What is a nursing facility administrator (NFA)?
A person who engages in the practice of nursing facility administration in an institution or facility that's licensed as a nursing facility by the Texas Department of Aging and Disability Services (DADS) under the Texas Health and Safety Code, Chapter 242, without regard to whether the person has an ownership interest in the facility or whether the functions and duties are shared with any other person.
What are the academic requirements for NFA examination and licensure?
To be licensed as an administrator, you must:
- Have at least a bachelor's degree in any subject from an accredited college that's approved by an accrediting association recognized by the Texas Higher Education Coordinating Board.
- Complete a minimum of 12 academic credit hours in long-term care administration or its equivalent that encompasses all National Association of Boards of Examiners of Long Term Care Administration Inc. (NAB) domains.
- Complete a minimum of 1,000 hours in an administrator-in-training (AIT) internship with a HHSC-approved preceptor in a licensed nursing facility. The internship must be in a nursing facility that has a minimum of 60 beds, unless HHSC grants an exception to the minimum bed requirement. HHSC may consider an exception to the 60-bed requirement on a case-by-case basis. To be considered, the facility with fewer than 60 beds must be located in a rural area and more than 50 miles away from a 60-bed facility. An applicant must submit to HHSC a written request to complete an internship in a facility with fewer than 60 beds. HHSC will notify the applicant of the status of the applicant's request.
What are the criminal history requirements to become a licensed NFA?
The following criminal history rules apply at Texas Administrative Code, Title 26, Part 1, Chapter 555 and at Texas Health and Safety Code, Chapter 250:
Rule §555.41 Licensure of Persons with Criminal Backgrounds
(a) Subject to subsection (f) of this section, the Texas Health and Human Services Commission (HHSC) may disqualify an applicant or licensee from taking an examination required by §555.18 of this chapter (relating to Examinations and Requirements to Take the Examinations), may deny an initial or renewal application for licensure, or impose a sanction listed in §555.57 of this chapter (relating to Schedule of Sanctions) if the applicant or licensee has been convicted of:
(1) an offense that directly relates to the duties and responsibilities of a nursing facility administrator (NFA);
(2) an offense listed in Article 42A.054, Code of Criminal Procedure; or
(3) a sexually violent offense, as defined by Article 62.001, Code of Criminal Procedure.
(b) HHSC considers the following when determining if a criminal conviction directly relates to the duties, responsibilities, and job performance of an NFA:
(1) the nature and seriousness of the crime;
(2) the extent to which a license may offer an individual an opportunity to engage in the same type of criminal activity; and
(3) the relationship of the crime to the ability or fitness required to perform the duties of an NFA.
(c) HHSC has determined that a conviction of the following crimes relates to nursing facility administration and reflects an inability to perform or tendency to inadequately perform as an NFA. Accordingly, HHSC proposes to deny an application for licensure from an applicant who has been convicted of any of the following crimes:
(1) intentionally acting as an NFA without a license;
(2) attempting or conspiring to commit or committing any offense under the following chapters of the Texas Penal Code:
(A) Title 5 (offenses against persons), including homicide, kidnapping, unlawful restraint, and sexual and assault offenses;
(B) Title 7 (offenses against property), including arson, criminal mischief, robbery, burglary, criminal trespass, theft, fraud, computer crimes, telecommunications crimes, money laundering, and insurance fraud;
(C) Title 9 (offenses against public order and decency), including disorderly conduct and public indecency; or
(D) Title 10 (offenses against public health, safety, and morals), including weapons, gambling, conduct affecting public health, intoxication, and alcoholic beverage offenses;
(3) committing an offense listed in Texas Health and Safety Code (THSC) §250.006(a) or (c); or
(4) committing an offense listed in THSC §250.006(b) within the last five years.
(d) If HHSC determines an applicant or licensee has a criminal conviction that directly relates to the duties and responsibilities of an NFA, HHSC considers the following in determining whether to take an action authorized by subsection (a) of this section:
(1) the extent and nature of the person's past criminal activity;
(2) the age of the person when the crime was committed;
(3) the amount of time that has elapsed since the person's last criminal activity;
(4) the conduct and work activity of the person before and after the criminal activity;
(5) evidence of the person's rehabilitation or rehabilitative effort while incarcerated or after release;
(6) evidence of the person's compliance with any conditions of community supervision, parole or mandatory supervision; and
(7) other evidence of the person's fitness, including letters of recommendation.
(e) HHSC may consider other crimes and pertinent information as a potential basis for denying an initial or renewal application.
(f) Convictions under federal law or the laws of another state or nation for offenses containing elements similar to offenses listed in subsection (c) of this section may be a basis for HHSC denying an initial application or imposing sanctions.
(g) A notice required under subsection (a) of this section must contain, as applicable:
(1) a statement that the applicant or licensee is disqualified from receiving the license or being examined for the license because of the applicant's or licensee's prior conviction of an offense specified in the notice, as provided in subsection (a)(2) and (a)(3) of this section; or
(2) a statement that:
(A) the final decision of the licensing authority to deny the applicant or licensee a license, or the opportunity to be examined for the license, will be based on the factors listed in subsection (d) of this section, as provided in subsection (a)(1) of this section; and
(B) the applicant or licensee has the responsibility to obtain and provide to HHSC evidence regarding the factors listed in subsection (d) of this section.
(h) If HHSC suspends or revokes a license, or denies an applicant or licensee a license or the opportunity to be examined for a license because of the applicant's or licensee's prior conviction of an offense, HHSC shall notify the person in writing of:
(1) the reason for the suspension, revocation, denial, or disqualification including any factor considered under subsection (b) and (d) of this section that served as the basis for suspension, revocation, denial, or disqualification;
(2) the procedure for judicial review; and
(3) the earliest date the applicant or licensee may appeal HHSC's action.
Individuals interested in becoming a licensed NFA in Texas may request HHSC to issue a criminal history evaluation letter regarding their eligibility. To request an evaluation letter, you must create an account in TULIP and request a Criminal History Evaluation Letter along with a FBI fingerprint check. In order to get the service code used for the NFA program, please contact NFA_Licensing_Program@hhs.texas.gov via email. Log into TULIP account to create applicant registration, login and password reset here.
Q: What's the function of the NAB?
A: The NAB is a national association that's composed of state boards or agencies. It's responsible for licensing long-term care administrators. The basic objective of the association is to assist these boards and agencies in carrying out their responsibilities in the licensure and relicensure of long-term care administrators. One of NAB's functions is to develop a national nursing home administrator exam.
What are the NAB's domains?
The four domains are:
- Care, Services & Support = Resident Care
- Operations = Finance, Risk Management, Human Resources
- Environment & Quality = Physical Environment, Care Setting & Regulatory Compliance of a facility
- Leadership & Strategy = Leadership and Management
What's the purpose of the NAB and state licensing examinations for nursing facility administrators?
To protect the public by ensuring that entry-level nursing home administrators have mastered a specific body of knowledge and can demonstrate the skills and abilities essential to competently practice within the profession. The state licensing examination encompasses the Nursing Facility Requirements for Licensure and Medicaid Certification.
What does the NAB exam cover?
The NAB exam covers content covered in the NAB AIT Manual. The NAB exams are competency-based assessments that are developed to protect the public by ensuring that entry-level administrators have mastered a specific body of knowledge necessary for competent practice within the profession. NAB develops and administers examinations across the continuum of long-term care. The AIT manual can be found, https://www.nabweb.org/seeking-licensure/ait-information/ait-program-manual
What does the State licensing exam cover?
The state exam covers the Nursing Facility Requirements for Licensure and Medicaid, Texas Administrative Code, TITLE 26 HEALTH AND HUMAN SERVICES, PART 1 HEALTH AND HUMAN SERVICES COMMISSION, CHAPTER 554 NURSING FACILITY REQUIREMENTS FOR LICENSURE AND MEDICAID CERTIFICATION https://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=26&pt=1&ch=554
How are the examinations administered?
The NAB and state licensing exams are computer-based tests that are administered through the Sylvan Prometric multistate network of testing centers.
How are the examinations scheduled?
In order to register for the examination(s), you must submit your application through the National Association of Boards of Examiners of Long Term Care Administrators (NAB) https://nab.learningbuilder.com/Learner/LearningPlan/List.
For assistance or to schedule an exam, please contact PSI Candidate Support: (833) 892-5442 or firstname.lastname@example.org.
How many times can I take the exams?
An applicant who fails the NAB examination or the state examination three times must repeat the 1,000-hour AIT internship before re-testing.
What cost is associated with receiving a license?
The fee schedule is as follows:
- Application: $100
- NAB examination: $425, which includes both NAB Core of Knowledge examination and Line of Service examination.
- NAB retest, NAB Core of Knowledge examination only: $300
- Line of Services examination in nursing home administration only: $175
- Initial licensure: $250
- State examination: $190
- Licensure renewal: $250 (biennially)
- Late renewal (90 days or less): An additional $125 for renewals made within 90 days of the license expiration date, totaling $375.
- Late renewal (91-365 days): An additional $250 for renewals made between 91 and 365 days of the license expiration date, totaling $500.
- Provisional license: $100
Once I receive my license, how often will I have to renew?
A licensed NFA is required to renew every two years. Each renewal period all license holders must complete a renewal application, complete 40 hours of NAB or HHSC approved continuing education and include a Texas Health and Human Services (HHSC) course in Infection Control and personal protective equipment found here:
Where can I find a list of approved continuing education courses?
Continuing education courses are approved by the National Association of Long Term Care Administrators Board (NAB). A list of the most current approved courses can be found at: https://www.nabweb.org/ce-database
I was licensed in another state. Can I transfer my license?
HHSC shall grant a provisional license to individuals who provide evidence of the following:
Rule §555.32 Provisional License
(a) The Texas Health and Human Services Commission (HHSC) issues a provisional license to an applicant currently licensed or registered as a nursing facility administrator (NFA) in another state who submits the following to HHSC:
(1) complete and notarized Provisional Licensure Questionnaire and Nursing Facility Administrator License Application forms;
(2) the application fee;
(3) the provisional license fee; and
(4) proof of the following:
(A) a license and good standing status in another state with licensing requirements substantially equivalent to the Texas licensure requirements;
(B) employment for at least one year as an administrator of record of a nursing facility in applicant's state;
(C) a passing score on the National Association of Long Term Care Administrator Boards examination and the state examination; and
(D) sponsorship by an NFA licensed by HHSC and who is in good standing, unless HHSC waives sponsorship based on a demonstrated hardship.
(b) A provisional license expires 180 days from the date of issue.
(c) HHSC issues an initial license certificate to a provisional license holder who satisfies the requirements for a license in §555.12 of this chapter (relating to Licensure Requirements) and §555.31 of this subchapter (relating to Initial license).
(d) HHSC may determine that a criminal conviction or sanction taken in another state is a basis for pending or denying a provisional license.
If an applicant has an NFA license issued by another state and is applying for a license under §555.12(a)(5) of this subchapter, the applicant must submit:
(1) a complete Reciprocity Licensure Questionnaire;
(2) the application fee;
(3) fingerprints for a Texas Department of Public Safety criminal background check; and
(4) proof of a license in good standing in another state.
Rule §555.12 Licensure Requirements
(a) An applicant must meet one of the following groups of requirements to obtain a license as a nursing facility administrator (NFA).
(1) An applicant has a baccalaureate degree in any subject from a college or university accredited by an agency recognized by the Texas Higher Education Coordinating Board; and
(A) a minimum of 15 semester credit hours in long-term care administration, or its equivalent, that includes courses in the five domains of the National Association of Long Term Care Administrator Boards (NAB);
(B) completed a 1,000-hour internship that meets the requirements in §555.13 of this subchapter (relating to Internship Requirements); and
(C) passed the state and NAB examinations described in §555.18 of this subchapter (relating to Examinations and Requirements to Take the Examinations).
(2) An applicant has a baccalaureate degree in health administration, health services administration, health care administration, or nursing that includes coursework encompassing the five domains of the NAB; and
(A) three years of management experience;
(B) completed a 500-hour internship that meets the requirements in §555.13 of this subchapter; and
(C) passed the state and NAB examinations described in §555.18 of this subchapter.
(3) An applicant has a master's degree in health administration, health services administration, health care administration, or nursing that includes coursework encompassing the five domains of the NAB; and
(A) one year of management experience;
(B) completed a 500-hour internship that meets the requirements in §555.13; and
(C) passed the state and NAB examinations described in §555.18 of this subchapter. (4) An applicant has a health services executive qualification; and
(4) An applicant has a health services executive qualification; and
(A) has not had a license revoked in any state; and
(B) passed the state examination described in §555.18 of this subchapter.
(5) An applicant has a license issued by a state other than Texas and meets the requirements for licensure in paragraphs (1), (2), or (3) of this subsection.
How long is the provisional license in effect?
A provisional license expires 180 days from the date of issuance. A provisional license holder who passes the state examination on the Nursing Facility Requirements for Licensure and Medicaid Certification will be fully licensed by HHSC.
How do I submit an application to become a nursing facility administrator?
In order to apply, you must create an account and apply through TULIP.
How can I become a preceptor?
To become a preceptor, an applicant must:
- have a license in good standing, and
- have at least 5 years experience as a nursing facility administrator, with the two most recent years in Texas, and
- attend a preceptor seminar.
Once a certificate has been issued, it is valid for two years from date of issuance.
What is nursing facility administrator (NFA) enforcement?
HHSC regulates and enforces NFAs and may make a referral and take an enforcement action against a licensed NFA for the following:
- Upon the determination of substandard quality of care (SQC) or immediate jeopardy (IJ) in a nursing facility (please note SQC/IJ tags result in the automatic referral of the NFA's license);
- A finding of a violation of Texas Health and Safety Code, Chapter 242, Subchapter I, Nursing Facility Administration, or 26 Texas Administrative Code (TAC) Chapter 555, Nursing Facility Administrators; and/or
- A public complaint filed against a NFA.
HHSC may also propose to deny an application for NFA licensure or renewal based on criminal history in accordance with the NFA licensure rules, Title 26 Texas Administrative Code (TAC) §555.41 (relating to Licensure of Persons with Criminal Backgrounds), and Texas Health and Safety Code 250.006 (relating to Convictions Barring Employment).
What action may the agency take against the license of a NFA found in violation?
The agency may take one or more of the following:
- Revocation of license;
- Suspension of license;
- Denial of application for license renewal;
- Assessment of an administrative penalty;
- Written letter of reprimand;
- Completion of continuing education units (CEUs);
- Probated Suspension of license under a certified preceptor; or
- Referral to the Office of the Attorney General for civil penalties.
How does HHSC determine that a violation occurred?
Upon receipt of a complaint or referral, a NFA investigator of the Quality Assurance Special Investigations Unit conducts an investigation to determine culpability of the NFA. This investigation is independent of, and in addition to, any other investigations or surveys conducted by HHSC regional staff of the nursing facility for licensure or Medicare/Medicaid certification purposes. Evidence, including interviews and statements from the NFA, other witnesses and survey documentation, is gathered and evaluated by the NFA Investigator and documented in a written investigation report. The alleged violation is either substantiated or unsubstantiated and further reviewed and approved by HHSC NFA Enforcement.
What is the Nursing Facility Administrators Advisory Committee's (NFAAC) role in NFA enforcement?
The NFAAC is a Governor-appointed committee that provides the department with recommendations for licensure sanctions and rule changes for the Nursing Facility Administrator Licensing Program pursuant to Texas Health and Safety Code, Chapter 242, Subchapter I. It is comprised of:
- One physician
- Three nursing facility administrators
- One registered nurse
- One social worker
- Three public members
NFA Enforcement coordinates with the NFAAC and facilitates quarterly meetings for the committee to review and discuss all reports of investigation made by HHSC as a result of complaints or referrals against a NFA, and make recommendations to HHSC regarding appropriate sanctions.
What "due process" is provided an NFA whom HHSC has proposed to sanction based on investigation findings, HHSC review and/or NFAAC recommendation?
Before imposing a proposed sanction, HHSC provides the licensee the following steps of due process:
- Opportunity to demonstrate compliance with all requirements by requesting an informal review (IR) within 10 days of receipt of the notice letter.
- Opportunity to request a formal hearing before an administrative law judge (ALJ) of the State Office of Administrative Hearings (SOAH) within 20 days of receipt of the formal notice letter.
- Opportunity to request a rehearing subsequent to the ALJ's issuance of a proposal for decision (PFD) as a result of the formal hearing.
- Opportunity to request judicial review in district court subsequent to a rehearing.
How is continuing education units (CEUs) imposed by HHSC as an enforcement action/sanction different from that required as part of the license renewal process?
They are altogether different; CEUs used for one requirement may not be used for the other. CEUs taken to satisfy a sanction must:
- Receive prior approval by Credentialing and Registry Enforcement (CARE);
- Be of an amount and subject specified in the sanction imposition notice; and
- Be completed within one year of notice of imposition.
How is prior approval of CEU sanction obtained?
Contact Credentialing and Registry Enforcement at 512-438-5495
What happens if a sanction imposed by HHSC is not satisfied?
HHSC will not renew the license of an NFA who is not in compliance or with a delinquent unsatisfied sanction. HHSC may revoke or suspend a NFA license whenever the imposed sanction is not completed and the NFA is out of compliance. Please note that operating without a license is a violation of statute. HHSC may refer NFAs with incomplete or unsatisfied sanctions to the Office of the Attorney General for civil penalties.
What action may the agency take for proposed denial of NFA initial application or renewal of NFA license?
The agency may take one or more of the following actions:
- Deny initial application or renewal of NFA license;
- Revoke NFA license; or
- Proceed with NFA license application or renewal process.
What "due process" is provided a NFA whom HHSC has proposed to deny initial license or renewal of NFA license based on criminal history?
Before denying a NFA initial application or renewal of NFA license, HHSC provides the licensee the following steps of due process:
- Opportunity to Show Employability (OSE) by submitting a letter with additional information and/or documentation regarding the eligible conviction(s) to CARE within 10 days of receipt of the notice letter;
- Further Administrative Review (FAR) for applicable referrals based on information and documentation provided in OSE;
- Opportunity to request a formal hearing before an administrative law judge (ALJ) of the State Office of Administrative Hearings (SOAH) within 30 days of receipt of the formal notice letter;
- Opportunity to request a rehearing subsequent to the ALJ's issuance of a proposal for decision (PFD) as a result of the formal hearing; and
- Opportunity to request judicial review in district court subsequent to a rehearing.
Who can I contact with questions?
Contact Credentialing and Regulatory Enforcement at 512-438-5495 for questions about:
- NFA complaints or referrals (procedures, status, etc.),
- Presentation of cases to NFAAC,
- Proposed/imposed sanctions (due process procedures, status, etc.),
- Prior approval of CEU, and
- NFA proposals to deny NFA initial application or renewal of license based on criminal history (CH) (procedures, status, etc.).
Contact the NFA Licensing Branch at 512-438-2015 for questions about:
- NFA licensure (requirements, status, etc.),
- Renewals (requirements, status, etc.),
- Qualifications/education/reciprocity, or
- Other NFA issues unrelated to complaints, referrals, investigations, or sanctions.