Become a Texas Nursing Facility Administrator

Traditional Initial Route Process Map (PDF)

• Complete educational requirements: Applicant must have a bachelor’s or master’s degree in any subject from a college or university accredited by an agency recognized by the Texas Higher Education Coordinating Board. This includes a minimum of 12 semester credit hours in long-term care administration or its equivalent with courses in the four domains of the National Association of Long-Term Care Administrator Boards (NAB), including: care services and supports; operations; environment and quality; and leadership and strategy.
• Complete internship hours: Applicant must complete a 1,000-hour internship in a nursing facility under an approved preceptor, which will be requested through the TULIP application. If internship hours are completed under the authority of a college, the college will document the internship hours on the college transcript.
  
  The applicant may qualify for a 500-hour internship if they have a bachelor’s or master’s degree in health administration, health services administration, health care administration, or nursing that includes coursework encompassing the four NAB domains. They must also have management experience (three years for bachelor’s or one year for master’s) working in a nursing facility or as assistant administrator of record in another state (one year). For more information, see 26 TAC 555.12 Licensure Requirements.
  • Military service members or veterans who want to receive credit for their military service toward their internship requirement, see the Credit Towards Internship for Military Service Members and Veterans section of this page to learn more.
• HHSC required training: Complete Infection Control and Personal Protective Equipment for NFAs Computer-Based Training.
• Submit application through TULIP: Log in to TULIP to create an applicant registration, complete an Initial License Application, and pay the $100 application fee.
  • Military service members, veterans or military spouses who want to have the application fee and corresponding license fee waived, see the Fee Waiver for Military Service Personnel, Veterans and Military Spouse section of this page to learn more. The TULIP application cannot be submitted until the fee waiver is approved and the fees are marked as waived.
  • Education tab: List of degree and educational requirements including the courses for the four NAB domains under the academic and alternative education tab.
  • Email official transcript(s) reflecting degree(s) from a college or university and 12 semester credit hours of NAB domains to NFA Licensing Program.
  • Request an internship with an approved preceptor.
  • Documents tab: Upload a resume if requesting a 500-hour internship waiver.
  • Complete FBI-based fingerprinting: Fingerprints for an FBI-based background check through the Department of Public Safety are required. Applicants will be provided with a link to complete the process.
  • HHSC staff will review the application. If they find deficiencies, they will place the application in response required status so the applicant can make corrections.
• Schedule and pass the national and state exams: Once the applicant has met the educational and application requirements above, HHSC will provide a link to take the Texas State and NAB exams. The NAB exam consists of two exams (core and the NFA line of service), and the applicant must pass both. The Texas exam consists of questions that cover the Nursing Facility Requirements for Licensure and Medicaid Certification, and the NAB exam covers content in the NAB AIT Manual. An applicant who fails the state or NAB examination three times must repeat the 1,000-hour AIT internship before retesting.
• Exam results: Once the applicant has taken an exam, it takes five business days for HHSC to receive the results from NAB. HHSC then adds exam results to the applicant’s TULIP account.
• Initial license fee: Once the applicant has passed both exams, TULIP notifies the applicant to pay the initial $250 licensure fee. It takes five to 10 business days for HHSC to receive an online payment.
• License issued: Once the initial licensure fee has been received, HHSC will issue an NFA license with a two-year licensure period, and the applicant will receive an auto reply from TULIP.
  • The newly licensed NFA will print their license from TULIP.

HSE Qualification Route Process Map (PDF)

• Requirements: An applicant must have entry-level competencies in a nursing facility, assisted living community, or home and community-based service provider in Texas or another state. They must also meet NAB’s minimum standards for qualification as an HSE. Submit proof of HSE qualification and certification that the applicant has not had an NFA or HSE license revoked in any state.
• Submit application through TULIP: Log in to TULIP to create an applicant registration, complete an HSE application, and pay the initial $100 application fee.
  • Military service members, veterans or military spouses who want to have the application fee and corresponding license fee waived, see the Fee Waiver for Military Service Personnel, Veterans and Military Spouse section of this page to learn more. The TULIP application cannot be submitted until the fee waiver is approved and the fees are marked as waived.
  • Documents tab: Upload proof of the HSE qualification and certification that the applicant has not had a license revoked in any state.
  • Complete FBI-based fingerprinting: Fingerprints for an FBI-based background check through the Department of Public Safety are required. Applicants will be provided with a link to complete the process.
  • HHSC staff will review the application. If they find deficiencies, they will place the application in Response Required status so the applicant can make corrections.
• Schedule and pass the state exam: Once the applicant has met the HSE requirements above, HHSC will provide a link to take the Texas State exam. The Texas exam consists of questions that cover the Nursing Facility Requirements for Licensure and Medicaid Certification. An applicant who fails the state examination three times must repeat the 1,000-hour AIT internship before retesting.
• Exam results: Once the applicant has taken an exam, it takes five business days for HHSC to receive the results from NAB. HHSC then adds exam results to the applicant’s TULIP account.
• Initial license fee: Once the applicant has passed the Texas exam, TULIP notifies the applicant to pay the initial $250 licensure fee. It takes five to 10 business days for HHSC to receive an online payment.
• License issued: Once the initial licensure fee has been received, HHSC will issue an NFA license, and the applicant will receive an auto reply from TULIP.
  • The newly licensed NFA will print their license from TULIP.

Reciprocity Route Process Map (PDF)

• Requirements: An individual must have an NFA or HSE license issued by a state other than Texas and meet the requirements for Texas licensure.
• Request NAB score: Applicant must request their NAB score from NAB so that NAB can release the score to Texas. To learn more about how to request a score transfer to a new state board, visit the NAB Exam Information FAQs webpage. HHSC will add your NAB score to your record in TULIP.
• Submit application through TULIP: Log in to TULIP to create an applicant registration, complete a NFA Request for Entry through Reciprocity application, and pay the initial $100 application fee.
  • Military service members, veterans or military spouses who want to have the application fee and corresponding license fee waived, see the Fee Waiver for Military Service Personnel, Veterans and Military Spouse section of this page to learn more. The TULIP application cannot be submitted until the fee waiver is approved and the fees are marked as waived.
  • Documents tab: Upload proof of license in good standing in another state and upload completed Form 5535: Reciprocity Licensure Questionnaire (PDF).
  • If the state that issued the applicant’s license is unable to verify education, four NAB domains, internship and exam scores on the form, it is the applicant’s responsibility to submit proof of these items along with this questionnaire.
  • Complete FBI-based fingerprinting: Fingerprints for an FBI-based background check through the Department of Public Safety are required. Applicants will be provided with a link to complete the process once the application is submitted and paid in TULIP.
  • HHSC staff will review the application. If they find deficiencies, they will place the application in Response Required status so the applicant can make corrections.
• Schedule and pass the state exam: Once the applicant has met the reciprocity requirements above, HHSC will provide a link to take the Texas State exam. The Texas exam consists of questions that cover the Nursing Facility Requirements for Licensure and Medicaid Certification. An applicant who fails the state examination three times must repeat the 1,000-hour AIT internship before retesting.
• Exam results: Once the applicant has taken the exam, it takes five business days for HHSC to receive the results from NAB. HHSC then adds exam results to the applicant’s TULIP account.
• Initial license fee: Once the applicant has passed the Texas exam, TULIP notifies the applicant to pay the initial $250 licensure fee. It takes five to 10 business days for HHSC to receive an online payment.
• License Issued: Once the initial licensure fee has been received, HHSC will issue an NFA license, and the applicant will receive an auto reply from TULIP.
  • The newly licensed NFA will print their license from TULIP.

Military Service Member or Spouse Route Process Map (PDF)

• Requirements: Applicants who are military service members stationed in Texas or a person who is married to a military service member stationed in Texas may hold a nursing facility administration position in Texas without obtaining a license, if the service member or spouse is currently licensed in good standing by another state and licensing requirements are substantially equivalent to Texas requirements. Substantially equivalent includes the same education and internship requirements as defined in the Texas Administrative Code.
• Submit application through TULIP: Log in to TULIP to create an applicant registration and complete a Military Spouse application under the Other State Certification Verification tab. Note that the name of the application has not been updated in TULIP to include military service members, but you can use this same application for both. There is no fee.
  • Documents tab: Upload license from other state, proof of the military service member’s or spouse’s residence in Texas, which may include a copy of the permanent change-of-station order for the military service member or a copy of the applicant’s military identification.
  • Complete FBI-based fingerprinting: Fingerprints for an FBI-based background check through the Department of Public Safety are required. Applicants will be provided with a link to complete the process once the application is submitted in TULIP.
  • HHSC staff will review the application and evaluate the criteria to determine whether another state’s licensing requirements are substantially equivalent to Texas requirements. If there are deficiencies, HHSC will place the application in Response Required status so the applicant can make corrections.
• License issued: HHSC will issue a NFA license. The license will expire three years from the date of issuance or when the military service member is no longer stationed in Texas or if the applicant does not maintain active status in the state they are licensed in — whichever comes first. This license may not be renewed. The applicant will receive an auto reply from TULIP when the license is available.
  • The newly licensed NFA will print their license from TULIP.
• It is the applicant’s choice whether they pursue a license through this process or through reciprocity.

Provisional License Route Process Map (PDF)

• Requirements: An applicant currently licensed or registered as an NFA or licensed as an HSE in another state with at least one year as the administrator of record at a nursing facility may request a provisional license if they do not meet the requirements for reciprocity. The provisional license will include a sponsorship by an NFA licensed by HHSC and who is in good standing, unless HHSC waives sponsorship based on a demonstrated hardship. The provisional license is effective for 180 days, during which time the licensee must come into compliance with all Texas requirements, including educational requirements (if applicable), internship requirements (if applicable), and pass the state exam.
• Request NAB score: Applicants must request NAB scores from NAB so that they can release the score to Texas. To learn more about how to request a score transfer to a new state board, visit the NAB Exam Information FAQs webpage. HHSC will add your NAB score to your TULIP record.
• Submit application through TULIP: Log in to TULIP to create an applicant registration, complete a Provisional application, and pay the $100 initial application fee.
  • Military service members, veterans or military spouses who want to have the application fee and corresponding license fee waived, see the Fee Waiver for Military Service Personnel, Veterans and Military Spouse section of this page to learn more. The TULIP application cannot be submitted until the fee waiver is approved and the fees are marked as waived.
  • Documents tab: Upload proof of licensure in good standing in another state and a completed and notarized Provisional Licensure Questionnaire Form 5518-NFA. If the state that issued your license is unable to verify education, internship, exam scores and courses in the four NAB domains, it’s your responsibility to submit proof of these items along with this questionnaire.
  • Work history tab: List employment of one year as an administrator of record at a nursing facility in the applicant’s state.
  • Notes tab: List NFA Sponsor.
  • Complete FBI-based fingerprinting: Fingerprints for an FBI-based background check through the Department of Public Safety are required. Applicants will be provided with a link to complete the process.
  • HHSC staff will review the application. If they find deficiencies, they will place the application in Response Required status so the applicant can make corrections.
• Issue provisional license: Once the applicant has met the provisional requirements above, HHSC will issue a provisional license valid for 180 days. Applicants must pass the Texas exam within the 180 days to receive a Texas NFA license. If the applicant is missing any of the educational or internship requirements, they must come into compliance within the 180 days. The applicant will receive an auto reply from TULIP.
  • The provisionally licensed NFA will print their provisional license from TULIP.
• Schedule and pass the state exam: Once the Provisional license is issued, HHSC will provide a link to take the Texas State exam. The Texas exam consists of questions that cover the Nursing Facility Requirements for Licensure and Medicaid Certification. An applicant who fails the state examination three times must repeat the 1,000-hour AIT internship before retesting.
• Exam results: Once the applicant has taken the exam, it takes five business days for HHSC to receive the results from NAB. HHSC then adds exam results to the applicant’s TULIP account.
• Initial license fee: Once the applicant has passed the Texas exam, TULIP will send a notification for the applicant to pay the initial $250 licensure fee. It takes five to 10 business days for HHSC to receive an online payment.
• License issued: Once the initial licensure fee has been received, HHSC will issue a Texas NFA license, and the applicant will receive an auto reply from TULIP.
  • The newly licensed NFA will print their license from TULIP.

• Requirements: Credit may be obtained for the applicant’s military service, training or education.
• Written request: Applicant must submit a written request uploaded into the initial application along with documentation of the type and dates of services, training or education. The documentation must include an explanation of how the service, training or education is substantially similar to the required training or education.

HHSC waives application fees if an applicant submits the following to NFA Licensing Program:

• A written request for a waiver.
• Documentation of military status of the military service member:
  • A copy of a current military service order issued to the applicant by the armed forces of the U.S., Texas or another state.
  • Documentation of the type and dates of the service, training and education the applicant received, and an explanation of why the applicant’s military service, training or education substantially meets all requirements for licensure in Texas. This does not apply to a provisional license applicant.
• Documentation of status as a military veteran:
  • A copy of a military service discharge order issued to the applicant by the armed forces of the U.S., Texas or another state.
• Documentation of status as a military spouse:
  • A copy of a marriage certificate issued to the applicant by a U.S. state or foreign government.
  • A copy of a current military service order issued to the applicant’s spouse by the armed forces of the U.S., Texas or another state.
• If HHSC requests additional documentation, the applicant must submit the requested documentation.
• HHSC approves a request for a waiver of fees submitted in accordance with this subsection if HHSC determines that the applicant is a military service member, military veteran or a military spouse, and the applicant’s military service, training or education substantially meets all the requirements for licensure for a military service member. HHSC will mark application fees waived in TULIP. The TULIP application cannot be submitted until the fee waiver is approved and the fees are marked as waived.