North Dakota - Personal Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

North Dakota funds in-home bathing, dressing, and transferring assistance through the Medicaid State Plan Personal Care Services (MSP-PC) and the HCBS Waiver, requiring agencies and individuals to enroll as Qualified Service Providers (QSPs) through the Department of Health and Human Services (HHS) Aging Services Division. North Dakota does not issue a traditional non-medical home care license; instead, the state uses the QSP authorization process as the sole regulatory gateway to operate and bill for these services.

Approval requires submitting a complete QSP application packet, passing fingerprint-based background checks, and demonstrating competency in specific care tasks before executing the Medicaid Program Provider Agreement (SFN 615). Agencies must also maintain a roster of cleared direct care workers and enroll via the ND Health Enterprise MMIS portal to receive reimbursement.

1. Service Definition and Scope

Personal Care Services in North Dakota encompass hands-on assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) for Medicaid-eligible individuals in their own homes.

These services are designed to prevent institutionalization by supporting individuals who require physical help or prompting to complete basic daily tasks safely.

• ADL Support: Hands-on assistance with bathing, dressing, toileting, transferring, and eating.
• IADL Support: Assistance with light housekeeping, laundry, and meal preparation when incidental to personal care.
• Service Location: Delivered exclusively in the member's private residence or community setting, not in licensed facilities.
• Excluded Tasks: Skilled nursing tasks, medication administration (unless specifically delegated), and sterile procedures are strictly prohibited under this service definition.

2. Regulatory and Oversight Agencies

The North Dakota Department of Health and Human Services (HHS) is the single state agency responsible for overseeing the QSP program, managing both the authorization of providers and the administration of Medicaid claims.

Unlike standard medical providers whose enrollment is contracted to Noridian, QSP enrollment is handled directly by internal HHS divisions.

• ND HHS Aging Services Division: Manages the Qualified Service Provider (QSP) authorization process and policy (https://www.hhs.nd.gov/aging).
• ND HHS Medical Services Division: Oversees Medicaid policy, waiver administration, and overall program compliance (https://www.hhs.nd.gov/healthcare).
• ND Health Enterprise MMIS: The official portal for Medicaid provider enrollment and claims submission (https://mmis.nd.gov/portals/wps/portal/ProviderEnrollment).

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota operates an open enrollment model for Qualified Service Providers. There is no Certificate of Need (CON), Request for Proposal (RFP) limitation, closed network, or county sponsorship required to apply for QSP status.

Any individual or agency that meets the baseline competency, background check, and insurance requirements may submit an application at any time.

• Certificate of Need: None exists for personal care or QSP services in North Dakota.
• Network Status: Open enrollment; there are no moratoria or closed managed care networks restricting new QSP applicants.
• Entity Formation: Agency applicants must be registered and in good standing with the North Dakota Secretary of State.
• NPI Requirement: Applicants must obtain a National Provider Identifier (NPI) prior to initiating the QSP application.

4. Licensure and Certification Requirements

Because North Dakota does not have a separate home care license category for non-medical personal care, the QSP certification serves as the operational authority.

Agencies must submit a comprehensive application packet to the Aging Services Division demonstrating that all administrative and direct care staff meet state standards.

• Application Form: Submission of the Qualified Service Provider Application (SFN 1603).
• Competency Documentation: Proof that direct care workers have been evaluated and deemed competent in specific ADL tasks.
• Liability Insurance: Agencies must maintain and provide proof of general liability insurance.
• CPR/First Aid: Required certification for staff providing direct care services.

5. Medicaid Provider Enrollment

QSP enrollment is managed directly by HHS, bypassing the Noridian contractor used for standard medical providers. Providers must apply electronically on the ND Health Enterprise MMIS portal.

The enrollment process links the authorized QSP status with the state's payment system, requiring detailed ownership disclosures and provider agreements.

• Enrollment Portal: Applications must be submitted via the ND Health Enterprise MMIS portal.
• Provider Agreement: Completion and signature of the Medicaid Program Provider Agreement (SFN 615).
• Ownership Disclosure: Submission of the Ownership and Control Interest Disclosure (SFN 1168) for any person with 5% or more interest.
• Revalidation: QSPs must revalidate their Medicaid enrollment every five years to maintain active billing status.

6. Staffing, Training and Background Checks

Direct care workers must prove competency in the specific tasks they will perform before delivering services. Agencies are responsible for maintaining these records.

North Dakota requires strict background screening for anyone with direct access to vulnerable adults.

• Background Checks: Fingerprint-based state and national criminal history record checks are required for all direct care staff.
• Competency Verification: Agencies must use state-approved checklists to verify staff can safely perform bathing, transferring, and other ADLs.
• Abuse/Neglect Training: Mandatory training on identifying and reporting abuse, neglect, and exploitation of vulnerable adults.
• Staff Roster: Agencies must maintain an up-to-date roster of cleared and competent staff available for state review.

7. Documentation, Policies and Records

QSPs must maintain detailed service records that perfectly match the client's state-authorized care plan. Deviations from the care plan without prior approval result in recouped funds.

Agencies must implement policies covering incident reporting, emergency preparedness, and client rights.

• Care Plan Adherence: Services must be delivered exactly as outlined in the client's HHS-approved care plan.
• Timesheets: Detailed daily records indicating the specific tasks performed, start/stop times, and client signatures.
• Incident Reporting: Critical incidents must be reported to the HHS Aging Services Division within 24 hours.
• Record Retention: All service and billing records must be retained for a minimum of five years.

8. Billing, Rates and Claims

Claims are submitted through the ND Health Enterprise MMIS portal based on 15-minute increments. Services must be prior-authorized by a state case manager.

North Dakota mandates the use of Electronic Visit Verification (EVV) for all personal care services to capture the exact time and location of service delivery.

• Billing System: Claims are processed through the ND Health Enterprise MMIS.
• Procedure Codes: Personal care is typically billed using HCPCS code T1019 (15-minute increments).
• Prior Authorization: No claims will be paid without an active service authorization generated by the client's case manager.
• EVV Mandate: Providers must use the state-sponsored EVV system or a compliant alternate system to record all visits.

9. Approval Sequence and Timeline

The process moves sequentially from entity setup to QSP application, followed by MMIS enrollment. Providers cannot bill for services provided prior to the official enrollment effective date.

The entire process typically takes 60 to 90 days, heavily dependent on the speed of background check processing.

• Step 1: Entity formation and obtaining an NPI.
• Step 2: Submission of the QSP Application (SFN 1603) and competency documentation to Aging Services.
• Step 3: Completion of fingerprint-based background checks for all applicable staff.
• Step 4: Submission of the electronic enrollment application via the MMIS portal (SFN 615 and SFN 1168).

10. Common Denials and Survey Findings

Applications are frequently delayed due to incomplete competency documentation or background check issues. Operating agencies often face recoupments during audits for documentation failures.

Strict adherence to the authorized care plan and EVV requirements is the primary focus of state compliance reviews.

• Missing Signatures: Failure to obtain required signatures on the SFN 615 or SFN 1168 forms.
• Failed Background Checks: Disqualifying criminal convictions for direct care staff.
• EVV Non-compliance: Billing for services without corresponding, compliant EVV data.
• Unauthorized Tasks: Performing and billing for tasks not explicitly listed on the client's authorized care plan.

11. Key Contacts and Resources

Applicants should rely on the official North Dakota HHS portals for the most current forms, manuals, and policy updates.

The Provider Enrollment help desk is available for technical assistance with the MMIS portal.

• ND HHS QSP Information: Official guidelines and forms (https://www.hhs.nd.gov/aging).
• ND MMIS Provider Portal: Enrollment and claims system (https://mmis.nd.gov/portals/wps/portal/ProviderEnrollment).
• Provider Enrollment Help Desk: (877) 328-7098 for assistance with MMIS applications.
• ND Medicaid Provider Policies: Current manuals and fee schedules (https://www.hhs.nd.gov/healthcare/medicaid/provider).

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