Practice requirements for ABA providers in North Dakota

No outpatient, clinic, or home-based ABA agency license was found. ND Medicaid enrolls ABA groups as ambulatory health care facilities, provider type 026, specialty 026 (Adolescent and Children Mental Health), taxonomy 261QM0855X (group application, revision 11-2025). Required items are an IRS CP 575 or 147C (or an IRS federal tax-exempt letter), a license from one rendering practitioner rather than a facility license, SFN 661 (EFT), SFN 1168 (ownership/controlling interest and conviction information, including managing employees and board members with dates of birth and SSNs), and SFN 615 (provider agreement signed by a managing employee). A group may enroll without SFN 1330 but cannot bill until a provider is affiliated. Retroactive effective dates are generally limited to 90 days, or up to 365 days for documented emergent care. A separate annual Department of Health and Human Services license is required only for a residential care facility for children with autism spectrum disorder, defined as a living facility providing 24-hour assistance for five or more children not related by blood or marriage to the operator (NDCC 23-09.4-01 and 23-09.4-03). That license states the maximum number of residents and is not valid for more than one year. Operating or managing such a facility without the license is a class B misdemeanor (NDCC 23-09.4-08(1)). A civil penalty of up to $1,000 for each violation and for each day the violation continues may also be assessed (NDCC 23-09.4-08(2)).

No statute or ND Medicaid ABA policy was found that requires a criminal-history check of each behavior technician or skills trainer. A full-text search of the current NDCC 12-60-24 PDF found no authority for Bureau of Criminal Investigation fingerprint checks for the Board of Integrative Health Care, chapter 43-57, chapter 43-64, or behavior analysts. Licensed behavior analyst and licensed assistant behavior analyst applicants must show good moral character and a history free of findings by the board, another state licensure board, or a court that would be grounds for discipline under chapters 43-64 and 43-57; the board may modify that restriction for cause (NDCC 43-64-04). NDAC 75-02-05-11 (effective April 1, 2018) requires fingerprint-based checks, paid by the provider and submitted within 30 days of request, for high-risk Medicaid providers and persons with 5 percent or more direct or indirect ownership, unless a successful fingerprint check was completed within five years by Medicare or another state Medicaid agency. North Dakota’s Provider Revalidation Strategy states that ABA providers are not in the state’s high-risk categories because analysts and technicians must enroll as individuals with NPIs and affiliate to an agency, and because ABA requires prior and continuing authorization. ABA group enrollment does require SFN 1168 conviction disclosure for owners, managing employees, and board members. Separately, Autism Spectrum Disorder waiver respite workers, and medically fragile waiver in-home support workers, must be 18 or older, live outside the child’s home, and pass criminal and abuse background checks; families use Veridian as the fiscal agent for respite. Those waiver roles are not the state-plan ABA skills-trainer credential.

Registered behavior technicians are not state-licensed. Effective January 1, 2020, an individual may not practice applied behavior analysis without a license from the State Board of Integrative Health Care (NDCC 43-64-02). NDAC 112-05-01-14(7) (effective January 1, 2021) exempts behavior technicians who deliver ABA under the extended authority and direction of a licensed behavior analyst or licensed assistant behavior analyst. They may not represent themselves as professional behavior analysts and must use a nonprofessional title such as “ABA technician,” “behavior technician,” “registered behavior technician,” or “tutor.” No opened state source sets an RBT coursework-hour total, a minimum age for technicians, or a numeric technician supervision ratio. Licensed behavior analyst (NDAC 112-05-01-02, effective January 1, 2021): doctorate or master’s degree from a program accredited or verified by the Association for Behavior Analysis International or approved by the Behavior Analyst Certification Board; passage of the BCBA examination; BACB certification; and passage of the North Dakota professional-responsibility examination once developed and approved by the board. Licensed assistant behavior analyst: bachelor’s degree from an ABAI-accredited or verified program or a BACB-approved program; passage of the BCaBA examination; the same North Dakota examination once developed; and proof of supervision by an in-state licensed behavior analyst who is currently BACB-certified and in good standing, with supervision that complies with current BACB supervision requirements. NDAC 112-05-01-03 requires a signed application, proof of current BACB certification in good standing sent directly by BACB, the application fee, and the initial license fee. The board issues a license when the applicant is at least 18 and past conduct aligns with the code of ethics adopted by the board (NDAC 112-05-01-05). Active licensees must complete at least 32 hours of board-accepted continuing education biennially, including 4 hours in ethics; one hour equals 50 minutes of class time (NDAC 112-05-01-10). The board application page also states 3 supervision CEUs for supervisors; that item is not in NDAC 112-05-01-10. Renewal is due by November 15 of each odd-numbered year (NDAC 112-05-01-08). Under the ND Medicaid Autism ABA policy posted by HHS as July 2025, service oversight must be a licensed BCBA, licensed BCBA-D, registered behavior analyst, or licensed clinical psychologist. Skills trainers must be an RBT, BCAT, registered behavior analyst, BCaBA, BCBA, BCBA-D, LBSW, LCSW, LMSW, LPCC, LMFT, speech-language pathologist, occupational therapist, or physical therapist. A person with a bachelor’s or master’s in social work, psychology, counseling, nursing, occupational therapy, physical therapy, child development, communication disorders, special education, sociology, elementary education, early childhood education, applied behavioral sciences, or human development and family sciences, or another degree approved case by case on transcript comparison, may enroll but must become an RBT or BCAT within six months of enrollment. Skills training must be supervised by a service-oversight practitioner acting within North Dakota scope-of-practice law. Agencies and schools must have a training process so staff have adequate knowledge of children in unsafe, crisis, or unstable situations; the policy states no hour minimum and names no curriculum. The care plan is updated every 180 days. The skills trainer, oversight practitioner, and caregiver meet at least monthly. The functional assessment must include the VB-MAPP or ABLLS-R. A majority of requested units are to be provided by an RBT.

Fees in NDAC 112-05-01-13 (effective January 1, 2021): application $50; initial license $500, prorated quarterly, for a biennial period ending November 15 of every odd year; temporary license $100, credited toward the initial license fee; renewal $100 on November 15 of every odd year; late filing $75; duplicate license $25. An initial license issued after July 1 of an odd-numbered year is treated as renewed on November 15 for two additional years with no added renewal fee (NDAC 112-05-01-08). The Board of Integrative Health Care application page states a conflicting cycle that expires December 31 of even-numbered years, with the same $50 application, $500 initial, $100 renewal, and $75 late fees, plus a $75 inactive renewal. Where the page and the administrative code conflict, the code controls. A licensee who changes office location must notify the board within 30 days, and the current certificate must be displayed in each office (NDAC 112-05-01-07). A person who on December 31, 2019, held a valid Board of Psychologist Examiners license or registration under NDCC chapter 43-32 is deemed to have met the education, experience, and examination requirements (NDCC 43-64-05; NDAC 112-05-01-02(3)). An individual providing ABA in a public school is exempt from behavior-analyst licensure but may not use the licensed behavior analyst or licensed assistant behavior analyst title unless licensed (NDAC 112-05-01-14(6)). Medicaid still requires a BCBA-written care plan for services approved on an IEP. Students in a defined program and persons accruing certifying-entity experience under that entity’s supervision are exempt (NDAC 112-05-01-14(1) and (2)). Students intending to seek licensure must have a signed written supervision contract with a qualified supervisor (NDAC 112-05-01-06). Medicaid ABA eligibility: under age 21, ND Medicaid-eligible on the date of service, an autism spectrum disorder diagnosis from the primary care provider or another licensed provider qualified to diagnose, and a Health Tracks/EPSDT screening within six months whose recommendation supports ABA. Approval is for 12 months. Services may occur in the home, community, school, or a provider’s facility. The agency or school submits a service-authorization request twice a year (annual and 180-day update). Lack of improvement for 4 to 6 weeks is the policy’s marker for timely treatment change. Punishment procedures that add or remove a stimulus will in most cases be denied. Telehealth is referred to the general ND Medicaid telehealth chapter; that chapter was not opened. NDAC 112-05-01-05 says the applicant must have met “chapter 112-04-01,” which is the acupuncture chapter; that cross-reference is in the adopted rule and its effect is unclear.

Under the February 2025 Medicaid policy, skills training must be supervised by a service-oversight practitioner (licensed BCBA, licensed BCBA-D, registered behavior analyst, or licensed clinical psychologist) acting within North Dakota scope-of-practice law, and must use evidence-based methods directed by that practitioner. The skills trainer must meet at least monthly with the service-oversight practitioner and the caregiver to review training objectives and care-plan changes. Monitoring also requires monthly meetings with the skills trainer and caregiver. If data show no improvement for 4 to 6 weeks, treatment must be changed. Agencies and schools must train staff for unsafe, crisis, or unstable situations, and service-oversight staff must be a BCBA, BCBA-D, registered behavior analyst, or licensed clinical psychologist. The BCBA-signed care plan and a service authorization are submitted twice a year (annual and 180-day update). NDAC 112-05-01-02 (effective Jan. 1, 2021) requires a licensed assistant behavior analyst to be supervised by an in-state licensed behavior analyst who is BACB-certified and in good standing, with supervision that complies with current BACB supervision requirements. NDCC 43-64-04(3) directs the board to set standards for licensed behavior analysts supervising licensed assistant behavior analysts. The Medicaid policy states no numeric supervision percentage, observation count, or caseload cap.