Nebraska - Assisted Living Facility — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Nebraska Department of Health and Human Services (DHHS) Division of Public Health licenses Assisted Living Facilities (ALFs) under Title 175, Chapter 4, while the Division of Medicaid and Long-Term Care (MLTC) funds these services through the Aged and Disabled (A&D) Waiver. Facilities providing shelter, food, and assistance with care activities continuously for 24 or more hours to four or more residents must hold this specific license.

Applicants must secure architectural plan approval and pass an initial life safety and compliance inspection from the DHHS Licensure Unit before a license is issued. Once licensed, facilities submit Form MC-19 through the Maximus Provider Data Management System (PDMS) to enroll as a Medicaid waiver provider and accept A&D Waiver participants.

1. Service Definition and Scope

In Nebraska, an Assisted Living Facility (ALF) provides housing, meals, personal supportive care, and supervision in a group setting for adults who cannot live independently. ALFs are distinct from nursing homes and cannot provide routine care by licensed nurses (RN/LPN).

Under the Medicaid Aged and Disabled (A&D) Waiver, certified ALFs provide waiver-funded assisted living services to eligible aged, blind, or disabled individuals. Facilities may offer different living units or service packages to waiver participants, which must be outlined in the Resident Service Agreement.

• Capacity Threshold: Licensure is required for any facility serving four or more residents.
• Service Duration: Care and supervision must be provided continuously for 24 or more hours.
• Nursing Restriction: Routine care by licensed nurses (RN/LPN) is strictly prohibited in the ALF setting.
• Medicaid Scope: Funded primarily through the Aged and Disabled (A&D) Waiver for eligible residents.
• Resident Agreement: Services provided must be detailed in a formal Resident Service Agreement.

2. Regulatory and Oversight Agencies

The Nebraska Department of Health and Human Services (DHHS) is the primary umbrella agency overseeing ALFs. The Division of Public Health handles facility licensure and life safety inspections.

The DHHS Division of Medicaid and Long-Term Care (MLTC) manages the A&D Waiver and provider enrollment, utilizing Maximus as the enrollment broker.

• Licensing Agency: DHHS Division of Public Health - Licensure Unit (https://dhhs.ne.gov/licensure/Pages/Assisted-Living-Facilities.aspx)
• Medicaid Authority: DHHS Division of Medicaid and Long-Term Care (https://dhhs.ne.gov/Pages/Medicaid-and-Long-Term-Care.aspx)
• Enrollment Broker: Maximus Provider Data Management System (PDMS) (https://nebraskamedicaidproviderenrollment.com/)
• Inspection Authority: State Fire Marshal (delegated authority for occupancy certificates) (https://sfm.nebraska.gov/)

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska does not require a Certificate of Need (CON) for Assisted Living Facilities. There are no closed networks, moratoria, or mandatory Request for Proposal (RFP) procurements blocking new ALF applications.

The primary structural precondition is architectural and life safety approval. Applicants constructing new facilities or remodeling existing ones must receive written approval of schematic and construction plans from the DHHS Licensure Unit before construction begins and before an application for licensure is fully processed.

• Certificate of Need: Genuinely none exists for ALFs in Nebraska.
• Plan Approval: Written DHHS approval of schematic and construction plans is required prior to building.
• Occupancy Certificate: Must obtain an occupancy certificate from the State Fire Marshal dated within the last 18 months.
• Zoning Compliance: Must meet local zoning and building codes before state review.
• Medicaid Prerequisite: An active DHHS ALF license is required before submitting Form MC-19 for Medicaid enrollment.

4. Licensure and Certification Requirements

ALF licensure is governed by Nebraska Administrative Code Title 175, Chapter 4 (175 NAC 4). Applicants must submit the Assisted-Living Facility Licensure Initial Application to the DHHS Licensure Unit.

The application requires detailed ownership disclosure, floor plans, and an architect or engineer's certification for new construction. The facility must pass an initial on-site compliance and life safety inspection prior to admitting residents.

• Regulation Citation: Title 175, Chapter 4 (175 NAC 4).
• Application Form: Assisted-Living Facility Licensure Initial Application.
• Architect Certification: Required for new construction to verify compliance with room sizes, hardware, and safety equipment.
• Inspection Notice: Must notify DHHS at least 30 days prior to planned occupancy for the initial on-site inspection.
• Ownership Disclosure: Must provide a complete list of names and addresses of all persons in control of the facility.

5. Medicaid Provider Enrollment

Licensed ALFs wishing to serve Medicaid waiver participants must enroll through the Maximus Provider Data Management System (PDMS). The core enrollment document is Form MC-19, the Nebraska Service Provider Agreement.

Providers must obtain a National Provider Identifier (NPI) and submit a W-9. Each physical location where services are provided must be enrolled separately with its own MC-19 agreement.

• Enrollment Portal: Maximus PDMS (https://nebraskamedicaidproviderenrollment.com/).
• Core Agreement: Form MC-19 (Nebraska Service Provider Agreement).
• Tax Documentation: W-9 required for businesses enrolling with an EIN.
• Identifier: National Provider Identifier (NPI) is mandatory for HCBS providers.
• Location Rule: A separate Form MC-19 is required for each physical facility location.

6. Staffing, Training and Background Checks

Nebraska requires ALF administrators to complete specific training and be officially designated. Facilities must maintain sufficient staff to meet the 24-hour care and supervision needs of the residents.

All employees, contractors, and sub-contractors must be screened against the Nebraska Medicaid Exclusion Provider List. Facilities must verify employment eligibility and conduct background checks as mandated by DHHS.

• Administrator Training: Initial Administrator training is required by DHHS.
• Administrator Change: Form required within five working days of an administrator change.
• Exclusion Screening: Providers must screen all staff against the Nebraska Medicaid Exclusion Provider List.
• Employment Verification: Providers must attest on Form MC-19 to verifying employment eligibility of all employees.
• Staffing Ratios: Must maintain adequate staffing to provide continuous 24-hour supervision and care.

7. Documentation, Policies and Records

ALFs must maintain comprehensive records for both licensure and Medicaid compliance. The foundational document for resident care is the Resident Service Agreement, which acts as the contract for services.

Facilities must also maintain policies regarding medication management, emergency assistance, and resident rights, even if specific services like transportation are optional under state regulations.

• Resident Contract: Resident Service Agreement detailing services, costs, and Medicaid Waiver policies.
• Floor Plans: Accurate floor plans and bed counts must be maintained and submitted during license renewal.
• Change Notifications: Must notify DHHS within five working days of changes to facility name or administrator.
• Bed Count Changes: Must notify DHHS within 30 working days of a change in the number of licensed beds.
• Dementia Care: Facilities providing Alzheimer's care must complete a Special Care Disclosure and Memory Care Endorsement Application.

8. Billing, Rates and Claims

Medicaid billing for ALF services is processed through the Nebraska Medicaid Management Information System (MMIS) via the Maximus portal. Services are billed under specific HCBS waiver procedure codes.

Rates for the A&D Waiver are established by DHHS MLTC and are based on the resident's assessed tier of need. Facilities must accept the Medicaid rate as payment in full for covered services.

• Billing System: Nebraska MMIS via Maximus PDMS.
• Waiver Program: Billed under the Medicaid Aged and Disabled (A&D) Waiver.
• Rate Structure: Tiered reimbursement based on DHHS MLTC fee schedules and resident assessments.
• Payment Prohibition: No payment is made for services furnished by individuals on the Medicaid Exclusion list.
• Remittance: Remittance advices are sent to the 'Pay to Name and Address' specified on Form MC-19.

9. Approval Sequence and Timeline

The approval process begins with architectural plan review by DHHS and the State Fire Marshal. Once construction or remodeling is complete, the facility submits the Initial Application and requests an inspection.

After passing the initial inspection and receiving the ALF license, the provider submits Form MC-19 through Maximus PDMS. Medicaid enrollment cannot begin until the physical license is issued.

• Step 1: Submit schematic and construction plans to DHHS for written approval.
• Step 2: Complete construction and obtain State Fire Marshal occupancy certificate.
• Step 3: Submit ALF Initial Application and notify DHHS 30 days prior to occupancy.
• Step 4: Pass DHHS initial on-site compliance and life safety inspection.
• Step 5: Receive ALF License from DHHS Division of Public Health.
• Step 6: Submit Form MC-19 and W-9 via Maximus PDMS for Medicaid enrollment.

10. Common Denials and Survey Findings

Licensure delays frequently occur due to failed life safety inspections or incomplete architectural certifications. Facilities must ensure all physical plant requirements in 175 NAC 4 are met before requesting the initial survey.

Medicaid enrollment denials typically stem from mismatched tax information, failure to provide a valid NPI, or attempting to enroll multiple physical locations under a single Form MC-19.

• Physical Plant Failures: Non-compliance with room sizes, grab bars, or hardware standards during initial inspection.
• Fire Safety: Lack of a current (within 18 months) occupancy certificate from the State Fire Marshal.
• Tax ID Mismatch: Legal name on Form MC-19 does not exactly match the IRS W-9 issuance.
• Location Errors: Submitting a P.O. Box instead of a physical address on Form MC-19.
• Exclusion Violations: Employing individuals listed on the Nebraska Medicaid Exclusion Provider List.

11. Key Contacts and Resources

Providers should utilize the DHHS Licensure Unit for all physical plant, regulatory, and initial licensing inquiries. The Maximus PDMS portal is the primary resource for Medicaid enrollment and revalidation.

Official forms, including the ALF Initial Application and Form MC-19, are hosted on the DHHS public forms directory.

• DHHS Licensure Unit: (402) 471-3324 (https://dhhs.ne.gov/licensure/Pages/Assisted-Living-Facilities.aspx)
• Medicaid Enrollment Portal: Maximus PDMS (https://nebraskamedicaidproviderenrollment.com/)
• DHHS Forms Directory: (https://public-dhhs.ne.gov/Forms/Home.aspx)
• State Fire Marshal: (https://sfm.nebraska.gov/)
• Nebraska Medicaid Exclusion List: (https://dhhs.ne.gov/Documents/Medicaid%20Excluded%20Providers.pdf)

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