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North Dakota - Integrated Employment — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

North Dakota Department of Health and Human Services (NDDHHS) funds Supported Employment and Individual Employment Support through the 1915(i) State Plan HCBS and the Traditional IID/DD Waiver. Approval to bill for these services requires an agency to first obtain either a Developmental Disabilities provider license under NDAC 75-04-01 or hold active national accreditation from CARF, COA, or CQL before submitting an enrollment application through the ND Health Enterprise MMIS Web Portal.

Individual employment specialists cannot enroll as independent standalone practitioners for this service. They must be employed by an approved 1915(i) or DD waiver Group Provider agency, which assumes responsibility for verifying that each staff member holds required credentials such as an Association of Community Rehabilitation Educators (ACRE) certificate or Certified Employment Support Professional (CESP) designation.

1. Service Definition and Scope

In North Dakota, Supported Employment provides intensive, ongoing supports that enable participants to secure and maintain paid employment in an integrated community setting at or above minimum wage. The service encompasses job development, job placement, and on-site job coaching tailored to the individual's vocational profile.

The service is designed to transition individuals away from facility-based day programs and into the competitive labor market, aligning with federal HCBS integration mandates.

2. Regulatory and Oversight Agencies

NDDHHS is the umbrella agency managing both the programmatic rules and the Medicaid financial infrastructure for HCBS. The Developmental Disabilities Section handles licensure and waiver operations, while the Medical Services Division oversees the MMIS portal and claims.

The North Dakota Secretary of State governs the corporate registration required before any agency can apply for Medicaid enrollment.

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota strictly limits direct Medicaid enrollment for Supported Employment to established group agencies; independent practitioners are structurally blocked from enrolling directly. There is no Certificate of Need or closed network moratorium, but the agency must secure either state DD licensure or national accreditation before the Medicaid application is accepted.

Agencies must also prove their corporate and employer standing at the state level before NDDHHS will process a Qualified Service Provider (QSP) application.

4. Licensure and Certification Requirements

Agencies opting for state licensure rather than national accreditation must apply through the NDDHHS Developmental Disabilities Section under NDAC 75-04-01. This process involves submitting operational policies, passing a programmatic review, and demonstrating compliance with the HCBS Settings Rule.

During the Medicaid enrollment phase, the agency must upload specific state forms to prove they have cleared this licensure or accreditation hurdle.

5. Medicaid Provider Enrollment

Once licensed or accredited, agencies enroll as a Qualified Service Provider (QSP) or 1915(i) Group Provider via the ND Health Enterprise MMIS Web Portal. The process requires establishing an ND Login, completing the online application, and signing the Medicaid Provider Agreement.

Providers must maintain their enrollment by responding to revalidation notices generated by the MMIS system.

6. Staffing, Training and Background Checks

NDDHHS requires specific baseline training for all QSP agency staff, plus specialized vocational certifications for those delivering Supported Employment. Supervisors must meet experience thresholds to oversee individual providers.

The agency is responsible for maintaining primary source verification of these credentials in the employee's personnel file.

7. Documentation, Policies and Records

Enrolled agencies must maintain comprehensive records that justify the billing of Supported Employment services. This includes individualized employment plans, daily contact notes, and proof of ongoing staff credentials.

State surveyors and Medicaid program integrity auditors will review these files to ensure services match the authorized person-centered plan.

8. Billing, Rates and Claims

Supported Employment is billed in 15-minute increments through the ND Health Enterprise MMIS portal. Rates are established by the NDDHHS Medical Services Division and published in the official fee schedules.

Providers must ensure they only bill for direct support time and not for periods where the individual is working independently without coaching.

9. Approval Sequence and Timeline

The critical path to approval begins with establishing the agency entity and securing either DD licensure or national accreditation, which is the longest phase. Only after the license or accreditation is in hand can the agency submit the Medicaid QSP/Group Provider enrollment.

Attempting to bypass the licensure/accreditation step will result in an immediate rejection of the MMIS application.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied at the Medicaid enrollment stage due to missing prerequisites, such as attempting to enroll without the required DD license or accreditation. During programmatic surveys, agencies often face citations for failing to maintain current staff certifications.

Strict adherence to the 6-month window for FWA training is a common administrative stumbling block for new applicants.

11. Key Contacts and Resources

Prospective Supported Employment providers should utilize the NDDHHS QSP Hub and the MMIS portal for enrollment guidance. The Developmental Disabilities Section is the primary contact for licensure inquiries.

The Secretary of State's portal is used for all initial corporate registrations and ongoing business standing verifications.

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