Nebraska - Home Modification Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Nebraska Department of Health and Human Services (DHHS) funds Home Modifications through the Aged and Disabled (AD) and Traumatic Brain Injury (TBI) waivers to adapt participants' living environments. Providers operate as general contractors who bid on specific structural adaptations, such as ramps and widened doorways, that are assessed and approved by the participant's service coordinator.

Approval requires active registration with the Nebraska Department of Labor as a contractor and enrollment through the Maximus Provider Data Management System (PDMS). Applicants must secure local building permits for structural changes and pass DHHS Provider Relations screening before billing the state, as Nebraska does not permit retroactive start dates for HCBS providers.

1. Service Definition and Scope

Home Modifications in Nebraska encompass physical adaptations to a participant's private residence that are necessary to ensure their health, welfare, and safety, or to enable them to function with greater independence. These services are authorized under specific Medicaid Home and Community-Based Services (HCBS) waivers.

The scope of this service is strictly limited to structural changes that address a documented functional limitation. It explicitly excludes general home maintenance, aesthetic upgrades, and modifications that add square footage to the home.

• Covered Modifications: Includes wheelchair ramps, grab bars, widened doorways, and accessible bathroom fixtures.
• Excluded Work: General home repair, roof replacement, carpeting, and aesthetic improvements are not covered.
• Waiver Authorities: Funded primarily through the Aged and Disabled (AD) Waiver and the Traumatic Brain Injury (TBI) Waiver.
• Service Limit: Reimbursement is subject to lifetime or annual monetary caps defined in the specific waiver appendix.
• Location Requirement: Modifications must be completed on the participant's primary private residence.

2. Regulatory and Oversight Agencies

The Nebraska DHHS Division of Medicaid and Long-Term Care (MLTC) oversees the waiver programs that fund home modifications. The actual enrollment of providers is managed by a third-party contractor, Maximus, which operates the state's provider portal.

Because Nebraska does not issue a distinct healthcare license for home modification providers, oversight of the physical construction work falls to the Nebraska Department of Labor and local municipal building departments.

• Nebraska DHHS Division of Medicaid and Long-Term Care: Administers the AD and TBI waivers (https://dhhs.ne.gov/Pages/Medicaid-and-Long-Term-Care.aspx).
• Maximus Nebraska Medicaid Provider Enrollment: Processes all HCBS provider applications through the PDMS portal (https://www.nebraskamedicaidproviderenrollment.com/).
• Nebraska Department of Labor: Manages mandatory Contractor Registration for construction businesses (https://dol.nebraska.gov/).
• DHHS Provider Relations: Conducts final state review and approval of Medicaid enrollment applications (https://dhhs.ne.gov/Pages/Medicaid-Provider-Screening-and-Enrollment-Forms.aspx).

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska operates as an "any willing provider" state for Medicaid HCBS waivers. There are no Certificates of Need (CON), closed networks, or mandatory Request for Proposal (RFP) procurements required to apply as a Home Modification provider.

The primary structural precondition is establishing legal authority to perform construction work in the state. An applicant must be a registered contractor before the Medicaid enrollment application will be approved.

• Certificate of Need: None exists for HCBS home modification services in Nebraska.
• Network Status: Nebraska is an "any willing provider" state; open enrollment is continuous without closed procurement windows.
• Contractor Registration: Applicants must hold an active Nebraska Department of Labor Contractor Registration before applying.
• Retroactive Enrollment: HCBS providers cannot receive a retroactive start date; DHHS approval must precede any service delivery.

4. Licensure and Certification Requirements

Nebraska DHHS does not issue a specific "Home Modification Provider" healthcare license. Instead, providers must meet standard commercial construction and local municipal licensing requirements to operate legally.

Providers are responsible for ensuring that all structural modifications comply with the Americans with Disabilities Act (ADA) guidelines and local building codes, which requires pulling appropriate permits for each job.

• State Licensure: No distinct DHHS healthcare license exists for this specific waiver service.
• Local Jurisdiction: Providers must hold applicable city or county general contractor licenses where the participant's home is located.
• Permitting: All structural modifications require approved local building permits prior to the commencement of construction.
• Code Compliance: Completed work must meet ADA accessibility guidelines and pass local municipal building inspections.

5. Medicaid Provider Enrollment

Enrollment is processed entirely through the Maximus Provider Data Management System (PDMS). Providers must submit their application, pay the federal application fee if applicable, and undergo screening based on their assigned risk level.

During the screening process, Maximus verifies business credentials and checks federal and state exclusion databases. DHHS Provider Relations performs the final review of all high-risk providers or applications with indeterminate information.

• Enrollment Portal: Maximus PDMS is the mandatory system for submitting all HCBS provider applications.
• Application Fee: Institutional and agency providers must pay the CMS-determined application fee via PECOS during initial enrollment.
• Screening Level: Providers are subject to limited or moderate risk screening, which includes monthly database checks against the OIG LEIE, SAM, and NMEP lists.
• Site Visits: Unannounced pre- and post-enrollment site visits may be conducted by Maximus for moderate-risk providers.

6. Staffing, Training and Background Checks

Because home modification providers do not provide direct personal care or medical services, clinical training is not required. However, owners and managing employees must pass standard Medicaid background screenings.

If a provider is elevated to a high-risk screening category, additional fingerprinting requirements apply. Providers must also ensure that any subcontracted tradesmen meet local licensing and safety standards.

• Background Checks: Owners with 5% or more interest are screened against state and federal exclusion lists.
• High-Risk Fingerprinting: If elevated to high risk, providers must undergo Fingerprint-based Criminal Background Checks (FCBC) by the Nebraska State Patrol.
• State Employee Restriction: Nebraska state employees cannot enroll as HCBS providers without a specific CEO exception.
• Subcontractor Oversight: The enrolled provider remains responsible for ensuring any subcontracted tradesmen meet code and safety standards.

7. Documentation, Policies and Records

Providers must maintain comprehensive records of all bids, permits, and final inspections. Nebraska Medicaid requires these documents to justify the billed amounts and verify that the work was completed safely and legally.

Service files must clearly link the completed structural modifications to the participant's approved waiver service plan and the initial bid submitted to the service coordinator.

• Bid Requirements: Providers must submit detailed written estimates for approval by the service coordinator before work begins.
• Permit Records: Copies of all local building permits must be retained in the provider's project file.
• Inspection Sign-offs: Final municipal inspection approvals must be documented to prove code compliance.
• Record Retention: All Medicaid service and billing records must be kept for the state-mandated retention period.

8. Billing, Rates and Claims

Home modifications are reimbursed on a Fee-for-Service (FFS) basis. Rates are not set by a fixed statewide fee schedule; rather, they are determined by the DHHS-approved bid amount for the specific project.

Providers submit claims only after the modification is fully completed, inspected, and signed off by the participant or service coordinator, ensuring the work meets the agreed-upon scope.

• Reimbursement Model: Paid via Fee-for-Service (FFS) after the modification is completed and inspected.
• Rate Setting: Reimbursement is based on the DHHS-approved bid amount for the specific project.
• Service Caps: Total billing cannot exceed the participant's lifetime or annual home modification waiver limit.
• Claim Submission: Claims are submitted through the Nebraska Medicaid MMIS after final inspection.

9. Approval Sequence and Timeline

The approval sequence begins with business formation and securing a Department of Labor registration. Only after these business prerequisites are met should the provider submit the Maximus Medicaid enrollment application.

Once submitted to Maximus, the application undergoes primary source verification before being routed to DHHS Provider Relations for final state approval and the issuance of a Medicaid ID.

• Step 1: Obtain Nebraska Department of Labor Contractor Registration and any required local municipal licenses.
• Step 2: Submit the HCBS provider enrollment application through the Maximus PDMS portal.
• Step 3: Maximus conducts primary source verification and federal/state database exclusion checks.
• Step 4: DHHS Provider Relations reviews the application for final state approval and assigns a Medicaid ID.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to mismatched information between the Maximus PDMS application and state corporate registries. Accuracy in ownership disclosure is critical.

Post-enrollment, providers often face audit findings for failing to secure or retain copies of local building permits, or for billing for modifications that deviate from the approved bid scope.

• Data Mismatches: Denials occur when owner information in PDMS does not match Medicare or state corporate records.
• Missing Permits: Auditors frequently cite providers for billing for completed work without retaining the required local building permits.
• Unapproved Scope: Completing and billing for modifications that were not explicitly approved in the initial bid.
• Exclusion Hits: Immediate denial occurs if any owner or managing employee appears on the OIG LEIE or NMEP lists.

11. Key Contacts and Resources

Providers should direct enrollment portal questions to Maximus Customer Service. Policy and final approval inquiries are handled by DHHS Provider Relations.

For questions regarding specific waiver authorizations or billing, providers must contact the HCBS claims support team or the participant's assigned service coordinator.

• Maximus Provider Enrollment: (844) 374-5022 or [email protected] (https://www.nebraskamedicaidproviderenrollment.com/).
• DHHS Provider Relations: [email protected] (https://dhhs.ne.gov/Pages/Medicaid-Provider-Screening-and-Enrollment-Forms.aspx).
• HCBS Claims/Billing Support: [email protected] or (402) 471-0667.
• Nebraska Department of Labor: Contractor Registration portal (https://dol.nebraska.gov/).

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