CASE MANAGEMENT SERVICES PROVIDER IN NEBRASKA

SUPPORTING INDIVIDUALS THROUGH COORDINATED CARE AND SERVICE PLANNING

Case Management Services in Nebraska facilitate coordinated care for individuals with disabilities, chronic illnesses, or complex health needs. These services help participants access healthcare, social services, and community resources, fostering independence and well-being. Case Management is authorized under the Nebraska Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: Nebraska Department of Health and Human Services (DHHS)

Role: Administers Medicaid waiver funding for Case Management Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Nebraska Medicaid and Long-Term Care (MLTC) Division

Role: Oversees quality standards, service delivery, and compliance for Case Management Services under HCBS waiver programs.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring Medicaid-funded Case Management Services meet HCBS quality, person-centered planning, and participant protection standards.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management Services offer comprehensive care coordination and planning for individuals needing long-term support, helping them achieve and maintain their highest level of independence.

Approved providers may deliver:

• Service Coordination: Connecting individuals to medical, behavioral, and social services.

• Care Planning: Developing and monitoring Individualized Service Plans (ISPs) to meet participants' needs and preferences.

• Resource Navigation: Assisting with applications for healthcare, housing, and community programs.

• Advocacy: Supporting individuals in voicing their preferences and accessing appropriate services.

• Crisis Intervention: Coordinating immediate care and support during emergencies.

• Ongoing Monitoring: Regularly reviewing the effectiveness of services and making necessary adjustments.

All services must be delivered according to the participant’s ISP and comply with Medicaid waiver guidelines.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register the business entity with the Nebraska Secretary of State.

• Obtain EIN from the IRS and NPI (Type 2).

• Enroll as a Medicaid Waiver Case Management provider via the Nebraska Medicaid Provider Enrollment Portal.

• Maintain general liability and professional liability insurance.

• Develop comprehensive policies for case management, client advocacy, and crisis response.

• Ensure staff meet background checks, health screenings, and relevant training requirements.

4. NEBRASKA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Complete the Provider Enrollment Application through the Nebraska Medicaid Provider Enrollment Portal for Case Management Services under HCBS waivers.

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, staff qualifications, and policy manuals.

Program Readiness Review:

• DHHS evaluates provider readiness, including staff qualifications, care coordination protocols, and documentation systems.

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for Case Management Services using designated billing codes.

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Nebraska Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Proof of general and professional liability insurance

• Case Management Services Policy & Procedure Manual, including:

  • Intake, assessment, and care planning procedures

  • Crisis intervention and emergency response protocols

  • Advocacy, resource linkage, and service coordination guidelines

  • Documentation standards, HIPAA compliance, and client rights policies

  • Staff credentialing, background checks, and continuing education records

  • Medicaid billing procedures and audit readiness

6. STAFFING REQUIREMENTS

Role: Case Management Program Director

Requirements: Bachelor’s degree in social work, human services, or healthcare; experience in care coordination preferred; supervisory experience beneficial.

Role: Case Managers

Requirements: Bachelor’s degree in social services or related field; training in care planning, crisis intervention, and Medicaid service coordination; background clearance.

All staff must complete:

• Training in person-centered planning and service coordination

• HIPAA and confidentiality training

• Crisis management and advocacy training

• Annual continuing education and competency evaluations

7. MEDICAID WAIVER PROGRAMS

Case Management Services are available under the following Nebraska Medicaid Waivers:

• Aged and Disabled (AD) Waiver

• Traumatic Brain Injury (TBI) Waiver

• Developmental Disabilities (DD) Waiver

• Children with Disabilities Waiver

• Home and Community-Based Services (HCBS) Waiver

Services may include:

• Service planning and coordination

• Advocacy and resource navigation

• Crisis intervention and follow-up

• Ongoing service monitoring and evaluation

8. TIMELINE TO LAUNCH

Phase: Business Formation and Compliance Preparation

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development

Timeline: 2–3 months

Phase: Nebraska Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing Setup and Case Management Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

Nebraska Department of Health and Human Services (DHHS)

Website: https://dhhs.ne.gov/

Nebraska Medicaid and Long-Term Care (MLTC) Division

Website: https://dhhs.ne.gov/Pages/Medicaid.aspx

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEBRASKA CASE MANAGEMENT SERVICES PROVIDER

WCG supports agencies in launching Medicaid-compliant Case Management Services in Nebraska, offering:

Scope of Work:

• Business registration, Medicaid enrollment, and compliance preparation

• Policy manual development for case management practices

• Staff training programs, credentialing templates, and care coordination protocols

• Medicaid billing system setup and claims management

• Branding, website development, and outreach strategies

• Quality assurance systems for client advocacy and service documentation

• Networking strategies to connect with healthcare and community resources

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.