North Dakota - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

North Dakota Medicaid covers home health services exclusively when delivered by agencies that are already certified to participate in the Medicare program and licensed by the North Dakota Department of Health and Human Services (HHS). The service delivers intermittent skilled nursing, home health aide support, and physical, occupational, or speech therapy to members requiring part-time care under a physician's order.

Approval to bill the North Dakota Medicaid Management Information System (MMIS) requires an active state home health agency license and a completed SFN 615 Medicaid Provider Agreement. Agencies must secure Medicare certification before the state will process the Medicaid enrollment application for this provider type.

1. Service Definition and Scope

In North Dakota, home health services consist of part-time or intermittent skilled nursing care, home health aide services, and licensed therapies. Services must be ordered by a licensed physician and delivered under a written plan of care.

The state defines these services strictly within the bounds of the North Dakota Nurse Practice Act and Medicaid policy manuals, ensuring care is medically necessary and properly supervised.

• Skilled Nursing: Defined under the North Dakota Nurse Practice Act (N.D.C.C. § 43-12.1) and provided by an RN or LPN under RN supervision.
• Therapy Services: Physical, occupational, and speech therapy provided by licensed therapists.
• Visit Limits: Capped at 50 visits per member per calendar year without prior authorization.
• Extended Hours: Requires prior authorization through Acentra using the Private Duty Nursing support tool.

2. Regulatory and Oversight Agencies

Multiple divisions within the North Dakota Department of Health and Human Services oversee home health agencies, handling everything from facility licensure to Medicaid enrollment and claims processing.

• North Dakota HHS Regulation, Licensure and Certification: Issues state home health agency licenses (https://www.hhs.nd.gov/health/regulation-licensure-and-certification).
• North Dakota Medicaid Medical Services Division: Manages provider enrollment and policy (https://www.hhs.nd.gov/).
• ND MMIS Web Portal: Processes provider enrollment applications and claims (https://mmis.nd.gov).
• Acentra: Contracts with ND Medicaid to process service authorizations for extended home health visits (https://acentra.com).

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota imposes a strict federal certification prerequisite before an agency can enroll as a Medicaid home health provider. An agency cannot simply obtain a state license and immediately bill Medicaid.

• Medicare Certification: Agencies must be certified to participate in the Medicare program before ND Medicaid will approve enrollment.
• State Licensure: An active North Dakota Home Health Agency license is required prior to Medicaid enrollment.
• NPI Requirement: The agency must possess an active organizational National Provider Identifier (NPI).
• Exclusion Checks: Owners and managing employees must be free of exclusions on the LEIE and SAM databases.

4. Licensure and Certification Requirements

The North Dakota HHS Health Facilities unit evaluates agencies against state minimum standards for home health licensure. Agencies must demonstrate clinical competence and administrative oversight.

• Core Service Requirement: The agency must provide skilled nursing and at least one other therapeutic service directly or under arrangement.
• Administrator: Must designate a qualified administrator to oversee day-to-day operations.
• Clinical Supervision: Nursing services must be directed by a registered nurse.
• Medicare Survey: The agency must pass a federal certification survey to obtain Medicare deemed status.

5. Medicaid Provider Enrollment

Enrollment is processed through the ND MMIS Web Portal. Providers must agree to state terms and maintain active credentials to remain in the Medicaid network.

• Application Portal: Submitted electronically via the ND MMIS Web Portal.
• Provider Agreement: Requires signature on the ND Medicaid Provider Agreement (SFN 615).
• Revalidation Cycle: Home health agencies must revalidate their Medicaid enrollment every five years.
• Portal Registration: Upon approval, providers receive a 7-digit Medicaid ID via USPS to register for MMIS web access.

6. Staffing, Training and Background Checks

Staff must hold active North Dakota licenses for their respective disciplines and practice within their legal scope. Unlicensed personnel must operate under strict supervision.

• Registered Nurses: Must hold an active ND license and supervise LPNs and home health aides.
• Therapists: Physical, occupational, and speech therapists must be fully licensed in North Dakota.
• Unlicensed Trainees: Health care trainees cannot enroll or bill ND Medicaid directly.
• Background Screening: Agencies must conduct criminal background checks on staff providing direct in-home care.

7. Documentation, Policies and Records

ND Medicaid requires strict adherence to documentation standards to support medical necessity and post-payment reviews. Failure to maintain records can result in payment clawbacks.

• Record Retention: Medical and financial records must be retained for at least 7 years after the last date a claim was paid or denied.
• Plan of Care: Must maintain a written, physician-ordered plan of care in the member's file.
• Clinical Communication: Rendering providers must document communication of clinical findings to the ordering provider.
• HIPAA Compliance: Providers must release records upon request to ND Medicaid for oversight under 45 C.F.R. § 164.512(d).

8. Billing, Rates and Claims

Claims are submitted to the ND MMIS using standard procedure codes. Providers must verify member eligibility and secure authorizations for extended care.

• Procedure Codes: Verified using the ND Medicaid Procedure Code Look-up Tool for current rates and ORP requirements.
• Eligibility Verification: Checked via the ND Medicaid MMIS Portal or Automated Voice Response System (1.877.328.7098).
• Supervising NPI: Limited license providers may bill under a supervising provider's NPI if not required to enroll independently.
• Medicare Primary: If Medicare is primary and covers the service, ND Medicaid prior authorization is not required.

9. Approval Sequence and Timeline

The pathway to becoming a billing provider requires sequential approvals from state and federal entities. Providers must complete each step before advancing to the next.

• Step 1: Obtain a North Dakota Home Health Agency license from HHS.
• Step 2: Complete the Medicare certification process and survey.
• Step 3: Submit the Medicaid enrollment application and SFN 615 via the MMIS portal.
• Step 4: Receive the 7-digit Medicaid ID by mail and register for MMIS web access.

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to missing prerequisites or documentation errors. Providers must ensure all federal and state requirements are met prior to submission.

• Missing Certification: Medicaid enrollment denied if the agency lacks Medicare certification.
• Visit Limit Exceedance: Claims denied if visits exceed the 50-visit annual cap without an Acentra prior authorization.
• Incomplete SFN 615: Enrollment rejected for missing signatures on the Provider Agreement.
• Poor Documentation: Post-payment review clawbacks due to failure to document clinical communication with the ordering physician.

11. Key Contacts and Resources

Providers should utilize official state portals and manuals for the most current regulations, rates, and enrollment instructions.

• ND Medicaid Provider Enrollment: 1-877-328-7098 (https://mmis.nd.gov).
• ND HHS Regulation, Licensure and Certification: 701-328-2310 (https://www.hhs.nd.gov/health/regulation-licensure-and-certification).
• ND Medicaid Policies: Home Health Services Manual (https://www.hhs.nd.gov/sites/www/files/documents/medicaid-policies/home-health.pdf).
• Acentra (Prior Authorizations): Manages extended visit requests (https://acentra.com).

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