Adult Day Care Regulations in North Dakota

Who regulates adult day care in North Dakota

The North Dakota Department of Health and Human Services (HHS) sets standards for adult day care providers that serve publicly funded participants. Under North Dakota Administrative Code chapter 75-03-23, HHS designates Qualified Service Providers (QSPs) to deliver home and community-based services paid with public funds, including adult day care.

Nursing facilities and basic care facilities can also offer adult day care with department approval. The sources reviewed for this guide do not describe a separate license for freestanding centers that serve only private-pay participants, so confirm your situation with HHS.

Types of adult day programs in North Dakota

The HHS home and community-based services policy manual defines adult day care as non-residential activities provided at least three hours per day on a regular schedule, combining health and social services. It recognizes two settings:

• Adult day care center: a program in a publicly accessible building that operates three to ten hours per day.
• Adult day care home: a program in a private residence with no more than four participants at a time.

Licensed nursing facilities (chapter 33-07-03.2) and basic care facilities (chapter 33-03-24.1) may also serve adult day participants who do not stay overnight.

Opening an adult day center in North Dakota

To serve participants funded by the Medicaid waiver or state programs, a center must be designated as a QSP. The QSP Agency Handbook (April 2024) and the adult day care section of the policy manual describe these steps:

1. Register with the North Dakota Secretary of State and get a National Provider Identifier (NPI).
2. Apply through the QSP Enrollment Portal. Freestanding centers upload a Statement of Actual Costs (SFN 55), which the department uses to set the rate.
3. Show that direct care staff qualify through the cognitive endorsement on form SFN 749 or a current North Dakota CNA, RN or LPN credential.
4. Get a fire and safety inspection from the local fire department or State Fire Marshal's office, and complete the compliance checklist (SFN 1703).
5. Complete the HHS site visit required before approval and at revalidation under the federal HCBS Settings Rule.

A nursing facility must get advance department approval before developing an adult day care service, and a basic care facility must get department approval to provide one.

Key requirements

• Staffing: a staff to participant ratio of at least one to eight, counting staff who spend 70 percent of their time in direct service.
• Competency: under NDAC 75-03-23-07, providers must show competency in procedures such as infection control, toileting and transfers, verified in writing by a listed health professional unless the worker holds a credential such as RN, LPN or CNA.
• Space: at least 35 square feet of program space per participant, at least one toilet per gender for every 15 participants, rest areas and two well-identified exits.
• Safety: posted fire and emergency procedures, fire drills twice a year, locked medication storage and first aid kits.
• Meals: a nutritious meal for each participant present at mealtime, plus mid-morning and mid-afternoon snacks.
• Setting limits: Medicaid waiver funds cannot pay for adult day care in a nursing home or hospital, though SPED and Expanded SPED recipients may attend there.

Medicaid funding for adult day in North Dakota

Adult day care is covered under the Medicaid Waiver for Home and Community Based Services, a 1915(c) waiver (ND.0273) for people age 65 and older and adults 18 to 64 with disabilities. Participants must need help with daily living activities and be able to take part in group activities.

HHS case managers authorize services. The waiver uses a fee-for-service system: the department pays enrolled QSPs that bill after delivering authorized services.

Billing basics

The HHS explanation of QSP billing codes (revised July 2026) lists procedure code S5101 for adult day care, billed as a half day (at least three but fewer than five hours) or a full day (at least five and no more than 11 hours in one day).

Case managers send authorizations through Therap, and providers should not start services before receiving them. Adult day care can be billed in Therap as a professional claim, and ND Medicaid must receive an original claim within 180 days of service. The handbook says a center's rate cannot change once set unless approved by legislative action.

An agency billing code guide updated in August 2025 lists adult day care as requiring electronic visit verification (EVV). Therap is the state EVV system, and other vendors must send data through the state aggregator, Sandata.

Other ways centers are paid

Two state-funded programs administered by HHS, Service Payments for Elderly and Disabled (SPED) and Expanded SPED, also pay for adult day care. Under SPED, participants may owe a sliding-scale service fee.

Enrolled veterans who meet VA eligibility and clinical criteria can get Adult Day Health Care through the VA, which may be provided at VA medical centers, State Veterans Homes or community organizations.

Official resources

• HHS Qualified Service Providers (QSP)
• QSP Agency Handbook
• HCBS Policy Manual: Adult Day Care
• NDAC Chapter 75-03-23
• NDAC Chapter 33-07-03.2: Nursing Facilities
• NDAC Chapter 33-03-24.1: Basic Care Facilities
• QSP Explanation of Billing Codes
• Medicaid Waiver for Home and Community Based Services
• HHS Electronic Visit Verification System
• VA Adult Day Health Care
• National Adult Day Services Association

Frequently asked questions

Do I need a license to open an adult day center in North Dakota?

The standards reviewed here tie adult day care to QSP designation for publicly funded participants and to department approval for nursing and basic care facilities. They do not describe a separate license for freestanding centers, so confirm with HHS before you open.

Does North Dakota Medicaid pay for adult day care?

Yes. The Medicaid Waiver for Home and Community Based Services covers adult day care, as do the state-funded SPED and Expanded SPED programs. The center must be an enrolled QSP, and an HHS case manager must authorize the service.

Who inspects adult day centers in North Dakota?

The local fire department or State Fire Marshal's office inspects a center before approval and every two years after that. HHS also completes a site visit before QSP approval and at revalidation.

Do North Dakota adult day centers have to use EVV?

An HHS agency billing guide updated in August 2025 lists adult day care as requiring EVV. The July 2026 billing code document does not include an EVV column, so check current guidance with HHS.