What it takes to become a licensed nursing home administrator in Missouri: the experience and education routes straight to the exams, the Administrator-in-Training (AIT) internship when you need one, the NAB exams and the Missouri state exam (NHA-MO), continuing education, renewal, and where to find a certified preceptor. Figures are taken from the official sources listed on this page, with section numbers.
| Who licenses | Missouri Board of Nursing Home Administrators (BNHA), a licensing board within the Department of Health and Senior Services (19 CSR 73-1) |
|---|---|
| Basic requirements | High school diploma or equivalent, good moral character, no disqualifying conviction (19 CSR 73-2.020(2)). Minimum age: 18 on the board’s checklist, 21 in the 2012 rule; confirm with the board |
| AIT requirement | None if you qualify through experience, a qualifying degree, or both (19 CSR 73-2.020(2)(E)). Otherwise an internship of at least 500 clock hours (bachelor’s or higher) to 2,000 (high school) |
| National exams | NAB Core of Knowledge + NHA Line of Service, a scaled 113 to pass each (19 CSR 73-2.070(6)); $480 for the two, paid to NAB |
| State exam | Required: the Missouri state exam (NHA-MO), through Pearson VUE; 75 percent to pass (19 CSR 73-2.070(6)); $210, two hours (NAB handbook) Details ↓ |
| Continuing education | 40 clock hours per two-year license, at least 10 in patient care, at most 20 online (19 CSR 73-2.050) |
| License renewal | Every two years; expires June 30, $100 (RSMo 344.040; 19 CSR 73-2.015) |
| Board fee | $150 application review, non-refundable (19 CSR 73-2.015) |
| Official sources | health.mo.gov (the board) · 19 CSR 73-2 · Chapter 344, RSMo · nabweb.org (national exams) |
Verified against the sources above, September 2026. Requirements change; the current statute and rules, as applied by the board, govern, so confirm with the board before you apply.
You are licensed by the Missouri Board of Nursing Home Administrators (BNHA), “a licensing board within the Department of Health and Senior Services” (19 CSR 73-1). Contact: bnha@health.mo.gov, (573) 751-3511, PO Box 570, Jefferson City, MO 65102.
The basics, 19 CSR 73-2.020(2): “A high school diploma or equivalent”, “good moral character”, and no conviction of an offense whose “essential element” is fraud, dishonesty or moral turpitude, or which involves the operation of a long-term care or other health-care facility.
Minimum age: the sources differ. The 2012 rule says “Twenty-one (21) years of age or over.” The board’s current checklist says 18, as do the 2023 reciprocity and temporary emergency license rules (2.025, 2.080). If you are between 18 and 21, confirm with the board.
On top of the basics, 19 CSR 73-2.020(2)(E) asks for one of these. Meet any one and you need no AIT:
| Experience | “A minimum of three (3) years of experience in health-care administration, full-time equivalency”: management responsibility including “the on-site supervision of at least three (3) staff persons in a licensed long-term care or acute-care facility or a licensed mental health facility, or a department of one of these facilities” (2.010(6)) |
|---|---|
| Education | An associate degree in health-care administration with at least 21 semester hours “directly in health-care administration”; a bachelor’s in health-care administration, gerontology (with a long-term care practicum, internship or both) or nursing (BSN or diploma); or a master’s or beyond in those fields |
| Education plus experience | An associate degree plus “two (2) years experience in a health-care facility”; a bachelor’s plus one year; or a master’s plus one year |
The checklist words the experience in the degree-plus-experience routes as “in a licensed long-term care facility, licensed acute-care facility, or licensed inpatient mental health facility”, and the 2020 statute (RSMo 344.030.2(2)) is broader than the 2012 rule, naming “an associate degree or higher from an accredited academic institution” with no subject. The board decides, so ask before relying on the statute.
Applying. You apply to the board first, with a $150 non-refundable review fee (19 CSR 73-2.015). Applications are reviewed at board meetings, so file early (2.070(5)). Fees are waived for two years for military families and for low-income applicants, below 130 percent of the federal poverty line or enrolled in TANF, MO HealthNet or SNAP (19 CSR 73-2.011; RSMo 324.015).
Meet one of the three routes and you need no Administrator-in-Training (AIT) program. The rules call it a “course of instruction and training”, and it applies if the board finds you do not meet 2.020(2)(E) (2.020(4)(A)), or, per the Department’s AIT page, after three exam failures (see also 2.070(8)).
It has two parts. Formal instruction is “coursework qualifying for academic credit”, passed with at least a C (2.031(1)), from “an accredited educational institution or affiliate” registered with the board (2.031(4)). The internship is supervised by a preceptor in a facility. The minimums depend on your education, 19 CSR 73-2.031(1)(A) to (E):
| Your education | Formal instruction | Internship, minimum | Of which in an ALF or RCF, at most |
|---|---|---|---|
| (A) High school diploma or equivalent | 315 clock hours | 2,000 clock hours | 667 |
| (B) Licensed practical nurse program | 225 clock hours | 800 clock hours | 267 |
| (C) Associate degree | None stated | 640 clock hours | 214 |
| (D) Three-year diploma, or bachelor’s degree | None stated | 500 clock hours | 167 |
| (E) Master’s degree or beyond | None stated | 500 clock hours | 167 |
These are minimums for the AIT route only, not for every candidate, as an earlier version of this page implied. Hours in an assisted living facility (ALF), or in a residential care facility (RCF) licensed as an RCF II on or before 27 August 2006 that still meets those standards, count only if it has 30 or more beds, up to the cap shown (2.031(10)).
Who can be your preceptor. The board approves a preceptor “for a period of two (2) years” who has been licensed at least 3 years, has been a Missouri administrator for 1 of the last 3 years, currently runs an intermediate care, skilled nursing or assisted living facility, or a residential care facility licensed as an RCF II on or before 27 August 2006 that still meets those standards, of “thirty (30) or more beds” in substantial compliance, has had no discipline, and has completed a board-approved preceptor training program (19 CSR 73-2.031(5)). The Department’s preceptor page lists only five criteria, without the 30 beds or substantial compliance, and names a board-approved preceptor training program plus an update course before renewal.
Other states: AIT Hours by State.
If the board has told you to complete an AIT, the free AIT Planner turns your internship minimum into an hours plan across facility departments. Missouri sets no fixed rotation schedule, so agree the plan with your preceptor. No account needed.
Open the free AIT PlannerUnder 19 CSR 73-2.070(3) qualified applicants take “the appropriate licensure-level” national exam from NAB, the National Association of Long Term Care Administrator Boards, and NAB’s Missouri page lists “NAB NHA & CORE National: Yes”. So you take the Core of Knowledge and NHA Line of Service exams, delivered by Pearson VUE. Figures from NAB’s Candidate Handbook (revised September 2026):
| Core of Knowledge | 125 questions (100 scored), 2 hours 30 minutes; $320 |
|---|---|
| NHA Line of Service | 75 questions (60 scored), 1 hour 30 minutes; $190 |
| Both together | $480, up from $455 on 1 February 2026, paid to NAB |
| Passing score | A scaled 113 on each; Missouri’s rule sets the same (19 CSR 73-2.070(6)) |
| Attempts | No more than 4 at each exam per cycle, 1 July to 30 June, with a new application for each retake |
| Deadline | The exams “must be taken within twelve (12) months of the written notice” that you qualify, or you reapply (2.070(2)) |
Missouri publishes no order for the exams; the handbook says candidates “should contact their states to determine the order”. More in NAB Exam Format and The Core Domains Explained.
The rule calls Missouri’s third exam the “state examination prescribed by the board” (19 CSR 73-2.070(4)); NAB’s handbook lists it as Missouri NHA-MO. The board prescribes it and NAB administers it: NAB’s Missouri page says “State Exam Administration: NAB”.
| How you take it | Scheduled through Pearson VUE (pearsonvue.com/us/en/nab.html or (800) 834-1426) after the board approves you |
|---|---|
| Time and fee | Two hours: “All state exams have a two-hour time limit”; $210. Both per NAB’s handbook; the fee is not in the board’s fee rule |
| Passing score | “Seventy-five percent (75%) on the state examination” (19 CSR 73-2.070(6)) |
| Timing | Within 12 months of the board’s written notice that you qualify (2.070(2)) |
| Retakes | Retest after paying the fees. Fail only one exam and do not pass it within 12 months, and you “shall be required to take and pass both examinations.” A third failure of either exam means a board-prescribed course before you reapply (2.070(7), (8)) |
| Questions | Ask the board for the question count and item format |
The Department’s NHA Sources of Study page names these “Areas of focus”: 19 CSR 30-86 (residential care and assisted living facilities), 30-87 (sanitation), 30-88 (resident rights and funds), 30-91 (authorized electronic monitoring) and Chapter 198, RSMo, the facility statute that holds the abuse reporting duty and the resident funds bond. It also lists Chapter 344, RSMo, the board’s own law, and Title 19 of the Code of State Regulations. For study aids it names the Department’s Licensure Regulation Manual and online review courses from the Missouri Association of Nursing Home Administrators (mlnha.org) and an in-seat federal review course from the Missouri Health Care Association.
The list does not name 19 CSR 30-85, the intermediate care and skilled nursing facility rules, and its “Areas of focus” line is identical to the one on the Department’s list for residential care and assisted living administrators. The same page says NHA-MO “is developed from Missouri’s long-term care facility regulations and laws pertaining to licensed residential care and assisted living facilities”, plus the board’s own rules and law. Our own suggestion, not the board’s: study 30-85 too, and ask the board what NHA-MO currently covers.
Five places where the Missouri text differs from the federal requirements in 42 CFR Part 483:
| Topic | Federal rule (42 CFR 483) | Missouri rule | Section |
|---|---|---|---|
| The administrator’s hours | The administrator is “Licensed by the State, where licensing is required”; Part 483 sets no full-time requirement (483.70(d)(2)(i)) | “The administrator shall be employed in the facility and serve in that capacity on a full-time basis” | 19 CSR 30-85.042(4) |
| Reporting abuse or neglect | Reported “immediately, but not later than 2 hours” if the events involve abuse or result in serious bodily injury, otherwise within 24 hours, to the administrator and other officials, including the State Survey Agency (483.12(c)(1)); investigation results “within 5 working days of the incident” (483.12(c)(4)) | The “long-term care facility administrator or employee” with reasonable cause to believe a resident was abused or neglected “shall immediately report or cause a report to be made to the department.” Knowingly failing to report is a class A misdemeanor; an administrator who knowingly conceals abuse or neglect resulting in death or serious physical injury commits a class E felony | RSMo 198.070.1, .3, .4; 19 CSR 30-88.010(25) |
| Resident funds when a resident leaves | On discharge, eviction or death, the funds and a final accounting are conveyed “within 30 days” (483.10(f)(10)(v)) | “Within five (5) calendar days of the discharge of a resident,” an accounting, and funds and possessions returned | 19 CSR 30-88.020(10) |
| Surety bond for resident funds | A surety bond, or other “assurance satisfactory to the Secretary”; no amount or multiple set (483.10(f)(10)(vi)) | “At least one and one-half (1 1/2) times the average monthly balance” (the bond is required by RSMo 198.096) | 19 CSR 30-88.020(14) |
| Cameras in resident rooms | No counterpart rule | A resident may place an authorized electronic monitoring device in their room (form DHSS-DRL-107), with roommate consent and an “Electronic Monitoring” notice at the main entrance | 19 CSR 30-91.010; RSMo 198.610 to 198.632 (notice: 198.628) |
Missouri: RSMo and 19 CSR, official texts, September 2026. Federal: eCFR, September 2026. Both funds rules cover discharge: 30 days federally, 5 calendar days in Missouri. We left out nurse staffing and administrator absences, which are also set in 19 CSR 30-85.042.
State NHA Exams Explained covers how state exams work in general.
We build practice sets for state exams one state at a time: questions drawn from the state’s own rules, each cited to its section, the way our Illinois supplement is built. Missouri is not built yet. Leave your email and we will tell you if we build it.
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Certified preceptors: the board lists them on the state’s open-data portal, BNHA - Preceptors on data.mo.gov, linked from its AIT page, showing name, license number, status, facility, preceptor start and expiry dates, contact and city. Per that page, you find a preceptor on the list, the preceptor emails the AIT and Preceptor Request and Agreement to bnha@health.mo.gov, and the board emails its decision and a start date. A listed preceptor is certified, but each pairing still needs approval.
AIT programs. The formal instruction must come from an accredited institution registered with the board (19 CSR 73-2.031(4)), so ask the board before you enroll. The “Approved Training Agency Report” on data.mo.gov lists continuing education providers, not AIT programs.
State associations: the Missouri Health Care Association sponsors the in-seat review course the Department names, and LeadingAge Missouri’s site says it offers board-approved online continuing education. Both can be useful for contacts with member facilities.
For the full step-by-step on approaching facilities and preceptors, see How to Find an AIT Preceptor and an Approved Program.
Licenses run two years. Under RSMo 344.040 they expire “on June thirtieth of the year following the year of issuance and every other year thereafter”. The board notifies you “By April 1” (19 CSR 73-2.050(1)), you file “during the month of May” (RSMo 344.040), and renewal costs $100 (2.015).
At least 5 percent of renewals are audited, and records are kept for 4 years (2.050). Late renewal within 12 months takes the fee, a $25 penalty, an employment statement and an explanation (2.055); after that you meet first-license requirements again, and practicing on an expired license is barred (RSMo 344.102). An inactive license costs $50 and takes 40 hours plus $100 to reactivate (2.053); a retired license can be reactivated “within five (5) years” with 20 hours for each calendar year (2.051).
Licensed elsewhere. 19 CSR 73-2.025 (amended 30 November 2023) covers a current administrator license from another state, a territory, DC or the military. You must be 18 or older and either NAB HSE-qualified, or have a passing NAB score and have “held in good standing for at least one (1) year” a license; the fee is $150. The rule says “the applicant must complete and pass the state examination” (2.025(5)), although the Department’s reciprocity checklist does not mention it. The rule governs, so plan on NHA-MO.
Temporary emergency license. Up to 120 days, only to replace an administrator who has died, been removed or vacated the position, for an applicant 18 or older with a high school diploma or equivalent, “preceded in the position by a fully licensed administrator”, who files within 10 working days of the vacancy (RSMo 344.030.4; 19 CSR 73-2.080).
Assisted living and residential care. RSMo 344.020 allows “a separate license” for administrators of assisted living and certain residential care facilities. It does not cover intermediate care or skilled nursing, and its candidates take the RC/AL-MO state exam; ask the board which NAB exams it requires. The NHA license covers all four facility types.
The legal sources for nursing home administrator licensure in Missouri, and the facility rules cited above.
Citations verified against official sources, September 2026. Provided for reference, not legal advice; the current official text governs.
None if you meet a route in 19 CSR 73-2.020(2)(E): three years of health-care administration experience, a qualifying degree, or a degree plus experience. Otherwise, or after three exam failures, the internship minimum depends on your education (19 CSR 73-2.031(1)): 2,000 clock hours with a high school diploma, 800 after an LPN program, 640 with an associate degree, and 500 with a three-year diploma, a bachelor’s or higher.
The NAB Core of Knowledge and NHA Line of Service exams, a scaled 113 to pass each, and the Missouri state exam, NHA-MO, 75 percent to pass (19 CSR 73-2.070(6)). All are taken within 12 months of the board’s written notice. NAB’s handbook lists $480 for the two NAB exams and $210 for NHA-MO.
The Department’s study page names 19 CSR 30-86, 30-87, 30-88 and 30-91 and Chapter 198, RSMo, and also lists Chapter 344, RSMo. It does not name 19 CSR 30-85, the skilled nursing and intermediate care rules; we suggest studying those too and asking the board.
The sources differ: the board’s current checklist says 18, but the 2012 rule, 19 CSR 73-2.020(2)(A), says 21. Confirm with the board.
40 clock hours per two-year license, at least 10 in patient care and no more than 20 online (19 CSR 73-2.050). Only extra hours earned in June carry over. Licenses expire June 30, you file in May, and renewal costs $100.
The board lists certified preceptors on data.mo.gov (BNHA - Preceptors), and each pairing needs board approval before the AIT begins. Ask the board whether it keeps a list of approved AIT programs.
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