North Dakota - Housing Stabilization — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In North Dakota, Housing Stabilization (tenancy support) is covered under the state's 1915(i) State Plan Amendment rather than a standalone waiver program. The service assists eligible Medicaid members with housing searches, application assistance, landlord mediation, and retention planning to help them secure and maintain independent living in the community [Table of Contents State/Territory Name: North Dakota State Plan Amendment (SPA) #: 2 3-0007 This file contains the following documents](https://www.medicaid.gov/medicaid/spa/downloads/ND-23-0007.pdf).

The single biggest structural barrier to entry is that North Dakota does not issue a distinct 'Housing Stabilization License.' Instead, applicants must first meet the overarching qualifications to enroll as a 1915(i) Group Provider or an individual Qualified Service Provider (QSP) through the ND Health Enterprise MMIS portal [Housing Stabilization Provider in North Dakota](https://waivergroup.com/selection-start-new-program/north-dakota/housing-stabilization). There is no shortcut to providing housing services; entities must clear the state's comprehensive Medicaid enrollment hurdles for 1915(i) providers before they can bill for tenancy supports.

1. Service Definition and Scope

Under North Dakota's 1915(i) State Plan Amendment, Housing Support (Stabilization) is defined as tenancy support services that assist individuals in successfully residing in their own homes. This includes direct assistance with housing searches, completing rental applications, understanding tenant rights, and mediating disputes with landlords.

The service is strictly administrative and supportive in nature. It does not cover direct financial assistance for room and board, rent payments, or security deposits, which must be funded through other community resources or the member's own income.

• Authority: 1915(i) State Plan Amendment (SPA) for Home and Community-Based Services.
• Service Name: Housing Support / Tenancy Support.
• Covered Activities: Housing search, application assistance, tenant rights education, and landlord mediation.
• Exclusions: Direct payment of rent, security deposits, utility bills, or room and board costs.
• Delivery Setting: Provided in the community or the individual's home, subject to HCBS Settings Rule compliance.

2. Regulatory and Oversight Agencies

The North Dakota Department of Health and Human Services (ND HHS) is the primary umbrella agency responsible for Medicaid and HCBS programs. Within ND HHS, the Medical Services Division manages provider enrollment, the MMIS portal, and claims processing [ND Medicaid Provider Information | Health and Human Services North Dakota](http://hhs.nd.gov/healthcare/medicaid/provider).

Quality assurance, compliance, and provider integrity are also managed internally by ND HHS. Because there is no specific facility license for this service, oversight is conducted through Medicaid provider enrollment revalidation and routine HCBS compliance audits.

• Primary Agency: North Dakota Department of Health and Human Services (ND HHS).
• Operating Division: Medical Services Division (manages Medicaid enrollment and the MMIS portal).
• Program Authority: ND HHS 1915(i) Program Administration.
• Quality Oversight: ND HHS Compliance and Provider Integrity unit.
• Federal Oversight: Centers for Medicare & Medicaid Services (CMS) via the 1915(i) SPA approval.

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota does not utilize a competitive Request for Proposals (RFP), Certificate of Need (CON), or closed network moratorium for 1915(i) Housing Support providers. The network is currently open to any willing provider that meets the state's qualifications.

The primary structural gatekeeping requirement is that an applicant must be eligible to enroll as a 1915(i) Group Provider or an individual Qualified Service Provider (QSP) [Housing Stabilization Provider in North Dakota](https://waivergroup.com/selection-start-new-program/north-dakota/housing-stabilization). There are no mandatory managed care subcontracting requirements for this specific HCBS service, as North Dakota delivers most Medicaid services through a fee-for-service model [North Dakota Medicaid Provider Enrollment | Done For You](https://contractingproviders.com/services/medicaid-enrollment-assistance/north-dakota).

• Network Status: Open enrollment; no closed networks or moratoria currently in effect for 1915(i) providers.
• Certificate of Need: Not required for non-residential HCBS tenancy support services in North Dakota.
• Base Designation: Must meet the qualifications to become a ND Medicaid Enrolled Provider under the 1915(i) or QSP taxonomy.
• Business Registration: Must be registered and in good standing with the North Dakota Secretary of State prior to application.
• Managed Care: No mandatory MCO affiliation required; services are primarily billed Fee-For-Service (FFS) directly to the state.

4. Licensure and Certification Requirements

North Dakota does not issue a specific facility or agency license for 'Housing Stabilization.' Instead, providers are certified through the Medicaid enrollment process by attesting to 1915(i) provider standards and HCBS Settings Rule compliance [Housing Stabilization Provider in North Dakota](https://waivergroup.com/selection-start-new-program/north-dakota/housing-stabilization).

Providers must undergo a site visit and review process to ensure compliance with the CMS HCBS Final Rule. This involves a Tier One site visit and the completion of the 1915(i) Initial HCBS Settings Review form by a Care Coordinator [Table of Contents State/Territory Name: North Dakota State Plan Amendment (SPA) #: 2 3-0007 This file contains the following documents](https://www.medicaid.gov/medicaid/spa/downloads/ND-23-0007.pdf).

• Specific License: None exists; approved entirely via 1915(i) provider enrollment and certification.
• HCBS Settings Rule: Must pass a Tier One site visit and complete the 1915(i) Initial HCBS Settings Review form.
• NPI Requirement: Must obtain a National Provider Identifier (NPI) prior to beginning the state application.
• Taxonomy: Must select the appropriate HCBS/Case Management or 1915(i) specific taxonomy codes during NPI registration.
• Self-Assessment: Must participate in the POC Attachment 1 - Self-Assessment initially and annually to ensure ongoing CMS HCBS Final Rule compliance.

5. Medicaid Provider Enrollment

Enrolling in North Dakota Medicaid is a mandatory four-step process conducted entirely online through the ND Health Enterprise MMIS portal [Medicaid Provider Enrollment | Health and Human Services North Dakota](https://www.hhs.nd.gov/healthcare/medicaid/provider/enrollment-information). Providers must first search the state's exclusion lists to confirm they do not already have an active enrollment.

Once verified, applicants submit their electronic application via the MMIS portal. Institutional and group providers may be subject to the federal Medicaid application fee unless they provide proof of payment to Medicare or another state's Medicaid program.

• System: ND Health Enterprise MMIS portal.
• Step 1: Search the ND HHS NPI/Taxonomy exclusion lists (Individual or Group) to confirm no current enrollment exists.
• Step 2: Submit the online application via the MMIS Web Portal Provider Enrollment link.
• Fee: Federal Medicaid application fee (approximately $709 for 2024) applies to group/agency providers unless waived.
• Revalidation: Required at least every 5 years per federal regulations (42 CFR 455.414).

6. Staffing, Training and Background Checks

Staff providing Housing Support must meet ND HHS qualifications for 1915(i) services. Because this service involves independent navigation and advocacy, staff are typically required to have experience in human services, case management, or housing navigation.

All direct care staff and agency owners must pass comprehensive background checks. North Dakota strictly enforces federal exclusion checks, requiring agencies to screen all employees against federal databases before hire and monthly thereafter.

• Background Checks: Fingerprint-based criminal background checks are required for all direct care staff and individuals with 5% or more ownership.
• Exclusions Check: Must screen staff monthly against the OIG List of Excluded Individuals/Entities (LEIE) and SAM.gov.
• Staff Qualifications: Typically requires a high school diploma/GED plus direct experience in human services, or a related degree (e.g., BSW).
• Training: Must complete ND HHS mandated 1915(i) provider training, including person-centered planning education.
• CPR/First Aid: Direct care staff must maintain current CPR and First Aid certifications.

7. Documentation, Policies and Records

Providers must maintain strict documentation that aligns directly with the member's Person-Centered Plan of Care (POC). ND HHS requires that every billed unit of housing stabilization is supported by a service note detailing the specific tenancy support activity performed.

Agencies must also maintain comprehensive internal policies that protect member rights, ensure HIPAA compliance, and outline grievance procedures. Records must be retained and made available for state or federal audits upon request.

• Person-Centered Plan: Services must be explicitly authorized in the member's ND HHS approved Plan of Care (POC) prior to delivery.
• Service Notes: Must document the date, exact start and stop times, specific housing support activities performed, and the member's response.
• Record Retention: Medicaid records must be retained for a minimum of 6 years (or longer if under active audit).
• Required Policies: Must maintain written policies on grievance procedures, incident reporting, and HIPAA compliance.
• Incident Reporting: Critical incidents must be reported to ND HHS within state-mandated timeframes (typically 24 hours).

8. Billing, Rates and Claims

Claims for 1915(i) Housing Support are submitted electronically through the ND Health Enterprise MMIS portal. Services are billed on a fee-for-service (FFS) basis using specific HCPCS codes designated by ND Medicaid [North Dakota Medicaid Provider Enrollment | Done For You](https://contractingproviders.com/services/medicaid-enrollment-assistance/north-dakota).

To receive payments and Electronic Remittance Advice (ERA), providers must register for the Medical Services Web File Transfer system. This secure environment requires a State of North Dakota Login ID and Authorization [ND Medicaid Provider Information | Health and Human Services North Dakota](http://hhs.nd.gov/healthcare/medicaid/provider).

• Billing Portal: ND Health Enterprise MMIS Web Portal.
• Method: Fee-for-service (FFS) billing directly to ND Medicaid.
• Codes: Billed using state-designated HCPCS codes for 1915(i) Housing Support (e.g., H0043 or state-specific modifier).
• Electronic Remittance: Must register for the Medical Services Web File Transfer system to receive ERAs.
• Timely Filing: Claims must generally be submitted within 12 months of the date of service to ensure payment.

9. Approval Sequence and Timeline

The end-to-end approval process begins with obtaining an NPI and registering the business entity with the North Dakota Secretary of State. Once these prerequisites are met, the provider submits the application through the ND Health Enterprise MMIS portal.

Processing times vary based on ND HHS volume and the completeness of the application. Generally, the Medicaid enrollment process takes 60 to 90 days from the date of a complete submission [North Dakota Medicaid Provider Enrollment | Done For You](https://contractingproviders.com/services/medicaid-enrollment-assistance/north-dakota).

• Phase 1: Obtain NPI and register business with the ND Secretary of State (1-2 weeks).
• Phase 2: Complete the Tier One site visit and 1915(i) Initial HCBS Settings Review form with a Care Coordinator.
• Phase 3: Submit the ND Health Enterprise MMIS portal application and pay applicable fees.
• Phase 4: ND HHS Medical Services Division review and background check processing (typically 60 to 90 days).
• Phase 5: Receipt of Welcome Letter and MMIS billing credentials, allowing service delivery to begin.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete MMIS portal entries or a failure to match the legal business name exactly across the IRS W-9, NPI registry, and state application. Missing background check fingerprint cards are another common cause for delay.

Post-enrollment, providers often face recoupments during ND HHS audits if their daily service notes do not match the authorized Person-Centered Plan. Failing to document exact start and stop times is a frequent survey citation.

• Application Denial: Mismatched legal business name between IRS W-9, NPI registry, and MMIS application.
• Application Delay: Failure to submit required background check fingerprint cards or pay the federal application fee.
• Audit Finding: Billing for housing support activities not explicitly authorized in the member's Plan of Care.
• Audit Finding: Missing exact start and stop times on daily service documentation.
• Audit Finding: Failure to conduct and document monthly OIG LEIE exclusion checks for all staff.

11. Key Contacts and Resources

Prospective providers should utilize the ND HHS website and the MMIS portal for the most current manuals, fee schedules, and enrollment guides. The Medical Services Division provides direct support for enrollment inquiries and portal navigation.

Providers must regularly check the ND Medicaid Provider Guidelines, Manuals and Policies webpage to stay updated on 1915(i) program changes and billing requirements [Medicaid Provider Enrollment | Health and Human Services North Dakota](https://www.hhs.nd.gov/healthcare/medicaid/provider/enrollment-information).

• Primary Agency: North Dakota Department of Health and Human Services (ND HHS) - Medical Services Division.
• Enrollment Portal: ND Health Enterprise MMIS Web Portal.
• Provider Guidelines: ND Medicaid Provider Guidelines, Manuals and Policies webpage.
• Support: ND HHS Provider Enrollment help desk (contact info available via the MMIS portal).
• Settings Rule Info: ND Approved Statewide Transition Plan documentation for HCBS compliance.

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