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Iowa Nursing Home Administrator — Requirements & Free Practice

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Nursing Home Administrator License

Ordinary license to practice nursing home administration in Iowa.

Licensing authority: Iowa Board of Nursing Home Administrators · Application information

Licensure by endorsement from another jurisdiction
Experience or qualifications
Show an active administrator license for at least two years immediately before application, or meet 481—980.2 qualifications (481—980.6(1)(b)).
Hse alternative
481—980.2 accepts HSE certification in place of its degree, NAB score, and training evidence; NAB HSE requires CORE and NHA among its exams.
Other exam credit
An earlier passing score may satisfy a current exam requirement; the applicant supplies evidence of the score.
Prior license
Hold or have held a nursing home administrator license in another jurisdiction and submit verification of the most recent license and any complaints (481—980.2(4), 980.6(1)).
Initial licensure as a foreign trained administrator
Fitness
Sound mental health and physical ability to perform administrator duties (Iowa Code §155.3).
Foreign credentials
Provide the International Educational Research Foundation equivalency evaluation and foreign nursing home administration diploma or certificate (481—980.3(1)-(2)).
General requirements
Meet 481—980.2 licensing criteria; HSE certification can satisfy its alternative proof path.
Training or experience
Show an administrator training program, practicum, or 2,080 hours of long-term health care administration work (481—980.3(3)).
Initial licensure by education, training, and examination
Application
Completed online application and fee; other requirements must be met before exam approval (481—980.2(1),(3)(b)).
Degree
Official baccalaureate or postbaccalaureate transcript from an accredited college or university (481—980.2(3)(a)).
Fitness
Sound mental health and physical ability to perform administrator duties (Iowa Code §155.3).
Training or experience
Administrator training program with qualified preceptor, accredited long-term care practicum, or board-approved 2,080 hours in a nursing home (481—980.2(3)(c)).
Initial licensure with NAB Health Services Executive certification
Application
Completed online application and fee (481—980.2(1)).
Fitness
Sound mental health and physical ability to perform administrator duties (Iowa Code §155.3).
Hse certification
Provide verification of NAB Health Services Executive certification as the alternative to the degree/training proof in 481—980.2(2)-(3). NAB awards this certification only after its required exams; RCAL and HCBS are other line-of-service examinations and are part of the HSE certification condition.
Late renewal during the grace period
No examination is required for this applicant pathway.
Grace period
Complete renewal within the 30-day grace period after expiration (481—980.1, 980.7(5)).
Renewal requirements
Meet all ordinary renewal requirements and pay a late fee (481—980.7(5)).

Official no-examination sources

Effective from 2026-09-22.

Expedited reciprocity for a veteran or active duty military spouse with substantially similar scope
No examination is required for this applicant pathway.
Board rule exam statement
481—7.3(1) states that veterans and spouses must pass exams required for reciprocity and receive credit for prior passed exams; Iowa Code §272C.12(1) directs issuance without an examination when its conditions are met.
Expedited review
Board gives a fully completed application priority (481—7.3(1)).
Military status
Applicant is a veteran or spouse of an active-duty US service member (Iowa Code §272C.12A(1)).
Prior license
Hold an unrestricted license in another jurisdiction with substantially similar Iowa practice scope (481—7.3(1)-(4); Iowa Code §272C.12).

Official no-examination sources

Effective from 2026-09-22.

Reactivation of an inactive license
No examination is required for this applicant pathway.
Application
Submit reactivation application and fee (481—980.8(1)).
Competence
Provide most recent out-of-jurisdiction license verification and 40 continuing education hours in two years or 2,080 hours active practice elsewhere in two years (481—980.8(2)).
Inactive status
Applicant holds an inactive Iowa administrator license and cannot practice until reactivated (481—980.7(6)).

Official no-examination sources

Effective from 2026-09-22.

Licensure through a reciprocal agreement
No examination is required for this applicant pathway.
Board discretion
Iowa Code §155.11 permits but does not compel the Board to issue this license.
Prior license
Hold a current nursing home administrator license from that jurisdiction (§155.11).
Reciprocal agreement
A current reciprocal agreement with the other licensing jurisdiction must exist (Iowa Code §§155.11, 147.44).

Official no-examination sources

Effective from 2026-09-22.

Reinstatement after suspension, revocation, or voluntary surrender
No examination is required for this applicant pathway.
Board order
Meet the terms of the disciplinary order or establish that the basis for discipline or surrender no longer exists and reinstatement serves the public interest (481—506.32).
Reactivation
After Board-approved reinstatement, obtain reactivation before practicing (481—980.9).
Waiting period
If no order terms set the timing, or after voluntary surrender, wait one year before the initial reinstatement application unless law provides otherwise (481—506.32(2)).

Official no-examination sources

Effective from 2026-09-22.

Biennial license renewal
No examination is required for this applicant pathway.
Application
Submit renewal application and fee (481—980.7(3)(b)).
Continuing education
Meet 40-hour biennial continuing education requirement, subject to the first-renewal rule (481—980.7(3); 481—981.2).
Reporting
Complete applicable mandatory reporter training or qualify for waiver (481—980.7(8)).
Timing
Renew by December 31 of odd-numbered years; a license issued within six months of renewal date waits until the subsequent renewal (481—980.7(1)-(2)).

Official no-examination sources

Effective from 2026-09-22.

Licensure by verification of an out of jurisdiction license
No examination is required for this applicant pathway.
Application checks
Submit application, fee, license verifications, scope information, and any required criminal-history materials (481—501.1(2)).
Discipline
Outstanding disciplinary matter or complaint may delay issuance (481—501.1(3)-(4)).
Prior exam
If the other jurisdiction required an exam, show it was passed previously; this is prior evidence, not a current Iowa exam leaf (§272C.12(1)(d)).
Prior license
Hold a current license in another jurisdiction with a substantially similar practice scope, in good standing (Iowa Code §272C.12(1); 481—501.1(1)).

Official no-examination sources

Effective from 2026-09-22.

Initial licensure using qualifying work experience instead of education or training
Relocation
Applicant relocated to Iowa from a jurisdiction that did not require a professional license for this profession (481—501.2(1)).
Remaining requirements
All other requirements, including required examinations, remain applicable (481—501.2(1)).
Work experience
At least three years of substantially similar work in the four years before application, with proof of Iowa residency and relevant documents (481—501.2).

Temporary Nursing Home Administrator License for Military Spouse or Veteran

Temporary license for a qualified military spouse or veteran completing Iowa education or training.

Licensing authority: Iowa Board of Nursing Home Administrators · Application information

Temporary licensure for a military spouse or veteran completing Iowa education or training
Board terms
Temporary period and public-protection conditions are set by the licensing authority (481—7.3(5)(b)).
Exams passed
481—7.3(5)(a) says a temporary license cannot issue if the applicant has not passed required examinations; previous passing scores may receive credit under 481—7.3(1).
Military status
Applicant is a veteran or spouse of an active-duty US service member with a license in another state (Iowa Code §272C.12A).
Scope difference
Other jurisdiction scope is similar but not substantially equivalent to Iowa; additional education or training is needed (481—7.3(5)).

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