FEDERAL NURSING HOME
ADMINISTRATOR EXAM
NAB Core of Knowledge & CMS Compliance
2026/2027 Edition
Long-Term Care Administration
Complete Study Guide with Verified Questions
EXAM SPECIFICATIONS
Time Allocation: 3 Hours
Total Questions: 150 Questions
Question Format: Multiple Choice with Rationales
Minimum Competency: 75% Required to Pass
Core Focus: NAB Domains, OBRA 87, CMS Conditions of Participation
NHA Federal Exam Prep 2026/2027 Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
This Federal Nursing Home Administrator Exam Prep covers the NAB Core of Knowledge for
long-term care administration. Content aligns with federal regulations including OBRA 1987, CMS
Conditions of Participation, and NAB examination domains required for NHA licensure.
CONTENT DISTRIBUTION - NAB CORE DOMAINS
• Customer Care, Supports & Services (20%) — Resident rights, quality of life, care planning,
MDS, activities, social services
• Human Resources (20%) — Staffing, recruitment, training, labor law, employee relations,
competency
• Finance (15%) — Budgeting, Medicare/Medicaid reimbursement, cost reporting, financial
management, billing
• Environment (15%) — Life Safety Code, emergency preparedness, infection control, physical
plant, maintenance
• Management & Leadership (15%) — Organizational management, leadership, governance,
strategic planning, QAPI
• Regulations (15%) — OBRA 87, CMS CoPs, survey process, F-tags, state operations manual,
compliance
QUESTION FORMAT & SCORING
Each item presents four options. Correct answers are highlighted in green with checkmark (✓).
Every question includes detailed rationale with federal regulation citations. Achieve 75% competency
to pass.
STUDY STRATEGY
Master OBRA 1987 requirements and CMS F-tags. Know resident rights, staffing ratios, and survey
protocols. Use rationales to understand regulatory intent and survey implications.
CURRICULUM ALIGNMENT
Questions reflect 2026/2027 standards: NAB Core of Knowledge, CMS State Operations Manual
Appendix PP, OBRA 87, Life Safety Code NFPA 101, and federal long-term care regulations.
NHA Federal Exam Prep 2026/2027 Page 2
, SECTION I: Customer Care, Supports & Services
1. OBRA 1987 requires that a comprehensive assessment (MDS) be completed within:
A. 7 days of admission
✓ B. 14 days of admission
C. 30 days of admission
D. 90 days of admission
Rationale: OBRA requires completion of comprehensive MDS within 14 days of admission per 42 CFR
483.20. Initial assessment within 48 hours. Quarterly assessments every 92 days.
2. The Nursing Home Reform Act is part of:
A. Medicare Modernization Act
✓ B. Omnibus Budget Reconciliation Act of 1987
C. Affordable Care Act
D. HIPAA
Rationale: OBRA 87 established Nursing Home Reform Act creating resident rights, quality standards, and
certification requirements. Not part of MMA, ACA, or HIPAA.
3. A resident has the right to refuse treatment under:
A. Facility policy only
✓ B. OBRA 87 and federal regulations
C. State law only
D. Physician order only
Rationale: 42 CFR 483.10(c) grants residents right to refuse treatment and participate in care planning. This
is federal law, not just facility policy or state-dependent.
4. The minimum nurse staffing hours per resident day for Medicare/Medicaid facilities is:
A. 2.5 hours
✓ B. 3.0 hours (including 0.55 RN)
C. 4.0 hours
D. No federal minimum
Rationale: CMS requires 3.0 HPRD total with 0.55 RN HPRD per 42 CFR 483.35. Some states require
more. No staffing = no certification.
5. A Quality Assessment and Assurance (QAA) committee must meet:
A. Monthly
✓ B. At least quarterly
C. Annually
D. Only when deficiencies occur
Rationale: 42 CFR 483.75 requires QAA committee to meet at least quarterly to identify quality issues. QAPI
is broader continuous program. Monthly not required by regulation.
NHA Federal Exam Prep 2026/2027 Page 3
, 6. An F-tag F880 relates to:
A. Resident rights
✓ B. Infection prevention and control
C. Pharmacy services
D. Dietary services
Rationale: F880 is Infection Control per State Operations Manual Appendix PP. F550 = resident rights, F755
= pharmacy, F800 = food services.
7. The minimum frequency for fire drills in nursing homes is:
A. Monthly
✓ B. Quarterly on each shift
C. Annually
D. Semi-annually
Rationale: Life Safety Code NFPA 101 requires fire drills quarterly on each shift. Monthly exceeds
requirement. Annual/semi-annual insufficient.
8. Medicare Part A covers skilled nursing facility care for up to:
A. 30 days
✓ B. 100 days per benefit period
C. 365 days
D. Unlimited
Rationale: Medicare Part A covers 100 days SNF per benefit period with qualifying hospital stay. Days 1-20:
$0, Days 21-100: daily copay. 365 is hospital lifetime reserve.
9. Abuse, neglect, or misappropriation must be reported to the state agency within:
A. 24 hours
✓ B. 2 hours if serious bodily injury, 24 hours otherwise
C. 7 days
D. 30 days
Rationale: 42 CFR 483.12 requires reporting within 2 hours for allegations involving serious bodily injury, 24
hours for all others. 7/30 days violates regulation.
10. A resident trust fund must have:
A. No interest earned
✓ B. Surety bond or equivalent protection
C. Commingled with facility funds
D. Monthly statements only
Rationale: 42 CFR 483.10(f) requires surety bond or deposit to protect resident funds. Must be separate
from facility funds. Quarterly statements required, not just monthly.
11. The Life Safety Code for nursing homes is:
NHA Federal Exam Prep 2026/2027 Page 4
ADMINISTRATOR EXAM
NAB Core of Knowledge & CMS Compliance
2026/2027 Edition
Long-Term Care Administration
Complete Study Guide with Verified Questions
EXAM SPECIFICATIONS
Time Allocation: 3 Hours
Total Questions: 150 Questions
Question Format: Multiple Choice with Rationales
Minimum Competency: 75% Required to Pass
Core Focus: NAB Domains, OBRA 87, CMS Conditions of Participation
NHA Federal Exam Prep 2026/2027 Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
This Federal Nursing Home Administrator Exam Prep covers the NAB Core of Knowledge for
long-term care administration. Content aligns with federal regulations including OBRA 1987, CMS
Conditions of Participation, and NAB examination domains required for NHA licensure.
CONTENT DISTRIBUTION - NAB CORE DOMAINS
• Customer Care, Supports & Services (20%) — Resident rights, quality of life, care planning,
MDS, activities, social services
• Human Resources (20%) — Staffing, recruitment, training, labor law, employee relations,
competency
• Finance (15%) — Budgeting, Medicare/Medicaid reimbursement, cost reporting, financial
management, billing
• Environment (15%) — Life Safety Code, emergency preparedness, infection control, physical
plant, maintenance
• Management & Leadership (15%) — Organizational management, leadership, governance,
strategic planning, QAPI
• Regulations (15%) — OBRA 87, CMS CoPs, survey process, F-tags, state operations manual,
compliance
QUESTION FORMAT & SCORING
Each item presents four options. Correct answers are highlighted in green with checkmark (✓).
Every question includes detailed rationale with federal regulation citations. Achieve 75% competency
to pass.
STUDY STRATEGY
Master OBRA 1987 requirements and CMS F-tags. Know resident rights, staffing ratios, and survey
protocols. Use rationales to understand regulatory intent and survey implications.
CURRICULUM ALIGNMENT
Questions reflect 2026/2027 standards: NAB Core of Knowledge, CMS State Operations Manual
Appendix PP, OBRA 87, Life Safety Code NFPA 101, and federal long-term care regulations.
NHA Federal Exam Prep 2026/2027 Page 2
, SECTION I: Customer Care, Supports & Services
1. OBRA 1987 requires that a comprehensive assessment (MDS) be completed within:
A. 7 days of admission
✓ B. 14 days of admission
C. 30 days of admission
D. 90 days of admission
Rationale: OBRA requires completion of comprehensive MDS within 14 days of admission per 42 CFR
483.20. Initial assessment within 48 hours. Quarterly assessments every 92 days.
2. The Nursing Home Reform Act is part of:
A. Medicare Modernization Act
✓ B. Omnibus Budget Reconciliation Act of 1987
C. Affordable Care Act
D. HIPAA
Rationale: OBRA 87 established Nursing Home Reform Act creating resident rights, quality standards, and
certification requirements. Not part of MMA, ACA, or HIPAA.
3. A resident has the right to refuse treatment under:
A. Facility policy only
✓ B. OBRA 87 and federal regulations
C. State law only
D. Physician order only
Rationale: 42 CFR 483.10(c) grants residents right to refuse treatment and participate in care planning. This
is federal law, not just facility policy or state-dependent.
4. The minimum nurse staffing hours per resident day for Medicare/Medicaid facilities is:
A. 2.5 hours
✓ B. 3.0 hours (including 0.55 RN)
C. 4.0 hours
D. No federal minimum
Rationale: CMS requires 3.0 HPRD total with 0.55 RN HPRD per 42 CFR 483.35. Some states require
more. No staffing = no certification.
5. A Quality Assessment and Assurance (QAA) committee must meet:
A. Monthly
✓ B. At least quarterly
C. Annually
D. Only when deficiencies occur
Rationale: 42 CFR 483.75 requires QAA committee to meet at least quarterly to identify quality issues. QAPI
is broader continuous program. Monthly not required by regulation.
NHA Federal Exam Prep 2026/2027 Page 3
, 6. An F-tag F880 relates to:
A. Resident rights
✓ B. Infection prevention and control
C. Pharmacy services
D. Dietary services
Rationale: F880 is Infection Control per State Operations Manual Appendix PP. F550 = resident rights, F755
= pharmacy, F800 = food services.
7. The minimum frequency for fire drills in nursing homes is:
A. Monthly
✓ B. Quarterly on each shift
C. Annually
D. Semi-annually
Rationale: Life Safety Code NFPA 101 requires fire drills quarterly on each shift. Monthly exceeds
requirement. Annual/semi-annual insufficient.
8. Medicare Part A covers skilled nursing facility care for up to:
A. 30 days
✓ B. 100 days per benefit period
C. 365 days
D. Unlimited
Rationale: Medicare Part A covers 100 days SNF per benefit period with qualifying hospital stay. Days 1-20:
$0, Days 21-100: daily copay. 365 is hospital lifetime reserve.
9. Abuse, neglect, or misappropriation must be reported to the state agency within:
A. 24 hours
✓ B. 2 hours if serious bodily injury, 24 hours otherwise
C. 7 days
D. 30 days
Rationale: 42 CFR 483.12 requires reporting within 2 hours for allegations involving serious bodily injury, 24
hours for all others. 7/30 days violates regulation.
10. A resident trust fund must have:
A. No interest earned
✓ B. Surety bond or equivalent protection
C. Commingled with facility funds
D. Monthly statements only
Rationale: 42 CFR 483.10(f) requires surety bond or deposit to protect resident funds. Must be separate
from facility funds. Quarterly statements required, not just monthly.
11. The Life Safety Code for nursing homes is:
NHA Federal Exam Prep 2026/2027 Page 4
