and perform the procedures permitted under the Program. Specifies actions to be taken if a facility or establishment learns that a certified nursing assistant intern is performing work outside of the scope of the Certified Nursing Assistant Intern Program's training. In provisions amending the Nursing Home Care Act, provides that, for the purpose of computing staff to resident ratios, direct care staff shall include certified nursing assistant interns. Amends the Public Aid Code. Requires the Department of Healthcare and Family Services to establish and implement a similar Certified Nursing Assistant Intern Program for facilities certified under the Code. Effective immediately.


LRB102 24448 CPF 33682 b

 

 

A BILL FOR

 

SB4004LRB102 24448 CPF 33682 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Department of Public Health Powers and
5Duties Law of the Civil Administrative Code of Illinois is
6amended by adding Section 2310-434 as follows:
 
7    (20 ILCS 2310/2310-434 new)
8    Sec. 2310-434. Certified Nursing Assistant Intern Program.
9    (a) As used in this Section, "facility" means a facility
10licensed by the Department under the Nursing Home Care Act,
11the MC/DD Act, or the ID/DD Community Care Act or an
12establishment under the Assisted Living and Shared Housing
13Act.
14    (b) The Department shall establish and implement a
15Certified Nursing Assistant Intern Program to address the
16increasing need for trained health care workers. Upon
17successful completion of the classroom education and
18on-the-job training requirements of the Program required under
19this Section, an individual may provide, at a facility, the
20patient and resident care services and perform the procedures
21permitted under subsection (e).
22    (c) In order to qualify as a certified nursing assistant
23intern, an individual shall successfully complete at least 8

 

 

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1hours of classroom education on the services and procedures
2permitted under subsection (e). The classroom education shall
3be:
4        (1) taken within a facility or at an alternate
5    location provided by the individual's employer;
6        (2) proctored by an advanced practice registered
7    nurse; and
8        (3) satisfied by the successful completion of an
9    approved 8-hour online training course.
10    (d) In order to qualify as a certified nursing assistant
11intern, an individual shall successfully complete at least 24
12hours of on-the-job training in the services and procedures
13permitted under subsection (e), as follows:
14        (1) The training program instructor shall be an
15    advanced practice registered nurse.
16        (2) The training program instructor shall ensure that
17    the student meets the competencies set forth under
18    subsection (e). The instructor shall document the
19    competencies.
20        (3) All on-the-job training shall be under the direct
21    observation of an advanced practice registered nurse.
22        (4) All on-the-job training shall be conducted at a
23    facility.
24    (e) A certified nursing assistant intern shall receive
25classroom and on-the-job training on how to provide the
26patient or resident care services and procedures required of a

 

 

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1certified nursing assistant's performance skills, including
2the Heimlich maneuver and ensuring the safety and well-being
3of a resident during feeding. A certified nursing assistant
4intern may perform the following optional skills if the
5supervising advanced practice registered nurse deems the
6certified nursing assistant intern able to do so:
7        (1) Measuring and recording temperature, pulse, and
8    respiration.
9        (2) Measuring and recording blood pressure.
10        (3) Measuring and recording weight.
11        (4) Measuring and recording height.
12    (f) A certified nursing assistant intern may not perform
13the following:
14        (1) Shaving a resident with a nonelectric razor.
15        (2) Nail care.
16        (3) Perineal care.
17        (4) Transfer using mechanical lift.
18        (5) Passive range of motion.
19        (6) Donning and doffing of personal protective
20    equipment other than gloves.
21    (g) A certified nursing assistant intern may only provide
22the patient or resident care services and perform the
23procedures that he or she is deemed qualified to perform that
24are permitted under subsection (e). A certified nursing
25assistant intern may not provide the procedures excluded under
26subsection (f).

 

 

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1    (i) The Program is subject to the Health Care Worker
2Background Check Act and the Health Care Worker Background
3Check Code codified under 77 Ill. Adm. Code 955. Program
4participants and personnel shall be included on the Health
5Care Worker Registry.
6    (j) A Program participant who has completed the training
7required under paragraph (5) of subsection (a) of Section
83-206 of the Nursing Home Care Act, has completed the Program
9from April 21, 2020 through September 18, 2020, and has showed
10competency in all of the performance skills permitted under
11subsection (e) shall be considered a certified nursing
12assistant intern.
13    (k) The requirement under subsection (b) of Section
14395.400 of Title 77 of the Illinois Administrative Code that a
15student must pass a BNATP written competency examination
16within 12 months after the completion of the BNATP does not
17apply to a certified nursing assistant intern under this
18Section.
19    (l) A certified nursing assistant intern shall enroll in a
20certified nursing assistant program within 6 months after
21completing his or her certified nursing assistant intern
22training under the Program. The individual may continue to
23work as a certified nursing assistant intern during his or her
24certified nursing assistant training. If the scope of work for
25a nurse assistant in training pursuant to 77 Ill. Adm. Code
26300.660 is broader in scope than the work permitted to be

 

 

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1performed by a certified nursing assistant intern, then the
2certified nursing assistant intern enrolled in certified
3nursing assistant training may perform the work allowed under
477. Ill. Adm. Code 300.660. The individual shall receive one
5hour of credit for every hour employed as a certified nursing
6assistant intern or as a temporary nurse assistant, not to
7exceed 40 hours of credit.
8    (m) A certified nursing assistant intern shall be
9considered a Nurse Aide in Training as provided under Appendix
10B of 77 Ill. Adm. Code 300.7080.
 
11    Section 10. The Assisted Living and Shared Housing Act is
12amended by adding Section 77 as follows:
 
13    (210 ILCS 9/77 new)
14    Sec. 77. Certified nursing assistant interns.
15    (a) A certified nursing assistant intern shall report to
16an establishment's charge nurse or nursing supervisor and may
17only be assigned duties authorized in Section 2310-434 of the
18Department of Public Health Powers and Duties Law of the Civil
19Administrative Code of Illinois by a supervising nurse.
20    (b) An establishment shall notify its certified and
21licensed staff members, in writing, that a certified nursing
22assistant intern may only provide the services and perform the
23procedures permitted under Section 2310-434 of the Department
24of Public Health Powers and Duties Law of the Civil

 

 

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1Administrative Code of Illinois. The notification shall detail
2which duties may be delegated to a certified nursing assistant
3intern.
4    (c) If an establishment learns that a certified nursing
5assistant intern is performing work outside of the scope of
6the Certified Nursing Assistant Intern Program's training, the
7establishment shall:
8        (1) stop the certified nursing assistant intern from
9    performing the work;
10        (2) inspect the work and correct mistakes, if done
11    improperly; and
12        (3) assign the work to the appropriate personnel.
 
13    Section 15. The Nursing Home Care Act is amended by
14changing Section 3-202.05 and by adding Section 3-613 as
15follows:
 
16    (210 ILCS 45/3-202.05)
17    Sec. 3-202.05. Staffing ratios effective July 1, 2010 and
18thereafter.
19    (a) For the purpose of computing staff to resident ratios,
20direct care staff shall include:
21        (1) registered nurses;
22        (2) licensed practical nurses;
23        (3) certified nurse assistants;
24        (4) psychiatric services rehabilitation aides;

 

 

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1        (5) rehabilitation and therapy aides;
2        (6) psychiatric services rehabilitation coordinators;
3        (7) assistant directors of nursing;
4        (8) 50% of the Director of Nurses' time; and
5        (9) 30% of the Social Services Directors' time; and .
6        (10) certified nursing assistant interns.
7    The Department shall, by rule, allow certain facilities
8subject to 77 Ill. Admin. Code 300.4000 and following (Subpart
9S) to utilize specialized clinical staff, as defined in rules,
10to count towards the staffing ratios.
11    Within 120 days of the effective date of this amendatory
12Act of the 97th General Assembly, the Department shall
13promulgate rules specific to the staffing requirements for
14facilities federally defined as Institutions for Mental
15Disease. These rules shall recognize the unique nature of
16individuals with chronic mental health conditions, shall
17include minimum requirements for specialized clinical staff,
18including clinical social workers, psychiatrists,
19psychologists, and direct care staff set forth in paragraphs
20(4) through (6) and any other specialized staff which may be
21utilized and deemed necessary to count toward staffing ratios.
22    Within 120 days of the effective date of this amendatory
23Act of the 97th General Assembly, the Department shall
24promulgate rules specific to the staffing requirements for
25facilities licensed under the Specialized Mental Health
26Rehabilitation Act of 2013. These rules shall recognize the

 

 

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1unique nature of individuals with chronic mental health
2conditions, shall include minimum requirements for specialized
3clinical staff, including clinical social workers,
4psychiatrists, psychologists, and direct care staff set forth
5in paragraphs (4) through (6) and any other specialized staff
6which may be utilized and deemed necessary to count toward
7staffing ratios.
8    (b) (Blank).
9    (b-5) For purposes of the minimum staffing ratios in this
10Section, all residents shall be classified as requiring either
11skilled care or intermediate care.
12    As used in this subsection:
13    "Intermediate care" means basic nursing care and other
14restorative services under periodic medical direction.
15    "Skilled care" means skilled nursing care, continuous
16skilled nursing observations, restorative nursing, and other
17services under professional direction with frequent medical
18supervision.
19    (c) Facilities shall notify the Department within 60 days
20after the effective date of this amendatory Act of the 96th
21General Assembly, in a form and manner prescribed by the
22Department, of the staffing ratios in effect on the effective
23date of this amendatory Act of the 96th General Assembly for
24both intermediate and skilled care and the number of residents
25receiving each level of care.
26    (d)(1) (Blank).

 

 

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1    (2) (Blank).
2    (3) (Blank).
3    (4) (Blank).
4    (5) Effective January 1, 2014, the minimum staffing ratios
5shall be increased to 3.8 hours of nursing and personal care
6each day for a resident needing skilled care and 2.5 hours of
7nursing and personal care each day for a resident needing
8intermediate care.
9    (e) Ninety days after the effective date of this
10amendatory Act of the 97th General Assembly, a minimum of 25%
11of nursing and personal care time shall be provided by
12licensed nurses, with at least 10% of nursing and personal
13care time provided by registered nurses. These minimum
14requirements shall remain in effect until an acuity based
15registered nurse requirement is promulgated by rule concurrent
16with the adoption of the Resource Utilization Group
17classification-based payment methodology, as provided in
18Section 5-5.2 of the Illinois Public Aid Code. Registered
19nurses and licensed practical nurses employed by a facility in
20excess of these requirements may be used to satisfy the
21remaining 75% of the nursing and personal care time
22requirements. Notwithstanding this subsection, no staffing
23requirement in statute in effect on the effective date of this
24amendatory Act of the 97th General Assembly shall be reduced
25on account of this subsection.
26    (f) The Department shall submit proposed rules for

 

 

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1adoption by January 1, 2020 establishing a system for
2determining compliance with minimum staffing set forth in this
3Section and the requirements of 77 Ill. Adm. Code 300.1230
4adjusted for any waivers granted under Section 3-303.1.
5Compliance shall be determined quarterly by comparing the
6number of hours provided per resident per day using the
7Centers for Medicare and Medicaid Services' payroll-based
8journal and the facility's daily census, broken down by
9intermediate and skilled care as self-reported by the facility
10to the Department on a quarterly basis. The Department shall
11use the quarterly payroll-based journal and the self-reported
12census to calculate the number of hours provided per resident
13per day and compare this ratio to the minimum staffing
14standards required under this Section, as impacted by any
15waivers granted under Section 3-303.1. Discrepancies between
16job titles contained in this Section and the payroll-based
17journal shall be addressed by rule. The manner in which the
18Department requests payroll-based journal information to be
19submitted shall align with the federal Centers for Medicare
20and Medicaid Services' requirements that allow providers to
21submit the quarterly data in an aggregate manner.
22    (g) The Department shall submit proposed rules for
23adoption by January 1, 2020 establishing monetary penalties
24for facilities not in compliance with minimum staffing
25standards under this Section. No monetary penalty may be
26issued for noncompliance during the implementation period,

 

 

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1which shall be July 1, 2020 through December 31, 2021. If a
2facility is found to be noncompliant during the implementation
3period, the Department shall provide a written notice
4identifying the staffing deficiencies and require the facility
5to provide a sufficiently detailed correction plan to meet the
6statutory minimum staffing levels. Monetary penalties shall be
7imposed beginning no later than January 1, 2022 and quarterly
8thereafter and shall be based on the latest quarter for which
9the Department has data. Monetary penalties shall be
10established based on a formula that calculates on a daily
11basis the cost of wages and benefits for the missing staffing
12hours. All notices of noncompliance shall include the
13computations used to determine noncompliance and establishing
14the variance between minimum staffing ratios and the
15Department's computations. The penalty for the first offense
16shall be 125% of the cost of wages and benefits for the missing
17staffing hours. The penalty shall increase to 150% of the cost
18of wages and benefits for the missing staffing hours for the
19second offense and 200% the cost of wages and benefits for the
20missing staffing hours for the third and all subsequent
21offenses. The penalty shall be imposed regardless of whether
22the facility has committed other violations of this Act during
23the same period that the staffing offense occurred. The
24penalty may not be waived, but the Department shall have the
25discretion to determine the gravity of the violation in
26situations where there is no more than a 10% deviation from the

 

 

SB4004- 12 -LRB102 24448 CPF 33682 b

1staffing requirements and make appropriate adjustments to the
2penalty. The Department is granted discretion to waive the
3penalty when unforeseen circumstances have occurred that
4resulted in call-offs of scheduled staff. This provision shall
5be applied no more than 6 times per quarter. Nothing in this
6Section diminishes a facility's right to appeal.
7(Source: P.A. 101-10, eff. 6-5-19; 102-16, eff. 6-17-21.)
 
8    (210 ILCS 45/3-613 new)
9    Sec. 3-613. Certified nursing assistant interns.
10    (a) A certified nursing assistant intern shall report to a
11facility's charge nurse or nursing supervisor and may only be
12assigned duties authorized in Section 2310-434 of the
13Department of Public Health Powers and Duties Law of the Civil
14Administrative Code of Illinois by a supervising nurse.
15    (b) A facility shall notify its certified and licensed
16staff members, in writing, that a certified nursing assistant
17intern may only provide the services and perform the
18procedures permitted under Section 2310-434 of the Department
19of Public Health Powers and Duties Law of the Civil
20Administrative Code of Illinois. The notification shall detail
21which duties may be delegated to a certified nursing assistant
22intern.
23    (c) If a facility learns that a certified nursing
24assistant intern is performing work outside of the scope of
25the Certified Nursing Assistant Intern Program's training, the

 

 

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1facility shall:
2        (1) stop the certified nursing assistant intern from
3    performing the work;
4        (2) inspect the work and correct mistakes, if done
5    improperly; and
6        (3) assign the work to the appropriate personnel.
 
7    Section 20. The MC/DD Act is amended by adding Section
83-613 as follows:
 
9    (210 ILCS 46/3-613 new)
10    Sec. 3-613. Certified nursing assistant interns.
11    (a) A certified nursing assistant intern shall report to a
12facility's charge nurse or nursing supervisor and may only be
13assigned duties authorized in Section 2310-434 of the
14Department of Public Health Powers and Duties Law of the Civil
15Administrative Code of Illinois by a supervising nurse.
16    (b) A facility shall notify its certified and licensed
17staff members, in writing, that a certified nursing assistant
18intern may only provide the services and perform the
19procedures permitted under Section 2310-434 of the Department
20of Public Health Powers and Duties Law of the Civil
21Administrative Code of Illinois. The notification shall detail
22which duties may be delegated to a certified nursing assistant
23intern.
24    (c) If a facility learns that a certified nursing

 

 

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1assistant intern is performing work outside of the scope of
2the Certified Nursing Assistant Intern Program's training, the
3facility shall:
4        (1) stop the certified nursing assistant intern from
5    performing the work;
6        (2) inspect the work and correct mistakes, if done
7    improperly; and
8        (3) assign the work to the appropriate personnel.
 
9    Section 25. The ID/DD Community Care Act is amended by
10adding Section 3-613 as follows:
 
11    (210 ILCS 47/3-613 new)
12    Sec. 3-613. Certified nursing assistant interns.
13    (a) A certified nursing assistant intern shall report to a
14facility's charge nurse or nursing supervisor and may only be
15assigned duties authorized in Section 2310-434 of the
16Department of Public Health Powers and Duties Law of the Civil
17Administrative Code of Illinois by a supervising nurse.
18    (b) A facility shall notify its certified and licensed
19staff members, in writing, that a certified nursing assistant
20intern may only provide the services and perform the
21procedures permitted under Section 2310-434 of the Department
22of Public Health Powers and Duties Law of the Civil
23Administrative Code of Illinois. The notification shall detail
24which duties may be delegated to a certified nursing assistant

 

 

SB4004- 15 -LRB102 24448 CPF 33682 b

1intern.
2    (c) If a facility learns that a certified nursing
3assistant intern is performing work outside of the scope of
4the Certified Nursing Assistant Intern Program's training, the
5facility shall:
6        (1) stop the certified nursing assistant intern from
7    performing the work;
8        (2) inspect the work and correct mistakes, if done
9    improperly; and
10        (3) assign the work to the appropriate personnel.
 
11    Section 30. The Illinois Public Aid Code is amended by
12adding Section 5-5.01b as follows:
 
13    (305 ILCS 5/5-5.01b new)
14    Sec. 5-5.01b. Certified Nursing Assistant Intern Program.
15    (a) The Department shall establish and implement a
16Certified Nursing Assistant Intern Program to address the
17increasing need for trained health care workers. Upon
18successful completion of the classroom education and
19on-the-job training requirements of the Program under this
20Section, an individual may provide, at a facility certified
21under this Act, the patient and resident care services and
22perform the procedures permitted under subsection (d).
23    (b) In order to qualify as a certified nursing assistant
24intern, an individual shall successfully complete at least 8

 

 

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1hours of classroom education on the services and procedures
2permitted under subsection (d). The classroom education shall
3be:
4        (1) taken within a facility or at an alternate
5    location provided by the individual's employer;
6        (2) proctored by an advanced practice registered
7    nurse; and
8        (3) satisfied by the successful completion of an
9    approved 8-hour online training course.
10    (c) In order to qualify as a certified nursing assistant
11intern, an individual shall successfully complete at least 24
12hours of on-the-job training in the services and procedures
13permitted under subsection (d), as follows:
14        (1) The training program instructor shall be an
15    advanced practice registered nurse.
16        (2) The training program instructor shall ensure that
17    the student meets the competencies under subsection (d).
18    The instructor shall document the competencies.
19        (3) All on-the-job training shall be under the direct
20    observation of an advanced practice registered nurse.
21        (4) All on-the-job training shall be conducted at a
22    facility.
23    (d) A certified nursing assistant intern shall receive
24classroom and on-the-job training on how to provide the
25patient or resident care services and procedures required of a
26certified nursing assistant's performance skills, including

 

 

SB4004- 17 -LRB102 24448 CPF 33682 b

1the Heimlich maneuver and ensuring the safety and well-being
2of a resident during feeding. A certified nursing assistant
3intern may perform the following optional skills if the
4supervising advanced practice registered nurse deems the
5certified nursing assistant intern able to do so:
6        (1) Measuring and recording temperature, pulse, and
7    respiration.
8        (2) Measuring and recording blood pressure.
9        (3) Measuring and recording weight.
10        (4) Measuring and recording height.
11    (e) A certified nursing assistant intern may not perform
12the following:
13        (1) Shaving a resident with a nonelectric razor.
14        (2) Nail care.
15        (3) Perineal care.
16        (4) Transfer using mechanical lift.
17        (5) Passive range of motion.
18        (6) Donning and doffing of personal protective
19    equipment other than gloves.
20    (f) A certified nursing assistant intern may only provide
21the patient or resident care services and perform the
22procedures that he or she is deemed qualified to perform that
23are permitted under subsection (d). A certified nursing
24assistant intern may not provide the procedures excluded under
25subsection (e).
26    (g) A certified nursing assistant intern shall report to a

 

 

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1facility's charge nurse or nursing supervisor and may only be
2assigned duties authorized in this Section by a supervising
3nurse.
4    (h) A facility shall notify its certified and licensed
5staff members, in writing, that a certified nursing assistant
6intern may only provide the services and perform the
7procedures permitted under subsection (d). The notification
8shall detail which duties may be delegated to a certified
9nursing assistant intern.
10    (i) If a facility learns that a certified nursing
11assistant intern is performing work outside of the scope of
12the Program's training, the facility shall:
13        (1) stop the certified nursing assistant intern from
14    performing the work;
15        (2) inspect the work and correct mistakes, if done
16    improperly; and
17        (3) assign the work to the appropriate personnel.
18    (j) The Program is subject to the Health Care Worker
19Background Check Act and the Health Care Worker Background
20Check Code codified under 77 Ill. Adm. Code 955. Program
21participants and personnel shall be included on the Health
22Care Worker Registry.
23    (k) A Program participant who has completed the training
24required under paragraph (5) of subsection (a) of Section
253-206 of the Nursing Home Care Act, has completed the Program
26from April 21, 2020 through September 18, 2020, and has shown

 

 

SB4004- 19 -LRB102 24448 CPF 33682 b

1competency in all of the performance skills permitted under
2subsection (d) shall be considered a certified nursing
3assistant intern.
4    (l) The requirement under subsection (b) of Section
5395.400 of Title 77 of the Illinois Administrative Code that a
6student must pass a BNATP written competency examination
7within 12 months after the completion of the BNATP does not
8apply to a certified nursing assistant intern under this
9Section.
10    (m) A certified nursing assistant intern shall enroll in a
11certified nursing assistant program within 6 months after
12completing his or her certified nursing assistant intern
13training under the Program. The individual may continue to
14work as a certified nursing assistant intern during his or her
15certified nursing assistant training. If the scope of work for
16a nurse assistant in training pursuant to 77 Ill. Adm. Code
17300.660 is broader in scope than the work permitted to be
18performed by a certified nursing assistant intern, then the
19certified nursing assistant intern enrolled in certified
20nursing assistant training may perform the work allowed under
2177. Ill. Adm. Code 300.660. The individual shall receive one
22hour of credit for every hour employed as a certified nursing
23assistant intern or as a temporary nurse assistant, not to
24exceed 40 hours of credit.
25    (n) A certified nursing assistant intern shall be
26considered a Nurse Aide in Training as provided under Appendix

 

 

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1B of 77 Ill. Adm. Code 300.7080.
 
2    Section 99. Effective date. This Act takes effect upon
3becoming law.