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

Last reviewed: 2026-09-10

The North Dakota Department of Health and Human Services (DHHS) Developmental Disabilities Section licenses Day Habilitation under the Traditional IID/DD HCBS Waiver. The service provides structured daytime programming outside the individual's residence to build self-help, socialization, and adaptive skills.

Applicants must secure approval of a Developmental Disabilities Provider Letter of Intent Application (SFN 1793) from the Regional Developmental Disabilities Program Administrator and submit verification of engagement with a state-approved accreditation agency before a provisional license is issued.

1. Service Definition and Scope

Day Habilitation in North Dakota is designed to assist individuals with intellectual or developmental disabilities in acquiring, retaining, or improving the self-help, socialization, and adaptive skills necessary to reside successfully in community settings.

Services are delivered in non-residential settings and must comply with federal HCBS Settings Rule requirements to ensure community integration and prevent institutional isolation.

• Target Population: Individuals with intellectual or developmental disabilities meeting ICF/IID level of care enrolled in the Traditional IID/DD HCBS Waiver.
• Service Setting: Non-residential, community-based or facility-based settings that pass state HCBS compliance surveys.
• Core Activities: Training in self-help, socialization, and adaptive skills.
• Exclusions: Cannot be billed concurrently with residential services or supported employment for the same hours of service.

2. Regulatory and Oversight Agencies

The North Dakota Department of Health and Human Services (DHHS) serves as the umbrella agency. The Developmental Disabilities (DD) Section handles provider licensing and waiver operations.

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

• Licensing Authority: ND DHHS Developmental Disabilities Section (https://www.hhs.nd.gov/human-services/developmental-disabilities)
• Medicaid Agency: ND DHHS Medical Services Division (https://www.hhs.nd.gov/healthcare/medicaid)
• Enrollment Portal: ND Health Enterprise MMIS (https://mmis.nd.gov)
• Regional Oversight: Regional Human Service Centers (https://www.hhs.nd.gov/human-services/regional-human-service-centers)

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota utilizes a regional approval and accreditation-gated model for new DD providers. Applicants cannot simply submit a license application; they must first clear regional intent and secure an accreditor.

The state requires proof of engagement with an accrediting body before any provisional license is granted.

• Regional Approval: Applicants must submit SFN 1793 (Letter of Intent) to the Regional Developmental Disabilities Program Administrator for approval before applying for licensure.
• Accreditation Engagement: Per NDAC 75-04-01, applicants must submit verification of engagement with a DHHS-approved accreditor to the Licensing Administrator prior to license approval.
• Business Plan: Required submission of a business plan with letters of reference during the initial intent phase.
• Orientation Requirement: Mandatory completion of the DD Section's new provider orientation process prior to licensure.

4. Licensure and Certification Requirements

Providers are licensed as DD Providers under North Dakota Administrative Code. Initial approval grants a provisional license, which requires the agency to achieve full accreditation within one year.

Facility-based day habilitation sites must also pass physical standards inspections.

• Regulation: NDAC 75-04-01 (Licensing of Providers of Services to Individuals with Developmental Disabilities).
• Application Form: SFN 1793 (Developmental Disabilities Provider Letter of Intent Application).
• Ownership Disclosure: SFN 1168 (Ownership/Controlling Interest and Conviction Information).
• Facility Standards: SFN 1555 (Physical Standards Checklist) required for facility-based day habilitation sites.
• Provisional License: Issued for up to one year; full accreditation must be achieved within this timeframe.

5. Medicaid Provider Enrollment

Enrollment is processed electronically through the ND Health Enterprise MMIS portal. Providers must enroll under the specific provider type designated for Developmental Disabilities.

Enrollment cannot be finalized until the DD Section has issued the provisional license.

• System: ND Health Enterprise MMIS Web Portal.
• Provider Type: 039 (Developmental Disabilities).
• License Number Format: Must be entered exactly as "DD 00000" in the MMIS system.
• Effective Date: Limited to no more than 90 days prior to the date the complete application packet is received.
• Revalidation: Required every 5 years for DD providers.

6. Staffing, Training and Background Checks

Agency leadership and direct support professionals must meet DD Section requirements for training, background checks, and exclusion screening.

The state mandates specific training on the federal HCBS Settings Rule to ensure community integration principles are upheld.

• Management Qualifications: Agency leadership must complete SFN 1168 detailing key management positions (CEO, CFO, COO).
• Staff Training: Must complete orientation and federal HCBS Settings Rule compliance training.
• Background Checks: Required for all staff with direct participant contact.
• Exclusion Screening: Staff and owners must be free of exclusions on the LEIE and SAM databases.

7. Documentation, Policies and Records

Day-to-day documentation must support census data auditing and periodic quality reviews by the state.

Policies must explicitly align with the CMS HCBS Settings Rule.

• Daily Records: Must include date of service, provider name, service name, in/out times, and individual's name.
• HCBS Compliance: Policies must ensure community integration and participant choice.
• Incident Reporting: Must maintain a standardized incident reporting policy compliant with DD Section rules.
• Record Retention: Must maintain documentation to support all billed claims for state or federal auditing.

8. Billing, Rates and Claims

Claims are submitted directly to the state via the MMIS portal or through approved vendor software.

Services must be authorized in advance by the regional Developmental Disabilities Program Manager (DDPM).

• Submission Method: North Dakota MMIS Web Portal or Vendor Software (e.g., Noridian).
• Payment Setup: Electronic Funds Transfer (EFT) banking information is entered during MMIS enrollment.
• Authorization: Services must be prior-authorized by the DDPM in the regional human service center.
• Billing Codes: Specific HCPCS codes and modifiers are assigned by the DD Section based on the authorized service plan.

9. Approval Sequence and Timeline

The approval process is sequential, beginning at the regional level, moving to state licensure, and concluding with MMIS enrollment.

Failure to respond to requests for missing information within 30 days will result in the application being withdrawn.

• Step 1: Submit SFN 1793 and business plan to the Regional Human Service Center.
• Step 2: Complete DD Section new provider orientation.
• Step 3: Submit verification of accreditation engagement and complete licensure packet (SFN 1168, SFN 1555).
• Step 4: Receive Provisional License (valid up to 1 year).
• Step 5: Enroll in ND Health Enterprise MMIS as Provider Type 039.
• Step 6: Achieve full accreditation within 12 months of provisional licensure.

10. Common Denials and Survey Findings

Licensure and enrollment delays frequently occur due to incomplete application packets or failure to secure regional approval first.

Survey deficiencies often relate to physical site standards or HCBS Settings Rule compliance.

• Incomplete Packets: Applications withdrawn if requested missing information is not submitted within 30 days.
• Accreditation Failure: Failure to secure full accreditation within the 1-year provisional license period.
• HCBS Settings Violations: Facility-based sites failing to demonstrate community integration or passing the surveyor review.
• Exclusion Hits: Owners or managing employees appearing on the LEIE or SAM exclusion lists.

11. Key Contacts and Resources

Prospective providers should utilize the state's official portals for forms, manuals, and enrollment.

The Regional Human Service Centers are the first point of contact for new service proposals.

• ND DHHS Developmental Disabilities Section: https://www.hhs.nd.gov/human-services/developmental-disabilities
• ND Health Enterprise MMIS Portal: https://mmis.nd.gov
• ND State Forms (SFN) Repository: https://www.nd.gov/eforms
• ND Medicaid Provider Enrollment: https://www.hhs.nd.gov/healthcare/medicaid/provider/enrollment-information

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