MA Training, Competency Testing & the Nurse Aide Registry

How You Become a Massachusetts CNA

A Certified Nursing Assistant (CNA) in Massachusetts is a trained, registry-listed caregiver who provides direct, hands-on care under the supervision of a licensed nurse. The pathway is set by the Massachusetts Department of Public Health (DPH) and codified in 105 CMR 156.000 (Nurse Aide Training and Competency Evaluation).

There are two non-negotiable gates. First, complete a DPH-approved Nurse Aide Training Program of at least 75 hours (lecture, lab, and supervised in-person clinical time). This meets the federal OBRA 1987 minimum. Second, pass the Nurse Aide Competency Evaluation — a knowledge test plus a clinical skills test.

For the exam, expect questions that test the 75-hour curriculum: activities of daily living, basic nursing skills, infection control, safety, resident rights, and the role of the aide. Knowing who tests you and what passing means is itself testable.

Who Administers the Test (and Who No Longer Does)

This is a common trap. As of 2024-2026, the MA Competency Evaluation is administered by D&S Diversified Technologies, LLP (D&SDT) - Headmaster, LLP under contract with MA DPH. Candidates register through the TMU portal at hdmaster.com; candidate support is (888) 401-0462.

• Prometric previously held the MA contract — it no longer administers the MA exam. Older study guides naming Prometric are out of date.
• The American Red Cross runs a national NACE product marketed elsewhere, but it does not administer the official Massachusetts state exam.
• DPH owns the Massachusetts Nurse Aide Registry (MANAR); D&S/Headmaster provides test and scoring services.

Since December 2024, the exam is offered in English, Spanish, Chinese, and Haitian Creole, with an audio (oral) option for candidates who read with difficulty.

Exam Format, Scoring & Fees

The evaluation has two parts that are scored independently. You must pass both.

Why the numbers matter: a 76% cut score is higher than the 70% used in many states, so MA leaves less margin — you can miss only 14 of 60 questions. On skills, a single missed critical (starred) step fails that whole task even if your percentage is high, because starred steps protect resident safety (for example, checking water temperature or identifying the resident).

What the Knowledge Test Covers

The 60 questions are drawn from a DPH-approved test plan that mirrors the federal subject areas. Knowing the rough weighting tells you where to focus study time. A representative subject-area distribution from the candidate handbook is:

The heaviest blocks — role/responsibility, basic nursing skills, disease process, rights, and safety — together make up well over half the test, so prioritize them.

The Clinical Skills Test in Detail

On skills day you are randomly assigned 3 to 4 tasks. One task is mandatory with handwashing embedded, because hand hygiene and indirect-care steps (privacy, identifying the resident, call light in reach) are scored on every task. Tasks you may draw include:

1. Handwashing (often the standalone or embedded skill).
2. Measuring and recording vital signs (pulse, respirations, blood pressure).
3. Ambulation using a gait/transfer belt, or a transfer.
4. Perineal care or a partial bed bath.
5. Passive range-of-motion to a joint, or positioning/occupied bed.

Critical (starred) steps are the safety-essential actions on each checklist. Miss one and you fail that task regardless of your percentage. If you err, tell the evaluator and correct it — self-correction is allowed; you need 80% with all starred steps done.

Eligibility & Background Checks

Before working in a licensed facility you must clear screening:

1. CORI — Criminal Offender Record Information check.
2. SORI — Sex Offender Registry Information check.
3. Completion of the approved 75-hour program (or a DPH training waiver under 105 CMR 156.100 for certain candidates).

A federally funded facility may employ a trainee for up to 120 days while they complete training and testing, but the aide must be registry-listed to keep working after that.

Step-by-Step: From Class to Registry

1. Finish a DPH-approved 75-hour program; your program registers you with D&S/Headmaster.
2. Receive your email notification and complete test registration in TMU at hdmaster.com.
3. Schedule and pass the 60-question knowledge test (76%).
4. Pass the skills test (3-4 tasks, 80% each, no missed starred steps).
5. DPH lists you on the MANAR — you are now a Massachusetts CNA.

Renewal & Common Mistakes

Massachusetts has one of the simplest renewals nationally. Every 24 months you must have worked at least 8 paid hours performing nursing or nursing-related services under a licensed nurse. There is no fee and no continuing-education requirement. Renewal is filed through the Health Profession Licensing System; unpaid and training hours do not count.

Frequent exam traps to avoid:

• Saying the test is 70% to pass — Massachusetts is 76%.
• Naming Prometric or the Red Cross as the MA administrator — it is D&S/Headmaster.
• Thinking CEUs are required for renewal — they are not; only 8 paid hours.
• Assuming unlimited retakes — you have 4 knowledge and 3 skills attempts inside 24 months, after which you must retrain.