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Autism Spectrum Disorder Waiver - Provider Information

This webpage contains information for North Dakota's Autism Spectrum Disorder Waiver service providers.

IMPORTANT: Autism Waiver service providers must have a Provider Agreement in place with the state before they can be reimbursed for waiver services. An agency wishing to provide waiver services must first enroll as a service provider. Enroll Here.

CONTACT:

Providers with questions should contact Katherine Barchenger, State Autism Coordinator, at 701-328-4630, toll free 800-755-2719, ND Relay TTY 800-366-6888, or kbarchenger@nd.gov.

Evaluation and Diagnostic Teams:

  • Level of Care Determination (SFN 60680) - Use to document in Medicaid Management Information system (MMIS)
  • Registration Intake Face Sheet (SFN 60602)

Service Managers:

  • Participant Service Plan (PSP) (SFN 600)
  • Progress Notes for Service Managers - Complete Monthly) (SFN 918)
  • Purchase Request Form for Assistive Technology items (SFN 688)
  • Incident Reporting Forms (SFN 60603)
  • Transition Plan (for transitioning off of the waiver) (SFN 60615)

Respite Care Providers:

  • Progress Notes for Respite Care Providers (SFN 60614)

 

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