Nebraska - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Nebraska Department of Health and Human Services (DHHS) Division of Disability and Aging (DDA) funds Companion services through the Aged and Disabled (AD) and Traumatic Brain Injury (TBI) Medicaid waivers for adults aged 18 and older.

Approval to bill NFOCUS service codes like 9510 or 7934 requires passing through the Maximus Nebraska Medicaid Provider Enrollment system. Before an application is even accepted in the portal, a state Resource Developer (RD worker) must issue a specific provider referral number to the applicant.

1. Service Definition and Scope

Companion is a service for adults on the HCBS Waiver for Aged and Adults and Children with Disabilities (AD) or Traumatic Brain Injury (TBI) Waiver. It provides social supports and supervision to participants in their homes and in community settings.

Providers must utilize Electronic Visit Verification (EVV) to track service delivery and are strictly required to bill only when active care is taking place.

• Target Population: Adults aged 18 and older enrolled in the AD or TBI waivers.
• Approved Settings: The participant's home and community settings.
• EVV Mandate: Requires an operational electronic visit verification system which allows the check-in and out of service appointments electronically.
• Billing Limitation: Providers must clock in and out of services throughout the day if a block of time exceeding one hour does not involve hands-on care.

2. Regulatory and Oversight Agencies

The Nebraska DHHS oversees the waivers and sets provider policy. Maximus acts as the state's enrollment broker, handling the portal and initial screening.

Background checks for high-risk providers are processed in coordination with the Nebraska State Patrol.

• Operating Agency: Nebraska DHHS Division of Disability and Aging (DDA) (https://dhhs.ne.gov/Pages/Aging.aspx)
• Enrollment Broker: Maximus Nebraska Medicaid Provider Enrollment (https://nebraskamedicaidproviderenrollment.com/)
• Background Check Authority: Nebraska State Patrol (https://statepatrol.nebraska.gov/)
• Policy Oversight: DHHS Division of Medicaid and Long-Term Care (https://dhhs.ne.gov/Pages/Medicaid-and-Long-Term-Care.aspx)

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska operates as an "any willing provider" state for Medicaid, meaning there are no Certificate of Need laws, closed networks, or competitive procurement (RFP) requirements for Companion services. Any provider meeting the qualifications can participate.

However, a strict procedural gate exists before portal access is granted. Agencies cannot simply create an account and apply; they must first be invited into the system by a state worker.

• Referral Requirement: A DHHS Resource Developer (RD worker) must make a provider referral to Maximus before an agency can apply.
• Referral Number: Applicants must possess the specific referral number generated by the RD worker to create an account in the Maximus portal.
• Network Status: Open network ("any willing provider" state), provided the applicant meets all qualifications.
• Moratoria: None currently active for AD or TBI waiver Companion services.

4. Licensure and Certification Requirements

Nebraska does not issue a distinct "Companion Service Agency" facility license. Instead, providers are certified directly through the Medicaid HCBS enrollment process based on meeting waiver-specific qualifications.

Providers must adhere to the standards outlined in the Division of Medicaid and Long-Term Care Service Provider Agreement.

• Facility Licensure: Not required for in-home Companion services.
• Service Provider Agreement: Must adhere to standards described in the Division of Medicaid and Long-Term Care Service Provider Agreement.
• Provisional Status: If enrolled provisionally under other licenses, providers must close provisional enrollment and re-enroll once fully licensed.
• Out-of-State Verification: Primary source verification is required for any licenses held in other states.

5. Medicaid Provider Enrollment

Enrollment is processed through the Nebraska MLTC Provider Registration Portal managed by Maximus. Providers must pay applicable federal application fees and undergo risk-based screening.

HCBS providers are not eligible for retroactive start dates; the effective date aligns with the final approval of the enrollment application.

• Portal: Nebraska MLTC Provider Registration Portal (https://nebraskamedicaidproviderenrollment.com/)
• Application Fee: Institutional and agency providers must pay the federal CMS application fee (verified via PECOS) for initial enrollment and revalidation.
• Location Requirement: Providers must enroll separately for each location where they provide services to Medicaid members.
• Retroactive Dates: HCBS providers cannot receive a retroactive start date; effective dates align with approval.

6. Staffing, Training and Background Checks

Direct support professionals providing Companion services must meet specific training and background check requirements, which vary slightly depending on the waiver.

High-risk providers face additional scrutiny, including fingerprinting for owners.

• TBI Training: TBI Waiver providers must complete DHHS-approved TBI training before providing Companion services.
• General Training: Must complete DHHS trainings upon request and use universal precautions.
• High-Risk Screening: Fingerprint-based Criminal Background Checks (FCBC) by the Nebraska State Patrol are required for high-risk providers and any person with 5% or more direct or indirect ownership control.
• Exclusion Checks: Monthly checks against the OIG LEIE, SAM, and Nebraska Medicaid Excluded Providers (NMEP) lists.

7. Documentation, Policies and Records

Agencies must maintain comprehensive records of service delivery, primarily managed through the EVV system.

Providers are subject to unannounced site visits to verify compliance with state regulations and documentation standards.

• EVV Compliance: Computer skills and access to technology for the EVV system are mandatory for Companion providers.
• Service Logs: Must document exact check-in and check-out times electronically.
• Policy Manuals: Must comply with all applicable Titles of the Nebraska Administrative Code and Nebraska State Statutes.
• Site Visits: Moderate and high-risk providers are subject to unannounced pre- and post-enrollment site visits by Maximus.

8. Billing, Rates and Claims

Companion services are billed using specific NFOCUS service codes. Reimbursement is tied strictly to documented hands-on care time.

Claims are processed through the Nebraska Medicaid MMIS based on EVV data.

• AD Waiver Codes: Companion (9510), Companion 2 (2551), Companion 3 (2241).
• TBI Waiver Codes: TBI Companion (7934), TBI Companion 2 (4167), TBI Companion 3 (5074).
• Billing Increments: Billed based on active care; providers must clock out if a gap in hands-on care exceeds one hour.
• System: Claims are processed through the Nebraska Medicaid MMIS based on EVV data.

9. Approval Sequence and Timeline

The process begins with the RD worker referral and ends with Maximus issuing a Medicaid ID.

Applications requiring additional scrutiny are routed to Nebraska Medicaid Provider Relations for state review.

• Step 1: Resource Developer (RD worker) makes a provider referral to Maximus.
• Step 2: Provider creates an account with Maximus using the referral number.
• Step 3: Maximus reviews the application, background checks, and conducts site visits if required.
• Step 4: State review by Nebraska Medicaid Provider Relations for high-risk or indeterminate applications.
• Step 5: Maximus assigns a Medicaid ID and finalizes enrollment.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to missing background checks or failure to properly utilize the EVV system.

Providers may appeal a denial within 90 days or submit additional information to comply with the requirements.

• Missing Referral: Attempting to create a Maximus portal account without a valid RD worker referral number.
• Background Check Failures: Incomplete Fingerprint-based Criminal Background Checks for owners with 5% or more control.
• EVV Non-Compliance: Inability to demonstrate operational access to or competency with the required EVV technology.
• Fee Evasion: Failure of agency providers to pay the required federal application fee during initial enrollment.

11. Key Contacts and Resources

Primary contacts include Maximus for enrollment support and DHHS for waiver policy questions.

Providers should have their provider ID and dates of service ready when contacting support.

• Maximus Enrollment Portal: https://nebraskamedicaidproviderenrollment.com/
• DHHS Provider Screening and Enrollment: https://dhhs.ne.gov/Pages/PSE-for-HCBS-Providers.aspx
• HCBS Provider Relations Email: [email protected]
• HCBS Provider Relations Phone: (402) 471-0667

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