How to start a home health agency in North Dakota

North Dakota requires a Home health agency license from North Dakota Department of Health and Human Services (health facilities licensing) to operate a home health agency. Fee: No license fee appears in NDAC 33-03-10.1 or NDCC ch. 23-17.3.

License required

Yes

License

Home health agency license

Issuing agency

North Dakota Department of Health and Human Services (health facilities licensing)

Fee

No license fee appears in NDAC 33-03-10.1 or NDCC ch. 23-17.3.

Renewal

Every year · Licenses expire December 31 each year; renewal depends on compliance found in periodic unannounced surveys.

Survey and inspection

Announced or unannounced on-site reviews, record review, staff interviews and home visits at any time.

Medicare certification

Separately, CMS put a 6-month nationwide moratorium on new Medicare enrollment of home health agencies (including new branches and practice locations) into effect on May 13, 2026; it can be extended in 6-month increments, and CMS left any Medicaid/CHIP moratorium to each state.

Regulation

NDCC ch. 23-17.3; NDAC 33-03-10.1

1. Apply on the department form, describing all services and the geographic area served
2. Provide evidence of adequate financial resources
3. Provide notarized statements on any license or Medicare/Medicaid actions and criminal proceedings in the past 5 years
4. Disclose all owners of 5% or more
5. Department inspection and fitness investigation
6. Receive the initial license before accepting patients

Staffing

• Administrator: physician, RN, or bachelor's graduate with 3 years health care management — or 6 years supervisory health care management without a degree
• Nurse executive/director of nursing: full-time salaried RN licensed in ND with 1 year full-time home health direct care and 3 years RN experience
• RN available by phone during operating hours

Training

• Home health aide training of at least 75 clock hours, including at least 16 classroom hours before supervised practical training
• 12 hours of in-service education per 12 months

Program

North Dakota Medicaid (ND Health and Human Services, Medical Services Division), including Medicaid Expansion

Enrollment portal

ND Health Enterprise MMIS Web Portal

Fiscal agent

Noridian Healthcare Solutions (provider enrollment contractor for every provider type except Qualified Service Providers)

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. ND HHS's enrollment page does not list a separate state fee.

Fingerprinting

Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. ND HHS's enrollment page does not list high-risk provider types. It does collect ownership and controlling-interest conviction information on form SFN 1168.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. ND HHS's enrollment page does not describe a separate state site visit process.

Revalidation

All provider records revalidate at least every five years; DME suppliers every three years. ND HHS posts a list of providers with upcoming or past-due revalidations. If the group or individual is actively enrolled in Medicare, ND Medicaid relies on Medicare's screening to speed things up. If not, the provider repeats the application-requirement and Noridian-submission steps.

Full North Dakota Medicaid enrollment guide →

CON program

No

Agency

North Dakota Department of Health and Human Services (facility licensing; bed moratorium)

Moratoria

Nursing facility beds may not be added to the state's licensed bed capacity between August 1, 2025 and July 31, 2029, except when a facility reverts basic care beds to nursing beds or relicenses beds delicensed after July 31, 2011. Licensed bed capacity may be transferred between entities, and a facility may reconfigure its nursing bed capacity no more than twice in 12 months (NDCC 23-16-01.1).

North Dakota certificate of need details →

Model

hybrid

State vendor

Therap (EVV system); Sandata (aggregator)

Services in scope

• personal care
• home health
• other HCBS

Alternate EVV allowed

Yes

Program

https://www.hhs.nd.gov/adults-and-aging/electronic-visit-verification-evv-system

North Dakota EVV requirements →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Home health agencies — active organization NPIs (NPPES)

126 (as of Sep 13, 2026)

Medicare-certified home health agencies (CMS Care Compare)

20 (as of May 27, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

104,194 (as of Jun 1, 2026)

All North Dakota Home health Medicaid rates, ranked →