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

Last reviewed: 2026-09-10

The North Dakota Department of Health and Human Services (ND HHS) funds Transitional Assistance Services through its Medicaid 1915(c) Home and Community-Based Services (HCBS) waivers to cover one-time setup expenses and coordination for members leaving institutional care. This service reimburses providers for securing essential household furnishings, utility deposits, and moving expenses required to establish a private community residence.

Approval to bill for these transition services requires an applicant to first obtain designation as an approved Qualified Service Provider (QSP) through the ND HHS Aging Services Division before submitting an electronic enrollment application via the ND Health Enterprise MMIS portal. Applicants cannot enroll directly as a Transitional Assistance Services provider without first clearing the state's QSP agency certification process.

1. Service Definition and Scope

In North Dakota, Transitional Assistance Services provide critical financial and coordination support to Medicaid members transitioning from a nursing facility or intermediate care facility into a private community dwelling. The service is strictly limited to one-time, non-recurring expenses necessary to establish a basic household.

Providers act as coordinators and purchasers, securing approved items and services on behalf of the member. The state caps the total allowable expenditure per transition, and all purchases must be explicitly authorized in the member's person-centered care plan prior to procurement.

• Covered Expenses: Security deposits, utility setup fees, essential household furnishings, and moving expenses.
• Excluded Costs: Monthly rental payments, ongoing utility charges, recreational items, and food.
• Target Population: Medicaid members transitioning from institutional settings to community-based living under an approved HCBS waiver.
• Service Limits: Capped at a specific lifetime maximum dollar amount per member as defined in the current waiver appendix.
• Coordination Role: Providers must locate, arrange, and purchase the approved items, ensuring delivery to the member's new residence.
• Setting Requirements: The destination home must meet the CMS HCBS Settings Rule requirements for community integration.

2. Regulatory and Oversight Agencies

The North Dakota Department of Health and Human Services (ND HHS) is the single state agency responsible for overseeing Medicaid HCBS waivers and provider enrollment. Within ND HHS, specific divisions handle different aspects of the provider lifecycle.

The Aging Services Division manages the Qualified Service Provider (QSP) certification process, while the Medical Services Division handles the final Medicaid enrollment and claims processing through the state's MMIS.

• North Dakota Department of Health and Human Services (ND HHS): https://www.hhs.nd.gov
• ND HHS Medical Services Division: https://www.hhs.nd.gov/healthcare/medicaid
• ND HHS Aging Services Division: https://www.hhs.nd.gov/human-services/aging
• ND Health Enterprise MMIS Portal: https://mmis.nd.gov/
• ND HHS Provider Enrollment: https://www.hhs.nd.gov/healthcare/medicaid/provider/enrollment-information

3. Gatekeeping Prerequisites: Who Can Even Apply

North Dakota does not require a Certificate of Need (CON) or a competitive Request for Proposals (RFP) to provide Transitional Assistance Services. The state operates an open enrollment model for this service.

However, the absolute structural precondition is that an agency must first be approved as a Qualified Service Provider (QSP) by ND HHS. A standalone business cannot simply enroll in Medicaid to offer this service; it must meet the overarching QSP agency standards first.

• QSP Designation: Applicant must be an approved Qualified Service Provider (QSP) in good standing with ND HHS.
• Business Registration: Must be registered as a legal business entity with the North Dakota Secretary of State.
• NPI Requirement: Must possess an active National Provider Identifier (NPI) registered to the agency.
• Exclusions Check: Must not appear on the OIG List of Excluded Individuals/Entities (LEIE) or the System for Award Management (SAM).
• No CON Required: North Dakota does not require a Certificate of Need for HCBS transition services.
• Open Enrollment: There are no closed networks or moratoria currently blocking new QSP applications.

4. Licensure and Certification Requirements

North Dakota does not issue a distinct facility or operational license specifically for "Transitional Assistance Services." Instead, the state relies on the Qualified Service Provider (QSP) certification framework to vet agencies.

To achieve QSP status, agencies must submit a comprehensive application packet to the Aging Services Division, demonstrating compliance with state administrative rules regarding liability insurance, business practices, and staff qualifications.

• QSP Certification: Required in lieu of a specific service license to deliver HCBS in North Dakota.
• Liability Insurance: Must maintain general and professional liability insurance at levels specified by ND HHS.
• Provider Agreement: Must sign and adhere to the conditions of the Medicaid Program Provider Agreement (SFN 615).
• Out-of-State Providers: Must submit the Out of State/Out of Network Enrollment Clarification Form (SFN 509) if located more than 50 miles from the ND border.
• Policy Manuals: Must maintain written policies covering client rights, incident reporting, and emergency preparedness.

5. Medicaid Provider Enrollment

Enrolling as a North Dakota Medicaid provider is a four-step process that culminates in an electronic application via the ND Health Enterprise MMIS portal. Providers must first verify they are not already enrolled by checking the state's NPI exclusion lists.

Once the online application is submitted, providers must send required supporting documentation via email, fax, or mail to Noridian Healthcare Solutions, the state's fiscal agent. Processing does not begin until both the portal application and all documents are received.

• Pre-Enrollment Search: Providers must search the ND HHS NPI lists to confirm no current enrollment exists before applying.
• MMIS Portal: All applications must be submitted electronically through the ND Health Enterprise MMIS portal.
• Supporting Documents: Must be emailed to [email protected] or faxed to 701-433-5956.
• Effective Date: Can be requested up to 90 days prior to the receipt of a complete application packet, provided the NPI was active.
• Application Fee: Subject to the federal Medicaid institutional provider application fee unless waived by Medicare enrollment.
• Medicaid ID: Upon approval, providers receive a 7-digit Medicaid ID number used for portal registration and billing.

6. Staffing, Training and Background Checks

Agencies providing Transitional Assistance Services must ensure that all staff involved in coordinating or purchasing items meet the state's baseline qualifications for HCBS workers. Because this service is primarily administrative and logistical, clinical licensure is not required.

All personnel must pass comprehensive background checks before having any contact with Medicaid members or managing their transition funds.

• Background Checks: All staff must undergo state and federal criminal record checks and child/adult abuse registry clearances.
• Basic Training: Staff must hold current CPR and First Aid certifications.
• Coordinator Qualifications: Must possess a high school diploma or equivalent and demonstrate competency in community resource navigation.
• Supervision: Unlicensed staff must operate under the administrative supervision of the QSP agency director.
• Exclusion Verification: Agencies must check staff against the LEIE and SAM databases monthly.
• Training Records: Agencies must maintain documented proof of all staff training and background clearances in personnel files.

7. Documentation, Policies and Records

North Dakota Medicaid requires providers to maintain legible financial and service records that fully justify all claims billed for Transitional Assistance Services. Because this service involves purchasing goods, meticulous receipt tracking is mandatory.

Records must be retained for a minimum of five years and made available to ND HHS or federal auditors upon request.

• Record Retention: All medical and financial records must be retained for at least five years from the date of service.
• Expense Receipts: Original, itemized receipts for all purchased goods and deposits must be kept in the member's file.
• Transition Plan: The member's person-centered care plan authorizing the specific transition expenses must be on file.
• Delivery Verification: Documentation proving that purchased items were successfully delivered to the member's new residence.
• Incident Reporting: Agencies must have policies for reporting critical incidents to ND HHS within required timeframes.
• Financial Audits: Providers must maintain separate accounting ledgers for transition funds to prevent commingling with agency operating funds.

8. Billing, Rates and Claims

Transitional Assistance Services are billed to North Dakota Medicaid through the ND Health Enterprise MMIS portal using specific HCPCS procedure codes designated for HCBS waivers. Reimbursement is based on actual costs incurred, up to the authorized limit.

Providers cannot bill for services or items until they have been successfully delivered or secured for the member. Prior authorization is strictly required for all transition expenses.

• Prior Authorization: All transition expenses must be pre-approved in the member's care plan before purchase.
• Reimbursement Basis: Paid based on actual receipted costs, not a flat per-diem or hourly rate.
• Claim Format: Billed electronically using the professional claim format (837P) or via the MMIS direct data entry portal.
• Retroactive Billing: Future effective dates will not be approved for more than 60 days prior to a service being provided.
• Supervising Provider Billing: Services rendered by limited-license staff must be billed under the supervising provider's NPI where applicable.
• Timely Filing: Claims must generally be submitted within 12 months of the date of service.

9. Approval Sequence and Timeline

Becoming a Transitional Assistance Services provider requires sequential approvals. An agency must first complete the QSP certification process with the Aging Services Division before initiating the MMIS enrollment.

Once the QSP status is granted, the MMIS enrollment process typically takes several weeks, depending on the completeness of the application and the speed of background check returns.

• Step 1: Register the business entity with the North Dakota Secretary of State and obtain an NPI.
• Step 2: Submit the Qualified Service Provider (QSP) application packet to the ND HHS Aging Services Division.
• Step 3: Upon QSP approval, submit the electronic Medicaid enrollment application via the ND Health Enterprise MMIS portal.
• Step 4: Email or fax required supporting documents (e.g., SFN 615) to Noridian Healthcare Solutions.
• Step 5: Receive the 7-digit Medicaid ID and register for MMIS web portal access.
• Revalidation: Providers must revalidate their Medicaid enrollment at least once every five years.

10. Common Denials and Survey Findings

Applications for Medicaid enrollment are frequently delayed or denied due to administrative errors, such as failing to submit the required supporting documentation after completing the online MMIS application.

During audits, providers of Transitional Assistance Services most commonly face recoupments for failing to maintain itemized receipts or purchasing items that were not explicitly authorized in the member's care plan.

• Incomplete Applications: Failing to send the SFN 615 Provider Agreement to Noridian after submitting the portal application.
• Unapproved Purchases: Billing for items (like food or monthly rent) that are explicitly excluded from TAS coverage.
• Missing Receipts: Inability to produce original, itemized receipts for purchased household goods during an audit.
• Care Plan Mismatch: Purchasing items that were not pre-authorized in the member's person-centered care plan.
• Background Check Failures: Allowing staff to coordinate transitions before receiving cleared background checks.
• Lapsed QSP Status: Failing to maintain active QSP certification, resulting in immediate Medicaid billing suspension.

11. Key Contacts and Resources

Prospective providers should direct QSP certification questions to the ND HHS Aging Services Division and Medicaid enrollment questions to Noridian Healthcare Solutions, the state's fiscal agent.

The ND Health Enterprise MMIS portal is the central hub for both the electronic application and subsequent claims submission.

• ND HHS Provider Enrollment (Noridian): [email protected] or 701-433-5956 (Fax)
• ND Health Enterprise MMIS Portal: https://mmis.nd.gov/
• ND HHS Aging Services Division: https://www.hhs.nd.gov/human-services/aging
• ND HHS Medical Services Division: https://www.hhs.nd.gov/healthcare/medicaid
• Provider Enrollment Help Desk: (877) 328-7098 or (701) 328-7098
• North Dakota Secretary of State: https://sos.nd.gov/

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