General Guidelines for All Applicants

Failure to submit the aforementioned information will result in the delay of your application. All positive response applications are subject to the review of the Board. You may be asked to make a personal appearance at a Board meeting to explain your response.

• Training and Licensure Requirements:
• Be a minimum of 21 years old
• Have a minimum of a high school diploma/equivalent
• Pass a national criminal history background check
• Pass Indiana’s jurisprudence exam
• Meet one of the following:
  • Be a licensed HFA or a registered, certified, or licensed health care practitioner under IC 16 or IC 25.
  • Have at least one (1) year of management experience:
    • in health care;
    • in housing;
    • in hospitality; or
    • providing similar services to the elderly.
      Verification of Employment form

    Expedited Approval (IC 25-19-1-10)

    - Approved NAB HSE (National Association of Long Term Care Administrators Boards Health Services Executive) license in good standing.

    Failure to submit the aforementioned information will result in the delay of your application. All positive response applications are subject to the review of the Board.

    Application Instructions

    1. Completed Application - Applications may be submitted online at MyLicense.IN.gov.
    2. Application Fee - $100.00 application fee to be paid by credit or debit card for applications submitted online. All application fees are nonrefundable.
    3. Criminal Background Check
    4. Positive Response Documentation: If you answer "Yes" to any questions on the application, explain fully in a statement that includes all details. Include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement. Please upload at the time of application or log back into your account and use the License Update option.
    5. Name Change Documentation: Documentation of any legal name change if your name differs from that on any of your documents. Documentation may include a copy of your marriage certificate or divorce decree. Please upload at the time of application or log back into your account and use the License Update option.
    6. Transcripts - Transcripts must show your degree. Please upload at the time of application or log back into your account and use the License Update option.
    7. AIT Program -Completion of an administrator-in-training program supervised by a board certified preceptor.
    8. Verification of State Licensure(s) - Verification of any registration/license/certification to practice any health-related profession or occupation in another state or territory. This can be uploaded to your application.
    9. Verification of Employment form - This can be uploaded to your application.

    The Fair Information Practice Act: In compliance with Ind. Code 4-1-6, this agency is notifying you that you must provide the requested information, or your application will not be processed. You have the right to challenge, correct, or explain information maintained by this agency. The information you provide will become public record. Your examination scores and grade transcripts are confidential except in circumstances where their release is required by law, in which case you will be notified.

    Mandatory Disclosure of U.S. Social Security Number: Your social security number is being requested by this state agency in accordance with Ind. Code 4-1-8-1 and 25-1-5- 11(a). Disclosure is mandatory, and this record cannot be processed without it. Failure to disclose your U.S. social security number will result in the denial of your application. Application fees are not refundable.

    Abandon Applications: If an applicant does not submit all requirements within one (1) year after the date on which the application is filed, the application for licensure is abandoned without any action of the Board. An application submitted after an abandoned application shall be treated as a new application.

    1. Completed Application - Applications may be submitted online at MyLicense.IN.gov.
    2. Application Fee - $100.00 application fee to be paid by credit or debit card for applications submitted online. All application fees are nonrefundable.
    3. Criminal Background Check
    4. Positive Response Documentation: If you answer "Yes" to any questions on the application, explain fully in a statement that includes all details. Include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement. Please upload at the time of application or log back into your account and use the License Update option.
    5. Name Change Documentation: Documentation of any legal name change if your name differs from that on any of your documents. Documentation may include a copy of your marriage certificate or divorce decree. Please upload at the time of application or log back into your account and use the License Update option.
    6. Requirements - Transcripts must show your completed education. Please upload at the time of application or log back into your account and use the License Update option. Meet one of the following:
       • Be a licensed HFA or a registered, certified, or licensed health care practitioner under IC 16 or IC 25.
       • Have at least one (1) year of management experience:
         • in health care;
         • in housing;
         • in hospitality; or
         • providing similar services to the elderly.
           Verification of Employment form - Can be uploaded to your application.
       • Possess an associate's degree in gerontology or health care.
       • Possess a bachelor's degree or higher degree from an accredited postsecondary educational institution.
       • Complete a 100-hour specialized course in residential care facility administration that is approved by the board.
       • Completed application with $100.00 application fee.
       • Official transcripts showing your degree has been conferred.

    The Fair Information Practice Act: In compliance with Ind. Code 4-1-6, this agency is notifying you that you must provide the requested information, or your application will not be processed. You have the right to challenge, correct, or explain information maintained by this agency. The information you provide will become public record. Your examination scores and grade transcripts are confidential except in circumstances where their release is required by law, in which case you will be notified.

    Mandatory Disclosure of U.S. Social Security Number: Your social security number is being requested by this state agency in accordance with Ind. Code 4-1-8-1 and 25-1-5- 11(a). Disclosure is mandatory, and this record cannot be processed without it. Failure to disclose your U.S. social security number will result in the denial of your application. Application fees are not refundable.

    Abandon Applications: If an applicant does not submit all requirements within one (1) year after the date on which the application is filed, the application for licensure is abandoned without any action of the Board. An application submitted after an abandoned application shall be treated as a new application.

    1. Completed Application - Applications may be submitted online at MyLicense.IN.gov. Be sure to indicate which examination you wish to retake in the "Obtained by Method" section.
    2. Application Fee -
       • If you are repeating the NAB or Examination - $50.00 repeat application fee to be paid by credit or debit card for applications submitted online. All application fees are nonrefundable.
       • If you are repeating the Indiana Jurisprudence Examination - $100.00 repeat application fee to be paid by credit or debit card for applications submitted online. All application fees are nonrefundable.
    3. Criminal Background Check

    The Fair Information Practice Act: In compliance with Ind. Code 4-1-6, this agency is notifying you that you must provide the requested information, or your application will not be processed. You have the right to challenge, correct, or explain information maintained by this agency. The information you provide will become public record. Your examination scores and grade transcripts are confidential except in circumstances where their release is required by law, in which case you will be notified.

    Mandatory Disclosure of U.S. Social Security Number: Your social security number is being requested by this state agency in accordance with Ind. Code 4-1-8-1 and 25-1-5- 11(a). Disclosure is mandatory, and this record cannot be processed without it. Failure to disclose your U.S. social security number will result in the denial of your application. Application fees are not refundable.

    Abandon Applications: If an applicant does not submit all requirements within one (1) year after the date on which the application is filed, the application for licensure is abandoned without any action of the Board. An application submitted after an abandoned application shall be treated as a new application.

    Reciprocity StandardMust meet all of these standards:
    • Passes criminal background check (in accordance with IC 25-1-21).
    • Practiced in another state for at least 1 year as any of the following:
      • Licensed HFA (active and in good standing);
      • Chief executive officer of a hospital; or
      • Chief operations officer of a hospital.

      The applicant has a NAB HSE (National Association of Long Term Care Administrators Boards Health Services Executive) license in good standing.

      The applicant to serve as preceptor shall file a new application for approval for each administrator-in-training applicant for whom the administrator desires to serve as preceptor. An application fee of $50.00 will need to be submitted with each application.

      HFA Preceptor Requirements

      • Hold an active HFA license in good standing.
      • Complete a board approved educational program
      • Meet any of the following:
        • Minimum of 2 years of work experience as an HFA
        • CEO of a CCRC; or
        • be employed as a regional manager for a health facility
        • Be approved by the Board prior to serving as the preceptor for an administrator-in-training.

        Preceptor Application Information

        1. Completed Application - The Health Facility Administrator that wishes to be a preceptor must apply here MyLicense.IN.gov and upload their preceptor certificate to the online application.
           • Please note: The Board cannot locate a preceptor for you nor do they provide a listing of health facility administrators who are qualified to act as preceptors in the State of Indiana.
        2. Location - The administrator-in-training program must be completed in a comprehensive care facility. You will serve as an administrator-in-training for a minimum of thirty-two (32) hours a week but no more than eight (8) hours daily. You are required to complete the program in a minimum of three (3) months and a maximum of twelve (12) months.
        3. Not Required - You do not need to complete/submit the following forms:
           • Verification of Administrator-in-Training Program for Health Facility Administrator Licensure Form
           • Verification of Employment of Applicants for Health Facility Administrator Licensure Form

        You MAY NOT begin your Administrator-In-Training program until you have received written approval from the Board. Along with this written approval, you will receive a packet of information that includes the following:

        1. Start Notification Form
        2. Notice of Change of Status and/or Discontinuance in AIT Program 3.
        3. Affidavit of Completion

        Once you are approved by the Board to begin your administrator-in-training program and receive your packet information, you will need to submit the Start Notification Form to the Professional Licensing Agency. This form is to be completed by you and your Preceptor.

        When you complete your administrator-in-training program, you must submit the Affidavit of Completion and register for the NAB examination at their website www.nabweb.org. Once our office receives the the passing NAB results, you will be emailed the Intent to Take the Health Facility Jurisprudence Examination form that lists the available examination dates. Please see section titled EXAMINATION INFORMATION on pages 5 and 6 for further details on the examination process.

        HFA Temporary Permit Information

        Temporary Permit Repealed (IC 25-19-1-3.5)
        1. Application - Apply online at https://mylicense.in.gov/eGov/ML1PLA.html
        2. Application Fee - $100.00 application fee to be paid by credit or debit card. All application fees are nonrefundable.
        3. Required Documentation: Please be prepared to upload the following with your application
           • Organization Description - Provide a brief description of your organization, including organization philosophy, objectives, and organizational chart.
           • Organization Background - Provide a brief description of the organization's background in continuing education and log term care education.
           • Brochure - A sample of advertising brochure for your program(s) for health facility administrators
           • Evaluation Sample - Description of evaluation techniques that will be utilized (attach sample) and provide a statement of how evaluations are utilized by your organization.
           • Certificate Sample - Provide a sample certificate to be awarded for completion of the program
           • Attendance - Provide a description of monitoring techniques utilized to verify attendance.
           • Records - Provide a description of record keeping system for continuing education programs to be offered and length of time records are kept.
           • Statement - Provide a statement regarding whether or not attendance at your programs are open to all health facility administrators.

        Important Information:

        • Sponsors of programs must file application with the board and be approved at least thirty (30) days prior to the date of the first presentation.
        • Approval of a sponsor will be valid for a maximum period of one (1) year. All approvals expire on January 31 of each year.
        • The sponsor is responsible for monitoring attendance of programs in such a way that verification of attendance throughout the program can be reliably assured.
        • Approved continuing education sponsors must retain the attendance records for a period of five (5) years, during which time the board may request review of these records.
        1. Completed Application - Applications may be submitted online at MyLicense.IN.gov.
        2. Application Fee - $100.00 application fee to be paid by credit or debit card for applications submitted online. All application fees are nonrefundable.
        3. Criminal Background Check
        4. Positive Response Documentation: If you answer "Yes" to any questions on the application, explain fully in a statement that includes all details. Include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement. Please upload at the time of application or log back into your account and use the License Update option.
        5. Name Change Documentation: Documentation of any legal name change if your name differs from that on any of your documents. Documentation may include a copy of your marriage certificate or divorce decree. Please upload at the time of application or log back into your account and use the License Update option.
        6. Health Facility Verification Form: Please upload page 3 of this document to your online application.
        7. Letter of Explanation: Please upload a detailed explanation as to why a provisional license is being requested. This must accompany the application for the board to consider your request.

        Statutory Requirement:

        IC 25-19-1-3.3 Provisional licenses; issuance; withdrawal
        Sec. 3.3. (a) The board may issue a provisional health facility administrator license or provisional residential care administrator license to an individual for a specific licensed health facility or residential care facility if the individual has:
        (1) at least two (2) years of administrative experience in a licensed health facility or residential care facility; and
        (2) not been convicted of a crime that has a direct bearing on the individual's ability to practice competently in accordance with IC 25-1-21.
        (b) The board may issue a provisional residential care administrator license to an individual for a specific residential care facility if the individual has:
        (1) at least two (2) years of administrative experience in a residential care facility; and
        (2) not been convicted of a crime that has a direct bearing on the individual's ability to practice competently in accordance with IC 25-1-21.
        (c) Subject to subsection (d), the chair of the board may issue a provisional health facility administrator license or a provisional residential care administrator license to an individual who appears to be qualified.
        (d) If the board determines that an individual described in subsection (c) fails to meet all applicable qualification for a provisional license described in subsection (a) or (b), the board may withdraw the provisional license.
        (e) Experience that an individual gains while practicing health facility administration with a provisional license issued under this section may count toward the requirements for an administrator in training, as approved by the board.

        Testing Information

        National Association of Board of Examiners of Long Term Care Administrators (NAB) Examination Once the licensure requirements have been satisfied, candidates for the NAB examination need to visit the NAB website at http://www.nabweb.org/ to apply for the appropriate examination. Once the Professional Licensing Agency receives your results from NAB stating that you have successfully passed the examination, you will receive the results via e-mail.

        Indiana Jurisprudence Examination Please be advised that IPLA proctors the HFA Jurisprudence Exam. The Jurisprudence exam information is only given to approved applicants. Candidates for the Indiana State Jurisprudence Examination must meet all the education and experience requirements prior to being approved to take the examination. There is not an additional fee to take the Jurisprudence exam. All applicants for licensure must take and pass the Indiana Jurisprudence examination.

        If you have a disability that may require some accommodation in taking the examinations, you must submit a Testing Accommodation Request Form to our office. If you are hearing or speech impaired, you may utilize the Indiana Relay System by calling 1-800-743-3333.

        Administrator-in-Training Program

        1. Start Notification Form
        2. Notice of Change of Status and/or Discontinuance in AIT Program
        3. Affidavit of Completion

        HFA AIT Program Requirements (IC 25-19-1-10)

        • Requires the AIT program to be a minimum of three (3) months and a maximum of twelve (12) months.
        • *Please note* Wavier requests must be submitted and approved before being approved to start the AIT.
        • Total of 680 hours
        • Of which, 200 hours may be from a state-approved, specialized course in long term care administration.
        • Either associate, bachelor’s, master’s, or doctoral degrees with no long-term care experience
          • Total of 880 hours
          • Of which, 200 hours may be from a state-approved, specialized course in long term care administration.
          • High school diploma or equivalency
            • Total of 1040 hours
            • Of which, 200 hours may be from a state-approved, specialized course in long term care administration.
            • The board may waive up to 30% (or 312 hours) of the required training hours for an HFA applicant with a high school diploma/equivalency who has served in a long-term care facility department manager position, based upon criteria approved by the board, provided the applicant's experience under consideration is verifiable to the board's satisfaction.

            - In addition to the AIT program, the HFA applicant must:

            Obtaining a Preceptor

            • Please note: The Board cannot locate a preceptor for you nor do they provide a listing of administrators who are qualified to act as preceptors in the State of Indiana.
            • To obtain a list of qualified administrators who have successfully completed the preceptor training through the Indiana Health Care Association, please contact Katie Niehoff with IHCA at kniehoff@ihca.org.

            HFA Applicants

            • The board may waive up to 30% (or 312 hours) of the required training hours for an HFA applicant with a high school diploma/equivalency who has served in a long-term care facility department manager position, based upon criteria approved by the board, provided the applicant's experience under consideration is verifiable to the board's satisfaction.
            • HFA A.I.T. Waiver Request Form

            You may satisfy the administrator-in-training requirements with one of the following:

            1. one (1) year active work experience as a licensed health facility administrator in another state; OR
            2. completion of a training program required for licensure as a health facility administrator in another state that is determined by the Board to be equivalent to the administrator-in-training requirements in this state; you will need to submit the Verification of Administrator-in-Training Program for Health Facility Administrator Licensure Form completed by the state that approved your administrator-in-training program; OR
            3. completion of a residency-internship in health care administration completed as part of a degree requirement (possession of associate degree, bachelor degree or higher) that is determined by the Board to be equivalent to the administrator-in-training requirements of this state; you will be required to submit documentation of this residency-internship; OR
            4. one (1) year active work experience as a chief executive officer or chief operations officer in a hospital; OR
            5. a master's degree in health care administration and six (6) months of active work experience as a licensed health facility administrator in another state.

            For additional information, you may contact the Board at 317-234-3022 or by e-mail at pla10@pla.in.gov.

            • Application - Apply online at https://mylicense.in.gov/eGov/ML1PLA.html\

            Upload a syllabus and course load. Once this application is complete, it will require an appearance at a board meeting before it can be licensed.

            * Please note, anyone wanting to enter into the AIT program does not complete this application. You will need to apply for the HFA license by exam*

            Renew Online!

            Renewal Instructions

            • Renew Online through MyLicense One!
            • HFA and RCA licenses expire on August 31 of even-numbered years.
            • The HFA and RCA renewal fee is $100.
            • View continuing education requirements prior to renewal to ensure you are in compliance with all rules and regulations.

            Renewal notices are sent approximately ninety (90) days prior to the expiration date. License holders with valid email addresses on file will be emailed the renewal notice. Those who do not have valid email addresses on file will be mailed the license renewal notice; this notice is mailed to the address on record with the Board. The Board has no way of knowing whether or not a notice reaches its destination; therefore, when a notice has been emailed to a valid email address or mailed, the duty of the Board has been performed.

            Reactivating an HFA License (IC 25-19-1-9.5)

            A licensed HFA who has been inactive for a period of 3 years or less at the date of the reactivation application is filed must show proof of having completed forty (40) hours of continuing education within the two (2) year period immediately before to the date the reactivation application is filed.

            A licensed HFA. who has been inactive for a period of 3 years or more at the date of the reactivation application is no longer required to:

            • Make a personal appearance before the board (board discretion if they have questions about the application that are unresolved before making a determination on the application, not automatic requirement);
            • Provide employment history during inactive period; or
            • Do any other additional requirements as deemed by the board.

            A licensed HFA. who has been inactive for a period of 3 years or more must still complete forty (40) hours of continuing education within the two (2) year period immediately before to the date the reactivation application is filed.

            Reinstating an HFA or RCA License

            A licensed HFA or RCA that has been expired for a period of 3 years or more must still the required continuing education within the two (2) year period immediately before to the date the reactivation application is filed. HFAs require forty (40) hour and RCAs require twenty (20) hours.

            • Reinstate Online!
            • Payment of the current renewal fee and current initial application fee.
            • Documentation to Upload:
              • Letter of work history or resume documenting what you have been doing since the Indiana license expired.
              • License verification of 1 current license.
              • Copy of the current hours of continuing education certificates

              CE Sponsor

              CE Sponsor - HFA licensees will Renew Online through MyLicense One. The license number and registration code are required to access the renewal and will be sent in the renewal notice roughly 90 days before the expiration.

              • Make a personal appearance before the board (board discretion if they have questions about the application that are unresolved before making a determination on the application, not automatic requirement);
              • Provide employment history during inactive period; or
              • Do any other additional requirements as deemed by the board.

              A licensed HFA. who has been inactive for a period of 3 years or more must still complete forty (40) hours of continuing education within the two (2) year period immediately before to the date the reactivation application is filed.

              Fee Schedule

              Health Facility Administrator Application/Renewal	Fee	Penalty	Total
              Application	$100	NA	$100
              Temporary Permit	$50	NA	$50
              Preceptor Certificate Application	$50	NA	$50
              Provisional License	$100	NA	$100
              Renewal - Unexpired - prior to August 31 of even-numbered years	$100	NA	$100
              Renewal - Expired < 3 Years - after August 31 of even numbered years but before 3 years	$100	$50	$150
              Renewal - Expired > 3 Years	$200	NA	$200

              Additional Information