Nebraska - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Nebraska, Case Management Services (often referred to as Service Coordination or Targeted Case Management) are overseen by the Department of Health and Human Services (DHHS), Division of Medicaid and Long-Term Care (MLTC) and the Division of Developmental Disabilities (DDD). The service is funded through Nebraska's 1915(c) HCBS Waivers (such as the Aged and Disabled Waiver and the Developmental Disabilities waivers) and the Medicaid State Plan. Approval to provide this service requires enrollment as a Medicaid provider through the Nebraska Medicaid Provider Screening and Enrollment portal.

Nebraska does not require a distinct state license or certification specifically to operate as a case management or service coordination agency. Instead, providers must meet the qualifications outlined in the specific waiver appendix or State Plan Amendment (SPA) and successfully complete the Medicaid provider enrollment process, which includes paying the required application fee and passing the federally mandated risk-based screening.

1. Service Definition and Scope

Case Management, or Service Coordination, in Nebraska involves assisting Medicaid waiver participants or targeted populations in gaining access to needed medical, social, educational, and other services. The service includes comprehensive assessment, person-centered service planning, referral, and ongoing monitoring of the individual's service package.

The scope of the service ensures that individuals receive the appropriate level of care in the least restrictive environment possible, coordinating both paid waiver services and unpaid natural supports.

• Service Name: Service Coordination (Aged and Disabled Waiver) or Targeted Case Management (State Plan).
• Core Function: Assessment of individual needs and development of a person-centered service plan.
• Core Function: Referral to appropriate service providers and community resources.
• Core Function: Ongoing monitoring and oversight of waiver services to ensure health, safety, and goal progression.
• Delivery Method: Can be provided by agency-based or independent providers, depending on the specific waiver or program rules.

2. Regulatory and Oversight Agencies

The primary oversight for Medicaid services in Nebraska is the Department of Health and Human Services (DHHS). Within DHHS, the Division of Medicaid and Long-Term Care (MLTC) manages the Medicaid program and the Aged and Disabled Waiver, while the Division of Developmental Disabilities (DDD) oversees services for individuals with intellectual and developmental disabilities.

Provider enrollment is handled through the Nebraska Medicaid Provider Screening and Enrollment portal, managed by a contracted vendor on behalf of DHHS.

• Oversight Agency: Nebraska DHHS Division of Medicaid and Long-Term Care (MLTC) (https://dhhs.ne.gov/Pages/Medicaid-and-Long-Term-Care.aspx).
• Oversight Agency: Nebraska DHHS Division of Developmental Disabilities (DDD) (https://dhhs.ne.gov/Pages/Developmental-Disabilities.aspx).
• Enrollment Portal: Nebraska Medicaid Provider Screening and Enrollment (https://nebraskamedicaidproviderenrollment.com).
• Federal Oversight: Centers for Medicare and Medicaid Services (CMS), which approves the 1915(c) waivers and State Plan Amendments.

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska does not impose a Certificate of Need, a closed network moratorium, or a mandatory managed care lead-agency affiliation requirement for basic HCBS Service Coordination or Targeted Case Management. The primary prerequisite is meeting the provider qualifications specified in the waiver or State Plan and successfully enrolling as a Nebraska Medicaid provider.

For certain specialized populations, such as independent providers who are also legal guardians, approval by the DDD Central Office may be required prior to providing services.

• Licensure Prerequisite: None required specifically for case management/service coordination agencies.
• Certification Prerequisite: None required specifically for case management/service coordination agencies.
• Network Affiliation: Not required; providers enroll directly with Nebraska Medicaid.
• Special Approval: Independent providers who are legal guardians must be approved by DDD Central Office (if applicable to the specific service/waiver).

4. Licensure and Certification Requirements

Nebraska does not issue a specific facility or agency license for HCBS Case Management or Service Coordination. Providers must comply with all applicable professional licensure standards, Titles of the Nebraska Administrative Code, and Nebraska State Statutes as appropriate for their staff.

Because there is no distinct license, the approval process relies entirely on the Medicaid provider enrollment screening and verification of staff qualifications.

• Agency License: No license required.
• Agency Certification: No certification required.
• Professional Licensure: Staff providing the service must hold any applicable professional licenses (e.g., social work, nursing) if required by the specific waiver definition.
• Compliance: Must comply with Titles of the Nebraska Administrative Code and Nebraska State Statutes.

5. Medicaid Provider Enrollment

To bill for Case Management or Service Coordination, an agency or individual must enroll through the Nebraska Medicaid Provider Screening and Enrollment portal. This process involves submitting an application, paying the required fee, and undergoing risk-based screening as mandated by the Affordable Care Act.

Providers must enroll separately for each location where they provide services to Medicaid members. Revalidation of the provider agreement is required every five years.

• Portal: Nebraska Medicaid Provider Screening and Enrollment (https://nebraskamedicaidproviderenrollment.com).
• Application Fee: $709 for 2024 (set annually by CMS), required for institutional providers, groups, or agencies.
• Fee Exemption: Not required if already enrolled in Medicare or if the fee was paid to another state's Medicaid program.
• Location Requirement: Providers must enroll separately for each practice location.
• Retroactive Enrollment: HCBS providers cannot receive a retroactive start date.
• Revalidation: Required every five years.

6. Staffing, Training and Background Checks

Staff providing Case Management or Service Coordination must meet the educational and experience qualifications outlined in the specific waiver appendix or State Plan Amendment. This typically involves a degree in a human services field or equivalent experience.

Providers are responsible for screening their employees based on the risk level of the services provided, which includes criminal background checks and checking abuse/neglect registries.

• Staff Qualifications: Must meet the specific education and experience requirements detailed in the applicable waiver (e.g., Aged and Disabled Waiver) or SPA.
• Background Checks: Agencies must screen employees, including criminal history and registry checks.
• Technology Skills: Providers must possess computer skills and access to technology to navigate the state-mandated web-based case management system.
• Training: Must complete any state-mandated orientation or training regarding person-centered planning and waiver rules.

7. Documentation, Policies and Records

Providers must maintain comprehensive records for each individual served, including the comprehensive assessment, the person-centered service plan, and detailed case notes documenting all contacts and coordination activities.

Agencies must also maintain internal policies and procedures that comply with the Division of Medicaid and Long-Term Care Service Provider Agreement, including incident reporting, grievance procedures, and quality assurance.

• Service Plan: Must maintain the current, approved person-centered service plan.
• Case Notes: Detailed documentation of all case management activities, referrals, and monitoring visits.
• Provider Agreement: Must adhere to standards described in the Division of Medicaid and Long-Term Care Service Provider Agreement.
• System Access: Must utilize the state-mandated web-based case management system for documentation where required.

8. Billing, Rates and Claims

Case Management and Service Coordination are billed to Nebraska Medicaid using specific HCPCS procedure codes and modifiers defined in the state's fee schedules. Rates are established by DHHS and published on the Medicaid fee schedule website.

Providers must ensure that all billed services are authorized in the individual's person-centered service plan and supported by adequate documentation.

• Billing System: Claims are submitted through the Nebraska Medicaid MMIS or the applicable Managed Care Organization (MCO) if the individual is enrolled in managed care.
• Rates: Established by DHHS and published on the Nebraska Medicaid fee schedule.
• Authorization: Services must be prior-authorized or included in the approved service plan before billing.
• MCO Contracting: If serving individuals in managed care, providers must credential and contract with the specific MCOs.

9. Approval Sequence and Timeline

Because there is no state licensure requirement, the approval sequence begins directly with Medicaid provider enrollment. The applicant submits the enrollment application, pays the fee, and undergoes the screening process.

The timeline is primarily dictated by the Medicaid enrollment vendor's processing time, which can take several weeks to a few months depending on application completeness and background screening.

• Step 1: Establish business entity and obtain NPI.
• Step 2: Submit application through the Nebraska Medicaid Provider Screening and Enrollment portal.
• Step 3: Pay the CMS-mandated application fee (if applicable).
• Step 4: Undergo risk-based screening and background checks.
• Step 5: Receive Medicaid provider ID and execute the Service Provider Agreement.

10. Common Denials and Survey Findings

Applications for Medicaid enrollment may be denied or delayed if the provider fails to pay the required application fee, submits incomplete information, or if staff do not meet the specific qualifications outlined in the waiver.

During program compliance reviews, common findings include inadequate documentation of case management activities, failure to update the person-centered service plan as needs change, and failure to complete required revalidation.

• Enrollment Delay: Failure to pay the application fee or provide proof of exemption.
• Enrollment Denial: Failure to pass risk-based screening or background checks.
• Compliance Finding: Incomplete or missing case notes to support billed activities.
• Compliance Finding: Failure to complete annual revalidation or five-year re-enrollment.

11. Key Contacts and Resources

Providers should utilize the DHHS website and the Medicaid enrollment portal for the most current forms, fee schedules, and waiver manuals. The enrollment vendor provides a dedicated help desk for application assistance.

For questions regarding specific waiver requirements or populations, providers should contact the respective DHHS division (MLTC or DDD).

• Nebraska DHHS Medicaid Provider Enrollment: https://dhhs.ne.gov/Pages/Medicaid-Provider-Screening-and-Enrollment-Forms.aspx
• Enrollment Portal: https://nebraskamedicaidproviderenrollment.com
• Enrollment Help Desk Email: [email protected]
• Enrollment Help Desk Phone: (402) 471-0667
• Nebraska DHHS Division of Medicaid and Long-Term Care: https://dhhs.ne.gov/Pages/Medicaid-and-Long-Term-Care.aspx

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