Home Health Agency Requirements in North Dakota

North Dakota Health and Human Services (HHS) licenses home health agencies through the Health Facilities Unit. The regulatory framework balances federal requirements with state-specific standards.

Regulatory Framework

Home health agency regulations are found in North Dakota Administrative Code Chapter 33-03-10.1:

  • Originally effective January 1, 1998
  • Most recently amended effective October 1, 2025
  • Legal authority: NDCC 23-01-04, 23-17.3-02, and 23-17.3-08

Federal Alignment

When state requirements conflict with federal requirements, the more stringent standard applies. This determination is made by the department.

Operational Requirements

Licensed home health agencies must:

  • Maintain clinical records in ink, typed, or electronic format
  • Safeguard records against loss or unauthorized use
  • Provide safety, emergency procedures, and in-service education during patient care

Notification Requirements

Agencies must notify the department of:

  • Transfer or change of ownership
  • Change in agency name
  • Services being added or deleted
  • Changes in geographic area served

License Denial or Revocation

Grounds for denial or revocation include fraud, deceit, misrepresentation, or bribery in obtaining or attempting to obtain a license.

Contact Information

North Dakota HHS Health Facilities Unit:

  • Website: hhs.nd.gov/health/regulation-licensure-and-certification/health-facilities-unit/home-health-agencies

Certified Nursing Assistant (CNA) Certification

The Health Facilities Unit is designated by CMS as the agency responsible for CNA registration and approves training programs throughout the state.

Training Requirements

NDHHS-approved Nurse Aide Training Programs (NATP) require:

  • 75 hours minimum total training
  • 30 hours of theoretical learning (patient care, hygiene, infection control)
  • 45 hours of practical clinical training
  • 16 clinical hours required before resident contact

Eligibility Requirements

  • Minimum age: 16 years
  • Ability to lift 50 pounds
  • Proficiency in reading, writing, and speaking English
  • Criminal background check
  • TB test
  • Drug screening for clinical practice

Certification Examination

The North Dakota Nurse Aide Competency Exam is administered by Headmaster:

  • Knowledge assessment: Multiple choice (written or oral format)
  • Skills assessment: Practical demonstration
  • Exam fee: $250 (separate from course fee)

Renewal Requirements

CNA certification must be renewed every two years:

  • At least 8 hours of paid nursing-related work under RN or LPN supervision within past 24 months
  • No renewal fee
  • No continuing education hours required (unlike LPNs and RNs)

North Dakota's renewal focuses on employment verification rather than CE hour submission.

Program Costs

Training costs vary by institution. Example: North Dakota State College of Science offers a self-paced course for $650.

Contact Information

Home Health Aide (HHA) Requirements

Home health aides in North Dakota must meet competency requirements based on the employing agency type.

Medicare-Certified Agencies

HHAs working for Medicare-certified home health agencies must complete:

  • 75 hours of training minimum
  • 16 hours of supervised practical training
  • Competency evaluation in required skill areas
  • 12 hours of annual in-service training

State Requirements

State-licensed agencies must ensure aides meet standards outlined in Chapter 33-03-10.1 NDAC, including appropriate supervision and ongoing education during patient care.

North Dakota Medicaid and Home Care Services

North Dakota Medicaid provides coverage for home health services and HCBS waiver programs for eligible residents.

2025-2026 Financial Eligibility

For HCBS Waiver programs (effective April 2025 - March 2026):

  • Income limit (single): $1,174 per month (90% of Federal Poverty Level)
  • Income limit (married, both applying): $1,587 combined per month
  • Asset limit (single): $3,000
  • Asset limit (married, both applying): $6,000 combined
  • Community Spouse Resource Allowance: $162,660

Look-Back Period

North Dakota applies a 60-month look-back period to review applicants' financial history for asset transfers before the application date.

Aged and Disabled Waiver

North Dakota's Medicaid Waiver for Home and Community Based Services (also called the Aged and Disabled Waiver) is a 1915(c) HCBS waiver providing long-term services and supports.

Program Purpose

The waiver prevents unnecessary nursing home admissions by providing community-based alternatives. Benefits vary based on individual needs and circumstances.

Available Services

Potential services include:

  • Home modifications for safety and accessibility
  • Personal emergency response systems
  • Home delivered meals
  • Adult day care
  • Respite care for family caregivers
  • Personal care assistance

Residential Settings

Waiver participants may reside in:

  • Their own home
  • A family member's home
  • Adult foster care homes
  • Assisted living residences
  • Residential care homes
  • Memory care facilities

Important Considerations

HCBS waivers are not entitlement programs—enrollment is limited and waiting lists may exist when capacity is reached.

2026 Waiver Amendments

North Dakota HHS has sought public input on waiver amendments expected to take effect January 1, 2026.

Physical Disabilities Services

A waiver amendment will expand services helping North Dakotans with physical disabilities live at home in their communities.

Intellectual and Developmental Disabilities

A separate waiver amendment will expand access for people with intellectual and developmental disabilities, offering a range of in-home and community-based services in the least restrictive setting.

How to Apply

Contact the Aging and Disability Resource Link:

  • Toll-free: 855-462-5465
  • TTY: 711
  • Email: [email protected]
  • Online: carechoice.nd.assistguide.net

Electronic Visit Verification (EVV)

North Dakota implements EVV requirements in compliance with the 21st Century Cures Act.

Required Data Elements

North Dakota's EVV system captures:

  • Type of service performed
  • Individual receiving the service
  • Date and location of service delivery
  • Individual providing the service
  • Time service begins and ends

Provider Responsibilities

Agencies must integrate EVV with billing and scheduling systems and train staff on proper documentation for compliance.

Medicare Home Health in North Dakota

Medicare-certified home health agencies in North Dakota must maintain both federal certification and state licensure.

Certification Requirements

Agencies must:

  • Hold valid North Dakota home health agency license
  • Meet all federal Conditions of Participation
  • Complete successful initial and periodic surveys
  • Comply with the more stringent of state or federal requirements

PDGM Operations

North Dakota agencies operate under the Patient-Driven Groupings Model (PDGM) with 30-day payment periods. Success requires accurate OASIS assessment, appropriate clinical coding, and efficient visit utilization—particularly important given the state's rural geography.

North Dakota Labor Laws for Home Care

North Dakota's labor environment reflects federal standards with limited state-specific additions.

Minimum Wage

North Dakota's minimum wage is $7.25 per hour, matching the federal rate. This is among the lowest in the nation.

Minimum Wage Exemptions

North Dakota exempts certain home care workers from standard minimum wage requirements:

  • Companionship service workers
  • Family home care providers

Overtime Requirements

  • Non-exempt employees receive 1.5x regular rate after 40 hours per workweek
  • Live-in employees: Exempt from overtime requirements

State-Funded Caregiver Overtime

For authorized care exceeding 40 hours weekly, caregivers submit claims normally and overtime is paid based on those claims. However, not all caregivers are guaranteed overtime hours.

Additional Requirements

  • FICA threshold: $2,800 in cash wages (2025) triggers withholding and payment of 15.3% FICA taxes
  • Workers' compensation: Not required for household employers, though coverage is recommended
  • Paid leave: No state paid leave law applies to household employers

Workforce Challenges and Strategies

North Dakota agencies face workforce dynamics shaped by extreme rural geography, low population density, and competitive labor markets from the energy sector.

Key Challenges

  • Rural geography: Large distances between population centers create significant travel time and costs
  • Low wages: $7.25 federal minimum wage floor creates competition with other sectors
  • Energy sector competition: Oil and gas industry offers higher wages in western North Dakota
  • Small labor pool: Limited population constrains workforce availability
  • Weather: Extreme winter conditions affect service delivery and worker travel

Effective Strategies

  • Competitive wages: Pay significantly above $7.25 minimum to attract and retain workers
  • Mileage reimbursement: Generous travel compensation for rural coverage
  • No-fee CNA renewal: Leverage North Dakota's free renewal to reduce worker burden
  • Flexible scheduling: Accommodate weather conditions and travel constraints
  • Community partnerships: Work with local colleges like NDSCS for training pipelines
  • Technology optimization: Efficient routing software for rural service delivery

Retention Best Practices

  • Wages competitive with energy sector entry-level positions
  • Benefits packages addressing healthcare and retirement needs
  • Career advancement from CNA to nursing pathways
  • Weather-related scheduling flexibility
  • Recognition programs celebrating worker contributions

Resources and Links

The Bottom Line

North Dakota's home health care environment combines a low-regulation approach with significant rural service delivery challenges. The October 2025 regulatory updates and January 2026 waiver amendments signal continued program evolution. Success in the Peace Garden State requires building competitive compensation packages well above the $7.25 federal minimum, developing efficient rural service delivery strategies, and leveraging partnerships with local training programs. The state's no-fee CNA renewal and employment-based maintenance requirements reduce administrative burden compared to more heavily regulated states.

Struggling with Workforce Challenges?

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