What it takes to become a licensed nursing home administrator in Massachusetts: the two degree and Administrator-in-Training (AIT) routes, preceptors and training sites, the NAB exams, fees, continuing education, yearly renewal and reciprocity.
| Who licenses | The Board of Registration of Nursing Home Administrators, in the Department of Public Health’s Bureau of Health Professions Licensure |
|---|---|
| Eligibility | Age 18 or older, good moral character, a qualifying degree, a Board-approved AIT and a passing score on the NAB exam (245 CMR 3.03(1)) |
| AIT requirement | At least 3 months with a master’s in one of six named fields, or at least 6 months with a bachelor’s (245 CMR 3.03(1)(a), (b)), at a skilled nursing facility of 50 or more beds under the rule, though the Board has approved exceptions. See the routes below |
| National exams | NAB CORE and NHA, both required, with up to 4 attempts per 1 July to 30 June cycle (Board notice, 20 February 2026); $480 for the two, paid to NAB |
| State exam | None, and no jurisprudence exam. 245 CMR 2.02 defines the licensing exam as “The Nursing Home Administrator Examination offered by NAB,” and NAB’s Massachusetts page lists no state exam |
| Continuing education | 20 contact hours per annual renewal period under 245 CMR 4.02(1); the Board’s pages count 40 hours from 1 July of an even year to 30 June of the next even year, so confirm with the Board. No carryover |
| License renewal | Every year, by 30 June (245 CMR 3.06(1)); $75, plus $57 if late |
| Board fees | $75 for the AIT application ($150 in the Board’s AIT checklist), $150 for the initial application and license, $225 by reciprocity; NAB’s exam fee is separate |
| Official sources | mass.gov (the Board) · 245 CMR · M.G.L. c. 112 · nabweb.org (national exams) |
Verified against the sources above, September 2026. Requirements change; the current rules, as the Board applies them, govern, so confirm with the Board before you apply.
The Board of Registration of Nursing Home Administrators licenses nursing home administrators. It sits in the Bureau of Health Professions Licensure, within the Department of Public Health.
The licensing law is M.G.L. c. 112, §§ 108 to 117. The Board’s rules are 245 CMR 2.00 to 6.00, all effective 30 December 2016.
| Website | The Board’s page · Licensing hub |
|---|---|
| Applications | Online through the Health Professions Licensing Portal, which NHA licensing moved to in December 2023 |
| Address | 250 Washington Street, Boston, MA 02108 |
| Phone and email | (800) 414-0168 or (617) 973-0806 · Multiboard.Admin |
245 CMR 3.03(1) sets the base:
Citizenship. The statute, M.G.L. c. 112, § 109, still lists U.S. citizenship as a condition of admission to the exam. The Board’s current rule, 245 CMR 3.03(1), and its application pages do not mention it. If this affects you, ask the Board.
245 CMR 3.03(1) sets two routes. The length of your Administrator-in-Training (AIT) program depends on your degree:
| Minimum AIT | Degree | 245 CMR |
|---|---|---|
| At least 3 months | A master’s or higher degree from a graduate school of health care administration, business or management, in one of six fields: gerontology; health care management; health care administration; health services administration; public health, with a concentration in administration; or human services administration | 3.03(1)(a) |
| At least 6 months | A bachelor’s degree from an accredited undergraduate school, in any field | 3.03(1)(b) |
No associate-degree or experience-only route is offered. The statute sets the same floor, “not less than three months as a nursing home administrator in training,” and requires you to submit evidence to the Board at least 2 weeks before the AIT starts (M.G.L. c. 112, § 110).
Months, not hours. The rules set the AIT in months. NAB’s Massachusetts summary shows a minimum of 520 hours and a maximum of 1,040; treat those as NAB’s approximation and plan on the months in 245 CMR 3.03(1). The Board does ask for progress reports “with completed hours,” so keep a log.
Credit toward the AIT. The Board may give credit for an on-site internship that meets 3.02(1), completed as part of your degree program, or for skilled nursing facility work it finds “substantially equivalent” (245 CMR 3.02(3)).
Under 245 CMR 3.02(1)(b), your preceptor must:
The Board holds to this: at its 20 June 2025 meeting it denied a preceptor request under 3.02(1)(b). Preceptors can earn CE for the work, up to 10 hours for a 3-month AIT and 20 for a 6-month AIT, but no more than 20 “for any two-year period” (Board Policy No. 04-01).
Other states: AIT Hours by State.
The free AIT Planner turns your AIT into a plan across facility departments. The department split is our planning aid, not a Massachusetts rule; 245 CMR 3.02 asks for a study plan but sets no list of rotations, so agree the plan with your preceptor. No account needed.
Open the free AIT PlannerMassachusetts requires both exams from NAB, the National Association of Long Term Care Administrator Boards: the Core of Knowledge (CORE) and the NHA Line of Service (NHA).
| CORE | 125 questions (100 scored, 25 pretest); 130 minutes to answer, within 150 minutes of seat time, per NAB’s candidate handbook |
|---|---|
| NHA | 75 questions (60 scored); 70 minutes to answer, within 90 minutes of seat time, per NAB’s candidate handbook |
| Scheduling | Through Pearson VUE |
| Fee | $480 for CORE and NHA together, paid to NAB, from 1 February 2026 |
| Attempts | “CORE, NHA, & RCAL exams: up to 4 attempts per cycle,” each cycle running 1 July to 30 June. The Board adopted NAB’s limits, in force from 1 January 2026, on 20 February 2026 |
More in NAB Exam Format and The Core Domains Explained.
Your application has a clock. The Board’s license application page says the application becomes void if its requirements are “not met within 1 year from the date the Board receives your application.” Plan your exam dates inside that year.
Older wording. The Board’s application page still mentions “Professional Examination Services” and an earlier name for NAB; use NAB’s current exam information to register.
Massachusetts has no state exam and no jurisprudence exam. 245 CMR 2.02 defines the licensing exam as NAB’s, NAB’s Massachusetts page lists no state exam, and the Board’s 2026 attempts notice concerns only NAB’s national exams.
Once you run a Massachusetts nursing home, you answer to the state’s long-term care facility rules, 105 CMR 150.000, and to 42 CFR Part 483 if the home is certified for Medicare or Medicaid. Five differences you will meet on the job, each with the Massachusetts section:
| Topic | Federal rule (42 CFR 483) | Massachusetts rule | Section |
|---|---|---|---|
| Nursing hours per resident | No numeric hours-per-resident-day minimum; “sufficient” staff (483.35(a)(1)), and a registered nurse “for at least 8 consecutive hours a day, 7 days a week” (483.35(b)(1)), unless waived. CMS’s 2024 minimums (3.48 total nurse hours per resident day and a 24/7 RN), which were never enforced, were repealed by an interim final rule published 3 December 2025 and effective 2 February 2026 (90 FR 55687) | At least 3.58 hours of care per resident per day, “of which at least 0.508 hours must be care provided” by a registered nurse, in facilities providing Level I, II or III care, on and after 1 April 2021 | 105 CMR 150.007(B)(2)(d), (3)(d), (4)(d) |
| The administrator | The governing body appoints an administrator who is “Licensed by the State, where licensing is required,” and is responsible for managing the facility (483.70(d)(2)(i), (ii)); every state must license administrators under its Medicaid plan (42 CFR 431.702). No full-time or on-premises rule | Facilities providing Level I care, Level II care in more than one unit, or Level III or IV care in more than two units must employ a full-time administrator. “A full-time administrator shall be on the premises during the working day”; a responsible person is named to act in the administrator’s absence, and both names and phone numbers are posted. In facilities providing Level I, II or III care, the administrator must be licensed by the Board | 105 CMR 150.002(B) |
| Reporting incidents | Alleged abuse, neglect, exploitation or mistreatment is reported to the administrator and to officials including the State Survey Agency “immediately, but not later than 2 hours” if it involves abuse or serious bodily injury, otherwise within 24 hours (483.12(c)(1)), with investigation results within 5 working days (483.12(c)(4)). Staff and others covered by section 1150B of the Social Security Act must report a reasonable suspicion of a crime against a resident to the State Survey Agency and law enforcement, within 2 hours if there is serious bodily injury, otherwise within 24 hours (483.12(b)(5)) | The facility must “immediately report to the Department” events such as an unanticipated death, a full or partial evacuation, a fire, a suicide, a serious criminal act, a strike, or a reportable disease that is part of a cluster or outbreak, is unusual, or is foodborne (150.002(G)(1)), and any suspected abuse, neglect, mistreatment or misappropriation of a resident’s property (150.002(G)(2)). Any other incident or accident that seriously affects a resident’s health or safety, or causes serious physical injury, is reported within seven days of the event (150.002(G)(3)) | 105 CMR 150.002(G) |
| Residents per bedroom | Up to four residents per room (483.90(e)(1)(i)); the limit of two applies only to facilities newly certified, or whose construction plans were approved, after 28 November 2016 | “No resident bedroom shall contain more than two beds” on and after 30 April 2022, in facilities providing Level I, II or III care; a facility that could not comply by then had to show DPH good faith efforts to comply | 105 CMR 150.017(B)(3)(b)(1); 150.320(B)(1) |
| Dementia training | All staff must be trained in dementia management and resident abuse prevention, with no set hours (483.95(c)(3)); nurse aides also get at least 12 hours of in-service training a year, including dementia management (483.95(g)(1), (2)) | 8 hours of initial training before working unsupervised, then 4 hours each calendar year, for all relevant staff, “whether or not care is provided to residents in a DSCU” (the rule’s term for a dementia special care unit) | 105 CMR 150.024(B)(1), (2); 150.025 |
Massachusetts: 105 CMR 150.000 on mass.gov (Register #1505, 29 September 2023), cross-checked on Justia’s mirror for 150.017, 150.024 and 150.320. Federal: 42 CFR Part 483 in the eCFR. In a certified home you meet both reporting rules. DPH held a public hearing on 13 February 2026 on proposed amendments to 105 CMR 150, so check the current text before relying on a row.
From the Board’s application, AIT, reciprocity and renewal pages:
| AIT program application | $75 in the Board’s fee table; $150 in the checklist on the same page |
|---|---|
| Initial application and license, one fee | $150 |
| Application by reciprocity | $225 |
| License renewal, every year | $75 |
| Late renewal, on top of the renewal fee | $57 |
| Returned check | $23 |
NAB’s Massachusetts page lists a $150 application fee and a $150 licensure fee; the Board’s page shows one combined $150 fee. On the AIT route, a first license comes to $225 paid to the Board ($75 plus $150, or $300 if the AIT fee is $150) and $480 paid to NAB.
The rule and the Board’s web pages count CE over different periods:
Twenty a year and forty over two years reach the same total, but the periods differ, so confirm with the Board how it will count your hours before you renew. The rule, in force since 30 December 2016, is the current law; the Board’s pages still use the 40-hour wording. Meeting 20 hours in each year satisfies both.
Each licensee must “renew his or her license each year on or before June 30th” (245 CMR 3.06(1)). The statute also provides for yearly renewal (M.G.L. c. 112, § 111), and the Board’s renewal page says “Every year, by June 30th.” NAB’s Massachusetts summary lists the renewal period as biennial; the statute, the rule and the Board all say every year.
Reciprocity. Under 245 CMR 3.04, the other state’s requirements must be “substantially similar,” and you show: a license in good standing in every jurisdiction where you hold one; a passing score on the NAB exam; and an AIT completed, or credited, that is substantially equivalent to 3.02. The statute allows licensure without examination where the other state’s standards are “at least the substantial equivalent of those prevailing in this commonwealth” (M.G.L. c. 112, § 113). The Board’s reciprocity page sets a $225 fee and asks for your NAB score through the Interstate Reporting Service, your current license, transcripts, a résumé, references, a CORI and an NPDB report, and proof of the 40-hour CE cycle unless you have been licensed under 19 months. On 26 June 2026 the Board voted to change this application to match 245 CMR 3.04, dropping transcripts, a résumé and references, so check the current form before you apply.
Temporary licenses. 245 CMR 3.00 has no temporary license provision, and NAB’s Massachusetts page lists none. M.G.L. c. 112, § 1B does let a board issue a qualifying military spouse a temporary license while completing Massachusetts requirements.
Military. For boards in the Bureau of Health Professions Licensure, the VALOR Act and M.G.L. c. 112, § 1B give credit for military education, training and service; automatic renewal without fee or CE while on active duty and for 90 days after release; and expedited licensure for military spouses licensed in another state who moved because of a military transfer. The Bureau’s page covers its boards generally, so confirm the details with the Board.
In Massachusetts you put your own AIT together: you propose a facility and a qualified preceptor, and the Board approves the plan before you start (245 CMR 3.02(2)).
What to look for. A skilled nursing facility with 50 or more beds (for a smaller site, ask the Board) whose full-time administrator holds a Massachusetts license in good standing and has practiced full time as an administrator for the 5 years immediately before your AIT.
The ACHCA Massachusetts Chapter. The chapter’s AIT Inquiries page asks candidates to email an application and resume to maachca@gmail.com and says it will “forward your information to all of our membership.” mass.gov’s AIT inquiry form page lists this chapter route and a separate national ACHCA route, where inquiries are posted to the ACHCA members’ forum and emailed to all members.
Associations. The Massachusetts Senior Care Association and LeadingAge Massachusetts are state associations you can contact.
For approaching facilities and preceptors step by step, see How to Find an AIT Preceptor and an Approved Program.
The legal sources for nursing home administrator licensure in Massachusetts, and the facility rules cited above. Massachusetts has no state exam, but these are the rules you train and work under.
Citations verified against official sources, September 2026. Provided for reference, not legal advice; the current official text governs. Mirrors are labeled where an official public link is not available.
At least 3 months with a master’s or higher degree in one of six named fields, or at least 6 months with a bachelor’s in any field (245 CMR 3.03(1)(a), (b)). The rules set months, not hours; NAB’s summary shows 520 and 1,040 hours. The site must be a skilled nursing facility with at least 50 beds, though the Board has approved exceptions, and the Board approves your plan before you start.
No. You take NAB’s CORE and NHA exams, and 245 CMR 2.02 defines the licensing exam as NAB’s. Since the Board’s notice of 20 February 2026 you have up to 4 attempts per 1 July to 30 June cycle on the CORE and NHA exams.
The rule sets 20 contact hours per annual renewal period (245 CMR 4.02(1)); the Board’s pages count 40 hours from 1 July of an even year to 30 June of the next even year, so confirm with the Board. Hours do not carry over, domestic and sexual violence training is required, and the license renews every year by 30 June.
You propose a skilled nursing facility with at least 50 beds (the Board has approved smaller sites) and a preceptor, normally its full-time administrator, with at least 5 years of full-time practice immediately before the preceptorship; the Board approves the plan first (245 CMR 3.02). The ACHCA Massachusetts Chapter circulates AIT inquiries to its members.
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