How to become a licensed nursing home administrator in Maryland: the degree routes, the Administrator-in-Training (AIT) internship, the NAB exams and the Maryland State standards exam, fees, continuing education and renewal, with section numbers.
| Who licenses | The State Board of Long-Term Care Administrators, in the Maryland Department of Health (§ 9-201) |
|---|---|
| Education | A health care administration degree; any other bachelor’s or master’s plus a 100-hour course; or the registered nurse route (COMAR 10.33.02.02C, F) |
| AIT requirement | Set in months, not hours: 12 months full-time at 40 hours a week, or 18 months part-time at 30 hours a week; experience can earn up to 12 months of credit (COMAR 10.33.02.04, .05) |
| National exams | NAB Core of Knowledge (CORE) and NHA Line of Service, a scaled score of 113 on each (COMAR 10.33.02.03B(3)) |
| State exam | Required: the State standards exam (NAB code NHA-MD), 100 questions in 2 hours on Maryland facility and Medicaid program rules, 75 percent to pass (COMAR 10.33.02.03B(3)), $210 per attempt, taken through NAB at Pearson VUE Details ↓ |
| Continuing education | 40 hours of NAB-approved CE every two years, with no carryover (COMAR 10.33.04.01), plus a one-time implicit bias training at your first renewal after 1 April 2026 |
| Renewal | Every two years, on the second anniversary of your license’s effective date; $200 (§ 9-311; COMAR 10.33.05.02D) |
| Official sources | health.maryland.gov/bonha (the Board) · COMAR 10.33 · Health Occupations Title 9 · nabweb.org (national exams) |
Verified September 2026. COMAR is the Code of Maryland Regulations; “§” numbers are sections of the Health Occupations Article of the Maryland Code. The Board’s rules were rewritten in January 2026, so confirm with the Board before you apply.
The license comes from the State Board of Long-Term Care Administrators (BLTCA), part of the Maryland Department of Health (Health Occupations § 9-201). Until 1 October 2022 it was the State Board of Examiners of Nursing Home Administrators. The 2022 laws that renamed it (Chapters 689 and 690) also gave it assisted living managers, who have needed a Board license since 1 July 2026. Some state pages still use the old name.
The Board’s home page lists (410) 764-4750; its FAQ, renewal and exam pages list (410) 767-6500.
The statute is the Health Occupations Article, Title 9, now headed “Nursing Home Administrators and Assisted Living Managers”; Subtitle 3 covers nursing home administrators. The Board’s rules were rewritten effective 19 January 2026: licensing moved from COMAR 10.33.01 to 10.33.02, with CE in 10.33.04 and fees in 10.33.05.
You must be at least 21, of good moral character, with a criminal history records check (§ 9-302(a) to (c)). Initial applications have been online only, through the Board’s Online Application Portal, since 16 September 2024. An application is void if you do not meet the requirements within 2 years of the Board receiving it (COMAR 10.33.02.02G).
Then you pass the State standards exam and, unless you qualify by endorsement, complete the AIT and pass the NAB exams (COMAR 10.33.02.02A(4) to (6); .07A):
| Route | Education and experience | Training | Section |
|---|---|---|---|
| Health care administration degree | A bachelor’s or master’s in healthcare, health administration or healthcare management, or an MBA with a health administration concentration | The AIT: 12 months full-time or 18 months part-time | 10.33.02.02C(3)(a); § 9-302(d)(1)(i)1 |
| Any other degree | Any other bachelor’s or master’s, plus a Board-approved 100-hour course in healthcare administration completed within the last 5 years | The AIT, as above | 10.33.02.02C(3)(b) |
| Registered nurse | An RN with an associate degree in nursing or a nursing diploma (no bachelor’s needed), at least 5 years as a nursing home director of nursing, 3 of them at the same facility, and the 100-hour course | At least 6 months of full-time training in a Board-approved program | § 9-302(f)(1); 10.33.02.02F |
| Licensed in another state | A valid license, never revoked or suspended, in every state where you have held one; 1 year as full-time administrator of record within the last 5 years; and a qualifying degree (waivable after 3 years’ practice elsewhere) | None: the AIT and NAB exams are waived; you pass the State standards exam unless the Board waives it | 10.33.02.07 |
Other training routes in the statute. Health Occupations § 9-302(d)(1)(ii)2 also accepts a year of full-time nursing home administration in a nursing home in place of the AIT, and § 9-302(f)(1)(iii) sets 6 months of training for RNs, while COMAR 10.33.02.02A(6) requires the AIT of everyone except endorsement applicants. The AIT is the usual route; ask the Board about the statutory ones.
The AIT is a “supervised 12-month full-time, or 18-month part-time, internship” (COMAR 10.33.02.04). Maryland sets it in months and weekly hours, not total hours:
A note on hours. NAB’s Maryland summary shows the AIT as 2,080 hours: 52 weeks of 40 hours, the full-time route only. The rule itself sets months.
On request, the Board may credit experience from the last 5 years (COMAR 10.33.02.04C); the health care roles need at least 18 months full-time with line responsibility over a department of 10 or more:
| Hospital administrator | Up to 8 months |
|---|---|
| Hospital or nursing home assistant administrator; department head | Up to 6 months |
| CCRC executive director; assisted living manager; senior management official, in health care or not | Up to 3 months |
| Resident or intern in an accredited bachelor’s or master’s program in healthcare administration | Credit for the residency or internship, up to 12 months in all |
Your preceptor holds the Board’s preceptor certificate and meets these tests (COMAR 10.33.02.06):
A preceptor “may not be responsible for more than two AITs at any one time”, and gives each at least 16 hours a week of direct, on-site supervision (10.33.02.05).
Other states: AIT Hours by State.
The free AIT Planner turns AIT hours into a plan across facility departments. That split is our planning aid, not a Maryland rule, so agree on the plan with your preceptor. No account needed.
Open the free AIT PlannerCOMAR 10.33.02.02A(5) requires both NAB exams: the Core of Knowledge (CORE) and the NHA Line of Service, at Pearson VUE test centers. Times are from NAB’s Candidate Handbook:
| Core of Knowledge | 125 questions (100 scored, 25 pretest), 150 minutes in all, 130 of them for answering questions |
|---|---|
| NHA Line of Service | 75 questions (60 scored, 15 pretest), 90 minutes in all, 70 of them for answering questions |
| Passing score | A scaled score of 113 on each (COMAR 10.33.02.03B(3)) |
| Fee | $480 for CORE and NHA applied for together, from 1 February 2026, paid to NAB. The NAB handbook lists $320 for CORE or $190 for NHA taken alone. |
| When | After month 8 of a full-time AIT or month 12 part-time (COMAR 10.33.02.02D(1)); your Authorization to Test is valid for 90 days |
| Retakes | Since 1 January 2026, NAB has allowed no more than 4 attempts at each exam per cycle (1 July to 30 June), each with a new application and fee |
More in NAB Exam Format and The Core Domains Explained.
COMAR 10.33.02.03 calls it the State standards exam; NAB lists it as exam code NHA-MD, and the Board’s exam page says NAB administers it. Once the Board approves you, you apply through NAB and schedule with Pearson VUE.
| Questions | 100, computer-based, split across five COMAR chapters (below) |
|---|---|
| Time | 2 hours: “All state exams have a two-hour time limit” (NAB Candidate Handbook) |
| Passing score | “75 percent correct answers” (COMAR 10.33.02.03B(3)) |
| Fee | $210 for each attempt, set by the exam service (NAB handbook; COMAR 10.33.05.02D(10)) |
| When | After 8 months of a full-time AIT or 12 months of a part-time one, and after the 100-hour course if your route needs it (COMAR 10.33.02.02D) |
| Retakes | The $210 applies to each attempt. NAB’s cap of 4 attempts per cycle names CORE, NHA and RC/AL, so whether it covers NHA-MD is unclear; confirm with the Board or NAB before you plan a retake |
| Not published | COMAR 10.33.02.03 sets no retake limit or waiting period, and the NAB handbook describes only test-center testing |
The exam covers “sections of the Code of Maryland Regulations (COMAR) that apply to nursing facilities” (Board exam page). These are facility, food service and Medicaid rules, not the licensure chapter, COMAR 10.33, and not Title 9. The published split:
| COMAR 10.07.02 | Nursing Homes, the Office of Health Care Quality licensing rules: 55 questions |
|---|---|
| COMAR 10.07.09 | Residents’ Bill of Rights: Comprehensive Care Facilities and Extended Care Facilities: 20 questions |
| COMAR 10.09.10 | Nursing Facility Services (Medicaid): 10 questions |
| COMAR 10.09.24 | Medical Assistance Eligibility: 5 questions |
| COMAR 10.15.03 | Food Service Facilities: 10 questions |
The exam page also lists six textbooks, from 2010 to 2016 editions, including the NAB Study Guide (5th ed.). More in State NHA Exams Explained.
Older details on the Board’s exam page. The page, which shows no update date, gives the NAB exam as “a 150-question computer-based exam”, mentions Internet Explorer 4.0 and calls the state exam “available online”. NAB’s current handbook describes Pearson VUE test centers, and this page follows it.
Five places where the Maryland facility rules set a different number, or add a requirement, compared with 42 CFR Part 483. All five come from COMAR 10.07.02, the chapter behind 55 of the 100 state exam questions:
| Topic | Federal rule (42 CFR 483) | Maryland rule | COMAR |
|---|---|---|---|
| Nurse staffing levels | Sufficient nursing staff on a 24-hour basis to meet residents’ needs (483.35(a)), with no hours-per-resident-day or staff-to-resident ratio minimum. CMS repealed the 2024 minimum staffing standards, which were never enforced, by interim final rule published 3 December 2025 (90 FR 55687, effective 2 February 2026) | “A minimum of 3 hours of bedside care per occupied bed per day”, and a ratio of bedside nursing staff to residents that may not “at any time be less than one to 15” | 10.07.02.19B, D |
| Registered nurse on duty | A registered nurse “for at least 8 consecutive hours a day, 7 days a week”, unless waived (483.35(b)(1)). The 24-hour registered nurse requirement of the 2024 standards went with the repeal | “At least one registered nurse, 24 hours per day and 7 days per week” | 10.07.02.19C |
| Cognitive impairment and mental illness training | Nurse aides: at least 12 hours of in-service training a year, including dementia management (483.95(g)); no set hours after hire for all staff | Staff who are licensed, certified or registered, and staff who help residents with activities of daily living: 8 hours within 90 days of hire, then 2 hours a year. All other employees: 2 hours within 90 days of hire, then 1 hour a year | 10.07.02.10 |
| Posting who is on duty | Daily staffing totals and hours by category, with the census, kept 18 months, or longer if state law requires (483.35(g)) | For each shift and each floor or unit: the names of staff on duty and the room numbers of the residents assigned to each, the charge nurse, the responsible registered nurse if the person in charge is not one, the medicine aide or other person giving medications, and the ratio of licensed and unlicensed staff to residents, on a form the Department provides or approves; records kept 1 year | 10.07.02.67 |
| Medical director | The facility must “designate a physician to serve as medical director” (483.70(g)); Part 483 sets no experience or training requirement for the role | A Maryland physician license, at least 2 years of experience or specialized training in geriatric or chronic care, and a physician-management curriculum from AMDA or one the Department approves, begun within the first year of employment | 10.07.02.15 |
The federal nursing home rules (42 CFR Part 483, Subpart B) apply only to facilities certified for Medicare or Medicaid, so a certified Maryland home must meet both sets of rules. Federal: eCFR, September 2026.
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No Board list. The Board’s preceptor page names no preceptors or AIT sites. The Board’s AIT forms, including its Administrator-In-Training Guidelines, come by email request from its forms page.
Finding a preceptor. Ask licensed administrators directly whether they hold the Board’s preceptor certificate (COMAR 10.33.02.06), and check a license with the Board’s license verification tool.
The 100-hour course. The Board’s exam page names three providers: AIT Resources, LLC, Elevate AIT and St. Joseph’s College of Maine.
Associations, for meeting administrators. The Health Facilities Association of Maryland (HFAM) is the main skilled nursing trade group; LifeSpan Network and LeadingAge Maryland are other ways to meet administrators who could precept.
For the full step-by-step on approaching facilities and preceptors, see How to Find an AIT Preceptor and an Approved Program.
Board fees are set in COMAR 10.33.05.02D, and the Board takes them online by card.
| Initial application | $100 |
|---|---|
| License | $200 |
| Renewal, every two years | $200 |
| Reinstatement | $300 |
| Inactive status | $100, then $100 every two years; $200 to reactivate |
| NAB CORE and NHA exams | $480 together, paid to NAB |
| State standards exam | $210 for each attempt, set by the exam service (10.33.05.02D(10)) |
Our estimate: $100 + $200 + $480 + $210 = $990 in Board and exam fees for a first attempt at each exam, plus the 100-hour course if needed. NAB’s Maryland page also lists a $100 AIT application fee, which COMAR 10.33.05.02 does not include; ask the Board whether it applies to you.
You need at least 40 hours of continuing education in the two years before each renewal (COMAR 10.33.04.01B). Courses must be NAB-approved, and certificates must show the NAB approval number, with two exceptions (10.33.04.01E; Board CE page):
“Effective March 19, 2012, no continuing education hours can be carried over” (Board CE page). The rule sets no required hours by topic. The Board audits a percentage of licensees (10.33.04.01C).
Implicit bias training, once. A one-time implicit bias and structural racism training is due at your first renewal after 1 April 2026 (COMAR 10.33.02.09; HB 783 of 2025, Chapter 478). Ask the Board whether it counts toward your 40 hours, and whether it applies to reinstatement or reactivation.
Renewal. “A license expires on the second anniversary of its effective date” (§ 9-311), so your renewal date is your own, not a statewide date. The Board sends notice at least 30 days before (COMAR 10.33.02.09). You renew with your CE, the $200 fee and a criminal history records check.
After it expires. The fee schedule has no late fee, and neither § 9-312 nor COMAR sets a grace period. Within 5 years you reinstate by meeting the renewal requirements and paying $300 (COMAR 10.33.02.10; § 9-312). After 5 years you meet the requirements for a new license.
Inactive status. You may not practice while inactive. After 5 or more years inactive, reactivating takes a new application, the 100-hour course, a new pass on the State standards exam and a criminal history check (COMAR 10.33.02.11).
Endorsement (COMAR 10.33.02.07). You need a valid license, never revoked or suspended, in every state where you have held one; 1 year as the full-time administrator of record within the last 5 years; a qualifying degree (waivable after 3 years’ practice elsewhere); and a pass on the Maryland State standards exam, which the Board may waive (10.33.02.07D). The NAB exams and the AIT are waived.
Provisional license for an interim administrator (§ 9-301(b); COMAR 10.33.02.08). Maryland has no general temporary license. If a licensed administrator leaves unexpectedly and no licensed replacement is available, the facility must appoint a non-licensed interim administrator, applying for a provisional license within 24 hours. The license lasts 90 days from the departure, plus up to 30 more for good cause.
Military. For a qualifying service member, veteran or spouse, boards must issue the license “within 15 business days” of a complete application (§ 1-704). The Board has a Servicemember Recognition License Application, by email request.
The laws, rules and other sources cited on this page.
Citations verified September 2026; the Justia link is a labeled mirror. For reference, not legal advice; the current official text governs.
Maryland sets the AIT in months, not hours: 12 months full-time at 40 hours a week, or 18 months part-time at 30 hours a week (COMAR 10.33.02.04, .05). Credit for past experience can take off up to 12 months, and the statute’s registered nurse route sets at least 6 months of full-time training.
The NAB Core of Knowledge and NHA Line of Service exams, with a scaled score of 113 on each, and the Maryland State standards exam, with 75 percent to pass (COMAR 10.33.02.03B(3)). The exams open after 8 months of a full-time AIT.
100 questions in 2 hours from five COMAR chapters of facility and Medicaid program rules: 10.07.02 (55 questions), 10.07.09 (20), 10.09.10 (10), 10.09.24 (5) and 10.15.03 (10), not the licensing rules in COMAR 10.33. It costs $210 for each attempt.
40 hours of NAB-approved continuing education in the two years before each renewal, with no carryover (COMAR 10.33.04.01), plus a one-time implicit bias and structural racism training at your first renewal after 1 April 2026 (COMAR 10.33.02.09).
The Board publishes no list of preceptors or AIT sites. Ask licensed administrators whether they hold the Board’s preceptor certificate, and ask the Board by email for its AIT forms.
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