nd.gov - The Official Portal for North Dakota State Government
North Dakota: Legendary. Follow the trail of legends
NDDHS logo
 arrow iconDHS Home arrow iconContact DHS arrow iconSkip Navigation Space

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.


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)


Return to the top of the page Top of page   Go back to the previous page Back to previous page

 Get Adobe Acrobat Reader Tested for W3C WAI AA Accessibility Tested for W3C Well-Formed XHTML Code Tested for W3C Well Formed Cascading Style Sheet Code