North Dakota - Assistive Technology Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In North Dakota, Assistive Technology Services are provided under the state's Medicaid Home and Community-Based Services (HCBS) Waivers, including the HCBS Waiver (0273.R06.00) and the Developmental Disabilities (DD) Waiver. These services encompass the evaluation of a participant's needs, the provision of specialized devices, and the training required to use them, all aimed at increasing the individual's functional capability and reducing their reliance on paid direct care staff.

The single biggest structural barrier to entry for this service in North Dakota is the strict sequential requirement to obtain designation as a Qualified Service Provider (QSP) through the North Dakota Department of Health and Human Services (ND HHS) Aging and Adult Services Division before an application will even be accepted in the state's Medicaid Management Information System (MMIS). Furthermore, if the provider is supplying physical devices rather than just evaluation and training, they are typically required to hold active Medicare DMEPOS supplier billing privileges as a precondition to Medicaid enrollment.

1. Service Definition and Scope

Assistive Technology in North Dakota encompasses specialized medical equipment, supplies, and communication devices that are not covered under the standard Medicaid State Plan Durable Medical Equipment (DME) benefit. The service is designed to promote independence and safety in the home and community.

The scope of the service includes the clinical evaluation of the participant's assistive technology needs, the purchasing or leasing of the customized device, equipment maintenance, and hands-on training for the participant or their unpaid caregivers to ensure effective use of the technology.

• Service Category: Assistive Technology under the North Dakota HCBS Waiver and Developmental Disabilities Waiver.
• Covered Activities: Needs assessment, device customization, equipment maintenance, and user training.
• Exclusions: Items that are not of direct medical or remedial benefit, or standard consumer electronics without a specialized modification.
• Primary Goal: Increase functional capability and reduce reliance on paid direct care staff.
• Target Population: Seniors and individuals with physical or developmental disabilities enrolled in ND HHS waiver programs.

2. Regulatory and Oversight Agencies

The North Dakota Department of Health and Human Services (ND HHS) serves as the umbrella agency overseeing all Medicaid and waiver operations. Within ND HHS, distinct divisions handle different aspects of provider approval and oversight.

The Medical Services Division manages the financial and enrollment aspects of Medicaid, while the Aging and Adult Services Division and the Developmental Disabilities Division manage the waiver programs, establish Qualified Service Provider (QSP) standards, and conduct provider compliance surveys.

• Primary Agency: North Dakota Department of Health and Human Services (ND HHS) (https://www.hhs.nd.gov)
• Medicaid Authority: ND HHS Medical Services Division (https://www.hhs.nd.gov/healthcare/medicaid)
• Waiver Operations: ND HHS Aging and Adult Services Division (https://www.hhs.nd.gov/human-services/aging)
• Provider Enrollment Portal: ND MMIS Health Enterprise Provider Portal (https://mmis.nd.gov/portals/wps/portal/ProviderEnrollment)

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota does not require a Certificate of Need (CON) or competitive Request for Proposals (RFP) procurement for Assistive Technology providers. The state operates an open enrollment network for Fee-For-Service (FFS) Medicaid waiver providers.

However, there is a strict structural precondition: an applicant must first be approved as a Qualified Service Provider (QSP) by ND HHS before attempting to enroll in the MMIS portal. Additionally, providers supplying physical devices must typically hold active Medicare DMEPOS enrollment, which acts as a federal gatekeeper before state Medicaid enrollment is permitted.

• Certificate of Need (CON): None required for HCBS Assistive Technology in North Dakota.
• Network Restrictions: Open enrollment; no closed networks or moratoria currently in effect for FFS Medicaid.
• Prerequisite Designation: Must obtain Qualified Service Provider (QSP) status from ND HHS before MMIS enrollment.
• Medicare Requirement: Device suppliers must typically hold active Medicare DMEPOS supplier billing privileges.
• Business Registration: Must be registered and in good standing with the North Dakota Secretary of State.

4. Licensure and Certification Requirements

North Dakota does not issue a distinct facility license for an Assistive Technology Agency. Instead, providers are approved and regulated under the standards outlined in North Dakota Administrative Code (NDAC) Article 75-03-23 for the Provision of Home and Community-Based Services.

While the agency itself is not licensed, the professionals conducting the assistive technology evaluations must hold active North Dakota state licenses in their respective clinical fields, and specialized national certifications are highly preferred for complex rehabilitation technology.

• Facility Licensure: No distinct facility license exists for AT agencies in North Dakota; providers operate under QSP approval.
• Governing Rule: North Dakota Administrative Code (NDAC) Article 75-03-23 (Provision of Home and Community-Based Services).
• Professional Licensing: Evaluators must hold active ND licensure (e.g., Occupational Therapist, Physical Therapist, or Speech-Language Pathologist).
• Specialized Certification: RESNA (Rehabilitation Engineering and Assistive Technology Society of North America) certification is highly preferred for complex rehab technology.
• Insurance Requirements: Must maintain general and professional liability insurance as dictated by ND HHS QSP standards.

5. Medicaid Provider Enrollment

Enrollment is a multi-step process completed via the ND MMIS Health Enterprise Provider Portal. Providers must first obtain a State of North Dakota Login ID and Authorization Code to access the system.

Because North Dakota delivers most Medicaid services through a fee-for-service model, state enrollment is the central step. Providers must submit their QSP approval, NPI, and pay the federal application fee unless they have already paid it to Medicare.

• System: ND MMIS Health Enterprise Provider Portal (https://mmis.nd.gov/portals/wps/portal/ProviderEnrollment).
• Provider Type: Typically enrolls under Provider Type for DME/Medical Supplies or specialized HCBS Waiver Provider depending on the exact service mix.
• Application Fee: Subject to the ACA institutional provider application fee unless waived via proof of recent Medicare enrollment payment.
• Revalidation: Required every five years for all ND Medicaid providers.
• Required Identifiers: National Provider Identifier (NPI) and Employer Identification Number (EIN).

6. Staffing, Training and Background Checks

Direct service staff and evaluators must meet strict educational and background criteria to ensure the safety of vulnerable waiver participants. ND HHS requires comprehensive background checks for all personnel with direct participant contact.

Evaluators must possess specific degrees or clinical licenses, and all staff providing in-person training must maintain basic life safety certifications.

• Evaluator Qualifications: Bachelor's or Master's degree in rehabilitation engineering, healthcare administration, human services, or related clinical field.
• Background Checks: Mandatory fingerprint-based criminal history record checks via the North Dakota Bureau of Criminal Investigation (BCI).
• Abuse Registry: Clearance through the ND Child Abuse and Neglect Registry and the ND Disqualified Caregiver Registry.
• Basic Training: CPR and First Aid certification required for staff providing direct, in-person training to participants.
• Ongoing Education: Must comply with ND HHS QSP continuing education requirements.

7. Documentation, Policies and Records

Providers must maintain comprehensive records of evaluations, device specifications, and participant training. ND HHS requires strict adherence to state record retention policies to support post-payment audits.

A critical component of documentation for Assistive Technology is the proof of delivery and the training log, which must be signed by the participant or their legal guardian to validate that the service was fully rendered.

• Record Retention: ND Medicaid requires providers to retain all service and billing records for a minimum of five years.
• Service Authorization: Must maintain the official ND HHS Prior Authorization notice for every device or evaluation billed.
• Delivery Documentation: Proof of delivery and installation signed by the waiver participant or their legal guardian.
• Training Logs: Documented dates, times, and outcomes of participant or caregiver training on the AT device.
• Incident Reporting: Must have a written policy for reporting adverse events or equipment failures to the participant's HCBS Case Manager.

8. Billing, Rates and Claims

North Dakota operates primarily on a Fee-For-Service (FFS) model for HCBS waivers. Assistive Technology requires prior authorization from the participant's case manager and the state before any service is rendered or equipment is purchased.

Claims are submitted electronically through the MMIS portal. Reimbursement is typically based on a state-defined fee schedule for evaluations and a manual pricing formula for customized devices.

• Billing Model: Fee-For-Service (FFS) submitted through the ND MMIS portal.
• Prior Authorization: 100 percent of Assistive Technology services and devices require prior authorization (PA) from ND HHS.
• Claim Format: Professional claims are submitted using the CMS-1500 format or electronic 837P equivalent.
• Rate Structure: Reimbursed based on the ND Medicaid HCBS Fee Schedule or manually priced based on the manufacturer's suggested retail price (MSRP) minus a state-defined discount.
• Modifiers: Specific HCPCS modifiers (e.g., NU for new equipment, RR for rental) must be used as outlined in the ND Medicaid Provider Manual.

9. Approval Sequence and Timeline

The end-to-end process requires sequential approvals, starting with business registration, moving to QSP approval, and ending with MMIS enrollment. Providers cannot skip steps or submit concurrent applications across these distinct gates.

The entire process typically takes 3 to 4 months, heavily dependent on the speed of the BCI background checks and the provider's existing Medicare enrollment status.

• Step 1: Register the business entity with the North Dakota Secretary of State (1 to 2 weeks).
• Step 2: Obtain Medicare DMEPOS enrollment if supplying physical medical equipment (60 to 90 days).
• Step 3: Submit the Qualified Service Provider (QSP) application to ND HHS Aging and Adult Services (30 to 45 days).
• Step 4: Create a North Dakota Login ID and submit the MMIS Provider Enrollment application (30 to 60 days).
• Step 5: Receive the ND Medicaid Provider ID and begin accepting HCBS case manager referrals.

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to administrative errors or failure to follow the strict prior authorization sequence. ND HHS audits often target missing delivery documentation.

Providers must ensure that no services are provided or billed prior to the official start date listed on the ND HHS Prior Authorization notice, as retroactive approvals are rarely granted.

• Enrollment Denial: Submitting the MMIS application before receiving official QSP approval from ND HHS.
• Claim Denial: Providing services or ordering equipment before the official Prior Authorization start date.
• Audit Finding: Missing participant signatures on the proof of delivery or training logs.
• Credentialing Delay: Incomplete background check submissions to the ND BCI.
• Revalidation Failure: Missing the 5-year revalidation window, resulting in automatic termination of the Medicaid Provider ID.

11. Key Contacts and Resources

Providers should rely on the official ND HHS portals and manuals for the most up-to-date requirements. The MMIS portal and QSP handbooks are the primary reference materials for maintaining compliance.

For specific questions regarding waiver policies or QSP enrollment, providers should contact the ND HHS Aging and Adult Services Division directly.

• ND HHS Provider Enrollment: https://www.hhs.nd.gov/healthcare/medicaid/provider/enrollment-information
• ND MMIS Web Portal: https://mmis.nd.gov/portals/wps/portal/ProviderEnrollment
• ND HHS HCBS Waivers Page: https://www.hhs.nd.gov/human-services/hcbs
• ND Secretary of State: https://sos.nd.gov
• ND Bureau of Criminal Investigation (BCI): https://attorneygeneral.nd.gov/law-enforcement/bureau-criminal-investigation

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