FEDERAL NURSING HOME
ADMINISTRATOR EXAM
NAB Core of Knowledge & CMS Regulations
2026/2027 Edition
Long-Term Care Management
160 Verified Questions with Detailed Rationales
EXAM SPECIFICATIONS
Time Allocation: 3 Hours
Total Questions: 160 Questions
Question Format: Multiple Choice with Rationales
Minimum Competency: 75% Required to Pass
Core Focus: NAB Domains, OBRA 87, CMS CoPs, F-Tags
NHA Federal Exam Prep 2026/2027 Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
This Federal Nursing Home Administrator Exam Prep covers the complete 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 across all
states.
CONTENT DISTRIBUTION - NAB CORE DOMAINS
• Customer Care, Supports & Services (20%) — Resident rights, quality of life, care planning, MDS
3.0, activities, social services, dietary
• Human Resources (20%) — Staffing, recruitment, training, labor law, employee relations,
competency, background checks
• Finance (15%) — Budgeting, Medicare/Medicaid reimbursement, PPS, cost reporting, financial
management, billing, accounts
• Environment (15%) — Life Safety Code NFPA 101, emergency preparedness, infection control,
physical plant, maintenance, utilities
• Management & Leadership (15%) — Organizational management, leadership, governance,
strategic planning, QAPI, performance improvement
• Regulations (15%) — OBRA 87, CMS CoPs 42 CFR 483, survey process, F-tags, State
Operations Manual, compliance, enforcement
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. Review financial reimbursement and Life Safety Code. Use rationales to understand
regulatory intent.
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
,NHA Federal Exam Prep 2026/2027 Page 3
, 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 4
ADMINISTRATOR EXAM
NAB Core of Knowledge & CMS Regulations
2026/2027 Edition
Long-Term Care Management
160 Verified Questions with Detailed Rationales
EXAM SPECIFICATIONS
Time Allocation: 3 Hours
Total Questions: 160 Questions
Question Format: Multiple Choice with Rationales
Minimum Competency: 75% Required to Pass
Core Focus: NAB Domains, OBRA 87, CMS CoPs, F-Tags
NHA Federal Exam Prep 2026/2027 Page 1
, Exam Overview & Content Outline
EXAM PURPOSE
This Federal Nursing Home Administrator Exam Prep covers the complete 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 across all
states.
CONTENT DISTRIBUTION - NAB CORE DOMAINS
• Customer Care, Supports & Services (20%) — Resident rights, quality of life, care planning, MDS
3.0, activities, social services, dietary
• Human Resources (20%) — Staffing, recruitment, training, labor law, employee relations,
competency, background checks
• Finance (15%) — Budgeting, Medicare/Medicaid reimbursement, PPS, cost reporting, financial
management, billing, accounts
• Environment (15%) — Life Safety Code NFPA 101, emergency preparedness, infection control,
physical plant, maintenance, utilities
• Management & Leadership (15%) — Organizational management, leadership, governance,
strategic planning, QAPI, performance improvement
• Regulations (15%) — OBRA 87, CMS CoPs 42 CFR 483, survey process, F-tags, State
Operations Manual, compliance, enforcement
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. Review financial reimbursement and Life Safety Code. Use rationales to understand
regulatory intent.
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
,NHA Federal Exam Prep 2026/2027 Page 3
, 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 4
