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

Last reviewed: 2026-08-16

In Nebraska, Adult Companion Services are administered primarily through the Aged and Disabled (AD) Waiver. This service provides non-medical supervision and social supports to adults ages 18 and older who are aged or have disabilities, ensuring they can safely remain in their homes or community settings rather than facing institutionalization. The service focuses on socialization and oversight rather than hands-on medical or personal care, as outlined by the Nebraska Department of Health and Human Services ([Services on the Aged and Disabled Waiver](https://dhhs.ne.gov/Pages/Medicaid-Aged-and-Disabled-Waiver.aspx)).

The single biggest structural barrier to entry for prospective providers in Nebraska is the strict sequencing of the state's managed care enrollment framework. Providers cannot simply apply to join a Medicaid health plan; they must first successfully secure an active Medicaid ID by passing screening through the state's Maximus-operated Provider Data Management System (PDMS). Only after the state approves this foundational enrollment can a provider approach the Heritage Health managed care organizations (MCOs) or the state's Centralized Credentialing Vendor to secure the network contracts required to actually bill for services ([Nebraska Medicaid Provider Enrollment: 2026 PDMS Guide](https://medsolercm.com/blog/nebraska-medicaid-provider-enrollment)).

1. Service Definition and Scope

Nebraska defines Companion Services under the Aged and Disabled (AD) Waiver as non-medical supervision and social supports provided to an adult participant. The primary goal is to ensure the health and safety of individuals who cannot safely be left alone, thereby preventing institutionalization and fostering community integration.

This service is distinct from personal care or chore services. While a companion may assist with light tasks incidental to the supervision, their core function is socialization and oversight. All services must be explicitly authorized in the participant's Individualized Service Plan (ISP) developed by their service coordinator ([Services on the Aged and Disabled Waiver](https://dhhs.ne.gov/Pages/Medicaid-Aged-and-Disabled-Waiver.aspx)).

• Target Population: Adults ages 18 and older who are enrolled in the Nebraska Aged and Disabled (AD) Waiver.
• Core Activities: Non-medical supervision, socialization, and safety monitoring.
• Service Setting: Delivered in the participant's home or in community settings.
• Exclusions: Cannot duplicate personal care, chore services, or skilled medical/nursing care.
• Authorizing Document: Services must be documented and approved in the participant's Individualized Service Plan (ISP).
• Incidental Assistance: May include light assistance with daily tasks only if incidental to the primary companion role.

2. Regulatory and Oversight Agencies

Nebraska does not issue a distinct facility or agency license specifically for "Adult Companion Agencies." Instead, providers are regulated directly through the Medicaid Home and Community-Based Services (HCBS) waiver certification and enrollment process. The Nebraska Department of Health and Human Services (DHHS) holds ultimate statutory authority over the program.

Day-to-day enrollment operations are outsourced to Maximus, which manages the Provider Data Management System (PDMS). Once enrolled, providers operate under the Heritage Health managed care system, which utilizes a Centralized Credentialing Vendor (Verisys) to verify provider qualifications on behalf of the state's contracted health plans ([Nebraska Medicaid Provider Enrollment: 2026 PDMS Guide](https://medsolercm.com/blog/nebraska-medicaid-provider-enrollment)).

• Primary Agency: Nebraska Department of Health and Human Services (DHHS).
• Operating Division: DHHS Division of Medicaid and Long-Term Care (MLTC).
• Enrollment Contractor: Maximus, responsible for operating the PDMS portal and conducting initial provider screening.
• Managed Care Program: Heritage Health, which administers Medicaid benefits through three contracted MCOs.
• Credentialing Vendor: Verisys, acting as the Centralized Credentialing Vendor (CVO) for Heritage Health MCOs effective January 2025.

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska does not impose a Certificate of Need (CON), county sponsorship requirement, or closed-network moratorium on Adult Companion Services. The market is generally open to willing providers who meet HCBS standards. However, there are strict structural prerequisites regarding how and when an application is submitted.

The most critical gatekeeping prerequisite is the mandatory sequencing of enrollment: a provider must obtain an active Nebraska Medicaid ID from DHHS before any Heritage Health MCO will accept a network application. Furthermore, as of June 1, 2025, DHHS strictly prohibits paper applications; any attempt to bypass the Maximus PDMS online portal will result in immediate rejection ([Nebraska Medicaid Provider Screening and ...](https://nebraskamedicaidproviderenrollment.com/Documents/MaximusNewsletter.pdf)).

• Certificate of Need (CON): None required for HCBS companion services in Nebraska.
• Network Status: Open enrollment; there are no state-mandated moratoria or closed RFP procurement windows.
• MCO Prerequisite: Providers must possess an active Nebraska Medicaid ID from DHHS before initiating network contracts with Heritage Health plans.
• Submission Mandate: Paper applications are strictly banned as of June 1, 2025; all enrollments must utilize the PDMS portal.
• Business Registration: Entities must be registered and in good standing with the Nebraska Secretary of State prior to applying.

4. Licensure and Certification Requirements

Because Nebraska lacks a specific statutory license category for non-medical companion agencies, providers achieve legal authority to operate through HCBS waiver certification. This certification is granted concurrently with Medicaid enrollment when the provider agrees to adhere to AD Waiver standards.

To pass the DHHS readiness review, agencies must demonstrate they have the necessary administrative infrastructure. This includes obtaining standard federal identifiers, maintaining adequate liability insurance, and establishing comprehensive agency policies for participant safety and staff oversight ([Provider enrollment for Home and Community-based Service ...](https://dhhs.ne.gov/Pages/PSE-for-HCBS-Providers.aspx)).

• State License: No distinct DHHS facility license is required for non-medical companion services.
• Waiver Certification: Achieved through approval of the Service Provider Agreement during Medicaid enrollment.
• Tax Identification: Must obtain an Employer Identification Number (EIN) from the IRS.
• National Provider Identifier (NPI): Must obtain a Type 2 NPI (for agencies) or Type 1 (for independent providers).
• Insurance Requirements: Must maintain active general liability and professional liability insurance policies.
• Policy Infrastructure: Must develop and maintain comprehensive policies for participant safety, emergency preparedness, and staff training.

5. Medicaid Provider Enrollment

Enrollment is processed entirely through the Nebraska Medicaid Provider Data Management System (PDMS), managed by Maximus. While Maximus gathers data and performs primary source verification, the DHHS Provider Relations team conducts the final review and issues the Medicaid ID.

Providers must complete the Service Provider Agreement electronically. Under federal rules, companion service providers are subject to categorical risk-level screening and must undergo revalidation every five years to maintain their active billing status ([Nebraska Medicaid Provider Enrollment: 2026 PDMS Guide](https://medsolercm.com/blog/nebraska-medicaid-provider-enrollment)).

• Enrollment Portal: Nebraska Medicaid Provider Data Management System (PDMS).
• Contractor: Maximus handles intake, screening, and primary source verification.
• Required Form: Service Provider Agreement (formerly Form MC-19, now completed electronically in PDMS).
• Screening Risk Level: Screened according to 42 CFR 455.450 risk levels, typically Limited or Moderate for HCBS agencies.
• Revalidation: Required every five years per federal rule 42 CFR 455.414.
• Application Fee: Subject to federal ACA application fees if categorized as an institutional provider, though independent HCBS providers may be exempt.

6. Staffing, Training and Background Checks

Companion service staff do not require medical licenses, but they must meet strict background and training criteria established by DHHS for the AD Waiver. Agencies bear the responsibility of verifying these qualifications before allowing any staff member to provide direct care.

Background checks are rigorous and must screen out individuals with disqualifying criminal convictions or those listed on state and federal abuse registries. Staff must also complete agency-led training on participant safety and mandatory reporting ([Nebraska Service Provider Agreement Instructions](https://atp.nebraska.gov/sites/default/files/doc/6_MC19Inst%20Nebraska%20Service%20Provider%20Agreement%20Instructions.pdf)).

• Minimum Age: Direct care companion staff must be at least 18 years old.
• State Registries: Must clear the Nebraska Adult and Child Abuse and Neglect Registries.
• Federal Exclusions: Must be screened against the OIG List of Excluded Individuals/Entities (LEIE) and GSA System for Award Management (SAM).
• Basic Qualifications: High school diploma or GED, and the ability to communicate effectively with the participant.
• Employment Verification: Must verify employment eligibility (Form I-9) for all staff.
• Required Training: Must complete training on participant safety, emergency procedures, HIPAA, and abuse/neglect reporting.

7. Documentation, Policies and Records

Providers must maintain comprehensive policy manuals and participant records to pass DHHS readiness reviews and survive post-enrollment audits. Documentation must definitively prove that services were delivered exactly as authorized in the participant's Individualized Service Plan (ISP).

Records must be kept securely in compliance with HIPAA. This includes detailed timesheets or electronic visit verification (EVV) logs that capture the exact dates, start and stop times, and the specific nature of the companion services provided ([ADULT HEALTH SERVICES PROVIDER IN NEBRASKA](https://www.waivergroup.com/post/adult-health-services-provider-in-nebraska)).

• Policy Manual: Must include procedures for participant safety, emergency preparedness, and grievance handling.
• Service Documentation: Timesheets or EVV logs detailing date, start/stop times, and specific activities performed.
• Care Plans: Must maintain a current copy of the participant's DHHS-approved Individualized Service Plan (ISP).
• Personnel Files: Must contain proof of background checks, training completion, and employment eligibility.
• HIPAA Compliance: Must maintain strict privacy protocols for all participant health and service records.
• Record Retention: Records must typically be retained for a minimum of five years following the date of service delivery.

8. Billing, Rates and Claims

Once enrolled with the state, providers must contract with the three Heritage Health MCOs (UnitedHealthcare, Molina, Nebraska Total Care) to bill for AD Waiver services. Because most participants are in managed care, claims are submitted directly to the respective MCO rather than the state's Medicaid Management Information System (MMIS).

Rates are established by DHHS MLTC, but the MCOs administer the payments based on authorized units. Services must be prior-authorized by the MCO based on the participant's ISP before any billing can occur ([Nebraska Medicaid Provider Enrollment: 2026 PDMS Guide](https://medsolercm.com/blog/nebraska-medicaid-provider-enrollment)).

• Billing System: Claims for AD Waiver participants are submitted to the participant's assigned Heritage Health MCO.
• State System: The state's MMIS processes fee-for-service claims, though this is rare for AD waiver participants.
• Prior Authorization: Services must be prior-authorized by the MCO based on the ISP before billing.
• Unit of Service: Typically billed in 15-minute increments using specific HCPCS codes designated for companion care.
• Centralized Credentialing: Verisys handles primary source verification for all three MCOs to streamline the contracting phase.
• Rate Setting: Maximum allowable rates are established by the DHHS Division of Medicaid and Long-Term Care.

9. Approval Sequence and Timeline

The end-to-end approval process requires sequential steps: state Medicaid enrollment must be completed first, followed by MCO credentialing and contracting. Attempting to bypass the state PDMS portal will result in immediate rejection by the MCOs.

The timeline can take several months and is heavily dependent on the provider submitting a complete, error-free electronic application. Delays in responding to Maximus's requests for additional information will pause the enrollment clock ([Nebraska Medicaid Provider Enrollment | Done For You](https://contractingproviders.com/services/medicaid-enrollment-assistance/nebraska)).

• Step 1: Register business entity with the Nebraska Secretary of State and obtain NPI/EIN (1-2 weeks).
• Step 2: Submit electronic application via the Maximus PDMS portal.
• Step 3: DHHS Provider Relations reviews and approves the Service Provider Agreement (typically 30-60 days).
• Step 4: Submit credentialing data to Verisys, the CVO for Heritage Health.
• Step 5: Execute network contracts with UnitedHealthcare, Molina, and Nebraska Total Care (60-90 days).
• Total Timeline: Expect 3 to 5 months from initial business registration to full MCO billing capability.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to administrative errors in the PDMS portal, such as mismatched NPI data, discrepancies with IRS records, or failure to respond to Maximus's requests for additional information within the allotted timeframe.

During post-enrollment audits, DHHS and MCOs commonly cite providers for inadequate documentation of service hours or failure to maintain current background checks on staff. Missing a revalidation deadline due to outdated contact information in PDMS is a leading cause of sudden enrollment termination ([Nebraska Medicaid Provider Enrollment: 2026 PDMS Guide](https://medsolercm.com/blog/nebraska-medicaid-provider-enrollment)).

• Application Denial: Submitting paper applications after the June 1, 2025 ban results in automatic rejection.
• Enrollment Delay: Discrepancies between the IRS legal name and the name entered in the PDMS portal.
• Audit Finding: Missing or incomplete timesheets that fail to align with the authorized ISP hours.
• Audit Finding: Employing staff who have not cleared the OIG LEIE or state abuse registries prior to their first shift.
• Audit Finding: Billing for companion services while the participant was receiving skilled medical care or was hospitalized.
• Revalidation Failure: Missing the 5-year revalidation notice due to outdated contact information in the PDMS portal.

11. Key Contacts and Resources

Providers should rely on official DHHS portals and the Maximus help desk for enrollment assistance. The Nebraska Medicaid Provider Manual is the definitive source for policy, coverage, and billing rules.

For MCO contracting, providers must engage with the specific provider relations departments of the Heritage Health plans and ensure their data is current with Verisys ([Provider enrollment for Home and Community-based Service ...](https://dhhs.ne.gov/Pages/PSE-for-HCBS-Providers.aspx)).

• Enrollment Portal: Nebraska Medicaid Provider Data Management System (PDMS).
• Enrollment Contractor: Maximus Provider Enrollment Help Desk (844-374-5022 or nebraskamedicaidpse@maximus.com).
• State Agency: Nebraska DHHS Division of Medicaid and Long-Term Care (MLTC).
• Policy Resource: Nebraska Medicaid Provider Manual (consolidated January 2026).
• MCO Credentialing: Verisys (Centralized Credentialing Vendor for Heritage Health).
• Managed Care Plans: UnitedHealthcare Community Plan of Nebraska, Molina Healthcare of Nebraska, and Nebraska Total Care.

See all Nebraska services · Nebraska Medicaid consulting · book a consultation.