North Dakota home care rules

North Dakota's Department of Health and Human Services (HHS) licenses home health agencies, but none of the documents we hold creates a license for non-medical home care.

More about North Dakota

To be paid with public funds, a non-medical agency enrolls with HHS as a Qualified Service Provider (QSP), and HHS pays it directly: the Aged and Disabled waiver does not use Medicaid health plans. Since June 11, 2026, ND Medicaid has not been enrolling new QSP agencies in Burleigh and Cass Counties. The pause lasts 6 months and may be extended.

51 official documents·collected September 22, 2026·checked against them September 23, 2026

License for non-medical home care?No license foundNo state license category in the documents we hold. To serve public-pay clients you must enroll with HHS as a QSP agency.

License for home health?YesHHS license under NDCC 23-17.3 and NDAC 33-03-10.1. Renew each year; licenses expire December 31.

EVVTherap, freeRequired for QSP personal care, homemaker, companionship, respite and other in-home services, and for home health. Other vendors are allowed if they send data to Sandata.

Medicaid health plansNot for waiver careHHS pays Aged and Disabled waiver providers directly and does not contract with health plans for waiver services

Compare states Federal rules →

What changed, and what to do about it

Red means act now, amber means read it this month, grey is for the record.

Read this monthEffective June 11, 2026 · 6 months, may be extended

New QSP agency enrollments paused in Burleigh and Cass Counties

ND Medicaid put a temporary moratorium on new QSP agency and DD agency enrollments in Burleigh and Cass Counties, and on new NEMT agencies statewide, citing a heightened risk of fraud, waste or abuse. Agencies already enrolled are not affected. Applications already in the final approval stage on June 11 continue; applications that had not reached final approval by then will be denied.

What to do: If you're in either county, keep your enrollment current and revalidate on time. If you planned to open a new agency there, wait for HHS's next update.

Sources (2)

ND Medicaid Provider Enrollment Moratoria June 2026 ↗our copyQSP Agency Handbook Jan 2026 ↗our copy

Read this monthRate sheet effective July 1, 2026 · revised July 23, 2026

QSP rate sheet effective July 1, 2026

HHS's rate sheet effective July 1, 2026 lists agency rates of $9.59 per 15 minutes for personal care, homemaker and respite and $9.28 for companionship and supervision, plus rural differential rates for QSPs who travel at least 21 miles round trip. The sheet doesn't show the earlier rates, so we can't say what changed.

What to do: Check that claims for services from July 1, 2026 use the rates on this sheet, and ask the case manager whether any client qualifies for a rural differential (approved case by case).

Sources (2)

QSP Rates and Rural Differential July 2026 ↗our copyQSP Agency Handbook Jan 2026 ↗our copy

Read this monthEffective January 1, 2026

Aged and Disabled waiver amendment in effect

The amendment brings in rate changes approved by the legislature, allows quarterly case manager monitoring by phone, and clarifies provider qualifications for Family Personal Care, Supervision and Waiver Personal Care. Live-in relatives who meet the rule's definition of family member cannot provide Waiver Personal Care or Supervision, even when an agency hires them; they provide Family Personal Care instead.

What to do: Check whether any of your staff who give Waiver Personal Care or Supervision live with the client as a relative.

Source:1915c HCBS Aged and Disabled Waiver ND.0273 Jan 2026 ↗our copy

For the recordEffective October 1, 2025

Home health licensing rule amended

Four sections of NDAC 33-03-10.1 were amended: definitions, governing body, quality assessment and performance improvement, and nursing services. The rule text we hold does not show what changed.

What to do: If you run a licensed home health agency, reread these four sections against your policies.

Source:NDAC 33-03-10.1 Home Health Agency Licensing Rules ↗our copy

For the recordDraft dated January 23, 2026 · proposed effective date June 1, 2026

Draft amendment to the Traditional IID/DD waiver

North Dakota's draft amendment adds a Host Home service, revises provider qualifications for Extended Home Health Care and updates the rules on paying relatives. The draft gives no comment deadline. Its proposed effective date has passed, and we don't hold an approved version.

What to do: DD providers: skim Appendix C for the Extended Home Health Care changes.

Source:Draft DD Traditional IID-DD Waiver ND.0037 June 2026 ↗our copy

Deadlines coming up

Dates taken from the rules and notices as we read them.

99days

December 31, 2026

Home health agency licenses expire

Every license expires December 31. Send your renewal early enough for HHS to process it before the new licensing period.

Source:NDAC 33-03-10.1 Home Health Agency Licensing Rules ↗our copy

Rules by topic

Every state follows the same outline, so you always know where to look. Open a topic for the detail.

Who regulates you

Licensing: Department of Health and Human Services (HHS) licenses home health agencies. Licensing appeals go to its division of health facilities.
QSP enrollment: HHS enrolls Qualified Service Providers (QSPs) through the QSP Enrollment Portal (QSP Enrollment: QSPinfo@nd.gov). Its Adult and Aging Services division reviews QSP complaints. The QSP Hub (701-777-3432, info@NDQSPhub.org) helps with enrollment, revalidation, EVV and billing.
Medicaid: ND Medicaid, part of HHS, enrolls medical providers such as home health agencies and pays claims through its claims system (MMIS). Provider line: 1-877-328-7098.
Adult protection: Vulnerable Adult Protective Services (VAPS), HHS. Central intake: 1-855-462-5465, option 2.

Sources (7)

NDCC 23-17.3 Home Health Agencies Law ↗our copyNDAC 33-03-10.1 Home Health Agency Licensing Rules ↗our copyQSP Agency Handbook Jan 2026 ↗our copyND Medicaid EVV Policy Oct 2025 ↗our copyMandatory Reporting Fact Sheet ↗our copyND Medicaid Provider Requirements ↗our copyND Medicaid Provider Enrollment ↗our copy

Licensing

Non-medical home care: None of the documents we hold creates a license for non-medical home care. The home health law covers agencies whose services include a registered nurse and at least one other therapeutic service. An agency that works only with private-pay clients does not need to enroll as a QSP.
Public-pay agencies: To serve people whose care HHS pays for, enroll as a QSP agency (NDAC 75-03-23-07). You will need a Type 2 NPI, proof of unemployment insurance, Workforce Safety and Insurance coverage and Secretary of State registration, plus fraud, waste and abuse training and orientation certificates. The agency checklist asks for at least two employees who give direct services. Revalidate at least every 5 years.
Name limits: A QSP agency name may not include "home health agency", "home health care", "home health services", "group home" or "nurse".
Home health: License required under NDCC 23-17.3 and NDAC 33-03-10.1. You must provide skilled nursing and at least one other therapeutic service. An initial license lasts no more than one year, and every license expires December 31. HHS renews licenses based on periodic unannounced onsite surveys, and may issue a provisional license for up to 90 days when it finds serious or repeated deficiencies.
Rule update: Four sections of NDAC 33-03-10.1 (definitions, governing body, quality program and nursing services) were amended effective October 1, 2025.

Sources (5)

NDCC 23-17.3 Home Health Agencies Law ↗our copyNDAC 33-03-10.1 Home Health Agency Licensing Rules ↗our copyQSP Agency Handbook Jan 2026 ↗our copyQSP Agency Revalidation Instructions ↗our copyNDAC 75-03-23 HCBS under SPED and Aged-Disabled Waiver ↗our copy

Your workers

QSP competency: Each direct-care employee needs an SFN 749 Documentation of Competency, signed by a licensed professional such as an RN, LPN, physician, PT or OT, before starting work. The form is valid for 5 years. A current ND CNA, LPN or RN credential can be used instead. A CNA cannot sign the form.
Screening: Enter every direct-care employee in the QSP Enrollment Portal before they serve public-pay clients. The portal checks ND courts, sex offender registries, SAM, the HHS OIG list and the ND exclusion list. The offenses that bar enrollment are listed in NDAC 75-03-23-07. Email QSPinfo@nd.gov within five business days if an owner's or employee's conviction history changes.
Home health aides: Aides must complete either a training and competency evaluation program (at least 75 hours, including 16 hours in the classroom and 16 hours of supervised practical training) or a competency evaluation program. Either way, a registered nurse must evaluate them before they give aide services. Aides also need 12 hours of in-service education every 12 months.
Reporting abuse: Caregivers are mandated reporters under NDCC 50-25.2-03 and must report abuse or neglect of a vulnerable adult as soon as possible. Willfully failing to report is an infraction. QSPs must also report critical incidents to the HCBS case manager within 24 hours and file a General Event Report in Therap.
Overtime: HHS pays overtime only to individual QSPs. Agency QSPs are not paid overtime by HHS and must follow overtime laws for their own employees.

Sources (6)

QSP Agency Handbook Jan 2026 ↗our copyNDAC 75-03-23 HCBS under SPED and Aged-Disabled Waiver ↗our copyNDAC 33-03-10.1 Home Health Agency Licensing Rules ↗our copyNDCC 50-25.2 Vulnerable Adult Protective Services ↗our copyMandatory Reporting Fact Sheet ↗our copyFAQs for Overtime Individual QSPs ↗our copy

Getting paid

Programs: The Medicaid waiver for the aged and disabled (ND.0273), the Service Payments for Elderly and Disabled program (SPED) and Expanded SPED, and Medicaid State Plan personal care. Waiver personal care is paid only to enrolled QSPs.
Authorizations: The HCBS case manager sends a service authorization in Therap. Don't provide services before you have it, or you may not be paid.
Rates: Rates from July 1, 2026: agency personal care, homemaker and respite $9.59 per 15 minutes; agency companionship and supervision $9.28. A rural differential applies for trips of at least 21 miles round trip (sheet revised July 23, 2026).
Deadlines and records: ND Medicaid must receive an original claim within 180 days from the date of service. QSP agencies keep service records for 7 years.
Home health: Paid per visit (encounter). Up to 50 visits per member per calendar year without prior approval; after that, request a service authorization from Acentra.
Health plans: HHS pays waiver providers directly and does not contract with health plans for waiver services. The Medicaid expansion law tells HHS to run expansion coverage by bidding through private carriers or using the health insurance exchange; the documents we hold don't name a carrier.

Sources (9)

1915c HCBS Aged and Disabled Waiver ND.0273 Jan 2026 ↗our copyNDAC 75-03-23 HCBS under SPED and Aged-Disabled Waiver ↗our copyQSP Agency Handbook Jan 2026 ↗our copyQSP Rates and Rural Differential July 2026 ↗our copyND Medicaid Timely Claims Filing ↗our copyND Medicaid Home Health Services Apr 2026 ↗our copyNDCC 50-24.1 Medical Assistance (Medicaid) ↗our copyND Medicaid EVV Policy Oct 2025 ↗our copyNDAC 75-03-24 Expanded SPED ↗our copy

EVV

Who: Includes agency and individual QSPs, licensed DD providers, self-directed providers, 1915(i) respite providers and home health agencies
Services: For QSPs: chore, companionship, extended personal care, homemaker, non-medical transportation, nurse education, personal care, respite, supervision and transitional living. For home health: aide, nursing and therapy visits.
Since: January 1, 2021 for personal care and related services; July 1, 2023 for home health
System: Therap is the state's free default system. You can use another vendor if it sends data to the state's data aggregator, Sandata, at your own cost. If you change vendors after enrolling, tell Adult and Aging Services (dhshcbs@nd.gov) and allow at least 3 weeks for the change.
Live-ins: Since March 1, 2024, personal care given by a live-in caregiver paid a daily rate does not need EVV. Live-ins paid by the 15-minute unit still use EVV.
Enforcement: Claims without matching EVV data can be denied. Manual corrections on 20% or more of claims in a review period may count as non-compliance.

Sources (4)

ND Medicaid EVV Policy Oct 2025 ↗our copyQSP Agency Handbook Jan 2026 ↗our copyQSP Live-In Daily Rate Information and FAQ ↗our copyND Medicaid Home Health Services Apr 2026 ↗our copy

What changed recently

Jul 2026: HHS's QSP rate sheet lists rates and rural differential rates effective July 1, 2026 (revised July 23, 2026).
Jun 2026: ND Medicaid paused new QSP agency and DD agency enrollments in Burleigh and Cass Counties, and new non-emergency medical transportation (NEMT) enrollments statewide, from June 11, 2026.
Jun 2026: Draft amendment to the Traditional IID/DD waiver, proposed to take effect June 1, 2026, would add a Host Home service and revise Extended Home Health Care provider qualifications. We hold only the draft.
Jan 2026: Aged and Disabled waiver amendment effective January 1, 2026. New QSP Agency Handbook.
Oct 2025: Home health licensing rule (NDAC 33-03-10.1) amended. ND Medicaid EVV policy reissued with format updates and clarifications.

Sources (7)

QSP Rates and Rural Differential July 2026 ↗our copyND Medicaid Provider Enrollment Moratoria June 2026 ↗our copyDraft DD Traditional IID-DD Waiver ND.0037 June 2026 ↗our copy1915c HCBS Aged and Disabled Waiver ND.0273 Jan 2026 ↗our copyQSP Agency Handbook Jan 2026 ↗our copyNDAC 33-03-10.1 Home Health Agency Licensing Rules ↗our copyND Medicaid EVV Policy Oct 2025 ↗our copy

Fine print: where the official documents disagree 1

Sometimes two official documents say different things. Here is what we went with, why, and what each document says, so you can judge for yourself.

Documents disagree

How long to keep records: 3 years or 7 years?

What this page uses: 7 years, counted from the latest of: the date of service, the date the record was created or last in effect, and the date the claim was paid or denied.

The waiver application gives 3 years as a federal minimum. ND Medicaid's policies (Provider Requirements and EVV, both October 2025) and the QSP Agency Handbook (January 2026) all say 7 years, but count from different starting points. Keeping records for 7 years from the latest of those dates meets every document.

1915c HCBS Aged and Disabled Waiver ND.0273 Jan 2026 ↗: "Records documenting the audit trail of adjudicated claims (including supporting documentation) are maintained by the Medicaid agency, the operating agency (if applicable), and providers of waiver services for a minimum period of 3 years as required in 45 CFR § 92.42." (Appendix I-2 e)
QSP Agency Handbook Jan 2026 ↗: "Agency QSPs must keep service records for seven (7) years from the date services were delivered"
ND Medicaid EVV Policy Oct 2025 ↗: "Records must be retained for at least 7 years after the last date the claim was paid or denied."
ND Medicaid Provider Requirements ↗: "Be kept for a minimum of seven (7) years from the date of their creation or the date when they were last in effect, whichever is later."

Questions agencies ask

Every answer was written and checked ahead of time, with the official document next to it. Nothing is made up on the spot.

Try:

Do I need a license to run a non-medical home care agency in North Dakota?

No license found, but enroll as a QSP to serve public-pay clients.

The license in the documents we hold is for home health agencies, whose services must include a registered nurse and at least one other therapeutic service. For clients whose care HHS pays for, a non-medical agency enrolls with HHS as a Qualified Service Provider (QSP) under NDAC 75-03-23-07. An agency that works only with private-pay clients does not need to enroll as a QSP.

Sources (3)

NDCC 23-17.3 Home Health Agencies Law ↗our copyQSP Agency Handbook Jan 2026 ↗our copyNDAC 75-03-23 HCBS under SPED and Aged-Disabled Waiver ↗our copy