The Centers for Medicare and Medicaid Services (CMS) requires that a CNA perform at least a day of nursing or nursing-related duties every 24 months. Additionally, long-term care facilities only are required to provide (and CNAs are required to complete) at least 12 hours of in-service training per year.

Long-term care facilities are the only entities mandated by state and federal law to verify eligibility and report qualifying employment to the registry. In Iowa, health care employment agencies that employ CNAs at long-term care facilities must also report hours for their employees working in long-term care facilities. Entities other than long-term care facilities (and health care employment agencies who staff CNAs in long-term care facilities) are not required by state or federal law to verify eligibility or report long-term care-eligible employment. However, the only way a CNA can remain active on the Iowa Direct Care Worker Registry is if their Iowa employer reports their hours to registry staff. 


Employment Hours are Reported Electronically to DIAL

Before the CNA's status on the registry expires, a long-term care facility or qualifying federally-certified entity can report employment for a CNA by logging in to DIAL's Health Facilities Database/Direct Care Worker Registry. Facilities should consider electronic verification of employment status at least yearly prior to their annual survey, but they may do so more often.

If an entity does not update CNA new hires as outlined, the registry will not accurately reflect the CNA’s current status.

The other entity types that can report a CNA's hours electronically to the Iowa Direct Care Worker Registry:

  • Hospices
  • Hospitals
  • Home health care agencies (HHAs)
  • Ambulatory surgical centers (ASCs)

Other Facility Types Report Hours by Letter to DIAL

Other facilities or employers are not able to report CNA hours electronically. Administrators or directors of nursing for those facilities will need to provide to DIAL a job description and an attestation letter on facility letterhead to registry staff showing the CNA has performed at least eight hours of paid, nursing or nursing-related duties. The employer must provide enough details to show that the CNA has met the long-term care employment guidelines.

Employers that cannot report CNA hours electronically via the Direct Care Worker Registry/Health Facilities database:

  • Assisted living programs (ALPs)
  • Intermediate care facilities (ICFs)
  • Residential care facilities (RCFs)
  • Group homes

Please note that a CNA cannot report their own hours to the registry, nor can the CNA provide a letter verifying employment from the employer to DIA directly.

Letters can be emailed to, faxed to 515.281.6259, or mailed to:

Iowa Direct Care Worker Registry
c/o Iowa Dept. of Inspections, Appeals, & Licensing
6200 Park Avenue, Suite 100
Des Moines, Iowa 50321