North Dakota - Assisted Living Facility — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

North Dakota Medicaid does not fund congregate residential care under the "Assisted Living Facility" licensure category; instead, the state utilizes the "Basic Care Facility" licensure to provide room, board, and personal care through the Medicaid State Plan Basic Care Assistance Program (BCAP) and the 1915(c) HCBS Waiver. Facilities must be licensed under North Dakota Century Code chapter 23-09.3 by the Department of Health and Human Services (HHS) Division of Health Facilities to enroll as a Medicaid provider.

Approval requires dual clearance: securing the Basic Care Facility license and enrolling in the ND Medicaid MMIS Portal using taxonomy code 311Z00000X. Providers must also coordinate with the Aging and Disability Resource Link (ADRL) and county case managers who authorize the Basic Care Personal Care Service Plan for each resident before Medicaid will reimburse for services.

1. Service Definition and Scope

In North Dakota, the Medicaid-funded equivalent to assisted living is termed Basic Care Services. The North Dakota Basic Care program provides room and board along with health, social, and personal care for residents to attain or maintain their highest level of functioning.

Services are authorized based on an assessment of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The facility provides 24-hour on-site response staff to meet scheduled and unpredictable needs, supervision, safety, and security.

• Covered Components: Room and board, personal care, therapeutic, social, and recreational programming.
• Non-Covered Services: Prescription drugs, over-the-counter medications, direct physician services, mental health services, dental services, and durable medical equipment.
• Medical Care Leave: Medicaid covers a maximum of 30 days per occurrence for medical care leave to hold a bed while a resident is in a hospital or nursing facility.
• Therapeutic Leave: Covered for residents expected to return to the facility to ensure bed availability.
• Target Population: Individuals age 65 or older, or 18 and older with a qualifying disability, who require supervision but are not severely impaired in toileting, transferring, or eating.

2. Regulatory and Oversight Agencies

Oversight of congregate residential care in North Dakota is divided between different divisions within the Department of Health and Human Services (HHS). While Assisted Living Facilities are overseen by the Health Response and Licensure Section and Food and Lodging, Medicaid-participating Basic Care Facilities are regulated by the Division of Health Facilities.

Medicaid enrollment and claims processing are managed by the HHS Medical Services Division through the state's MMIS portal.

• Licensing Agency: ND HHS Division of Health Facilities (https://www.hhs.nd.gov/health/regulation-licensure-and-certification/health-facilities-unit/basic-care-facilities) licenses Basic Care Facilities.
• Medicaid Agency: ND HHS Medical Services Division (https://www.hhs.nd.gov/) manages the Basic Care Assistance Program and HCBS Waiver.
• Life Safety Oversight: ND HHS Division of Life Safety and Construction reviews physical plant and construction standards.
• Food Service Licensing: ND HHS Food and Lodging (https://ro.eprops.hhs.nd.gov/fs/4fVz/cfd90ccc) licenses the dietary and lodging components.

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota requires facilities seeking Medicaid reimbursement for congregate care to obtain a Basic Care Facility license; an Assisted Living Facility license is insufficient for Medicaid enrollment. The state strictly enforces physical plant and Life Safety Code requirements before a license application is accepted.

Additionally, facilities must demonstrate compliance with the federal HCBS Settings Rule. The Department of Human Services must verify that the facility's operations and physical setting do not isolate Medicaid beneficiaries from the broader community.

• Licensure Prerequisite: Must hold or be approved for a Basic Care Facility license under NDCC 23-09.3; Assisted Living licensure (NDCC 23-09) does not qualify for the Basic Care Assistance Program.
• HCBS Settings Verification: Must obtain documentation from the Department of Human Services verifying compliance with home and community-based setting requirements.
• Life Safety Clearance: Must pass a construction and physical plant review by the Division of Life Safety and Construction.
• Need Review: While the historical Certificate of Need program primarily targeted skilled nursing and hospitals, Basic Care bed capacity is heavily regulated by state appropriations and bed moratoriums defined in state statute.

4. Licensure and Certification Requirements

Basic Care Facilities are licensed under North Dakota Century Code chapter 23-09.3 and North Dakota Administrative Code chapters 33-03-24.1 and 33-03-24.2. Licenses are issued on a calendar year basis and expire on December 31st of each year.

Facilities may request waivers for specific licensure standards if they can prove the lack of compliance does not adversely affect resident health or safety, using the Basic Care Facility Waiver Request Form.

• Statutory Authority: North Dakota Century Code 23-09.3.
• Regulatory Code: North Dakota Administrative Code 33-03-24.1 and 33-03-24.2.
• Renewal Cycle: Licenses must be renewed annually, expiring on December 31st.
• Waiver Process: Providers can submit a Basic Care Facility Waiver Request Form to the Division of Health Facilities for care standards or the Division of Life Safety for construction standards.
• Food Code Compliance: Must adhere to the North Dakota Food Code (NDCC 33-33-04.1).

5. Medicaid Provider Enrollment

Once licensed as a Basic Care Facility, the provider must enroll in the North Dakota Medicaid program to receive reimbursement. Enrollment is processed through the ND Medicaid MMIS Portal.

Providers must use the specific taxonomy code designated for Basic Care and submit the Basic Care Facility application. The billing provider's National Provider Identifier (NPI) must be active and linked to the facility.

• Enrollment Portal: ND Medicaid MMIS Portal (https://www.hhs.nd.gov/).
• Taxonomy Code: Must enroll with taxonomy code 311Z00000X (Basic Care).
• Application Form: Providers must utilize the specific Basic Care Facility application during the MMIS enrollment process.
• NPI Requirement: The eligible servicing and billing provider NPIs must be enrolled with ND Medicaid on the date of service.

6. Staffing, Training and Background Checks

Basic Care Facilities must maintain sufficient 24-hour on-site response staff to meet the scheduled and unpredictable needs of residents. Staffing ratios and qualifications are dictated by the facility's licensure rules.

North Dakota allows unlicensed staff to provide assistance with medications, provided the facility complies with the state Nurse Practice Act and specific medication administration regulations.

• Background Checks: Before employing a new staff person, facilities must check state registries and licensure boards to identify any findings of inappropriate conduct, disciplinary actions, or termination.
• Medication Administration: Unlicensed staff may assist with medications in accordance with state requirements and the Nurse Practice Act.
• 24-Hour Staffing: Must maintain 24-hour on-site response staff to provide supervision, safety, and security.
• Assessment Staff: Resident assessments must be conducted within 14 days of move-in and at least quarterly thereafter by qualified personnel.

7. Documentation, Policies and Records

Medicaid reimbursement is contingent upon strict documentation, primarily the Basic Care Personal Care Service Plan. This plan is developed by the member's case manager based on ADL and IADL scores and transmitted to the facility via the department's electronic case management system.

Facilities must maintain comprehensive medical and financial records that fully justify the services billed to ND Medicaid.

• Service Plan: A Basic Care Personal Care Service Plan must be completed by the member's case manager and sent to authorized facility personnel.
• Record Retention: Records must be retained for at least 7 years after the last date the claim was paid or denied.
• Resident Assessments: Must document health, psychosocial, functional, nutritional, and activity status; personal care needs; and capacity for self-preservation.
• Leave Day Tracking: Must accurately document and track Medical Care Leave (up to 30 days) and Therapeutic Leave days.

8. Billing, Rates and Claims

Basic Care services are billed to North Dakota Medicaid using the UB-04 claim form or the 837i electronic format. Facilities must submit a claim for every month a member is in the facility to allow the system to apply recipient liability (spend-down) correctly.

Claims must separate room and board from personal care services using specific revenue codes. The day of a resident's death or discharge is considered a covered day and must be included in the billed units.

• Claim Format: UB-04 claim form or 837i electronic transaction.
• Timely Filing: Original claims must be received within 180 days from the date of service.
• Revenue Code 0110: In-House Medicaid Days for Room & Board (private).
• Revenue Code 0120: In-House Medicaid Days for Room & Board (semi-private).
• Revenue Code 0167: Personal Care Services Days.
• Revenue Codes 0183/0185: Therapeutic Leave Days (0183) and Medical Leave Days (0185) for Room & Board.
• Billing Frequency: Do not bill more than one calendar month per claim; submit immediately after the month ends.

9. Approval Sequence and Timeline

The approval process begins with physical plant clearance and Life Safety Code approval for the building. Once the physical environment is approved, the provider submits the Basic Care Facility licensure application to the Division of Health Facilities.

After the license is issued and HCBS Settings Rule compliance is verified, the provider submits the Medicaid enrollment application through the MMIS portal. Medicaid enrollment cannot be backdated prior to the effective date of the Basic Care license.

• Step 1: Life Safety and Construction review of the physical facility.
• Step 2: Submission of the Basic Care Facility licensure application to the Division of Health Facilities.
• Step 3: Verification of HCBS Settings Rule compliance by the Department of Human Services.
• Step 4: Submission of the Basic Care Facility application via the ND Medicaid MMIS Portal.
• Step 5: Case manager authorization of the Basic Care Personal Care Service Plan for individual residents.

10. Common Denials and Survey Findings

Licensure and enrollment delays frequently occur when facilities attempt to bill Medicaid under an Assisted Living Facility license rather than the required Basic Care Facility license. Physical plant deficiencies during Life Safety inspections are also a primary cause of licensure delays.

During post-payment audits, claims are commonly recouped if the facility bills for personal care days without an active, case-manager-approved Basic Care Personal Care Service Plan on file, or if leave days exceed the 30-day medical leave limit.

• Wrong Licensure: Applying for Medicaid enrollment with an Assisted Living license instead of a Basic Care license.
• Missing Service Plans: Billing for personal care (Revenue Code 0167) without an authorized Service Plan from the county case manager.
• HCBS Settings Violations: Failing to demonstrate community integration, resulting in denial of Medicaid waiver funding.
• Timely Filing: Failing to submit claims within the 180-day window.
• Recipient Liability Errors: Failing to submit monthly claims to properly apply the resident's spend-down liability.

11. Key Contacts and Resources

Providers should utilize the North Dakota HHS website for access to licensure rules, Medicaid billing manuals, and provider enrollment portals. The Aging and Disability Resource Link (ADRL) is the primary contact for resident eligibility and case management referrals.

For specific policy questions, providers can reference the ND Medicaid Billing and Policy Manual for Basic Care Services.

• ND HHS Division of Health Facilities: Oversees Basic Care licensure (https://www.hhs.nd.gov/health/regulation-licensure-and-certification/health-facilities-unit/basic-care-facilities).
• ND Medicaid Provider Enrollment: Manages MMIS portal access and taxonomy registration (https://www.hhs.nd.gov/).
• Aging and Disability Resource Link (ADRL): Handles referrals for Basic Care Case Managers ([email protected]).
• ND HHS Food and Lodging Portal: For dietary and lodging licensure components (https://ro.eprops.hhs.nd.gov/fs/4fVz/cfd90ccc).

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