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

Last reviewed: 2026-08-16

In North Dakota, Integrated Employment—commonly referred to as Supported Employment—is a critical service funded primarily through the state's 1915(c) Traditional Individuals with Intellectual and Developmental Disabilities (ID/DD) Waiver and the 1915(i) State Plan Amendment. The service encompasses job development, job placement, and on-site job coaching designed to help individuals with disabilities secure and maintain competitive work in integrated community settings at or above minimum wage.

The single biggest structural barrier to entry for prospective Supported Employment providers in North Dakota is the state's strict licensure and accreditation gate. North Dakota does not issue a standalone "Supported Employment" license; instead, an agency must either achieve full licensure as a Developmental Disabilities provider under North Dakota Administrative Code (NDAC) 75-04-01 or obtain and maintain national accreditation (such as from CQL or CARF) before the North Dakota Department of Health and Human Services (ND HHS) will even accept a Medicaid provider enrollment application for this service.

1. Service Definition and Scope

Supported Employment in North Dakota is defined as individualized services that assist participants in obtaining and maintaining competitive integrated employment. This means work performed on a full-time or part-time basis in the general workforce, for which the individual is compensated at or above the state's minimum wage, and not less than the customary rate paid by the employer for the same or similar work performed by individuals without disabilities.

The scope of the service covers the entire employment lifecycle, from initial career exploration to long-term job retention. Providers are expected to fade their direct support over time as the participant gains independence and natural supports in the workplace.

• Job Development: Identifying potential job opportunities, contacting employers, and matching participant skills with community business needs.
• Job Coaching: Providing direct, on-the-job training and support to help the participant learn job tasks and workplace etiquette.
• Career Planning: Creating individualized employment plans with achievable goals based on vocational assessments.
• Workplace Accommodation: Assisting employers and participants with adaptive tools, environmental modifications, and task restructuring.
• Follow-Along Support: Ongoing, intermittent assistance provided after the participant is stabilized in their job to ensure long-term employment retention.

2. Regulatory and Oversight Agencies

The North Dakota Department of Health and Human Services (ND HHS) is the umbrella agency responsible for Medicaid and HCBS waiver administration. Within ND HHS, specific divisions handle the programmatic oversight, licensure, and claims processing for Supported Employment services.

Providers must interact with multiple divisions depending on the specific waiver (e.g., Developmental Disabilities vs. Behavioral Health) and the stage of their enrollment.

• Agency: ND HHS Medical Services Division (MSD) Role: Manages the state Medicaid program, oversees the MMIS portal, and handles final provider enrollment (https://www.hhs.nd.gov/healthcare/medicaid).
• Agency: ND HHS Developmental Disabilities (DD) Division Role: Administers the Traditional ID/DD Waiver, processes NDAC 75-04-01 licensure, and authorizes services (https://www.hhs.nd.gov/dd).
• Agency: ND HHS Behavioral Health Division Role: Administers the 1915(i) State Plan Amendment which also covers Supported Employment for eligible populations (https://www.hhs.nd.gov/behavioral-health).
• Agency: North Dakota Division of Vocational Rehabilitation (DVR) Role: Often the first payer for initial job placement services before long-term Medicaid HCBS waiver funding kicks in (https://www.hhs.nd.gov/vr).

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota operates an open enrollment model for Medicaid HCBS providers, meaning there are no Certificate of Need (CON) laws, closed networks, or Request for Proposal (RFP) procurement moratoriums blocking new entrants. However, strict structural prerequisites must be met before an application is accepted.

The most significant gatekeeping prerequisite is the requirement for overarching agency licensure or national accreditation. A provider cannot simply incorporate and immediately bill Medicaid for Supported Employment; they must first pass the state's DD licensure review or hold an approved national accreditation.

• Licensure/Accreditation Gate: Applicants must be licensed under NDAC 75-04-01 or hold current national accreditation (e.g., CQL, CARF) before applying for Medicaid enrollment.
• Business Registration: The entity must be formally registered and in good standing with the North Dakota Secretary of State.
• Federal Identifiers: The agency must obtain an Employer Identification Number (EIN) from the IRS and a Type 2 National Provider Identifier (NPI).
• Network Status: North Dakota utilizes a fee-for-service model for these waivers; there are no managed care plan contracting requirements or closed network moratoriums for this specific service.

4. Licensure and Certification Requirements

Because North Dakota does not have a distinct "Supported Employment Agency" license, providers typically fall under the regulatory framework of NDAC 75-04-01, which governs all providers of services to eligible individuals with developmental disabilities.

To obtain this licensure, agencies must submit a comprehensive application to the ND HHS Developmental Disabilities Division, demonstrating compliance with state health, safety, and administrative standards, as well as the federal HCBS Settings Rule.

• Rule Citation: NDAC 75-04-01 (Licensure of Providers of Services to Eligible Individuals with Developmental Disabilities).
• Application Submission: Initial licensure applications and policy manuals must be submitted directly to the ND HHS Developmental Disabilities Division.
• Policy Manual: Providers must develop and submit a Supported Employment Policy & Procedure Manual detailing vocational assessment, job coaching, and participant rights.
• Insurance Requirements: Applicants must maintain and provide proof of general liability and professional liability insurance.
• HCBS Settings Compliance: Providers must demonstrate that their services integrate participants into the broader community and do not isolate them, in strict adherence to the CMS HCBS Settings Rule.

5. Medicaid Provider Enrollment

Once licensure or accreditation is secured, the agency must formally enroll as a billing provider through the North Dakota Medicaid Management Information System (MMIS) Web Portal.

This step links the agency's NPI, licensure status, and banking information to the state's payment system, allowing the provider to receive a Provider Identification Number (PID) and bill for authorized services.

• System: North Dakota MMIS Web Portal (https://mmis.nd.gov/portals/wps/portal/ProviderEnrollment).
• Application Type: Providers must complete the online enrollment application specifically for HCBS Waiver Services or 1915(i) Supported Employment.
• Application Fee: Providers are subject to the federal Medicaid institutional application fee (approximately $709) unless they have already paid it to Medicare or another state's Medicaid program.
• Provider Agreement: The authorized official must sign the North Dakota Medicaid Provider Agreement, legally binding the agency to state and federal billing regulations.

6. Staffing, Training and Background Checks

North Dakota requires all direct support professionals (DSPs) and job coaches to meet minimum educational and background standards before they can work independently with waiver participants.

Agencies are responsible for maintaining personnel files that prove ongoing compliance with training mandates, particularly regarding person-centered planning and abuse/neglect reporting.

• Minimum Education: Job coaches and direct support staff must possess a high school diploma or GED.
• Background Checks: All staff must undergo fingerprint-based criminal background checks via the North Dakota Bureau of Criminal Investigation (BCI) and clear the state Child and Adult Abuse Registries.
• Core Training: Staff must demonstrate competency and complete training in person-centered planning and the specific employment goals of the individuals they support.
• Safety Certifications: CPR and First Aid certification are required for all direct care staff prior to independent client contact.
• Health Screenings: Agencies must ensure staff complete any required health screenings or immunizations as dictated by NDAC 75-04-01.

7. Documentation, Policies and Records

Thorough documentation is required to justify Medicaid billing and to pass routine audits conducted by the ND HHS Medical Services Division and the Developmental Disabilities Division.

Records must clearly link the daily activities of the job coach to the specific vocational goals outlined in the participant's person-centered care plan.

• Service Notes: Daily documentation must include the date, start and end times, duration of service, and specific employment goals addressed during the session.
• Person-Centered Plan Alignment: All billed activities must be explicitly authorized in and aligned with the participant's individualized care plan.
• Vocational Assessments: Agencies must maintain records of initial and ongoing job readiness evaluations and career planning procedures.
• Incident Reporting: Providers must have documented policies for, and records of, any critical incidents, injuries, or behavioral events occurring on the job site.
• Record Retention: North Dakota Medicaid requires all service and billing records to be securely retained for a minimum of six years.

8. Billing, Rates and Claims

Supported Employment services in North Dakota are reimbursed on a fee-for-service basis. Providers submit claims electronically through the ND MMIS Web Portal after services have been rendered and documented.

Services must be prior-authorized by the participant's DD Program Manager or HCBS Case Manager. Billing for unauthorized units will result in automatic claim denials.

• Billing System: All claims must be submitted electronically via the North Dakota MMIS Web Portal.
• Prior Authorization: Services cannot be billed unless they are prior-authorized in the MMIS system based on the participant's approved care plan.
• Billing Increments: Job coaching and follow-along supports are typically billed in 15-minute increments using standard HCPCS codes designated by ND Medicaid.
• Third-Party Liability: Providers must ensure that services are not concurrently funded by the Division of Vocational Rehabilitation (DVR) or the public school system (IDEA) before billing Medicaid.

9. Approval Sequence and Timeline

Becoming a Supported Employment provider in North Dakota is a multi-step process that can take several months, largely depending on whether the agency is pursuing national accreditation or state licensure.

Providers should not hire extensive direct care staff until the overarching agency licensure and MMIS enrollment are nearing completion, as Medicaid will not retroactively pay for services provided prior to the official enrollment date.

• Step 1: Register the business entity with the North Dakota Secretary of State and obtain an EIN and NPI (1-2 weeks).
• Step 2: Apply for and obtain national accreditation (e.g., CQL) or complete the NDAC 75-04-01 licensure process with the DD Division (6-12 months).
• Step 3: Submit the Provider Enrollment Application via the ND MMIS Web Portal, including all proof of licensure/accreditation and insurance (30-60 days).
• Step 4: Receive the Medicaid Provider Identification Number (PID) and begin accepting participant authorizations from DD Program Managers.

10. Common Denials and Survey Findings

Applications for Medicaid enrollment are frequently delayed or denied due to missing structural prerequisites, particularly the failure to secure the required licensure or accreditation beforehand.

During post-enrollment audits, the state frequently cites providers for documentation failures, which can lead to costly Medicaid clawbacks.

• Application Denial: Submitting the MMIS enrollment application before obtaining NDAC 75-04-01 licensure or national accreditation.
• Application Denial: Failure to complete required fingerprint-based background checks for all listed owners and managing employees during enrollment.
• Survey Finding: Service notes that are generic and fail to describe how the job coach specifically assisted the participant in meeting their person-centered employment goals.
• Survey Finding: Billing for job coaching time when the participant was not actually present or engaged in employment-related activities.

11. Key Contacts and Resources

Prospective providers should utilize the official state portals and contact the relevant ND HHS divisions directly for the most current applications, fee schedules, and policy manuals.

The ND MMIS Provider Enrollment unit and the Developmental Disabilities Division are the primary points of contact throughout the startup phase.

• Entity: ND HHS Provider Enrollment Unit Role: Handles MMIS portal issues and Medicaid enrollment status (Phone: 877-328-7098, URL: https://mmis.nd.gov/portals/wps/portal/ProviderEnrollment).
• Entity: ND HHS Developmental Disabilities Division Role: Oversees NDAC 75-04-01 licensure and waiver policy (Phone: 800-755-8529, URL: https://www.hhs.nd.gov/dd).
• Entity: North Dakota Secretary of State Role: Processes initial business registration and entity formalization (URL: https://sos.nd.gov).
• Entity: ND Medicaid Provider Manuals Role: Hosts the official billing guidelines and policy manuals for HCBS providers (URL: https://www.hhs.nd.gov/healthcare/medicaid/provider/manuals-and-guidelines).

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