Nebraska - Home Health Service — 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 Home Health Agencies under Title 175 NAC 14 to deliver intermittent skilled nursing and therapeutic services to individuals in their permanent or temporary residences. Agencies must submit the Home Health Agency Licensure Application along with a $650 initial fee and pass an initial compliance inspection based on agency-specific organizational charts, job descriptions, and policies.

Agencies seeking Medicaid reimbursement must secure Medicare certification under 42 CFR Part 484 before the Division of Medicaid & Long-Term Care will approve their enrollment via the Maximus portal. Providers must demonstrate compliance with Outcome and Assessment Information Set (OASIS) transmission requirements prior to the initial certification survey, and Medicaid will only pay for home health agency services provided by these Medicare-certified entities.

1. Service Definition and Scope

In Nebraska, a Home Health Agency is defined under Title 175 NAC 14 as a person or legal entity providing skilled nursing care or a minimum of one other therapeutic service (physical therapy, speech pathology, occupational therapy, respiratory care, home health aide, social work, intravenous therapy, or dialysis) in a patient's residence.

Under Title 471 NAC 9, Nebraska Medicaid covers these services when they are medically prescribed and provided on a full-time, part-time, or intermittent basis. Services must be directed by a current, signed physician, nurse practitioner, physician assistant, or clinical nurse specialist order.

• Skilled Nursing: Provided by licensed RNs or LPNs under a physician-ordered plan of care.
• Therapeutic Services: Includes physical, occupational, and speech therapy, as well as respiratory care and dialysis.
• Home Health Aide Services: Personal care and assistance tasks delegated and supervised by a registered nurse.
• Geographic Service Area: Agencies must define the specific Nebraska counties they serve; any expansion requires contiguous county approval.
• Durable Medical Equipment: Billed under the home health agency provider number according to 471 NAC 7 methodologies.

2. Regulatory and Oversight Agencies

The Nebraska Department of Health and Human Services (DHHS) divides oversight between the Licensure Unit, which handles state facility licensing, and the Division of Medicaid & Long-Term Care, which manages Medicaid policy and provider relations.

Federal oversight is managed by the Centers for Medicare and Medicaid Services (CMS), which dictates the Conditions of Participation (CoP) that Nebraska agencies must meet to achieve the Medicare certification required for Medicaid enrollment.

• DHHS Division of Public Health Licensure Unit: Issues state licenses and conducts compliance inspections (https://dhhs.ne.gov/licensure/Pages/Home-Health-Agencies.aspx).
• DHHS Division of Medicaid & Long-Term Care: Manages Medicaid policy, prior authorizations, and provider relations (https://dhhs.ne.gov/Pages/Medicaid-Provider-Screening-and-Enrollment-Forms.aspx).
• Maximus: The contracted vendor operating the Nebraska Medicaid Provider Screening and Enrollment portal (https://www.nebraskamedicaidproviderenrollment.com/).
• Centers for Medicare and Medicaid Services (CMS): Establishes federal CoPs and OASIS requirements for Medicare certification (https://www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center.html).

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska does not utilize a Certificate of Need (CON) program for Home Health Agencies, meaning the market is generally open to new applicants. However, the state imposes a strict sequential prerequisite structure where state licensure must be fully secured before federal certification can be requested.

The most restrictive structural precondition for Medicaid enrollment is the Medicare certification mandate. Under 471 NAC 9-005.042(B), Nebraska Medicaid explicitly restricts payment for home health agency services to Medicare-certified home health agencies, barring state-only licensed agencies from enrolling as Medicaid home health providers.

• State Licensure Prerequisite: An agency cannot operate or apply for Medicare certification without first holding an active Home Health Agency license issued by the DHHS Licensure Unit.
• Medicare Certification Requirement: Nebraska Medicaid requires agencies to be Medicare-certified under 42 CFR Part 484 to receive Medicaid reimbursement for home health services.
• OASIS Transmission Capability: New agencies must prove they can successfully transmit OASIS data to the state system prior to their initial Medicare certification survey.
• Provisional License Restriction: Providers enrolled with a provisional state license cannot be reimbursed under a permanent license until a new Medicaid enrollment is completed.

4. Licensure and Certification Requirements

Agencies must submit the non-fillable Home Health Agency Licensure Application to the DHHS Licensure Unit. The application requires disclosure of ownership, the designated administrator, services provided, and the specific geographical area (counties) served.

Prior to issuing a license, DHHS conducts an initial inspection to verify compliance with 175 NAC 14-006 (Standards of Operations, Care and Treatment). Following licensure, agencies are subject to unannounced onsite compliance inspections.

• Initial Licensure Fee: A non-refundable fee of $650 must accompany the initial application.
• Medicare Hotline Brochure: Agencies must print and provide the DHHS Medicare Home Health Agency Hotline Brochure to all Medicare patients upon admission.
• Change of Ownership: Licensees must notify DHHS in writing 10 days before an agency is sold, leased, or discontinued, as licenses are non-transferable.
• Change of Premises: Agencies must notify DHHS before moving; new counties added to the service area must be contiguous to the previously approved area.

5. Medicaid Provider Enrollment

All Medicaid providers must enroll through Maximus, the screening and enrollment contractor for DHHS. The Provider Relations team reviews the Maximus screening data to make final eligibility determinations.

Enrollment is location-specific, and agencies must maintain active enrollment through periodic revalidation. HCBS providers are not eligible for retroactive start dates.

• Maximus Portal: Applications must be submitted online via the Maximus Nebraska Medicaid Provider Enrollment system.
• Separate Location Enrollment: Providers must enroll separately for each physical location where they provide services to Medicaid members.
• Annual Screening: HCBS providers undergo a yearly renewal process where all file information is reviewed.
• Revalidation: Required every 5 years; Maximus sends email notices starting 180 days before the revalidation deadline.

6. Staffing, Training and Background Checks

Home Health Agencies must employ qualified personnel licensed by the DHHS Division of Public Health or the appropriate licensing agency in their practice state. The agency administrator is responsible for daily operations and ensuring all staff meet competency standards.

Agencies must screen all employees against state registries to ensure patient safety, particularly for vulnerable adults and children receiving in-home care.

• Nursing Licensure: RNs and LPNs must hold active, unencumbered licenses in Nebraska or a compact state.
• Registry Checks: Agencies must verify staff against the Nebraska Child/Adult Abuse & Neglect Registry.
• Therapy Staff: Physical, occupational, and speech therapists must hold current Nebraska licenses for their respective disciplines.
• Home Health Aides: Must complete a competency evaluation program and be supervised by a registered nurse.

7. Documentation, Policies and Records

Title 471 NAC 9 mandates strict record-keeping requirements for home health services. Agencies must maintain comprehensive clinical records that justify the medical necessity of the services billed.

Compliance with state licensure (175 NAC 14) requires agencies to develop and implement specific organizational charts, job descriptions, and operational policies before a license is issued.

• Record Retention: Clinical and billing records must be retained for no fewer than six years for audit purposes.
• Plan of Care: Must include the beneficiary's name, Medicaid ID, date of birth, and be signed by the ordering physician or mid-level practitioner.
• Advanced Directives: Agencies must document the presence of legal documents (e.g., living wills) guiding healthcare decisions if the client becomes incapacitated.
• Time Documentation: Nurses must maintain records documenting the exact time worked for which payment is claimed.

8. Billing, Rates and Claims

Nebraska Medicaid reimburses home health services under a Fee-for-Service (FFS) model using HCPCS and CPT codes listed in the Nebraska Medicaid Practitioner Fee Schedule. Payment is the lower of the provider's submitted charge or the Medicaid allowable rate.

Services require prior authorization and must be logged in the state's Electronic Visit Verification (EVV) system. Medicaid will not pay for services that do not match the actual hours recorded in EVV.

• Prior Authorization: Requested electronically using the ASC X12N 278 transaction or by submitting Form MS-72 (Nebraska Home Health Prior Authorization).
• Claim Format: Claims must be submitted electronically using the ASC X12N 837 professional transaction.
• Electronic Visit Verification (EVV): Mandatory for in-home personal care and home health services to record the exact time of service delivery.
• Private Duty Nursing Claims: Billed using Form MC-82-N, and the signed plan of care must be submitted with the claim.

9. Approval Sequence and Timeline

The approval process is strictly sequential. An agency must first apply for and receive a state Home Health Agency license from the DHHS Licensure Unit, which involves a $650 fee and an initial compliance review.

Once state-licensed, the agency must demonstrate OASIS transmission capability, undergo a Medicare certification survey, and receive its CMS certification number before applying for Medicaid enrollment via Maximus.

• Step 1: State Licensure: Submit application, fee, and policies to DHHS Licensure Unit; pass initial inspection.
• Step 2: OASIS Setup: Establish connectivity and demonstrate successful transmission of OASIS data.
• Step 3: Medicare Survey: Undergo the initial Medicare Conditions of Participation survey to obtain federal certification.
• Step 4: Medicaid Enrollment: Submit the application through the Maximus portal, including proof of Medicare certification.

10. Common Denials and Survey Findings

Licensure and enrollment delays frequently occur when agencies fail to follow the sequential prerequisite rules or submit incomplete documentation. The DHHS Licensure Unit will halt applications if organizational charts or policies do not meet 175 NAC 14 standards.

Medicaid claims are routinely denied if the services billed do not perfectly align with the prior authorization, the physician's plan of care, or the timestamps recorded in the EVV system.

• Premature Medicaid Application: Denials occur when agencies apply to Maximus before obtaining their final Medicare certification.
• EVV Discrepancies: Claims are rejected if the billed hours exceed or do not match the actual hours noted in the EVV system.
• Incomplete Plans of Care: Prior authorization requests (Form MS-72) are denied if they lack the required physician or mid-level practitioner signature.
• Contiguous County Violations: Agencies face citations if they provide services in counties not contiguous to their approved geographic service area without prior DHHS notification.

11. Key Contacts and Resources

Providers should direct state licensure questions to the DHHS Licensure Unit's Office of Outpatient & In-Home Care Services. Medicaid enrollment inquiries are handled by Maximus and the DHHS Provider Relations team.

For billing and claims issues, providers must contact the specific Managed Care Organization (MCO) they are billing, or the DHHS ACCESSNebraska team for Fee-for-Service HCBS claims.

• DHHS Licensure Unit (Home Health): (402) 471-4967 or [email protected] (https://dhhs.ne.gov/licensure/Pages/Home-Health-Agencies.aspx).
• Maximus Customer Service: (844) 374-5022 or [email protected] (https://www.nebraskamedicaidproviderenrollment.com/).
• Medicaid Provider Relations: (402) 471-9018 or [email protected] (https://dhhs.ne.gov/Pages/Medicaid-Provider-Screening-and-Enrollment-Forms.aspx).
• NE Medicare Home Health Hotline: (800) 245-5832 (Required for patient distribution).

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