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

Last reviewed: 2026-08-16

Transitional Assistance Services in North Dakota are authorized under the state's 1915(c) Home and Community-Based Services (HCBS) Waiver. This service provides critical financial and logistical support, covering one-time set-up expenses such as security deposits, essential furnishings, and utility connections to help Medicaid beneficiaries move out of institutional settings like nursing facilities and into their own community homes.

The single biggest structural barrier to entry for this service in North Dakota is the requirement to obtain designation as a Qualified Service Provider (QSP) through the North Dakota Department of Health and Human Services (ND HHS) Aging Services Division prior to Medicaid enrollment. Without an approved QSP status specifically authorizing HCBS waiver services, an applicant is structurally blocked from accessing the ND Health Enterprise MMIS portal to enroll as a billing provider.

1. Service Definition and Scope

In North Dakota, Transitional Assistance Services are designed to eliminate the financial barriers that prevent Medicaid members from leaving institutional care. The service funds the concrete, one-time costs associated with establishing a basic household in the community.

This service is strictly limited to non-recurring expenses and coordination efforts. It does not cover ongoing living expenses, and all purchases must be directly tied to the individual's transition as outlined in their approved care plan.

• Covered Expenses: Security deposits, utility set-up fees, essential household furnishings, and moving expenses.
• Service Limits: Capped at a specific lifetime or per-transition dollar amount as defined in the individual's person-centered service plan.
• Target Population: Aged and physically disabled Medicaid beneficiaries transitioning from institutional care to independent community living.
• Excluded Costs: Monthly rental or mortgage payments, regular utility bills, food, and recreational items.
• Authorizing Authority: North Dakota 1915(c) Medicaid Waiver for Home and Community Based Services (0273.R06.00).

2. Regulatory and Oversight Agencies

The North Dakota Department of Health and Human Services (ND HHS) serves as the umbrella agency overseeing this service. Responsibilities are divided between divisions handling waiver policy and those handling Medicaid claims.

Local administration and case management are handled by regional offices, which play a critical role in authorizing the specific transition expenses for each beneficiary.

• Operating Agency: ND HHS Aging Services Division administers the HCBS waiver and approves Qualified Service Provider (QSP) status.
• Medicaid Agency: ND HHS Medical Services Division oversees the ND Health Enterprise MMIS and federal Medicaid compliance.
• Local Administration: Human Service Zones (formerly County Social Services) provide local case management and generate prior authorizations.
• Federal Oversight: Centers for Medicare and Medicaid Services (CMS) approves the 1915(c) waiver and provides federal matching funds.

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. There are no closed networks or moratoria currently in effect for this provider type.

However, the absolute structural precondition is that an applicant must first be approved as a Qualified Service Provider (QSP) by the ND HHS Aging Services Division. The Medicaid enrollment portal will summarily reject any application for HCBS billing if the applicant does not already hold an active QSP authorization for the specific waiver service.

• Structural Precondition: Must obtain Qualified Service Provider (QSP) status from ND HHS Aging Services Division before Medicaid MMIS enrollment.
• Certificate of Need (CON): Not required for HCBS Transitional Assistance Services in North Dakota.
• Network Status: Open enrollment; no current moratoria or closed network restrictions for QSPs.
• NPI Requirement: Must obtain a Type 1 (Individual) or Type 2 (Organization) National Provider Identifier (NPI) prior to application.
• Business Registration: Must be registered and in good standing with the North Dakota Secretary of State before applying for QSP status.

4. Licensure and Certification Requirements

North Dakota does not issue a distinct facility license for Transitional Assistance Services, as it is an administrative and purchasing service rather than a residential facility. Instead, providers must meet the certification standards outlined in the ND HHS Service Chapter 525-05.

Agencies and individuals must submit proof of business registration, liability insurance, and compliance with federal HCBS Settings Rules during the QSP certification process.

• Certification Authority: ND HHS Aging Services Division issues the required QSP certification.
• Regulatory Citation: ND HHS Policy Manual Service Chapter 525-05-45 (Standards for Qualified Service Providers).
• Insurance Requirements: Must maintain general liability insurance and provide a certificate of insurance during the QSP application.
• HCBS Settings Compliance: Must attest to compliance with the CMS HCBS Settings Rule, ensuring services integrate the individual into the community.
• Lease Documentation: Providers with provider-owned settings must submit their lease policy and lease template as part of the initial licensure/certification requirements.

5. Medicaid Provider Enrollment

Once QSP certification is obtained, providers must enroll electronically through the North Dakota Health Enterprise MMIS portal. The Medical Services Division processes these applications to issue a Medicaid provider number.

Providers must complete the required risk-based screening and ensure their taxonomy codes match the services authorized under their QSP certificate.

• Enrollment Portal: North Dakota Health Enterprise MMIS Web Portal.
• Application Fee: Subject to the CMS institutional provider application fee unless enrolled as an individual or the fee is waived/paid to another state.
• Risk Category: Typically categorized as Limited or Moderate risk, depending on the exact provider taxonomy and existing Medicare enrollments.
• Required Identifiers: Valid NPI and taxonomy code matching the Transitional Assistance service profile.
• Out-of-State Providers: Must complete the OOS Telehealth Attestation if providing remote coordination, though physical transition services require local presence.

6. Staffing, Training and Background Checks

All QSP staff providing direct services or handling waiver funds must pass comprehensive background checks and meet minimum competency standards. North Dakota strictly enforces exclusion list checks to protect vulnerable adults.

Training includes a mandatory new provider orientation covering federal HCBS rules, person-centered planning, and state-specific QSP responsibilities.

• Age Requirement: Direct service staff and QSP applicants must be at least 18 years of age.
• Background Checks: Fingerprint-based criminal background checks required for agency owners and direct care staff.
• Registry Checks: Mandatory screening against the ND Child Abuse and Neglect Registry and the National Sex Offender Registry.
• Exclusion Screening: Monthly checks against the OIG List of Excluded Individuals/Entities (LEIE) and SAM.gov (formerly EPLS).
• Mandatory Training: Completion of the ND HHS new provider orientation, covering HCBS settings rules and QSP standards.

7. Documentation, Policies and Records

QSPs must maintain rigorous documentation to justify the one-time transition expenses billed to the waiver. This includes retaining original receipts, lease agreements, and coordination logs.

All records must align perfectly with the participant's person-centered service plan developed by the HCBS Case Manager, proving that every dollar spent was pre-approved.

• Expense Receipts: Must retain original receipts for all purchased items (deposits, furniture, moving fees) for a minimum of five years.
• Service Plan Alignment: All expenditures must be explicitly authorized in the participant's person-centered service plan prior to purchase.
• Quality Review Form: Must participate in and retain copies of the Medicaid Waiver Quality review (State Form Number 1154).
• Policy Manual: Must maintain an agency policy manual detailing grievance procedures, critical incident reporting, and HIPAA compliance.
• Audit Readiness: Records must be made available upon request to ND HHS or the Office of Inspector General (OIG) for health and financial audits.

8. Billing, Rates and Claims

Transitional Assistance Services are billed on a fee-for-service (FFS) basis through the ND Health Enterprise MMIS. Because these are often one-time setup costs, billing requires strict prior authorization.

Reimbursement is limited to the actual cost of the approved items or services, up to the waiver's established cap, and providers cannot mark up the cost of purchased goods.

• Billing System: Claims are submitted electronically via the ND Health Enterprise MMIS portal.
• Prior Authorization: 100 percent of Transitional Assistance expenditures require prior authorization from the local Human Service Zone case manager.
• Reimbursement Model: Fee-for-service based on actual receipted costs, not a flat per-diem rate.
• Service Caps: Subject to strict lifetime or per-transition maximum dollar limits as defined in the 1915(c) waiver application.
• Claim Format: Billed using standard professional claims (CMS-1500 format/837P) with specific HCPCS codes designated for transition services.

9. Approval Sequence and Timeline

The end-to-end process from initial QSP application to active Medicaid billing status typically takes 60 to 90 days, depending on the completeness of the application and background check processing times.

Providers must sequence their applications correctly: business registration, followed by QSP certification, and finally MMIS enrollment.

• Step 1: Register business entity with the ND Secretary of State and obtain an NPI (1-2 weeks).
• Step 2: Submit QSP application and background check forms to ND HHS Aging Services Division (30-45 days).
• Step 3: Complete mandatory new provider orientation scheduled by ND HHS.
• Step 4: Submit Medicaid enrollment application via ND Health Enterprise MMIS portal (30-45 days).
• Step 5: Receive welcome letter and MMIS billing credentials from ND HHS Medical Services Division.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete background check forms or failure to provide required insurance certificates. During quality reviews, the most common finding is billing for unauthorized items.

The Office of Inspector General (OIG) and ND HHS actively audit HCBS providers for compliance with health, safety, and financial regulations, penalizing those who lack proper documentation.

• Missing Prior Authorization: Claims denied because the purchased items were not explicitly listed in the person-centered service plan.
• Unallowable Costs: Billing for prohibited items such as monthly rent, food, or entertainment electronics.
• Incomplete Background Checks: QSP application denial due to missing fingerprint cards or failure to clear the ND Child Abuse Registry.
• Lapsed Insurance: Suspension of QSP status for failing to maintain or provide proof of continuous general liability insurance.
• Documentation Deficiencies: Audit findings and recoupment for failing to retain original receipts for transition purchases.

11. Key Contacts and Resources

Providers should utilize the official ND HHS portals and contact numbers for application assistance and policy clarification. The Aging Services Division is the primary contact for QSP rules.

The ND MMIS Provider Relations team handles technical issues with the enrollment portal and claims submission.

• QSP Enrollment Contact: ND HHS Aging Services Division, HCBS Program Administrator.
• Medicaid Provider Enrollment: ND MMIS Provider Enrollment Unit, Phone: (877) 328-7098.
• Policy Manuals: ND HHS Provider Guidelines, Manuals and Policies webpage (Service Chapter 525-05).
• Enrollment Portal: North Dakota MMIS Web Portal (mmis.nd.gov).
• Local Coordination: Human Service Zones (formerly County Social Services) for case management and prior authorizations.

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