Q: What is a nursing facility administrator (NFA)?
A: 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.
Q: What are the academic requirements for NFA examination and licensure?
A: 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 15 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 DADS-approved preceptor in a licensed nursing facility with a minimum of 60 beds.
Q: What are the criminal history requirements to become a licensed NFA?
A: The following criminal history rules apply at Texas Administrative Code, Title 40, Part 1, Chapter 18 and at Texas Health and Safety Code, Chapter 250:
§18.41 Licensure of Persons with Criminal Backgrounds
(a) DADS considers an applicant's or a licensee's conviction of a crime related to the duties, responsibilities and job performance of an administrator as a potential basis for:
(1) denying an initial or renewal application for licensure; and
(2) imposing a sanction listed in §18.57 of this chapter (relating to Schedule of Sanctions).
(b) DADS considers the following when determining if a criminal conviction directly relates to the duties and responsibilities of a nursing facility administrator:
(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 nursing facility administrator.
(c) DADS has determined that the following crimes relate to nursing facility administration and reflect an inability or tendency of an individual to inadequately perform as an administrator:
(1) intentionally acting as a nursing facility administrator without a license; and
(2) attempting or conspiring to commit 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; and
(D) Title 10 (offenses against public health, safety, and morals), including weapons, gambling, conduct affecting public health, intoxication, and alcoholic beverage offenses.
(d) DADS may consider other crimes and pertinent information as a potential basis for denying an initial or renewal application.
(e) Convictions under federal law or another state or nation for offenses containing elements similar to offenses listed in subsection (c) of this section may be a basis for DADS imposing sanctions.
Sec.§250.006. CONVICTIONS BARRING EMPLOYMENT.
(a) A person for whom the facility is entitled to obtain criminal history record information may not be employed in a facility if the person has been convicted of an offense listed in this subsection:
(1) an offense under Chapter 19, Penal Code (criminal homicide);
(2) an offense under Chapter 20, Penal Code (kidnapping and unlawful restraint);
(3) an offense under Section 21.02, Penal Code (continuous sexual abuse of young child or children), or Section 21.11, Penal Code (indecency with a child);
(4) an offense under Section 22.011, Penal Code (sexual assault);
(5) an offense under Section 22.02, Penal Code (aggravated assault);
(6) an offense under Section 22.04, Penal Code (injury to a child, elderly individual, or disabled individual);
(7) an offense under Section 22.041, Penal Code (abandoning or endangering child);
(8) an offense under Section 22.08, Penal Code (aiding suicide);
(9) an offense under Section 25.031, Penal Code (agreement to abduct from custody);
(10) an offense under Section 25.08, Penal Code (sale or purchase of a child);
(11) an offense under Section 28.02, Penal Code (arson);
(12) an offense under Section 29.02, Penal Code (robbery);
(13) an offense under Section 29.03, Penal Code (aggravated robbery);
(14) an offense under Section 21.08, Penal Code (indecent exposure);
(15) an offense under Section 21.12, Penal Code (improper relationship between educator and student);
(16) an offense under Section 21.15, Penal Code (improper photography or visual recording);
(17) an offense under Section 22.05, Penal Code (deadly conduct);
(18) an offense under Section 22.021, Penal Code (aggravated sexual assault);
(19) an offense under Section 22.07, Penal Code (terroristic threat);
(20) an offense under Section 33.021, Penal Code (online solicitation of a minor);
(21) an offense under Section 34.02, Penal Code (money laundering);
(22) an offense under Section 35A.02, Penal Code (Medicaid fraud);
(23) an offense under Section 42.09, Penal Code (cruelty to animals); or
(24) a conviction under the laws of another state, federal law, or the Uniform Code of Military Justice for an offense containing elements that are substantially similar to the elements of an offense listed by this subsection.
(b) A person may not be employed in a position the duties of which involve direct contact with a consumer in a facility before the fifth anniversary of the date the person is convicted of:
(1) an offense under Section 22.01, Penal Code (assault), that is punishable as a Class A misdemeanor or as a felony;
(2) an offense under Section 30.02, Penal Code (burglary);
(3) an offense under Chapter 31, Penal Code (theft), that is punishable as a felony;
(4) an offense under Section 32.45, Penal Code (misapplication of fiduciary property or property of a financial institution), that is punishable as a Class A misdemeanor or a felony;
(5) an offense under Section 32.46, Penal Code (securing execution of a document by deception), that is punishable as a Class A misdemeanor or a felony;
(6) an offense under Section 37.12, Penal Code (false identification as peace officer); or
(7) an offense under Section 42.01(a)(7), (8), or (9), Penal Code (disorderly conduct).§
(c) In addition to the prohibitions on employment prescribed by Subsections (a) and (b), a person for whom a facility licensed under Chapter 242 or 247 is entitled to obtain criminal history record information may not be employed in a facility licensed under Chapter 242 or 247 if the person has been convicted:
(1) of an offense under Section 30.02, Penal Code (burglary); or
(2) under the laws of another state, federal law, or the Uniform Code of Military Justice for an offense containing elements that are substantially similar to the elements of an offense under Section 30.02, Penal Code.
(d) For purposes of this section, a person who is placed on deferred adjudication community supervision for an offense listed in this section, successfully completes the period of deferred adjudication community supervision, and receives a dismissal and discharge in accordance with Section 5(c), Article 42.12, Code of Criminal Procedure, is not considered convicted of the offense for which the person received deferred adjudication community supervision.
Individuals interested in becoming a licensed NFA in Texas may request DADS to issue a criminal history evaluation letter regarding their eligibility.§ To request an evaluation letter, you must complete and submit to DADS a Department of Public Safety Texas criminal conviction report and fingerprint card along with Form 5530-NFA, "Request for a Criminal History Evaluation Letter."
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.
Q: What are the NAB's domains?
A: The five 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
Q: What's the purpose of the NAB and state licensing examinations for nursing facility administrators?
A: 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.
Q: What does the NAB exam cover?
A: 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/aitmanual
Q: What does the State licensing exam cover?
A: 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
Q: How are the examinations administered?
A: The NAB and state licensing exams are computer-based tests that are administered through the Sylvan Prometric multistate network of testing centers.
Q: How are the examinations scheduled?
A: 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) Centralized Database and Online Management (CDOM) System https://wwwpsiexams.com. Internet registration is available 24 hours a day. In order to register by Internet, complete the steps below:
- Log onto PSI's website and create an account. Please enter your email address and your name. This information must match exactly with the information you previously submitted to AANPCP. Be sure to check the box next to "Check here to attempt to locate existing records for you in the system."
- Create your password, select your security question, and create your security answer.
- Once you are logged in, your record will be found and you will now be ready to schedule the exam. Enter your zip code and a list of the testing sites closest to you will appear. Once you select the desired testing site, available dates will appear.
Telephone Scheduling - To schedule an examination, please call (800) 733-9267. The times of operation for live operators are as follows:
|Time Zone||Monday – Friday||Saturday - Sunday|
|Eastern Time||8 a.m. – 8 p.m.||9 a.m. - 5:30 p.m.|
|Central Time||7 a.m. – 7 p.m||8 a.m. - 4:30 p.m.|
|Mountain Time||6 a.m. – 6 p.m.||7 a.m. - 3:30 p.m.|
|Pacific Time||5 a.m. – 5 p.m.||6 a.m. - 2:30 p.m.|
Q: How many times can I take the exams?
A: An applicant who fails the NAB examination or the state examination three times must repeat the 1,000-hour AIT internship before re-testing.
Q: What cost is associated with receiving a license?
A: The fee schedule is as follows:
- Application: $100
- NAB examination: $350, September 15, 2014: $375
- Initial licensure: $250
- State examination: $175, March 1, 2015: $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.
- Duplicate license: $25
- Provisional license: $100
Q: Once I receive my license, how often will I have to renew?
A: 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 approved continuing education and obtain a Personal Criminal History Record from the Department of Public Safety (DPS). DADS must receive the required documents before the expiration date or the NFA license will expire. To obtain your criminal history record, download the most current Texas DPS fingerprint form and instructions.
Q: Where can I find a list of approved continuing education courses?
A: 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: http://www.nabweb.org/continuing-education
Q: I was licensed in another state. Can I transfer my license?
A: DADS shall grant a provisional license to individuals who provide evidence of the following:
- current licensure or registration as a nursing facility administrator by another state or other jurisdiction that is in good standing; and
- a bachelor's degree in any subject from an accredited college approved by an accrediting association recognized by the Texas Higher Education Coordinating Board or evidence satisfactory to DADS of having completed sufficient education, training, and experience in nursing facility administration; and
- a passing score on the National Association of Boards of Examiners of Long Term Care Administrators, Inc. (NAB) examination; and
- employment as the licensed nursing facility administrator of record of a licensed nursing facility for a period of at least two years; and
- employment as the licensed nursing facility administrator of record of a licensed nursing facility for a period of at least two years; and
- sponsorship by an individual licensed as a nursing facility administrator in this state.
Q: How long is the provisional license in effect?
A: 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 DADS.
Q: How do I submit an application to become a nursing facility administrator?
A: In order to apply, you must create an account and apply through TULIP.
Q: How can I become a preceptor?
A: 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.
Q: What is nursing facility administrator (NFA) enforcement?
A: Enforcement is the action taken by the agency (DADS) against a licensed NFA upon a finding of a violation of Texas Health and Safety Code, Chapter 242, Subchapter I, Nursing Facility Administration, or 40 Texas Administrative Code (TAC) Chapter 18, Nursing Facility Administrators.
Q: What action may the agency take against the license of an NFA found in violation?
A: The agency may take one or more of the following:
- Revocation of license;
- License suspension;
- Denial of application for license renewal;
- Assessment of an administrative penalty;
- Written letter of reprimand;
- Require a licensee to participate in continuing education;
- Probation; or
- Referral to the Office of the Attorney General for civil penalties.
Q: How does DADS determine that a violation occurred?
A: Upon receipt of a complaint or referral, an investigator of the Professional Credentialing Enforcement Unit conducts an on-site investigation. This investigation is independent of, and in addition to, any other investigations or surveys conducted by DADS regional staff of the nursing facility for licensure or Medicare/Medicaid certification purposes. Evidence, including statements from the NFA and other witnesses and survey documentation, is gathered and evaluated and a report written.
Q: What is the Nursing Facility Administrators Advisory Committee's (NFAAC) role in NFA enforcement?
A: The NFAAC reviews all reports of investigation made by DADS as a result of complaints or referrals and makes recommendations regarding appropriate sanctions.
Q: What "due process" is provided an NFA whom DADS has proposed to sanction based on investigation findings and NFAAC recommendation?
A: Before imposing a proposed sanction, DADS provides the licensee an opportunity to demonstrate compliance with all requirements by requesting an informal review (IR) within 10 days of receipt of the notice letter. Additionally, the licensee may request a formal hearing before an administrative law judge of the State Office of Administrative Hearings (SOAH) within 20 days of receipt of the formal notice letter. If an administrative penalty is proposed, DADS will automatically schedule a hearing with SOAH unless the NFA accepts the penalty.
Q: How is continuing education (CEU) imposed by DADS as an enforcement action/sanction different from that required as part of the license renewal process?
A: They are altogether different; CEU used for one requirement may not be used for the other. CEU taken to satisfy a sanction must:
- Receive prior approval by the Professional Credentialing Enforcement Unit;
- Be of an amount and subject specified in the imposition notice;
- Be completed within one year of notice of imposition; and
- Not be self- or home study.
Q: What happens if a sanction imposed by DADS is not satisfied?
A: DADS will not renew the license of an NFA with a delinquent unsatisfied sanction; operating without a license is a violation of statute. DADS may refer unsatisfied sanctions to the Office of the Attorney General for civil penalties.
Q: How is prior approval of CEU obtained?
A: Contact the Professional Credentialing Enforcement Unit at 512-438-5495.
Q: Who can I contact with questions?
A: Contact the Professional Credentialing Enforcement Unit 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.), and
- Prior approval of CEU.
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.