OpenExamsFREE PRACTICE — ANY EXAM

Maryland Nursing Home Administrator — Requirements & Free Practice

US-MD · License preparation

702 free questions · Answer explanations · No signup required

Choose what to practice

Start with an exam below. Your examination requirements depend on your application pathway. View licensing requirements

Combined practice

Choose an exam or combined practice to begin.

Licenses, application pathways and examination requirements

Each license and applicant pathway has its own requirements and exemptions. Choosing practice questions does not determine your eligibility.

Nursing Home Administrator License

License required to practice as a nursing home administrator in Maryland, subject to statutory exceptions.

Licensing authority: Maryland State Board of Long-Term Care Administrators · Application information

Initial licensure by endorsement
Maryland State's Standards Examination
Board Discretion
Board may grant endorsement in its discretion.
Education
Board may waive education after at least three years of out-of-state licensure and practice.
Experience
One year as full-time nursing home administrator of record within the last five years.
National Exams
COMAR 10.33.02.07A expressly excuses endorsement applicants from the NAB exams.
Other License
Hold a valid, unsuspended and unrevoked nursing home administrator license in every state of prior licensure or reciprocal endorsement.
Reciprocity
Other state must have substantially equivalent qualification and examination standards and give similar recognition to Maryland licenses.
Training
COMAR 10.33.02.07A excuses endorsement applicants from the AIT program.
Waiver
Board may waive the State standards examination when the applicant satisfies Health Occupations §9-306(b).
Renew inactive status
No examination is required for this applicant pathway.
Fee
Pay biennial inactive-status renewal fee.
Practice
May not practice while inactive.
Prior Status
Existing inactive license status.

Official no-examination sources

Effective from 2026-09-22.

Transfer to inactive status
No examination is required for this applicant pathway.
Application
Submit Board inactive-status application and fee.
Practice
May not practice while inactive.
Prior Status
Current active license.

Official no-examination sources

Effective from 2026-09-22.

Initial licensure by examination
Age
At least 21 years old.
Application
Submit Board online application, fee, character references and recent photograph.
Character
Good moral character.
Criminal History
State and national criminal history records check.
Education
Qualifying degree; an applicant with a different degree completes a Board-approved 100-hour health administration course within five years.
Exam Timing
May take the State and NAB exams after the prescribed minimum AIT period and other licensure requirements.
Training
Complete the Board-approved administrator-in-training program, subject to the statutory experience alternatives and exemptions.
New licensure after more than five years expired
Current Requirements
Meet current new-license requirements, including education, training, background check, and application.
Prior Status
Prior license expired more than five years before application.
Reactivation after at least five years inactive
Maryland State's Standards Examination
Application
Submit new online application and fees.
Course
Complete a Board-approved 100-hour healthcare or health administration course.
Criminal History
Submit evidence of State and national criminal history records check.
Prior Status
Previously licensed nursing home administrator on inactive status for at least five years.
Reactivation before five years inactive
No examination is required for this applicant pathway.
Fee
Pay required fees.
Practice
Must not have practiced while inactive.
Prior Status
Inactive status for less than five years; apply before current inactive term expires.
Renewal
Meet current renewal and continuing-education requirements.

Official no-examination sources

Effective from 2026-09-22.

Reinstatement within five years after expiration
No examination is required for this applicant pathway.
Criminal History
Provide criminal history record check when required after one year without renewal.
Fee
Pay reinstatement fee.
Prior Status
License expired less than five years earlier and was neither suspended nor revoked.
Renewal
Meet current renewal and continuing-education requirements.

Official no-examination sources

Effective from 2026-09-22.

Biennial renewal
No examination is required for this applicant pathway.
Continuing Education
Complete Board-required continuing education and the applicable first-renewal implicit-bias training.
Criminal History
Provide criminal history record check when required by Health Occupations §9-311(f).
Fee
Pay renewal fee.
Timing
Renew before expiration for a two-year term.

Official no-examination sources

Effective from 2026-09-22.

Provisional Nursing Home Administrator License

Provisional license permitting an appointed nonlicensed person to act as interim nursing home administrator for up to 90 days.

Licensing authority: State Board of Long–Term Care Administrators · Application information

Provisional interim licensure
No examination is required for this applicant pathway.
Appointment
Nursing home appoints an interim person and applies for the provisional license within 24 hours.
Board Discretion
Board determines good moral character and ability to administer the facility.
Criminal History
Appointee submits criminal history records check unless previously checked as an active Maryland health occupations licensee.
Term
90 days, extendable by 30 days for good cause.
Trigger
Unexpected departure of licensed administrator and no licensed replacement available.

Official no-examination sources

Effective from 2026-09-22.

Maryland State's Standards Examination

Provider
National Association of Long Term Care Administrator Boards
Format
Computer-based
Exam questions
100
Passing score
75 percent correct
Examination outline
  • COMAR 10.07.02 — Nursing Homes (55%)
  • COMAR 10.07.09 — Residents' Bill of Rights: Comprehensive Care Facilities and Extended Care Facilities (20%)
  • COMAR 10.09.10 — Nursing Facility Services (10%)
  • COMAR 10.09.24 — Medical Assistance Eligibility (5%)
  • COMAR 10.15.03 — Food Service Facilities (10%)
Examination sources

NAB National Core Knowledge Exam for Long-Term Care Administrators (CORE)

Provider
Pearson VUE
Format
Objective multiple-choice items with four response options, one correct; delivered by Pearson VUE
Exam questions
125 (100 scored, 25 non-scored pretest)
Time limit
150 minutes seat time; 2 hours 10 minutes to answer questions
Passing score
Scaled score of 113 on a 50-150 scale
Exam fee
CORE only $320; CORE and NHA combo $480 (effective 2/1/2026)
Examination outline
  • Care, Services, and Supports (39%)
    • Quality of Care: Medical and Nursing Care Practices
    • Quality of Care: Medication Management and Administration
    • Quality of Care: Disease Management (e.g., acute vs. chronic conditions)
    • Quality of Care: Nutrition and Hydration (e.g., specialized diets)
    • Quality of Care: Activities of Daily Living (ADLs) and Independent Activities of Daily Living (IADLs)
    • Quality of Care: Rehabilitation and Restorative Programs
    • Quality of Care: Care Recipient Assessment and Interdisciplinary Care Planning
    • Quality of Care: Clinical and Medical Records and Documentation Requirements (e.g., storage, retention, destruction)
    • Quality of Care: Medical Director
    • Quality of Care: Emergency Medical Services (e.g., CPR, first aid, Heimlich maneuver, AED)
    • Quality of Care: Transition of Care (e.g., admission, move-in, transfer, discharge, and move-out)
    • Quality of Care: Basic Healthcare Terminology
    • Quality of Life: Psychosocial Needs (e.g., social, spiritual, community, cultural)
    • Quality of Life: Person-Centered Care and Comprehensive Care Planning
    • Quality of Life: Care Recipient Bill of Rights and Responsibilities
    • Quality of Life: Care Recipient Safety (e.g., fall prevention, elopement prevention, adverse events)
    • Quality of Life: Care Recipient (and Representative) Grievance, Conflict, and Dispute Resolution
    • Quality of Life: Care Recipient Advocacy (e.g., Ombudsman, resident and family council)
    • Quality of Life: Care Recipient Decision-Making (e.g., capacity, power of attorney, guardianship, conservatorship, code status, advance directives, ethical decision-making)
    • Quality of Life: Care Recipient (and Representative) Satisfaction
    • Quality of Life: Recognition of Maltreatment (e.g., abuse, neglect, exploitation)
    • Quality of Life: Mental and Behavioral Health (e.g., cognitive impairment, depression, social support systems)
    • Quality of Life: Trauma-Informed Care (e.g., PTSD)
    • Quality of Life: Pain Management
    • Quality of Life: Death, Dying, and Grief
    • Quality of Life: Restraint Usage and Reduction
    • Quality of Life: Foodservice (e.g., choice and menu planning, dietary management, food storage and handling, dining services)
    • Quality of Life: Social Services Programs
    • Quality of Life: Therapeutic Recreation and Activity Programs
    • Quality of Life: Community Resources, Programs, and Agencies (e.g., meals on wheels, housing vouchers, Area Agencies on Aging, Veterans Affairs)
    • Ancillary Services: Hospice and Palliative Care
    • Ancillary Services: Specialized Medical Equipment (e.g., oxygen, durable medical equipment)
    • Ancillary Services: Transportation for Care Recipients
    • Ancillary Services: Telemedicine (e.g., e-health)
    • Ancillary Services: Diagnostic Services (e.g., radiology, lab services)
    • Ancillary Services: Dental and Oral Care Services
    • Ancillary Services: Healthcare Partners and Clinical Providers (e.g., MD/DO, Nurse Practitioner, Psychiatrist, Podiatrist, Dentist)
    • Ancillary Services: Volunteer Programs
  • Operations (37%)
    • Financial Management: Budgeting and Forecasting
    • Financial Management: Financial Analysis (e.g., ratios, profitability, debt, revenue mix, depreciation, operating margin, cash flow)
    • Financial Management: Revenue Cycle Management (e.g., billing, accounts receivable, accounts payable, collections)
    • Financial Management: Financial Statements (e.g., income/revenue statement, balance sheet, statement of cash flows, cost reporting)
    • Financial Management: Revenue and Reimbursement (e.g., PDPM, PDGM, ACOs, HMOs, Medicaid, private payors)
    • Financial Management: Financial Reporting Requirements (e.g., requirements for not-for-profit, for-profit, and governmental providers)
    • Financial Management: Integration of Clinical and Financial Systems (e.g., EMR/HER, MDS)
    • Financial Management: Internal Financial Management Controls (e.g., segregation of duties, access)
    • Financial Management: Supply-Chain Management (e.g., inventory control)
    • Financial Management: Resident Trust Accounts for Personal Funds
    • Risk Management: OSHA Rules and Regulations
    • Risk Management: Workers’ Compensation
    • Risk Management: Ethical Conduct and Standards of Practice
    • Risk Management: Compliance Programs
    • Risk Management: Risk Management Process and Programs
    • Risk Management: Quality Improvement Processes (e.g., root cause analysis, PDCA/PDSA)
    • Risk Management: Scope of Practice and Legal Liability
    • Risk Management: Internal Investigation Protocols and Techniques (e.g., incidents, adverse events)
    • Risk Management: Mandatory Reporting Requirements (e.g., incidents, adverse events, abuse, neglect, financial exploitation, fraud)
    • Risk Management: Insurance Coverage (e.g., liability, property)
    • Risk Management: Healthcare Record Requirements (e.g., confidentiality, disclosure, safeguarding, HIPAA, HITECH)
    • Risk Management: Security (e.g., cameras, monitoring systems, locks, staff location reporting)
    • Risk Management: Contracted Services (e.g., roles, responsibilities, oversight, background checks)
    • Human Resources: Federal Human Resources Laws, Rules, and Regulations (e.g., ADA, FMLA, Wage and Hour, FLSA)
    • Human Resources: Selection and Hiring Practices (e.g., EEOC, interviewing, adverse impact, protected classes, occupational qualifications)
    • Human Resources: Compensation and Benefits Programs (e.g., time off, healthcare insurance, employee pay and payroll)
    • Human Resources: Organizational Staffing Requirements and Reporting (e.g., PBJ)
    • Human Resources: Staff Certification and Licensure Requirements
    • Human Resources: Professional Development (e.g., maintenance of credentials, continuing education)
    • Human Resources: Employee Training and Orientation
    • Human Resources: Performance Evaluation
    • Human Resources: Human Resource Policies (e.g., drug-free workplace, discipline, job classification, photography and video, social media usage, mobile phone usage)
    • Human Resources: Employee Record-Keeping Requirements
    • Human Resources: Employee Grievance, Conflict, and Dispute Resolution
    • Human Resources: Employee Satisfaction, Engagement, and Retention
    • Human Resources: Cultural Competence and Diversity Awareness
    • Human Resources: Labor Relations (e.g., union, collective bargaining [CBA], contract/pool staff)
  • Environment and Quality (13%)
    • Care Setting: Federal Codes and Regulations for Building, Equipment, Maintenance, and Grounds
    • Care Setting: Person-Centered Environment (e.g., home-like environment)
    • Care Setting: Safety and Accessibility (e.g., ADA, safety data sheets)
    • Care Setting: Facility Management and Environmental Services
    • Care Setting: Information Systems Infrastructure (e.g., configurations, data security, technical controls)
    • Care Setting: Preventative and Routine Maintenance Programs (e.g., pest control, equipment, mechanical systems)
    • Care Setting: Infection Control and Sanitation (e.g., linens, kitchen, hand washing, healthcare-acquired infections, hazardous materials)
    • Care Setting: Disaster and Emergency Planning, Preparedness, Response, and Recovery (e.g., Appendix Z)
    • Regulatory Compliance: Federal Healthcare Laws, Rules, and Regulations
    • Regulatory Compliance: Government Programs and Entities (e.g., Medicare, Medicaid, waivers)
    • Regulatory Compliance: Certification and Licensure Requirements for the Organization
  • Leadership and Strategy (11%)
    • Leadership: Organizational Structures (e.g., departments, functions, systemic processes)
    • Leadership: Organizational Change Management
    • Leadership: Organizational Behavior (e.g., organizational culture, team building, group dynamics)
    • Leadership: Leadership Principles (e.g., communication, styles, mentoring, coaching, personal professional development)
    • Leadership: Governance (e.g., board of directors, governing bodies, corporate entities, advisory boards)
    • Leadership: Professional Advocacy and Governmental Relations
    • Organizational Strategy: Mission, Vision, and Value Statements
    • Organizational Strategy: Strategic Business Planning (e.g., new lines of service, succession management, staffing pipeline)
    • Organizational Strategy: Business Analytics (e.g., evidence-based practice, data analytics)
    • Organizational Strategy: Business Development (e.g., sales, marketing, partnerships, ACOs, contracts and agreements, negotiations)
    • Organizational Strategy: Public Relations and External Stakeholders (e.g., hospitals, referrals sources, local community, donors)
Examination sources

NAB National Nursing Home Administrators Line of Service Exam (NHA)

Provider
Pearson VUE
Format
Objective multiple-choice items with four response options, one correct; delivered by Pearson VUE
Exam questions
75 (60 scored, 15 non-scored pretest)
Time limit
90 minutes seat time; 1 hour and 10 minutes to answer questions
Passing score
Scaled score of 113 on a 50-150 scale
Exam fee
NHA only $190; CORE and NHA combo $480 (effective 2/1/2026)
Examination outline
  • Care, Services, and Supports (45%)
    • Quality of Care: Medical and Nursing Care Practices
    • Quality of Care: Medication Management and Administration
    • Quality of Care: Nutrition and Hydration (e.g., specialized diets)
    • Quality of Care: Rehabilitation and Restorative Programs
    • Quality of Care: Care Recipient Assessment and Interdisciplinary Care Planning
    • Quality of Care: Clinical and Medical Records and Documentation Requirements (e.g., storage, retention, destruction)
    • Quality of Care: Medical Director
    • Quality of Care: Emergency Medical Services (e.g., CPR, first aid, Heimlich maneuver, AED)
    • Quality of Care: Transition of Care (e.g., admission, move-in, transfer, discharge, and move-out)
    • Quality of Life: Psychosocial Needs (e.g., social, spiritual, community, cultural)
    • Quality of Life: Person-Centered Care and Comprehensive Care Planning
    • Quality of Life: Care Recipient Bill of Rights and Responsibilities
    • Quality of Life: Care Recipient Safety (e.g., fall prevention, elopement prevention, adverse events)
    • Quality of Life: Care Recipient (and Representative) Grievance, Conflict, and Dispute Resolution
    • Quality of Life: Care Recipient Advocacy (e.g., Ombudsman, resident and family council)
    • Quality of Life: Care Recipient Decision-Making (e.g., capacity, power of attorney, guardianship, conservatorship, code status, advance directives, ethical decision-making)
    • Quality of Life: Recognition of Maltreatment (e.g., abuse, neglect, exploitation)
    • Quality of Life: Mental and Behavioral Health (e.g., cognitive impairment, depression, social support systems)
    • Quality of Life: Trauma-Informed Care (e.g., PTSD)
    • Quality of Life: Pain Management
    • Quality of Life: Death, Dying, and Grief
    • Quality of Life: Restraint Usage and Reduction
    • Quality of Life: Foodservice (e.g., choice and menu planning, dietary management, food storage and handling, dining services)
    • Quality of Life: Social Services Programs
    • Quality of Life: Therapeutic Recreation and Activity Programs
    • Ancillary Services: Hospice and Palliative Care
    • Ancillary Services: Transportation for Care Recipients
    • Ancillary Services: Diagnostic Services (e.g., radiology, lab services)
    • Ancillary Services: Dental and Oral Care Services
    • Ancillary Services: Healthcare Partners and Clinical Providers (e.g., MD/DO, Nurse Practitioner, Psychiatrist, Podiatrist, Dentist)
    • Ancillary Services: Volunteer Programs
  • Operations (28%)
    • Financial Management: Revenue and Reimbursement (e.g., PDPM, PDGM, ACOs, HMOs, Medicaid, private payors)
    • Financial Management: Financial Reporting Requirements (e.g., requirements for not-for-profit, for-profit, and governmental providers)
    • Financial Management: Integration of Clinical and Financial Systems (e.g., EMR/EHR, MDS)
    • Financial Management: Resident Trust Accounts for Personal Funds
    • Risk Management: OSHA Rules and Regulations
    • Risk Management: Compliance Programs
    • Risk Management: Scope of Practice and Legal Liability
    • Risk Management: Internal Investigation Protocols and Techniques (e.g., incidents, adverse events)
    • Risk Management: Mandatory Reporting Requirements (e.g., incidents, adverse events, abuse, neglect, financial exploitation, fraud)
    • Risk Management: Healthcare Record Requirements (e.g., confidentiality, disclosure, safeguarding, HIPAA, HITECH)
    • Risk Management: Security (e.g., cameras, monitoring systems, locks, staff location reporting)
    • Risk Management: Contracted Services (e.g., roles, responsibilities, oversight, background checks)
    • Human Resources: Organizational Staffing Requirements and Reporting (e.g., PBJ)
    • Human Resources: Staff Certification and Licensure Requirements
    • Human Resources: Professional Development (e.g., maintenance of credentials, continuing education)
    • Human Resources: Employee Training and Orientation
    • Human Resources: Performance Evaluation
    • Human Resources: Employee Record-Keeping Requirements
    • Human Resources: Cultural Competence and Diversity Awareness
  • Environment and Quality (27%)
    • Care Setting: Federal Codes and Regulations for Building, Equipment, Maintenance, and Grounds
    • Care Setting: Person-Centered Environment (e.g., home-like environment)
    • Care Setting: Safety and Accessibility (e.g., ADA, safety data sheets)
    • Care Setting: Facility Management and Environmental Services
    • Care Setting: Preventative and Routine Maintenance Programs (e.g., pest control, equipment, mechanical systems)
    • Care Setting: Infection Control and Sanitation (e.g., linens, kitchen, hand washing, healthcare-acquired infections, hazardous materials)
    • Care Setting: Disaster and Emergency Planning, Preparedness, Response, and Recovery (e.g., Appendix Z)
    • Regulatory Compliance: Federal Healthcare Laws, Rules, and Regulations
    • Regulatory Compliance: Government Programs and Entities (e.g., Medicare, Medicaid, waivers)
    • Regulatory Compliance: Certification and Licensure Requirements for the Organization
    • Regulatory Compliance: Regulatory Survey and Inspection Process
    • Regulatory Compliance: Procedures for Informal Dispute Resolution (IDR)
    • Regulatory Compliance: Centers for Medicare and Medicaid Services (CMS) Quality Measures
    • Regulatory Compliance: Quality Assurance and Performance Improvement (QAPI)
    • Regulatory Compliance: Bed-Hold Requirements
    • Regulatory Compliance: Pre-Admission Screening Annual Review (PASRR)
    • Regulatory Compliance: Facility Assessment
Examination sources