North Dakota - Residential Care Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

North Dakota Health and Human Services (ND HHS) authorizes Residential Habilitation under the Medicaid Waiver for Home and Community Services and the traditional Developmental Disabilities (DD) waiver. Agencies seeking to provide this 24-hour service must first secure a Developmental Disabilities provider license under North Dakota Administrative Code (NDAC) 75-04-01 and subsequently enroll as an Agency Qualified Service Provider (QSP) under NDAC 75-03-23.

Approval requires strict adherence to state-mandated training protocols, including medication administration modules administered through Minot State University. Furthermore, client-specific pre-approval from the ND HHS Program Administrator is a mandatory gate before services can be authorized or billed for any individual Medicaid recipient.

1. Service Definition and Scope

In North Dakota, Residential Habilitation is defined as a service providing ongoing daily support, skills training, restoration, or maintenance for individuals eligible for the Medicaid Waiver for Home and Community Services.

The service encompasses 24-hour support, including assistance with activities of daily living, routine medication administration, and specific delegated medical tasks, ensuring the health and safety of the recipient in a community-based residential setting.

• Target Population: Individuals eligible for the Medicaid Waiver for Home and Community Services who require ongoing daily support.
• Service Scope: Includes skills training, restoration, maintenance, and direct assistance with daily living activities.
• Medical Tasks: Encompasses routine medication administration and specific medical tasks (e.g., TED socks, vitals) when delegated by a Registered Nurse.
• Sleep Staff: Overnight support may be authorized for individuals with intermittent nighttime needs who cannot be left alone.

2. Regulatory and Oversight Agencies

The North Dakota Department of Health and Human Services (ND HHS) serves as the primary regulatory and oversight body for Residential Habilitation services.

Within ND HHS, the Developmental Disabilities Section manages licensure, while the Medical Services Division oversees Medicaid provider enrollment and waiver administration.

• North Dakota Health and Human Services (ND HHS): https://www.hhs.nd.gov
• ND HHS Developmental Disabilities Section: https://www.hhs.nd.gov/human-services/developmental-disabilities
• ND HHS Medical Services Division: https://www.hhs.nd.gov/healthcare/medicaid
• ND HHS Provider Enrollment: https://www.hhs.nd.gov/healthcare/medicaid/provider

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota imposes strict structural prerequisites for Residential Habilitation providers. The service is restricted entirely to licensed agencies; individual practitioners cannot apply.

Before any service authorization is granted, the agency must secure client-specific pre-approval from the ND HHS Program Administrator.

• Entity Type Restriction: Service must be provided by an enrolled Medicaid Agency; individual Qualified Service Providers (QSPs) are explicitly ineligible.
• Licensure Prerequisite: Applicants must hold an active DD Provider License according to NDAC 75-04-01 before Medicaid enrollment.
• Client-Specific Pre-Approval: Pre-approval from the ND HHS Program Administrator is required before this service can be authorized for any specific recipient.
• Nursing Capacity: The agency must employ or contract with a licensed Registered Nurse (RN) to oversee medication administration and medical task delegation.

4. Licensure and Certification Requirements

Agencies must be licensed as Developmental Disabilities providers under North Dakota state law to offer Residential Habilitation.

This licensure ensures that the agency meets all structural, safety, and programmatic standards required to support vulnerable adults in 24-hour settings.

• Statutory Authority: Governed by North Dakota Century Code chapter 25-16.
• Regulatory Code: Licensed according to North Dakota Administrative Code (NDAC) 75-04-01.
• Agency QSP Enrollment: Must meet Agency Qualified Service Provider standards under NDAC 75-03-23.
• Facility Standards: Settings must comply with the federal HCBS Settings Final Rule ensuring privacy, integration, and tenant rights.

5. Medicaid Provider Enrollment

Following licensure, agencies must enroll as Medicaid providers through the North Dakota Health Enterprise MMIS.

Providers must register as an Agency Qualified Service Provider (QSP) and execute a formal Medicaid Provider Agreement with ND HHS.

• Provider Type: Must enroll specifically as an Agency Qualified Service Provider (QSP).
• NPI Requirement: Must obtain a Type 2 National Provider Identifier (NPI) and a Federal Employer Identification Number (EIN).
• Application Portal: Enrollment is processed through the North Dakota Health Enterprise MMIS Provider Enrollment portal.
• Provider Agreement: Requires a signed North Dakota Medicaid Provider Agreement and mandatory disclosure forms.

6. Staffing, Training and Background Checks

North Dakota mandates rigorous, specific training for all direct contact staff providing Residential Habilitation, heavily emphasizing medication safety and specialized care.

Agencies must designate a Program Coordinator to oversee staff competency and program implementation.

• Program Coordinator: Agency must name a Program Coordinator responsible for in-service training and individual program implementation.
• TBI and Dementia Training: Must be completed within 30 days of providing care and renewed every 2 years.
• Medication Administration: Staff must complete Minot State University medication modules and pass the test with a score of 85% or higher.
• Medication Practicum: Must be administered by an agency RN once yearly and as needed for specific tasks.
• Cohabitation Restriction: Residential Habilitation providers or staff are prohibited from living with the care recipient.

7. Documentation, Policies and Records

Providers must maintain detailed, person-centered documentation that aligns with the recipient's authorized care plan.

Medical task delegation requires specific state forms and documented RN oversight.

• Individualized Program Plan (IPP): Must be developed by the Program Coordinator within the first 30 days of service provision.
• IPP Review Cycle: The IPP must be forwarded to the case manager and reviewed/approved by the state program administrator every 6 months.
• Medical Task Delegation Form: Evidence of training of QSP agency staff by the RN must be documented using State Form Number (SFN) 585.
• Agency Policies: Providers must submit agency policies specific to any medical tasks being completed by direct support staff.

8. Billing, Rates and Claims

Reimbursement for Residential Habilitation is tiered based on the level of support required, distinguishing between active 24-hour support and overnight sleep staff.

Federal rules strictly prohibit billing Medicaid for room and board expenses.

• Maximum Rate: When an individual requires 24-hour support and two caregivers, the maximum rate authorized is the 24-hour support rate.
• Sleep Staff Rate: Authorized up to eight hours per night at 75% of the hourly Community Support Services rate.
• Room and Board Exclusion: Federal Medicaid funds cannot cover room and board; these costs must be collected separately via lease agreements.
• Claim System: Claims are submitted electronically through the North Dakota Health Enterprise MMIS.

9. Approval Sequence and Timeline

Becoming a provider is a sequential process starting with corporate registration and culminating in client-specific service authorization.

Agencies cannot bill for services until all licensure, enrollment, and pre-approval steps are fully executed.

• Step 1: Register the business entity with the North Dakota Secretary of State.
• Step 2: Apply for and secure DD Provider Licensure under NDAC 75-04-01 through ND HHS.
• Step 3: Complete Agency QSP enrollment through the ND Medicaid provider portal.
• Step 4: Secure client-specific pre-approval from the HCBS Program Administrator prior to initiating billable services.

10. Common Denials and Survey Findings

Regulatory surveys frequently cite agencies for failing to meet strict training timelines or documentation deadlines.

Medication administration errors and unauthorized care arrangements are primary drivers of compliance actions.

• Training Delays: Failure to complete mandatory TBI and dementia training within the strict 30-day window of hire.
• Medication Errors: Staff administering medications without a documented 85% passing score on Minot State University modules or missing the annual RN practicum.
• IPP Non-Compliance: Failure to develop the Individualized Program Plan within 30 days or missing the required 6-month review cycle.
• Unauthorized Relatives: Relatives providing care without documented pre-approval from the HCBS Program Administrator.

11. Key Contacts and Resources

Providers must utilize official state resources for policy manuals, training modules, and enrollment portals.

The following links provide direct access to North Dakota's regulatory and training infrastructure.

• North Dakota Health and Human Services: https://www.hhs.nd.gov
• ND HHS Medicaid Waivers Page: https://www.hhs.nd.gov/healthcare/medicaid/medicaid-waivers
• ND HHS Provider Enrollment: https://www.hhs.nd.gov/healthcare/medicaid/provider
• Minot State University NDCPD (Medication Training): https://www.ndcpd.org

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