Chapter C2 – Article 30. Advanced Skills for Community Health Aides and Practitioners

Sec. C2.30.010. Authority.

1. This Board retains the authority to approve, modify, restrict, suspend, or revoke advanced skill certification at any time.

Sec. C2.30.020. Definition.

1. An “advanced skill” is a specific, teachable, structured procedure, technique or protocol for patient care that:
   1. is in addition to the skills and the scope of CHA/P basic training;
   2. remains consistent with CHA/P basic training that includes learning objectives, hands-on skills, and demonstration of competency to a satisfactory level;
   3. remains consistent with the CHA/P role in the village clinic setting to provide safe and necessary patient care;
   4. is limited to non-emergency medical skills;
   5. may be performed by a certified CHA/P who is employed by a tribal health organization, is in good standing, and only under specific circumstances;
   6. complies with these Standards and Procedures; and
   7. is approved for use within a specific tribal health organization and by the Board.

Sec. C2.30.030. Limitations.

1. Not all possible advanced skills may be considered appropriate or approved under certification at the discretion of the Board. Some skills may remain outside the CHA/P scope of practice under certification, even with additional training. The Board reserves the right to determine which advanced skills are considered appropriate for inclusion under certification.

Sec. C2.30.040. Requirements.

An advanced skill must:

1. be within the scope of practice and training of the independently licensed healthcare professional who train and assesses competencies for the advanced skill;
2. be within the scope of practice and training of the supervising physician or their designated independently licensed healthcare provider (medical traffic provider) overseeing the CHA/P’s patient encounter and the advanced skill in which the CHA/P uses it;
3. remain optional for individual CHA/Ps to perform;
4. be approved through the Board application process that includes a tribal health organization’s proposed plan for CHA/P training, demonstration of competency, and re-evaluation of competency with appropriate documentation;
5. require review and co-signature by the supervising physician or designated supervising provider for each patient encounter involving an advanced skill;
6. include other requirements for Board approval considered necessary;
7. may be suspended or revoked by the tribal health organization medical director or their physician designee within the tribal health organization for medical or safety reasons for an individual CHA/P or regionally. The Board is to be informed within 10 business days of such action with relevant information. It may be reinstated at the tribal health organization medical director’s discretion, requiring that the Board be notified within 10 business days; and
8. require periodic re-evaluation of each CHA/P’s training and competencies every 2 years unless otherwise specified by the Board.

Sec. C2.30.050. Process for Tribal Health Organization Advanced Skill Approval.

1. A tribal health organization seeking approval for an advanced skill shall submit an application in the form and by the process the Board requires. The application must:
   1. identify a specific health need within the community and how the advanced skill addresses it;
   2. provide an overview and specific information about initial training and demonstration to the required level of competency and re-evaluation of competency every two years unless otherwise specified by the Board;
   3. describe the advanced skill procedure, technique, or protocol step-by-step using widely accepted references; and
   4. include the plan by the tribal health organization to implement and review the use of the advanced skill and update the Board as required under certification. This shall include medical and administrative oversight staff appropriate to the tribal health organization.
2. Review process. The staff assigned to the Board and either the Board or its designated work group will review applications, may require deadlines before meetings, request additional information, and suggest changes before consideration. The work group must consist of physicians, state licensed advanced practice providers, and CHPs, who are experts in areas of CHA/P training, evaluation, and scope of practice.
3. The tribal health organization will have an opportunity to present the proposal to the Board and answer questions at the time of consideration before a decision is made, during which time the designated work group will share its recommendations. Board members representing or employed by the tribal health organization proposing the advanced skill need to recuse themselves from voting.
4. Decision and Implementation. Upon approval, the Board will provide implementation requirements and an expiration date. If denied, reasons will be given with any recommendations. If the tribal health organization wants to amend the application, it can be resubmitted through the designated process for reconsideration.

Sec. C2.30.060. Appeal Process.

1. Appeal Process. If the Board denies an application for an advanced skill, the tribal health organization may initiate processes set forth in chapter A-4 [hearing, requests for reconsideration, and appeals].

Sec. C2.30.070. Ongoing Requirements.

1. The tribal health organization will report CHA/Ps in good standing who successfully meet initial and recertification requirements for the advanced skill to the Board. The Board will add the tribal health organization, advanced skill, and expiration date for the advanced skill to the CHA/P’s certification file and certificate. A CHA/P’s use of an advanced skill is specific to a CHA/P’s practice within the tribal health organization that it is approved for.
2. The tribal health organization must establish reporting systems and conduct ongoing quality assurance.