North Dakota - Day Habilitation Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In North Dakota, Day Habilitation is a structured, non-residential service designed to help individuals with intellectual and developmental disabilities (I/DD) build self-help, socialization, and adaptive skills. These services are primarily funded through the North Dakota Traditional I/DD Home and Community-Based Services (HCBS) Waiver and are overseen by the North Dakota Department of Health and Human Services (ND HHS).

The single biggest structural barrier to entry for this service is the sequential licensing prerequisite: an applicant cannot enroll in the state's Medicaid system until they first secure a Developmental Disabilities Provider License from the ND HHS Developmental Disabilities Section. This requires passing a rigorous Initial HCBS Setting Review to prove compliance with federal integration mandates, followed by the submission of a comprehensive DD Provider Application (SFN 1794) and an extensive Policies/Procedures Checklist (SFN 1544).

1. Service Definition and Scope

Day Habilitation in North Dakota provides structured daytime programming outside of the individual's residence. The service focuses on fostering community integration, adaptive skills, and socialization for individuals with intellectual and developmental disabilities.

Services must be directly tied to the individual's goals as determined through a person-centered planning process. The activities are designed to prevent institutionalization by enhancing the participant's ability to engage meaningfully in their community.

• Target Population: Individuals with intellectual or developmental disabilities enrolled in the North Dakota Traditional I/DD Waiver.
• Setting Requirements: Must be provided in a non-residential, community-based setting that fully complies with the CMS HCBS Settings Final Rule.
• Core Activities: Skill-building in self-care, communication, socialization, community navigation, and fine/gross motor development.
• Person-Centered Plan: Service tasks and activities must directly align with the individual's Individualized Program Plan (IPP).
• Provider Exclusions: Under North Dakota rules, Day Habilitation may not be provided by the individual's legal spouse or legal guardian.
• Agency Requirement: Services must be provided by an enrolled Medicaid Agency Qualified Service Provider (QSP); individual QSPs are not eligible to provide this service.

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 HCBS waiver programs. Within ND HHS, responsibilities are divided between programmatic licensing and Medicaid financial administration.

Prospective providers must interact with multiple divisions to achieve full approval, starting with the Developmental Disabilities Section for licensure and concluding with the Medical Services Division for billing enrollment.

• North Dakota Department of Health and Human Services (ND HHS): The primary state agency overseeing all human services and Medicaid programs (https://www.hhs.nd.gov).
• ND HHS Developmental Disabilities (DD) Section: Manages the I/DD waiver, conducts setting reviews, and issues the required DD provider licenses (https://www.hhs.nd.gov/human-services/dd).
• ND HHS Medical Services Division: Administers the state Medicaid program, establishes fee schedules, and oversees provider integrity (https://www.hhs.nd.gov/healthcare/medicaid/provider).
• ND Health Enterprise MMIS Web Portal: The official state system for Medicaid provider enrollment, claims submission, and remittance (https://mmis.nd.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota does not utilize a Certificate of Need (CON) program, closed network moratorium, or Request for Proposals (RFP) procurement process for Day Habilitation services. The state operates an open enrollment model for qualified agencies.

However, there is a strict sequential gatekeeping prerequisite: an applicant cannot submit a Medicaid enrollment application to the Medical Services Division without first obtaining a Developmental Disabilities Provider License from the ND HHS DD Section. Facility-based settings must also pass a physical site review before the license application is accepted.

• Designation/Procurement: Open enrollment; there are no RFP, moratorium, or Certificate of Need (CON) barriers for Day Habilitation in North Dakota.
• Prerequisite Licensure: Applicants must obtain a Developmental Disabilities Provider License from the ND HHS DD Section before MMIS Medicaid enrollment is permitted.
• HCBS Setting Review: New facility-based settings must pass the Initial Home & Community Based Services (HCBS) Setting Review prior to licensure to ensure they do not have institutional characteristics.
• Business Registration: The operating entity must be registered and in good standing with the North Dakota Secretary of State.
• NPI Requirement: The agency must obtain a Type 2 National Provider Identifier (NPI) prior to initiating the state application process.

4. Licensure and Certification Requirements

To become a licensed DD provider in North Dakota, agencies must submit the comprehensive North Dakota Developmental Disabilities Provider Application (SFN 1794). This process requires demonstrating strict compliance with North Dakota Administrative Code (NDAC) 75-04-01.

The application requires extensive documentation, including financial disclosures, proof of insurance, and a detailed crosswalk of agency policies against state and federal standards.

• Application Form: Must complete and submit the North Dakota Developmental Disabilities Provider Application (SFN 1794).
• Policy Checklist: Must submit the Policies/Procedures Checklist (SFN 1544) demonstrating compliance with state operational rules.
• HCBS Assurance: Must sign and submit the Provider Assurance to the Federal Home and Community Based Services (HCBS) Regulations (SFN 1010).
• Financial Disclosure: Submission of Financial Disclosure Statements (SFN 236) is required for initial licensure and renewal.
• Facility Inspections: Facility-based locations must submit blueprints (for new settings) and current fire inspections (SFN 223).
• Insurance and Convictions: Must submit Proof of Insurance (SFN 234) and Criminal Conviction Statements (SFN 235).

5. Medicaid Provider Enrollment

After obtaining the DD Provider License, agencies must enroll as a Medicaid provider through the ND Health Enterprise MMIS Web Portal. North Dakota delivers these waiver services through a fee-for-service model, making state enrollment the final step to billing.

Providers must create a state login, complete the web-based enrollment application, and upload their newly acquired DD license and business credentials.

• Enrollment Portal: Applications must be submitted electronically via the ND Health Enterprise MMIS Web Portal (https://mmis.nd.gov/portals/wps/portal/ProviderEnrollment).
• Login Credentials: Providers must first obtain a State of North Dakota Login ID and Authorization Code to access the MMIS portal.
• Provider Type: Must enroll as an Agency Qualified Service Provider (QSP) under the appropriate Developmental Disabilities taxonomy.
• Required Documentation: Must upload the ND DD license, IRS EIN confirmation, NPI confirmation, and ownership disclosure forms.
• Application Fee: Subject to the federal Medicaid institutional provider application fee, unless waived by prior Medicare or other state Medicaid enrollment.
• Revalidation: Enrolled providers must revalidate their Medicaid enrollment through the MMIS portal every 5 years.

6. Staffing, Training and Background Checks

North Dakota requires Day Habilitation providers to employ qualified leadership and direct care staff. Standards are outlined in NDAC 75-03-23 (Qualified Service Providers) and specific DD licensing rules.

Agencies must maintain rigorous background check standards, screening all patient-facing staff against state and federal exclusion lists before they provide any services.

• Program Coordinator Qualifications: Must hold a Bachelor's or Master's degree in social work, human services, healthcare administration, or a related field, with experience in habilitation programming.
• Direct Support Professionals (DSPs): Must complete required state-approved DD training modules and maintain current CPR and First Aid certification.
• Federal Exclusion Checks: Mandatory screening against the OIG List of Excluded Individuals/Entities (LEIE) and SAM.gov Excluded Parties List System.
• State Registries: Must verify staff against the National Sex Offender Registry and the North Dakota Child Abuse and Neglect Registry.
• Criminal Background Checks: Fingerprint-based state and federal criminal history record checks are required for all staff with direct participant contact.

7. Documentation, Policies and Records

Providers must maintain comprehensive records that tie daily service delivery directly to the individual's person-centered plan. The ND HHS DD Section conducts periodic reviews to ensure documentation compliance.

Failure to maintain accurate, contemporaneous records of service delivery and goal progression can result in immediate recoupment of Medicaid funds.

• Individualized Program Plan (IPP): Must be developed by the QSP Agency Program Coordinator within the first 30 days of service provision and reviewed every 6 months.
• Service Alignment: Daily task and activity documentation must explicitly tie to the individual's goals as determined in the IPP and the HCBS Case Manager's authorization.
• State Approval: The IPP must be forwarded to the case manager and reviewed and approved by the state program administrator.
• Incident Reporting: Must maintain and follow policies for documenting and reporting critical incidents, abuse, neglect, or exploitation directly to ND HHS.
• Attendance Records: Must keep daily logs of participation, including start/stop times and specific community integration activities completed.
• Personnel Files: Must retain proof of staff qualifications, background check clearances, and ongoing training records for state audit.

8. Billing, Rates and Claims

Day Habilitation services are billed on a fee-for-service basis directly to North Dakota Medicaid using the MMIS portal. Rates are established by the ND HHS Medical Services Division and are subject to state legislative appropriation.

Providers must ensure that all billed services are supported by an active prior authorization from the participant's HCBS Case Manager.

• Billing System: Claims are submitted electronically via the ND Health Enterprise MMIS Web Portal.
• Prior Authorization: Services must be prior-authorized by the HCBS Case Manager and reflected in the individual's service authorization before billing can occur.
• Billing Codes: Services are billed using specific HCPCS codes designated for Day Habilitation under the Traditional I/DD Waiver.
• Claim Status: Providers can check claim status via the MMIS portal or the Automated Voice Response System (AVRS) at 1-877-328-7098 (Option 4).
• Electronic Remittance: Providers must set up Electronic Funds Transfer (EFT) and receive Electronic Remittance Advice (ERA) through the MMIS system.

9. Approval Sequence and Timeline

The end-to-end process for becoming a Day Habilitation provider in North Dakota involves sequential approvals from the Secretary of State, the DD Section, and the Medical Services Division.

Because the DD licensure and HCBS setting reviews must be completed before Medicaid enrollment begins, prospective providers should plan for a multi-month startup phase.

• Step 1: Business Formation: Register with the ND Secretary of State and obtain an EIN and Type 2 NPI (1-2 weeks).
• Step 2: HCBS Setting Review: Submit facility blueprints and pass the Initial HCBS Setting Review for new locations (30-60 days).
• Step 3: DD Licensure Application: Submit SFN 1794 and all required policy checklists (SFN 1544) to the ND HHS DD Section (60-90 days).
• Step 4: MMIS Enrollment: Submit the Medicaid provider enrollment application via the ND Health Enterprise MMIS portal (30-60 days).
• Total Estimated Timeline: 4 to 6 months from initial business registration to active Medicaid billing status, depending on state processing volume.

10. Common Denials and Survey Findings

Applications and ongoing licenses are most frequently delayed or denied due to incomplete policy documentation or failure to meet the CMS HCBS Settings Rule.

During routine state surveys, documentation errors regarding the Individualized Program Plan (IPP) are the most common source of citations and corrective action plans.

• HCBS Settings Rule Non-Compliance: Facilities that isolate individuals from the broader community or have institutional characteristics fail the initial setting review.
• Incomplete Policy Checklists: Failure to fully complete and provide supporting documentation for the Policies/Procedures Checklist (SFN 1544).
• Missing Background Checks: Staff files lacking documented OIG LEIE, SAM.gov, or state registry clearances prior to the employee's start date.
• IPP Deficiencies: Individualized Program Plans that are not completed within the required 30-day window or fail to align with the case manager's authorization.
• Fire Inspection Lapses: Expired or missing facility fire inspections (SFN 223) for facility-based day habilitation locations.

11. Key Contacts and Resources

Prospective providers should utilize the official ND HHS portals and contact the Developmental Disabilities Section directly for application materials, form numbers, and guidance.

For billing and portal access issues, the Medicaid Call Center is the primary point of contact.

• ND HHS Developmental Disabilities Section: Phone: (701) 328-8930 | Email: dhsddreq@nd.gov | Web: https://www.hhs.nd.gov/human-services/dd
• ND Medicaid Provider Enrollment Portal: Web: https://mmis.nd.gov/portals/wps/portal/ProviderEnrollment
• ND Medicaid Call Center: Phone: 1-877-328-7098 (Toll-free, 8:00 am - 5:00 pm CST).
• ND HHS Medical Services Division: Phone: 1-800-755-2604 | Web: https://www.hhs.nd.gov/healthcare/medicaid/provider
• North Dakota Secretary of State: For business registration and certificates of good standing (https://sos.nd.gov).

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