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

Last reviewed: 2026-09-10

The North Dakota Department of Health and Human Services (NDDHHS) Developmental Disabilities Section licenses Prevocational Services under the state's 1915(c) Traditional ID/DD Waiver, while the Medical Services Division oversees Prevocational Training under the 1915(i) State Plan Amendment. These time-limited, community-based services prepare individuals for competitive integrated employment or volunteer work by developing general work readiness skills such as attendance, task completion, and workplace safety.

Approval requires submitting the North Dakota DD Provider Application (SFN 1794) to the DD Section to obtain a provisional license, followed by mandatory national accreditation within one year of issuance. Once licensed, agencies must complete a four-step Medicaid enrollment process through the ND Health Enterprise MMIS portal to receive a provider agreement and bill for authorized services.

1. Service Definition and Scope

In North Dakota, Prevocational Services (under the 1915(c) waiver) and Prevocational Training (under the 1915(i) SPA) are defined as time-limited, community-based services that prepare an individual for employment or volunteer work. The service focuses on teaching general work skills and concepts rather than specific job-task training.

The scope includes developing communication skills, workplace safety, mobility, and routine task completion. Services must be documented in the participant's Person-Centered Plan (PCP) and cannot duplicate services available through the Medicaid State Plan or Vocational Rehabilitation.

2. Regulatory and Oversight Agencies

The North Dakota Department of Health and Human Services (NDDHHS) serves as the single State Medicaid Agency. Within NDDHHS, the Medical Services Division maintains ultimate authority over Medicaid operations, while the Developmental Disabilities (DD) Section handles direct licensing and oversight for 1915(c) waiver providers.

Provider enrollment and claims processing are managed through the ND Health Enterprise MMIS portal, which serves as the central hub for all North Dakota Medicaid billing and revalidation activities.

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota does not require a Certificate of Need (CON), Request for Proposals (RFP) procurement, or closed-network managed care contracting to become a Prevocational Services provider. The state operates an open enrollment model for qualified agencies.

However, a strict structural prerequisite exists for 1915(c) DD waiver providers: applicants must secure a provisional DD license from the NDDHHS DD Section before Medicaid enrollment is permitted, and they are legally mandated to obtain national accreditation (e.g., from CQL or CARF) within one year of receiving that provisional license to continue operating.

4. Licensure and Certification Requirements

Agencies seeking to provide Prevocational Services under the DD waiver must comply with North Dakota Administrative Code (NDAC) 75-04-01. The process begins by requesting a New Provider Packet from the DD Section and submitting the North Dakota DD Provider Application (SFN 1794).

Upon successful review and site visit, NDDHHS issues a provisional license valid for up to one year. Once the provider achieves the required national accreditation, the state issues an unrestricted license, which must be renewed annually.

5. Medicaid Provider Enrollment

Enrolling as a North Dakota Medicaid provider is a four-step process conducted entirely online. Before applying, agencies must search the state's NPI exclusion lists and MMIS portal to ensure they do not already have an active enrollment profile.

Applications are submitted electronically through the ND Health Enterprise MMIS portal. Providers must sign a provider agreement attesting to compliance with all 1915(c) or 1915(i) waiver policies and complete mandatory revalidation every five years.

6. Staffing, Training and Background Checks

Agency providers are responsible for hiring, training, and supervising all staff delivering Prevocational Services. Staff must meet the specific competency requirements outlined in the approved 1915(c) or 1915(i) waiver appendices.

North Dakota requires comprehensive background checks for all direct support professionals. Agencies must also ensure staff complete training on participant rights, universal precautions, and the reporting of abuse, neglect, and exploitation.

7. Documentation, Policies and Records

Providers must maintain comprehensive administrative and clinical records in accordance with NDAC 75-04-01 and Medicaid standards. A formal confidentiality policy compliant with HIPAA is explicitly required and must be updated with the DD Section if changed.

Service delivery must be meticulously documented to align with the goals established in the participant's Person-Centered Plan (PCP). Agencies must also maintain written procedures for the use of restraints and incident reporting, making them available for NDDHHS review upon request.

8. Billing, Rates and Claims

Prevocational Services are billed to North Dakota Medicaid through the ND Health Enterprise MMIS portal. Services must be prior-authorized by the Developmental Disabilities Program Manager (DDPM) at the regional human service center before delivery begins.

Reimbursement rates are established by NDDHHS and published on the state's official fee schedules. Providers must ensure claims accurately reflect the time-limited nature of the service and do not overlap with school hours or other funded programs.

9. Approval Sequence and Timeline

The approval sequence begins with contacting the NDDHHS DD Section to request a New Provider Packet. The agency completes the checklist and submits SFN 1794 along with required policies and inspection reports.

If the application is complete, NDDHHS conducts a review and issues a provisional license. The agency then completes the four-step Medicaid enrollment via the MMIS portal. Finally, the agency has exactly one year from provisional licensure to secure national accreditation.

10. Common Denials and Survey Findings

Licensure applications are frequently delayed or withdrawn if the applicant fails to submit all required verifications within 30 days of receiving an incomplete notice from the DD Section. Strict adherence to application timelines is critical.

During surveys and revalidations, common citations include failure to secure or maintain national accreditation within the one-year provisional window, inadequate documentation linking daily activities to PCP employment goals, and lapsed staff background checks.

11. Key Contacts and Resources

Prospective providers should begin by contacting the NDDHHS Developmental Disabilities Section for licensing packets and the Medical Services Division for Medicaid enrollment inquiries. Regional Human Service Centers serve as the primary contact for participant authorizations.

All official forms, fee schedules, and provider manuals are hosted on the NDDHHS website and the ND Health Enterprise MMIS portal.

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