This chapter governs nursing home administrator applicants and licensees in the State pursuant to Health Occupations Article, Title 9, Annotated Code of Maryland. Except as otherwise provided by law, to qualify for an initial license to practice nursing home administration in the State, the applicant shall: Be at least 21 years old; Be of good moral character; Submit to a State and national criminal history records check in accordance with Health Occupations Article, §9-302.1, Annotated Code of Maryland; Obtain a passing score on the State standards exam; Obtain a passing score on the national licensure exams provided by NAB; and Except for an endorsement applicant, successfully complete the AIT program as set forth in Regulation .04 of this chapter. The Board’s receipt of the State and national criminal history records check from the Central Repository, as provided in Health Occupations Article, §9-302.1(c), Annotated Code of Maryland, satisfies Health Occupations Article, §9-303(3), Annotated Code of Maryland. The applicant shall submit to the Board: The completed Board online application; The application fee as set forth under COMAR 10.33.05.02D; Satisfactory evidence that the applicant has a bachelor’s or master’s degree in: Healthcare, health administration, or healthcare management, or the equivalent, with a concentration in healthcare administration or health administration or a master’s degree in business with a concentration in healthcare administration or health administration from an accredited college or university; or A field other than as described in §C(3)(a) of this regulation and has completed within the last 5 years a minimum 100-hour course approved by the Board in healthcare administration or health administration; Two letters of character reference, which are signed and dated within 3 months prior to the date of application, from individuals engaged in either business or professional work on company or business letterhead: Who shall attest to the good moral character of the applicant; and Which may not be those from current employers or members of the applicant's family; and A passport type and size photograph of the applicant, which shall have been taken within 3 months prior to the date of application. Except for an endorsement applicant, an applicant may take the State standards exam and NAB exams when the applicant has completed: A minimum of 8 months of the full-time 12-month AIT program or its equivalent or 12 months of the 18-month part-time AIT program or its equivalent; and The other requirements for licensure as specified in this regulation. The 100-hour course for applicants with a bachelor’s or master’s degree in a field other than those described in §C(3)(a) of this regulation shall: Contain the subject matter relating to healthcare or health administration set forth under Regulation .03A of this chapter; and Be taken for credit for the purpose of initial licensure and be a course that has been approved by the Board. An applicant who provides satisfactory evidence to the Board that the applicant is a registered nurse and who meets the requirements of Health Occupations Article, §9-302(f)(1), Annotated Code of Maryland, is not required to have a bachelor’s or master’s degree. An application shall be void if an applicant fails to meet all the requirements for licensure within 2 years of receipt of the application by the Board. To pursue licensure after that time, the applicant shall: Submit a new application; and Meet the requirements for licensure that are in effect at the time of reapplication. Subjects for Examination. The State standards exam and the NAB exams shall include, at a minimum, the following subjects: Applicable standards of environmental health and safety; Local health and safety regulations; General administration; Psychology of patient care; Principles of medical care; Personal and social care; Therapeutic and supportive care and services in long-term care; Departmental organization and management; and Community interrelationships. Scoring Examinations. The passing score for licensure examinations for a license shall be determined by the Board. The Board shall determine a method of scoring each part of the exams separately and shall apply that method uniformly to all applicants taking the exams. Minimum Passing Scores. The following apply. The NAB national exams—scale score of 113 on the: NAB CORE exam; and NAB NHA exam; and The State standards exam—75 percent correct answers. General Provisions. An AIT program is a supervised 12-month full-time, or 18-month part-time, internship during which the AIT works under the guidance and supervision of a preceptor who is a licensed administrator that meets the qualifications set forth in Regulations .05 and .06 of this chapter. The AIT program is a required phase of education consisting of both the supervised practice of nursing home administration in the environment of the nursing home, performing and participating in the day-to-day duties of each position, when legally permissible, in each of the following service areas: Administration; Business office; Nursing; Resident activities; Social services; Medical records; Dietary services; Maintenance; Environmental services, including housekeeping and laundry; Rehabilitation services; and Quality assurance. Prior to Board approval of the AIT program, the AIT applicant and preceptor shall develop an outline for the written course of instruction and dates of rotation schedule for the provision of practical training, experience, and learning situations that includes: The 11 basic service areas set forth in §A(2) of this regulation; The AIT's past experience and allocation of clinical experiences in the nursing home; and Approval by the Board. An AIT may not, during the normal working hours of the program, fill a specific, specialized position in the nursing home. The AIT shall be exposed to all shifts during the AIT program. If the AIT is a department head, notice shall be conspicuously posted in the nursing home stating who the acting department head will be while the AIT is performing training duties. If an applicant does not meet all of the requirements for licensure after having completed 12 months in the full-time or 18 months in the part-time AIT program, the preceptor and applicant have the option to work out a plan satisfactory to the Board to continue studying in the AIT program beyond the 12 or 18 months until all the requirements are met. The Board or Board committee shall interview each applicant and proposed preceptor, or preceptors, before the approval of an AIT program. After the interview, the AIT and preceptor shall sign an AIT contract and submit it to the Board for consideration of approval. The Board may approve the AIT program if it is satisfied that the background and circumstances of the applicant and preceptor, or preceptors, qualify them for the AIT program. A change of preceptor may be authorized by the Board upon submission of: Application by the proposed new preceptor; Evidence satisfactory to the Board that the proposed preceptor is certified by the Board; and A new signed AIT contract by the AIT and preceptor. If a preceptor is found by the Board to have failed to provide adequate training, the Board may cancel the preceptor's authorization to serve as a preceptor for a period of time prescribed by the Board. The AIT and preceptor shall comply with the AIT contract. An individual duly registered as an AIT whose internship is interrupted by service in the armed forces of the United States shall be permitted to resume the internship without loss of credit at any time within 1 year after the date of the AIT's separation from active service. Application Requirements. The Board may approve an application for a nursing home AIT program only if it determines that the application contains satisfactory evidence that: The applicant is at least 21 years old; The applicant is of good moral character; The applicant's training will be supervised by a Board-certified preceptor; and The AIT program meets the other requirements set forth in this regulation. The training proposed to be provided to the applicant shall be satisfactory to the Board. The applicant shall participate in training provided in: A nursing home licensed in the State, as defined in COMAR 10.33.01.02B; and Not more than two licensed nursing homes in the State approved by the Board for training. If two nursing homes are utilized for training, one shall have at least 60 beds. If there are subject areas as specified in the list of subjects provided in §A(2) of this regulation that are not available in the nursing home approved by the Board for training, the Board may require training in other facilities. Credit for Prior Experience. The AIT program is a minimum of 12 months for full-time programs or 18 months for part-time programs unless, upon request from the applicant to review prior work experience, the Board awards credit for prior experience within the last 5 years. The amount of credit awarded is at the discretion of the Board, based on an applicant’s work experience demonstrating exposure to the core of knowledge set forth in Regulation .04A(2) of this chapter, but may not exceed; Six months for a hospital assistant administrator; Eight months for a hospital administrator; Six months for a nursing home assistant administrator; Six months for a department head; Three months for an Executive Director of a continuing care retirement community; Three months for an assisted living manager; Three months for a healthcare-related senior management official; or Three months for a non-healthcare-related senior management official. Qualifying Experience for Healthcare Related Professions in §C(1)(a)—(f) of this regulation. The minimum experience required for receiving credit towards the AIT program includes: A minimum of 18 months as a full-time employee, with line responsibility for hiring, firing, budget, and supervision of at least one department comprised of ten or more employees; and Reporting directly to the nursing home administrator or chief executive officer. Qualifying Experience for Healthcare Related or Non-Healthcare Related Senior Management Official in §C(1)(g) and (h) of this regulation. The following requirements set the minimum experience required for receiving credit: Minimum of 18 months as a full-time senior management official of a single nursing home or entity; and Administrative responsibility for the total operation of the nursing home or entity and its multiple departments, as applicable. Experience credit can be awarded on a month-to-month basis totaling 12 months for: An individual who has worked as a licensed nursing home administrator in another state; A resident or intern in a program offered by an accredited college or university for the purpose of satisfying the requirements for a baccalaureate or master's degree in healthcare administration; or An individual who has successfully completed an AIT program in another state, if the program is substantially comparable to the AIT program in the State, as determined by the Board. The preceptor for an AIT shall be currently certified by the Board under Regulation .06 of this chapter. The preceptor may not be responsible for more than two AITs at any one time. The preceptor shall devote a minimum of 16 hours per week of direct, on-site supervision for each AIT, which may be on an individual or combined basis in the case of two AITs. The preceptor may be the administrator of record of the facility in which the training is to take place, provided that the preceptor has had a minimum of 30 days of oversight in the facility where the training is to take place immediately prior to beginning the AIT program. The preceptor may not be the administrator of record for a facility other than the facility designated for training. A minimum of 80 percent of the training shall occur during 8 consecutive hours for full-time programs or 6 consecutive hours for part-time programs each day (except for regular days off) between the hours of 7 a.m. and 7 p.m. A minimum of 40 hours per week for full-time or 30 hours per week for part-time shall be devoted to continuous, bona fide training activities which include observing and performing the day-to-day duties of each position, when legally permissible, in the service areas referred to in Regulation .04A(2) of this chapter. The applicant may spend a maximum of 50 percent of the training in a family-owned or family-operated nursing home, and the remainder of the time shall be spent in another Board-approved facility. An employee may not be a preceptor for their employer. Required AIT Reports. The AIT and preceptor shall maintain a progress report for the training program on the forms provided by the Board for every 3 months of the training program. The report shall: Be submitted by the AIT and the preceptor to the Board's office on the dates specified by the Board; and Include the following: A detailed description of activity or area covered, or both, and dates of rotation, and, if applicable, an explanation for any changes to the Board-approved rotation schedule; A detailed analysis of any problems observed, new experiences, insights gained, and the AIT's role in problem solutions; and The course of instruction outline including signatures from the preceptor, AIT, and department managers to verify that the AIT trained in those departments. If the reports are not submitted to the Board's office by the date specified by the Board, the AIT shall be considered to have violated the terms of the AIT contract. Discontinuance of AIT Status in a Nursing Home. The AIT and the preceptor shall report discontinuance within 10 days to the Board. Within 10 days of the date of discontinuation, the preceptor shall file a report to the Board detailing the AIT's experience and abilities. The AIT may fulfill the training requirement in no more than two licensed nursing facilities, with a lapse of no more than 90 days between the two periods of training. The Board shall issue a certificate of qualification to be a preceptor in the AIT program if the following conditions are met: The preceptor holds and has held a license from the Board for 1 year or longer; The proposed preceptor has been satisfactorily employed in nursing home administration for a minimum of 3 years as the nursing home administrator of record; The proposed preceptor has no disciplinary action pending nor is currently under investigation by the Board; Individuals seeking certification as preceptors in the AIT program shall submit evidence of the successful completion of the preceptor training course offered by NAB; and The proposed preceptor has either been employed full time as a nursing home administrator of record for a minimum of 2 of the past 3 years immediately before application to precept or meets the following qualifications: Works on the same property as the nursing home where the AIT program will be conducted; Is able to demonstrate to the Board the proposed preceptor’s active, direct, and material management and daily operations of the nursing home; and Has been actively licensed as a nursing home administrator for a minimum of 5 years immediately before application to precept. If the proposed preceptor has not precepted an AIT program within the past 5 years, the proposed preceptor shall recertify as a preceptor by completing the preceptor training course offered by NAB. The Board may disapprove a preceptor for a training program: If the preceptor has failed to remain in compliance with this chapter; or At any time for good cause. The Board, in its discretion, may grant a license by endorsement to practice nursing home administration in the State, upon satisfactory evidence that the endorsement applicant, in addition to the requirements of this section, meets all the qualifications and requirements for a nursing home administrator license set forth in Regulation .02 of this chapter, except that the endorsement applicant is not required to: Take the NAB exams set forth under Regulation .03 of this chapter; or Participate in the AIT program that is set forth under Regulation .04 of this chapter. The endorsement applicant shall: Possess a valid license as a nursing home administrator, which has not been revoked or suspended in each state from which the applicant has ever received a nursing home administrator license or reciprocal endorsement; Provide satisfactory evidence of having completed one year as the full-time nursing home administrator of record in a nursing home within the last 5 years; and Be familiar with State and local health and safety regulations related to nursing homes by evidence of a passing score on the State standards exam. To be granted a State nursing home administrator license, the endorsement applicant shall possess a nursing home administrator license in other states that shall: Maintain a system and standard of qualification and examination for a license, which are substantially equivalent to those required by this State; and Give similar recognition and endorsement to nursing home administrator licenses of this State. The Board may waive: The education requirements of COMAR 10.33.02.02C(3), if the endorsement applicant provides satisfactory evidence to the Board that the endorsement applicant is licensed and has practiced as a nursing home administrator for at least 3 years in another state; and The State standards examination, if the endorsement applicant provides satisfactory evidence to the Board that the endorsement applicant met the requirements of Health Occupations Article, §9-306(b), Annotated Code of Maryland. As an exception to the licensure requirements in this chapter, a nursing home shall immediately appoint an individual not licensed to practice as a nursing home administrator to act as the interim nursing home administrator if: A licensed nursing home administrator in the State leaves or is removed from the position as a nursing home administrator by death or other unexpected cause; and A licensed nursing home administrator in the State is unavailable to fill the position. The departure of the licensed nursing home administrator specified under §A of this regulation is by unexpected cause if: The departure occurred suddenly; The departure was unforeseen; and There was insufficient time for the nursing home to obtain the services of a nursing home administrator licensed in the State. The appointed non-licensed individual may begin acting as the interim nursing home administrator upon appointment by the nursing home. No later than 24 hours after the appointment of the non-licensed individual as interim nursing home administrator, under §A of this regulation, the nursing home shall: File an application with the Board requesting a provisional license for the non-licensed individual; Notify the Board of the circumstances involved in the departure of the licensed nursing home administrator; Notify the Board of the credentials of the non-licensed individual; and If requested, provide the Board with the acts the nursing home took, or is taking, to hire a nursing home administrator who is licensed in the State. State and National Criminal History Records Check. The appointed non-licensed individual shall immediately submit to a criminal history records check, in accordance with Health Occupations Article, §9-302.1, Annotated Code of Maryland. A criminal history records check is not required if the appointed non-licensed individual is actively licensed by a health occupations board in the State who previously has completed a criminal history records check required for licensure, certification, or registration. The Board may deny approval of an appointment based on the results of a criminal history records check after consideration of the factors listed in Health Occupations Article, §9–308(b)(1), Annotated Code of Maryland. Provisional License. The Board may issue a provisional license to the applicant if the Board determines that: The applicant is of good moral character; The departure of the licensed nursing home administrator was by unexpected cause; and The applicant is capable of adequately administering the nursing home for the provisional period. If the Board grants the application for the provisional nursing home administrator license, the provisional license is in effect for 90 days from the date of the departure of the licensed nursing home administrator. For good cause shown, the Board may extend the provisional license period by 30 days. Denial of Provisional License. If the application for a provisional license is denied by the Board, the nursing home may request a meeting with the Board to contest the denial. The nursing home shall provide the request for a meeting to the Board within 5 business days of the denial. If the nursing home requests a meeting, the appointed non-licensed individual may remain acting as the interim nursing home administrator until the Board issues a decision. If the Board denies the application for a provisional license after a meeting contesting the initial denial, the non-licensed individual shall immediately cease acting as the interim nursing home administrator upon receipt of the decision. If the nursing home does not file a timely request for a meeting with the Board, the non-licensed individual shall cease acting as the interim nursing home administrator within 5 business days of the denial. If the non-licensed individual is required to cease acting as the interim nursing home administrator under §H of this regulation, and a nursing home administrator licensed in the State remains unavailable to fill the nursing home administrator position, the nursing home may appoint another non-licensed individual as set forth in this regulation. As a result of §I of this regulation, if the nursing home appoints another non-licensed individual, and a provisional license is granted, the provisional license is in effect for 90 days from the date of the departure of the nursing home administrator licensed in the State, unless the Board extends the provisional license, for good cause shown, for an additional 30 days. Upon request by the nursing home, for reasonable cause, the Board may extend the 24-hour time period for meeting the requirements of §D of this regulation. The Board shall send each licensee a renewal notice that states the: Date on which the current license or current registration expires; Latest date by which the renewal application and documentation can be received by the Board in order for the renewal license to be issued before the current license expires; and Amount of the renewal fee as specified in COMAR 10.33.05.02D. At least 30 days before the current license expires, the Board shall send the renewal notice by electronic means to the last known electronic mail address or first-class mail to the physical address of the licensee. Licensees shall satisfactorily complete the minimum continuing education requirements set forth under COMAR 10.33.04. Licensees shall complete an implicit bias and structural racism training program approved by the Cultural and Linguistic Health Care Professional Competency Program in accordance with Health-General Article, §20-1306, Annotated Code of Maryland, for an applicant’s first renewal after April 1, 2026. The Board shall reinstate an individual whose license has expired if the individual: Meets the renewal requirements of this chapter and Health Occupations Article, §9-312, Annotated Code of Maryland; Pays the reinstatement fee as specified under COMAR 10.33.05.02D; and Satisfactorily completes the minimum continuing education requirements set forth under COMAR 10.33.04.01. A previously licensed nursing home administrator who fails to apply for licensure reinstatement within 5 years after the expiration date of the license shall meet the requirements for a new license in effect at the time of the request in order to be licensed to practice as a nursing home administrator in the State. In accordance with Health Occupations Article, §9-312.1, Annotated Code of Maryland, a request by an active licensee to transfer a license to inactive status shall be granted upon receipt of the: Completed Board-approved inactive status application; and Payment of the required, non-refundable, biennial inactive status fee set forth in COMAR 10.33.05.02D. An individual: May apply for inactive status only if the individual’s license is still active at the time the inactive status application request is made; Shall renew and pay the biennial inactive status fee during each renewal period; and Is not authorized to and may not practice as a nursing home administrator in the State while on inactive status. Reactivation. The Board shall reactivate the license of a licensee who is on inactive status if the licensee: Completes an application form for reactivation of the license before expiration of the 2-year term of inactive status on the form required by the Board; Complies with the renewal requirements in effect at the time the licensee seeks to reactivate the license; Meets the continuing education requirements set by the Board; Has not practiced as a nursing home administrator in the State while on inactive status; Pays all appropriate fees set by the Board under COMAR 10.33.05.02D; Has been on inactive status for less than 5 years; and Is otherwise entitled to be licensed. Before the Board may reactivate the license of an individual who has been on inactive status for 5 years or more, the individual shall: Submit a new online application; Pay all appropriate fees set by the Board under COMAR 10.33.05.02D; Complete a 100-hour Board–approved course in healthcare administration or health administration; Pass the State standards exam for nursing home administrators; and Submit satisfactory evidence of having completed a State and national criminal history records check in accordance with Health Occupations Article, §9–302.1, Annotated Code of Maryland. A nursing home administrator whose inactive status expires before the license is reactivated shall meet the reinstatement requirements set forth in Health Occupations Article, §9-312, Annotated Code of Maryland. The Board is not required to consider an application that is incomplete. The applicant shall submit to the Board any additional relevant documentation requested by the Board if the Board determines the application documentation received is incomplete or insufficient. The Board may hold an incomplete application for a license for up to 1 year from the date of receipt. After 1 year from the date of receipt, the Board shall close a pending application that is incomplete. If an application has been closed under §D of this regulation, to obtain a license the applicant shall submit a new application fee and otherwise comply with all applicable license requirements. Each individual licensed as a nursing home administrator in the State shall display printed verification of licensure in a conspicuous place in the office or place of business or employment of the licensee. A licensed nursing home administrator shall give the Board written or electronic notice within 30 days of a change of: Mailing address; Legal name; or Email address. Failure to notify the Board of any change of mailing address, legal name, or email address within 30 days of the change may result in a fine as set forth under COMAR 10.33.05.02D. Health Occupations Article, §§9-205, 9-301—9-316.1, and 9-401—9-501, Annotated Code of Maryland Effective date: January 19, 2026 (53:1 Md. R 22)