Jurisdiction and Authority
Section summaryHHSC administers the Nurse Aide Registry under a state-federal framework. The Board of Nursing does not regulate CNAs; CNAs do not hold professional licenses in the same sense as RNs and LVNs.
CNA certification is a state administrative listing required for work in federally-funded nursing facilities (Medicare and Medicaid). The federal framework at 42 C.F.R. §483.156 requires each state to maintain a Registry and to enter findings of abuse, neglect, misappropriation, and (for states that include it) financial exploitation. Texas rules implementing the Registry sit at 40 Tex. Admin. Code Chapter 94.
This jurisdictional difference matters because a CNA who is also a nursing student or a licensed nurse can face two parallel administrative tracks — one before HHSC for the Registry, one before BON for the license. The procedural rules are different, the evidentiary standards are similar, and outcomes in one do not automatically determine the other.
Triggering Conduct
Section summaryThe Registry covers four categories of conduct in nursing-facility settings: abuse, neglect, misappropriation of resident property, and financial exploitation. Each has a specific statutory and regulatory definition.
Definitions:
- Abuse
- Willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting harm, pain, or mental anguish.
- Neglect
- Failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness.
- Misappropriation
- Deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's belongings or money without the resident's consent.
- Financial Exploitation
- Illegal or improper act or process of an individual using the resources of an older or disabled person for monetary or personal benefit, profit, or gain.
Investigation Process
Section summaryHHSC investigates complaints from facilities, residents, families, ombudsmen, and other sources. The process includes record review, witness interviews, and a written finding before any Registry entry.
Procedural framework under 40 TAC Chapter 94:
- Intake of the complaint (from the facility, the resident or family, the Long-Term Care Ombudsman, or another source).
- Investigation including facility-record review, witness interviews, and the CNA's response.
- Written notice to the CNA of the preliminary finding.
- Informal review opportunity.
- Contested case hearing before SOAH if requested.
- Final order and Registry entry if the finding is sustained.
Hearing Rights
Section summaryThe CNA has the right to a contested case hearing before SOAH. The hearing follows the Texas Administrative Procedure Act and provides procedural due process before any finding is entered on the Registry.
The contested case hearing follows the standard APA framework: discovery, prehearing conference, evidentiary hearing before an Administrative Law Judge, Proposal for Decision, and HHSC Final Order. The CNA can present documentary evidence, call witnesses, cross-examine the agency's witnesses, and submit briefing.
The pre-deprivation hearing right is constitutionally significant — under Cleveland Board of Education v. Loudermill, 470 U.S. 532 (1985), an individual whose protected interest is at stake is entitled to notice and a meaningful opportunity to be heard before the deprivation occurs. The Registry hearing framework operationalizes this requirement.
Effect of a Finding
Section summaryA sustained finding is permanent and is visible to every nursing facility nationwide that conducts a Registry check before hire. The federal framework requires the check, so the practical effect is industry exclusion.
Registry findings do not expire in most circumstances. The federal framework provides limited rescission rights for findings of neglect in specific circumstances (when the neglect was a single incident, did not result in serious harm, and the individual has met other criteria over the years), but abuse, misappropriation, and financial exploitation findings are generally permanent.
Because federal nursing-facility law at 42 C.F.R. §483.156 requires Registry checks before any hire of nursing-facility staff, a sustained finding effectively excludes the individual from nursing-aide work nationwide. The CNA can sometimes work in non-nursing-facility healthcare roles (private home care, residential care that is not Medicare/Medicaid certified), but mainstream nursing-aide employment is closed.
Parallel Criminal Exposure
Section summaryMany Registry-triggering events also support criminal prosecution. The administrative case and the criminal case proceed on different timelines under different standards.
Abuse and neglect of elderly or disabled individuals can support prosecution under the Texas Penal Code (see, among others, Penal Code Chapter 22 assault provisions and Penal Code §22.04 injury to elderly individual). Misappropriation and financial exploitation can support theft prosecutions under Penal Code Chapter 31 and exploitation of an elderly individual under Penal Code §32.55. The criminal standard (beyond reasonable doubt) is higher than the Registry standard (preponderance), so a sustained Registry finding does not automatically support criminal conviction and a not-guilty criminal verdict does not preclude a Registry finding.
Coordination of the criminal and administrative defenses is essential. Statements made in the Registry process are evidence in the criminal case, and statements in the criminal case can be used in the Registry process.
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Call (972) 370-5060 →The Texas certified nurse aide framework
The Texas certified nurse aide (CNA) framework operates under Texas Department of Aging and Disability Services (now part of Health and Human Services) regulations under Health and Safety Code Chapter 250. The framework provides certification for nurse aides who work in long-term care facilities and various other healthcare settings. The certification involves training requirements, examination requirements, and continuing certification considerations.
The disciplinary grounds for CNA certification reach abuse, neglect, or mistreatment of facility residents, theft from residents or facilities, conviction of specific offenses, drug or alcohol impairment affecting practice, and various other categories. The grounds reflect the substantial public protection concerns associated with CNA work in long-term care settings where residents are often vulnerable.
The investigation framework for CNA cases typically begins with reports from long-term care facilities, family members, or regulatory inspectors. The investigations include review of facility records, interviews with residents and facility staff, examination of any physical evidence, and consultation with healthcare experts. The CNA respondent has rights to notice and to participate in the investigation.
The Nurse Aide Registry framework and the federal requirements
The Texas Nurse Aide Registry tracks the certification status of CNAs working in Texas. The Registry is part of the federally-required state nurse aide registry system under the Nursing Home Reform Act provisions in 42 U.S.C. Section 1396r. The federal framework requires states to maintain registries of nurse aides and to record any findings of abuse, neglect, or misappropriation involving registry-listed aides.
The Registry findings produce substantial long-term consequences. Aides with substantiated findings of abuse, neglect, or misappropriation are typically permanently barred from working in long-term care facilities receiving federal funding. The bar applies across states because of the federal framework and the information sharing among state registries. The defense should understand the long-term implications of any Registry finding.
The annulment process under the Registry framework allows aides to seek removal of Registry findings under specific circumstances. The process requires substantial evidence and is typically limited to specific categories of findings. The defense should consider whether annulment may be available and should pursue it where appropriate.
The abuse and neglect framework
The abuse and neglect framework addresses CNA conduct that produces harm to residents. The framework includes physical abuse, sexual abuse, psychological abuse, neglect of basic care needs, and various other categories. The framework recognizes that CNA work involves substantial responsibilities for vulnerable residents who depend on the aides for basic care.
The defense in abuse and neglect cases requires careful factual development of the specific incidents. The defense should examine the resident clinical condition, the specific incidents alleged, the contemporary documentation, the witness accounts, and the broader facility environment. The cumulative analysis can support defense theories about the specific conduct and the broader context.
The training and supervision considerations in CNA cases can sometimes affect the disciplinary analysis. CNAs who received inadequate training or supervision may have stronger defenses than CNAs who acted contrary to clear training and supervision. The defense should examine the training and supervision context and should consider whether systemic facility issues contributed to the specific incidents.
Disposition framework and the career implications
The disposition framework in CNA cases includes various negotiated outcomes and contested administrative proceedings. The negotiated outcomes can include remedial training, supervised practice arrangements, certification suspensions, and certification revocations. The disposition options should be evaluated against the realistic outcomes and the comprehensive career implications.
The career implications of CNA discipline can be substantial. CNAs who are barred from long-term care work face substantial limitations on healthcare employment opportunities. The defense should consider alternative healthcare and non-healthcare career paths that may be available even after Registry findings, and should help CNAs plan for the practical implications.
The criminal prosecution implications of CNA discipline cases can be substantial in cases involving serious abuse or neglect allegations. The defense should coordinate the regulatory and any criminal proceedings carefully, with attention to the Fifth Amendment implications and the comprehensive case strategy. The cumulative considerations can substantially affect the strategic decisions and the realistic outcomes available across both proceedings.
Frequently Asked Questions
Can the Registry finding be removed later?
Does the Registry only affect nursing-facility work?
I am a CNA and an RN — does a Registry finding affect my RN license?
What is the standard of proof in a Registry hearing?
Should I respond to the HHSC investigator without a lawyer?
Read the full Texas Nursing License Defense Guide
This article is one section of our comprehensive Texas Nursing License Defense Guide. The pillar guide covers recent developments, official resources, and the complete framework with deeper analysis.
Read the Pillar Guide →Next Steps
If you are facing a situation described here, consult counsel promptly. Many issues in this area run on strict deadlines.
- Call (972) 370-5060
- Email info@landllawgroup.com
Cite this guide
Bluebook: Reggie London & Njeri London, Texas CNA Certification Revocation, L&L Law Group (May 30, 2026), https://landllawgroup.com/insights/cna-aide-certification-revocation-texas/.
APA: London, R., & London, N. (2026, May 30). Texas CNA Certification Revocation. L&L Law Group.