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Ohio Nursing Home Administrator — Requirements & Free Practice

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Nursing Home Administrator License

Nursing Home Administrator License

Licensing authority: Ohio Board of Executives of Long-Term Services and Supports · Application information

Initial licensure by examination after approved nursing home administration degree
Application and fees
Complete Board application and pay application and license fees (R.C. 4751.20(A)(1),(9)).
Background and fitness
Satisfy criminal-records and suitability requirements (R.C. 4751.20(A)(5)-(6); O.A.C. 4751-1-05(A)(2),(6)).
Completion window
Finish licensure within three years after meeting exam eligibility unless the Board extends it (O.A.C. 4751-1-05(E)).
Education
An accredited baccalaureate degree and approved nursing home administration academic preparation (O.A.C. 4751-1-05(A)(3)-(4)).
Minimum age
At least 21 years old (R.C. 4751.20(A)(3)).
Qualifying experience
An approved baccalaureate or master’s nursing home administration degree requires no further qualifying administrative experience (O.A.C. 4751-1-05(A)(5)(b),(d)).
Emergency vacancy issuance before exam passage
Application and fees
Complete Board application and pay application and license fees (R.C. 4751.20(A)(1),(9)).
Background and fitness
Satisfy criminal-records and suitability requirements (R.C. 4751.20(A)(5)-(6); O.A.C. 4751-1-05(A)(2),(6)).
Completion window
Finish licensure within three years after meeting exam eligibility unless the Board extends it (O.A.C. 4751-1-05(E)).
Education
An accredited baccalaureate degree and approved nursing home administration academic preparation (O.A.C. 4751-1-05(A)(3)-(4)).
Minimum age
At least 21 years old (R.C. 4751.20(A)(3)).
Operator request
A nursing home operator requests issuance to fill a vacancy caused by death, illness, or other unexpected cause (R.C. 4751.20(B)).
Score deadline
Provide proof of passing the licensing examinations within 180 days after issuance (R.C. 4751.20(B)).
Recognition of out of state government or private certification
No examination is required for this applicant pathway.
Background
Complete BCI/FBI background check and conviction report (O.A.C. 4751-1-14(A)(3)-(6)).
Board discretion
If experience is short, the Board may require residency and core of knowledge training (O.A.C. 4751-1-14(C)).
Ohio law
Be familiar with Ohio laws and rules on facility and administrator licensure (O.A.C. 4751-1-14(A)(2)).
Prior qualification
Government certification or private certification from a jurisdiction without the license; satisfy corresponding Chapter 4796 criteria (R.C. 4796.03-.04).

Official no-examination sources

Effective from 2026-01-01.

Recognition of work experience in a jurisdiction without a license
No examination is required for this applicant pathway.
Background
Complete BCI/FBI background check and conviction report (O.A.C. 4751-1-14(A)(3)-(6)).
Board discretion
If experience is short, the Board may require residency and core of knowledge training (O.A.C. 4751-1-14(C)).
Ohio law
Be familiar with Ohio laws and rules on facility and administrator licensure (O.A.C. 4751-1-14(A)(2)).
Prior qualification
Qualifying experience in a jurisdiction without the license; statutory practice-period waiver may apply (R.C. 4796.05; O.A.C. 4751-1-14(A)(1)(b)).

Official no-examination sources

Effective from 2026-01-01.

Recognition of out of state occupational license
No examination is required for this applicant pathway.
Background
Complete BCI/FBI background check and conviction report (O.A.C. 4751-1-14(A)(3)-(6)).
Board discretion
If experience is short, the Board may require residency and core of knowledge training (O.A.C. 4751-1-14(C)).
Ohio law
Be familiar with Ohio laws and rules on facility and administrator licensure (O.A.C. 4751-1-14(A)(2)).
Prior qualification
Substantially similar out-of-state license in good standing, ordinarily held one year with recent practice (R.C. 4796.03).

Official no-examination sources

Effective from 2026-01-01.

Reinstatement within one year after expiration
No examination is required for this applicant pathway.
Timing education fee
Apply within one year, pay reinstatement and late fees, and document required continuing education. (R.C. 4751.24).

Official no-examination sources

Effective from 2026-01-01.

Discretionary reissuance after revocation
No examination is required for this applicant pathway.
Board discretion
The Board directs the manner of application and decides whether to reissue (R.C. 4751.33(A)).
Waiting period
Wait at least one year after revocation (R.C. 4751.33(A)).

Official no-examination sources

Effective from 2023-04-06.

Relicensure after abandonment
Background
Complete BCI/FBI background check and conviction report (O.A.C. 4751-1-15(B)-(E)).
Board discretion
The Board may relicense an abandoned Ohio license holder (O.A.C. 4751-1-15(A)).
Current qualification
Meet current Ohio minimum qualifications and apply to the Board (O.A.C. 4751-1-15(A)).
License renewal
No examination is required for this applicant pathway.
Timing education fee
Apply before expiration, pay fee and complete Board-approved continuing education. (R.C. 4751.24).

Official no-examination sources

Effective from 2026-01-01.

Initial licensure by examination after residency
Application and fees
Complete Board application and pay application and license fees (R.C. 4751.20(A)(1),(9)).
Background and fitness
Satisfy criminal-records and suitability requirements (R.C. 4751.20(A)(5)-(6); O.A.C. 4751-1-05(A)(2),(6)).
Completion window
Finish licensure within three years after meeting exam eligibility unless the Board extends it (O.A.C. 4751-1-05(E)).
Core course
Residency applicants must complete the core of knowledge course before examinations (O.A.C. 4751-1-05.1(C)).
Education
An accredited baccalaureate degree and approved nursing home administration academic preparation (O.A.C. 4751-1-05(A)(3)-(4)).
Minimum age
At least 21 years old (R.C. 4751.20(A)(3)).
Qualifying experience
Standard baccalaureate: nine months/1,500 hours; master’s or higher: six months/1,000 hours of approved residency, subject to Board reduction (O.A.C. 4751-1-05(A)(5)).

Health Services Executive License

Health Services Executive License

Licensing authority: Ohio Board of Executives of Long-Term Services and Supports · Application information

Initial Health Services Executive license for licensed NHA
Background fee
Satisfy criminal-records requirements and pay the HSE license fee (R.C. 4751.21(A)(4)-(6)).
Hcbs exam
The currently offered NAB HCBS Line of Service exam is required for HSE qualification, but TASK has no registered nationwide version.
Nab hse
Obtain NAB Health Services Executive qualification (R.C. 4751.21(A)(3)).
Nha license
Hold a current Ohio nursing home administrator license (R.C. 4751.21(A)(2)).
Rcal exam
The currently offered NAB RCAL Line of Service exam is required for HSE qualification, but TASK has no registered nationwide version.
Recognition of out of state government or private certification
No examination is required for this applicant pathway.
Background
Complete BCI/FBI background check and conviction report (O.A.C. 4751-1-14(A)(3)-(6)).
Board discretion
If experience is short, the Board may require residency and core of knowledge training (O.A.C. 4751-1-14(C)).
Ohio law
Be familiar with Ohio laws and rules on facility and administrator licensure (O.A.C. 4751-1-14(A)(2)).
Prior qualification
Government certification or private certification from a jurisdiction without the license; satisfy corresponding Chapter 4796 criteria (R.C. 4796.03-.04).

Official no-examination sources

Effective from 2026-01-01.

Recognition of work experience in a jurisdiction without a license
No examination is required for this applicant pathway.
Background
Complete BCI/FBI background check and conviction report (O.A.C. 4751-1-14(A)(3)-(6)).
Board discretion
If experience is short, the Board may require residency and core of knowledge training (O.A.C. 4751-1-14(C)).
Ohio law
Be familiar with Ohio laws and rules on facility and administrator licensure (O.A.C. 4751-1-14(A)(2)).
Prior qualification
Qualifying experience in a jurisdiction without the license; statutory practice-period waiver may apply (R.C. 4796.05; O.A.C. 4751-1-14(A)(1)(b)).

Official no-examination sources

Effective from 2026-01-01.

Recognition of out of state occupational license
No examination is required for this applicant pathway.
Background
Complete BCI/FBI background check and conviction report (O.A.C. 4751-1-14(A)(3)-(6)).
Board discretion
If experience is short, the Board may require residency and core of knowledge training (O.A.C. 4751-1-14(C)).
Ohio law
Be familiar with Ohio laws and rules on facility and administrator licensure (O.A.C. 4751-1-14(A)(2)).
Prior qualification
Substantially similar out-of-state license in good standing, ordinarily held one year with recent practice (R.C. 4796.03).

Official no-examination sources

Effective from 2026-01-01.

Reinstatement within one year after expiration
No examination is required for this applicant pathway.
Timing education fee
Apply within one year, pay reinstatement and late fees, and document required continuing education. (R.C. 4751.25).

Official no-examination sources

Effective from 2026-01-01.

Discretionary reissuance after revocation
No examination is required for this applicant pathway.
Board discretion
The Board directs the manner of application and decides whether to reissue (R.C. 4751.33(A)).
Waiting period
Wait at least one year after revocation (R.C. 4751.33(A)).

Official no-examination sources

Effective from 2023-04-06.

License renewal
No examination is required for this applicant pathway.
Timing education fee
Apply before expiration, pay fee and complete Board-approved continuing education. (R.C. 4751.25).

Official no-examination sources

Effective from 2026-01-01.

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