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North Dakota - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The North Dakota Department of Health and Human Services (HHS) Developmental Disabilities Section licenses and oversees the Traditional IID/DD HCBS Waiver, which funds residential, day, and family support services. Prospective agencies must first secure a provisional license under North Dakota Administrative Code (NDAC) 75-04-01 by submitting a comprehensive policy and procedure packet to the DD Section before any Medicaid enrollment application is accepted.

Approved providers deliver services ranging from Day Habilitation to Residential Habilitation and Supported Living. The state utilizes the Health Enterprise MMIS for claims processing and mandates the use of specific state-approved electronic health record systems for incident reporting and service documentation.

1. Service Definition and Scope

North Dakota's Traditional IID/DD HCBS Waiver provides community alternatives to institutional placement for individuals with intellectual disabilities and related conditions. Services are accessed through the state's eight regional human service centers.

The waiver covers a comprehensive array of services designed to support individuals in their homes and communities, focusing on skill acquisition, retention, and health and safety.

2. Regulatory and Oversight Agencies

The North Dakota Department of Health and Human Services operates as the single state Medicaid agency. The Medical Services Division handles Medicaid rules, while the Developmental Disabilities Section manages daily waiver operations.

Regional Human Service Centers act as the local access points for participants, managing eligibility and service planning.

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota does not currently utilize a closed network, competitive procurement (RFP), or Certificate of Need for standard I/DD waiver services. However, an agency cannot enroll in Medicaid until it successfully obtains a provisional license from the DD Section.

Prospective providers must build their agency to meet the state's licensure standards and submit their application directly to the DD Section for review.

4. Licensure and Certification Requirements

Providers must comply with NDAC 75-04-01, which governs the licensure of providers of services to eligible individuals with developmental disabilities. The initial application requires a comprehensive review of the agency's operational policies.

Once the policy review is approved, the state issues a provisional license, allowing the provider to enroll in Medicaid and begin serving participants.

5. Medicaid Provider Enrollment

After obtaining a provisional DD license, agencies must enroll as a North Dakota Medicaid provider through the Health Enterprise MMIS portal.

Providers must ensure their National Provider Identifier (NPI) matches their service locations and taxonomy codes.

6. Staffing, Training and Background Checks

Direct support professionals (DSPs) must meet age and background requirements before providing care. North Dakota mandates specific developmental disabilities training modules.

Agencies are responsible for maintaining training records and ensuring all background checks are cleared prior to direct participant contact.

7. Documentation, Policies and Records

Providers must maintain detailed service records that align with the participant's person-centered service plan. North Dakota utilizes Therap Services as the state-contracted electronic system for DD providers.

Incident reporting protocols must strictly follow state definitions for abuse, neglect, and exploitation.

8. Billing, Rates and Claims

Claims are submitted electronically to the ND MMIS. Rates for the Traditional IID/DD HCBS Waiver are established by the ND HHS Medical Services Division.

Services must be prior-authorized in the system based on the participant's approved service plan before claims will pay.

9. Approval Sequence and Timeline

The process begins with the licensure application to the DD Section, followed by Medicaid enrollment. The entire sequence typically takes several months depending on policy review times.

Providers cannot bill for services provided prior to the effective date of their Medicaid enrollment.

10. Common Denials and Survey Findings

Applications and surveys are frequently delayed or denied due to incomplete policy submissions or failure to adhere to background check timelines.

During on-site surveys, state reviewers focus heavily on documentation accuracy and staff training compliance.

11. Key Contacts and Resources

Primary contacts for prospective I/DD providers include the DD Section for licensure and the Medical Services Division for enrollment.

Providers should regularly check the ND HHS website for policy updates and provider bulletins.

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