What it takes to become a licensed nursing home administrator in Ohio: who licenses you, the Administrator Residency (Ohio’s AIT) and the Core of Knowledge course, the NAB exams, fees, continuing education, renewal and finding a preceptor, with section numbers.
| Who licenses | The Ohio Board of Executives of Long-Term Services and Supports (BELTSS), within the Ohio Department of Aging (ORC 4751.02) |
|---|---|
| Eligibility | Age 21 or older, a bachelor’s degree, the Core of Knowledge course or a NAB-accredited NHA degree, and BCI and FBI background checks (OAC 4751-1-05(A), 4751-1-09(C)(3)) |
| AIT requirement | The Administrator Residency: 1,500 hours over 9 months with a bachelor’s, 1,000 over 6 months with a master’s, none after a NAB-accredited NHA program (OAC 4751-1-05(A)(5)) Routes ↓ |
| National exams | NAB Core of Knowledge and NHA Line of Service, both required, at Pearson VUE; $480 for the two applied for together, paid to NAB (exams required by OAC 4751-1-07(A); fee per NAB) |
| State exam | None since 1 February 2025, when Ohio dropped its state exam (OAC 4751-1-06, 4751-1-07(A)); the BELTSS FAQ still mentions it Details ↓ |
| Continuing education | 40 hours for each two-year renewal, including one ethics course; last names A to L from 2026, M to Z from 2027 (OAC 4751-1-10(D), 4751-1-10.1, 4751-1-13) |
| Renewal | Every two years (ORC 4751.24(A)); $800; licenses expire on 1 January, 1 April, 1 July or 1 October, every other year |
| Official sources | beltss.ohio.gov (the Board) · OAC Chapter 4751-1 · ORC Chapter 4751 · nabweb.org (national exams) |
Verified against the sources above, September 2026. OAC is the Ohio Administrative Code; ORC is the Ohio Revised Code. Requirements change, so confirm with BELTSS before you apply.
Your license comes from the Ohio Board of Executives of Long-Term Services and Supports (BELTSS), which ORC 4751.02 establishes “in the department of aging”. BELTSS replaced the Board of Examiners of Nursing Home Administrators under Am. Sub. HB 59 in 2013, so older material may use the old name. Most of its rules, OAC Chapter 4751-1, were last amended effective 1 January 2026.
The Board issues two licenses: the nursing home administrator (NHA) license this page covers, and a voluntary Health Services Executive (HSE) license (OAC 4751-1-10.2(B)), first adopted in rule on 1 January 2020.
| Online portal | MyBELTSS (beltss.age.ohio.gov/MYBELTSS), for applications and renewals |
|---|---|
| Office | 30 E Broad St, 22nd Floor, Columbus OH 43215-3414 · (614) 466-5114 |
OAC 4751-1-05(A) sets the base for every applicant:
Ohio’s Administrator-in-Training (AIT) is the Administrator Residency (AR) Program. How long yours runs depends on your degree (OAC 4751-1-05(A)(5)):
| Your route | Residency | OAC |
|---|---|---|
| Bachelor’s degree | 9 months and 1,500 hours of full-time residency | 4751-1-05(A)(5)(a) |
| Bachelor’s from a NAB-accredited NHA program | None | 4751-1-05(A)(5)(b) |
| Master’s degree or higher | 6 months and 1,000 hours of full-time residency | 4751-1-05(A)(5)(c) |
| Master’s from a NAB-accredited NHA program | None | 4751-1-05(A)(5)(d) |
| Reduction for experience | The Board may grant a three-month, 500-hour reduction for significant nursing facility experience, so as few as 1,000 hours with a bachelor’s or 500 with a master’s. Apply before your program is approved | 4751-1-09(F) |
“Both the months and the hours apply” (4751-1-09(G)(1)), so finishing the hours early does not shorten the months.
Unless you graduated from a NAB-accredited NHA program, you also need the Core of Knowledge: “one hundred hours of academic directed study”, no more than 20 of them by distance learning (OAC 4751-1-05.1). You can take it before, during or after the residency, but its hours do not count toward residency hours (05.1(C); 09(G)(2)), and you finish it before the exam. The BELTSS 2024 Core flyer names the Ohio Health Care Association and LeadingAge Ohio as providers and listed tuition of $1,495 for that year’s session. LeadingAge Ohio, which ran the winter 2026 session, lists its next session for 11 to 28 January 2027 at the OCLC Conference Center, with registration by 7 December 2026; BELTSS lists it as virtual, so confirm the format. OHCA ran the summer 2026 session.
Under OAC 4751-1-09(J), your preceptor:
The Board approves a preceptor for each residency, so approval is applied for every time ((J)(7)). Preceptors earn CE for it: 6 hours for a full residency, 3 for half or more (4751-1-13(A)(7), (8)).
Other states: AIT Hours by State.
The free AIT Planner turns your residency hours into a plan across facility departments. That split is our planning aid, not an Ohio rule: Ohio asks for a professional development plan on NAB’s form and the mandatory self-assessment, so agree the plan with your preceptor. No account needed.
Open the free AIT Planner“Every applicant … shall be required to pass the national examinations” (OAC 4751-1-07(A)). These are the exams of NAB, the National Association of Long Term Care Administrator Boards, and they cover NAB’s “domains of practice” (4751-1-06). 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 |
| Fee | $480 for the Core and NHA applied for together, from 1 February 2026, paid to NAB |
| Passing | NAB’s passing score, a scaled 113, applied to each exam separately (4751-1-07(B); NAB handbook) |
| Scheduling | The Board approves you and Pearson VUE notifies you. NAB’s handbook allows 90 days from the Authorization to Test to schedule and sit; the BELTSS exam page gives 60 days from paying the exam fee. Plan on the shorter window |
| NAB attempts | Since 1 January 2026, up to 4 attempts per exam cycle (1 July to 30 June) |
If you fail. You file a new application to test (4751-1-07(D)). The BELTSS office can approve your second and third attempts; a fourth means appearing before the Board. After three failures you meet the Board’s added education or experience requirements (07(E)), and 4751-1-05(G) asks you to “complete an additional residency” before “retesting a fourth and final time”. After a fourth failure you reapply as a new applicant. NAB’s own cap of 4 attempts per cycle applies as well.
Filling a sudden vacancy. Since 1 January 2025, to fill an unexpected vacancy, an operator can ask for a license for someone who meets the requirements but has not yet passed the exam. Proof of passing the exam must then be submitted “not later than one hundred eighty days after a license is issued” (ORC 4751.20(B); OAC 4751-1-10(C)).
More in NAB Exam Format and The Core Domains Explained.
No, not since 1 February 2025. Until then, Ohio’s rules required “the national and state examinations”, and OAC 4751-1-06 said “The Ohio state examination, based on Ohio’s laws and rules, is also required.” Rules effective 1 February 2025 removed both, and the current OAC 4751-1-07(A), effective 1 January 2026, requires only “the national examinations”. The BELTSS Direct College and Exam Information pages describe only the NAB exams, and NAB’s Ohio page lists only the NAB NHA and Core exams.
Applying from another state. Neither the endorsement statute (ORC 4751.201) nor the endorsement rule (OAC 4751-1-14) requires an exam; the rule asks only that you be “familiar with Ohio’s laws and rules” (14(A)(2)). Two undated answers in the BELTSS FAQ still refer to it: one tells out-of-state administrators “you must pass the Ohio examination, which is based on Ohio’s laws and rules,” and another speaks of being approved “to sit for the Ohio examination.” That wording comes from the repealed rule, and the BELTSS out-of-state page mentions no Ohio exam. BELTSS can confirm this if you are unsure: Jennifer See is the contact for out-of-state and college applicants (jsee@age.ohio.gov, 614-644-7516).
Ohio law still matters. Every renewal needs an ethics course, and once you run a home you work under Ohio’s nursing home rules (OAC Chapter 3701-17) and statutes (ORC Chapter 3721).
The NAB exams are national exams, not Ohio exams. In an Ohio nursing home you answer to Ohio’s nursing home rules and statutes, and to 42 CFR Part 483 if the home is certified for Medicare or Medicaid. Five differences that apply on the job, each with the Ohio section:
| Topic | Federal rule (42 CFR 483) | Ohio rule | Ohio section |
|---|---|---|---|
| Administrator on site | The administrator must be “Licensed by the State, where licensing is required” (483.70(d)(2)(i)); 483.70 sets no minimum hours on site | In a home with a licensed capacity under 100 beds, the administrator is present “to the extent necessary for effectively managing the home”, and “not less than sixteen hours during each calendar week”; at 100 beds or more, full time (30 hours or more a week) | OAC 3701-17-08(A); 3701-17-01(J) |
| Direct care hours | Sufficient nursing staff, with licensed nurses on a 24-hour basis unless waived (483.35(a)(1)); no hours-per-resident-day minimum. CMS repealed the 2024 minimum staffing standards, which were never enforced, by interim final rule (90 FR 55687, published 3 December 2025, effective 2 February 2026) | Sufficient direct care staff on each shift, and a “minimum daily average of two and one-half hours of direct care and services per resident per day” from nurse aides, registered nurses and licensed practical nurses (including nurses with administrative and supervisory duties) | OAC 3701-17-08(C) |
| Nurse coverage | A registered nurse “for at least 8 consecutive hours a day, 7 days a week” (483.35(b)(1)) and a full-time RN director of nursing (483.35(b)(2)), each unless waived | A registered nurse as director of nursing (two RNs may share the role), on duty 5 days a week, 8 hours a day, mostly between 6 a.m. and 6 p.m., and a “registered nurse on call whenever one is not on duty” | OAC 3701-17-08(B)(1), (D) |
| Resident grievances | The facility names a “Grievance Official” (483.10(j)(4)(ii)) and must act promptly on grievances from resident or family groups (483.10(f)(5)(iv)); no grievance committee is required | The administrator establishes a grievance committee of staff and residents, sponsors or outside representatives, with “not more than one staff member to every two residents, sponsors, or outside representatives” | ORC 3721.12(A)(2) |
| Criminal records checks | The facility may not employ people found guilty of abuse, neglect, exploitation, misappropriation of property or mistreatment by a court of law, among others (483.12(a)(3)). The section does not itself require a criminal records check, though a facility must check the nurse aide registries before an aide works (483.35(d)(4), (5)) | The administrator must request a BCI criminal records check of each applicant for a direct-care position, plus FBI records if the applicant cannot show 5 years of Ohio residency; offenses listed in OAC 3701-13-05 bar employment unless pardoned or the personal character standards of OAC 3701-13-06 are met | ORC 3721.121; OAC 3701-13-05, 3701-13-06 |
The federal nursing home rules (42 CFR Part 483, Subpart B) apply only to facilities certified for Medicare or Medicaid; in a certified home you meet both sets of rules. The federal reporting duties apply there too: the facility reports alleged abuse, neglect, exploitation or mistreatment “immediately, but not later than 2 hours” if it involves abuse or serious bodily injury, and within 24 hours otherwise (483.12(c)(1)), and covered individuals report a reasonable suspicion of a crime against a resident, within 2 hours if there is serious bodily injury, otherwise within 24 hours (483.12(b)(5); section 1150B of the Social Security Act).
Ohio’s own reporting duty. A licensed administrator who knows or suspects that a resident has been abused, neglected or exploited, or that resident property has been misappropriated, by anyone the facility uses to provide services to residents, must report it to the director of health (ORC 3721.22(A)(2)). Good-faith reports are protected (3721.22(C)).
Start by calling homes. The BELTSS FAQ puts it plainly: “The best way to find a preceptor is to call local facilities.” The Board then approves the preceptor you find for your residency.
The ACHCA matching form. The FAQ also points to the American College of Health Care Administrators matching form, which does not require membership.
The Core of Knowledge. BELTSS names the Ohio Health Care Association (OHCA) and LeadingAge Ohio as its providers.
For approaching facilities and preceptors step by step, see How to Find an AIT Preceptor and an Approved Program.
Board fees are in OAC 4751-1-16 and ORC 4751.20 and 4751.24; several were raised in 2025 by HB 96 (136th General Assembly). “All fees are non-refundable” (4751-1-16).
| Administrator residency application | $250 (OAC 4751-1-16) |
|---|---|
| License application | $250 (ORC 4751.20(A)(1)) |
| Original license | $800 (ORC 4751.20(A)(9)) |
| NAB Core and NHA exams | $480 for the two applied for together, from 1 February 2026, paid to NAB |
| Renewal, every two years | $800 (ORC 4751.24(B)) |
| Late renewal | $50 for each calendar quarter late, up to $200, on top of the renewal fee (ORC 4751.24(C)) |
| Temporary license | $350 |
| Endorsement of an out-of-state license | Ask BELTSS which fees apply. The $150 in OAC 4751-1-16 is for Ohio licensees going to another state |
| Health Services Executive (HSE) license | $100 (OAC 4751-1-10.2(C)), then $100 each year to renew (ORC 4751.25) |
NAB’s Ohio page still shows older, lower fees, so go by the Ohio rule. By our count, the residency route comes to $250 + $250 + $800 + $480 = $1,780 in Board and NAB fees for a first attempt at both exams, plus the Core of Knowledge tuition.
You need “forty clock hours of approved continuing education biennially” (OAC 4751-1-13(A)), earned in “the twenty-seven-month period preceding renewal”. That is 40 hours for each two-year renewal, not each year.
Renewal. “A nursing home administrator license is valid for two years” (ORC 4751.24(A)), as it has been since HB 509 (134th General Assembly) took effect on 6 April 2023. Licenses expire on 1 January, 1 April, 1 July or 1 October, every other year (BELTSS late renewal page), and you renew online in MyBELTSS before that date (4751-1-10.1(E), (F)). The BELTSS FAQ says the Board has no “authority or leeway to grant grace periods”: the license lapses automatically at expiration (4751-1-10(G)).
Out-of-state license (ORC 4751.201, in effect since 29 December 2023; OAC 4751-1-14). The Board “shall” license you if you hold a license in good standing in another state, or, from a state that does not license administrators, have satisfactory work experience (9 to 12 months under OAC 4751-1-14) or a government or private certification. Ohio’s general out-of-state licensing law, ORC Chapter 4796, adds conditions: good standing wherever you are licensed, and normally at least a year holding the license and a year of practice in the last five. No exam is required. You also need to be “familiar with Ohio’s laws and rules” and pass BCI and FBI checks. If your experience falls short, the Board may require a residency and the Core (14(C)). Ask BELTSS which fees apply to you. The $150 endorsement fee in OAC 4751-1-16 is for Ohio licensees going to another state.
Temporary license (OAC 4751-1-11). Up to 180 days, to fill a vacancy caused by death, illness or another cause. You need a bachelor’s degree and BCI and FBI checks, and the time does not count toward a residency (11(D)). The fee is $350.
Military (OAC 4751-1-10.3). Equivalent military training can count, and the CE period is extended by the months of active duty.
The laws, rules and pages cited above, all on official sites.
Citations verified against official sources, September 2026. Provided for reference, not legal advice; the current official text governs.
The Administrator Residency is 1,500 hours over 9 months with a bachelor’s degree, 1,000 hours over 6 months with a master’s, and none if you graduated from a NAB-accredited NHA program; the Board may grant a three-month, 500-hour reduction for significant experience (OAC 4751-1-05(A)(5), 4751-1-09(F)).
The NAB Core of Knowledge and NHA Line of Service exams, at Pearson VUE, after the Board approves you to test (OAC 4751-1-07(A)). NAB charges $480 for the two applied for together. Ohio has had no state exam since 1 February 2025.
No. Ohio dropped its state laws-and-rules exam on 1 February 2025, and OAC 4751-1-07(A) now requires only the national examinations. Undated BELTSS FAQ answers still mention an Ohio examination for out-of-state administrators, but the endorsement rule (OAC 4751-1-14) requires no exam.
40 clock hours for each two-year renewal, including one ethics course (OAC 4751-1-13); last names A to L from 2026, M to Z from 2027. The license is valid for two years (ORC 4751.24(A)).
BELTSS advises calling local facilities, and its FAQ points to the ACHCA matching form. Your preceptor needs at least 2 years of full-time practice as a licensed administrator in Ohio (a separate standard applies at approved out-of-state sites), may train no more than 2 residents at once, and is approved by the Board for your residency (OAC 4751-1-09(J)).
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