Nebraska - Homemaker Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Nebraska Department of Health and Human Services (DHHS) Division of Disability and Aging funds Homemaker services under the Family Support Waiver (FSW) and Comprehensive Developmental Disabilities (CDD) Waiver using NFOCUS service codes 9769 (Agency) and 9393 (Independent). Approval to bill for these general household support tasks requires a direct referral from a state Resource Developer (RD) worker before an applicant can even access the Maximus enrollment portal.

Providers operate under a Fee-for-Service (FFS) model and must adhere to the Division of Medicaid and Long-Term Care Service Provider Agreement. Because Nebraska does not issue a standalone Homemaker License, agency providers must instead obtain DHHS certification to provide Developmental Disabilities (DD) services and complete the Maximus screening process without the option for retroactive start dates.

1. Service Definition and Scope

Homemaker services in Nebraska provide general household activities when the family member usually responsible is temporarily absent or unable to manage the home. Under the DD waivers, this service is specifically restricted to participants aged 18 and younger who live with an unpaid caregiver.

The scope includes routine household tasks necessary to maintain a clean and safe environment. It does not include direct personal care or medical services, which fall under different waiver definitions and require separate Home Health or Personal Assistance Services (PAS) approvals.

• Target Population: Participants age 18 and younger living with an unpaid caregiver under DD waivers.
• Covered Tasks: Meal preparation, laundry, grocery shopping, and light housekeeping.
• Delivery Models: Can be offered by a DD agency provider, an independent provider, or a vendor.
• NFOCUS Code (Agency): 9769 for agency-based homemaker services.
• NFOCUS Code (Independent): 9393 for independent homemaker providers.

2. Regulatory and Oversight Agencies

The Nebraska Department of Health and Human Services (DHHS) oversees all Medicaid HCBS waivers through its specialized divisions. The Division of Disability and Aging (DDA) manages the specific waiver rules and provider certifications for the CDD and FSW programs.

Provider enrollment and screening are contracted out to Maximus, which operates the state's Medicaid provider portal. The Division of Medicaid and Long-Term Care (MLTC) holds the ultimate Service Provider Agreement and sets reimbursement rates.

• Nebraska DHHS: Administers the overarching Medicaid program (https://dhhs.ne.gov/).
• Division of Disability and Aging (DDA): Manages the CDD and FSW waivers and certifies DD agencies (https://dhhs.ne.gov/Pages/Developmental-Disabilities.aspx).
• Division of Medicaid and Long-Term Care (MLTC): Oversees the Service Provider Agreement and Medicaid compliance (https://dhhs.ne.gov/Pages/Medicaid-and-Long-Term-Care.aspx).
• Maximus: Operates the Nebraska Medicaid Provider Enrollment portal and conducts background screening (https://www.nebraskamedicaidproviderenrollment.com/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska enforces a strict referral-based gatekeeping system for HCBS provider enrollment. An applicant cannot independently initiate a Medicaid enrollment application for Homemaker services; a state Resource Developer (RD) worker must first make a provider referral to Maximus.

Once the RD worker submits this referral, the applicant receives a specific referral number required to create an account in the Maximus system. There are no Certificate of Need (CON) requirements or closed network moratoria for this service, but the RD referral acts as the absolute structural precondition to entry.

• Resource Developer (RD) Referral: Required structural precondition; an RD worker must initiate the referral to Maximus before application.
• Referral Number: The unique identifier generated by the RD worker, required to create a Maximus portal account.
• Retroactive Enrollment Ban: HCBS providers cannot receive a retroactive start date; approval must be finalized before billing.
• State Employee Restriction: State employees are barred from enrolling as in-home providers unless granted a specific CEO exception.

4. Licensure and Certification Requirements

Nebraska does not issue a distinct Homemaker Agency license. Instead, agencies providing this service under the DD waivers must be certified by DHHS as a Developmental Disabilities (DD) agency provider.

To achieve this certification, the agency must demonstrate compliance with the Nebraska Administrative Code and state statutes governing DD services. Independent providers (individuals) bypass agency certification but must still meet all Medicaid screening and universal precaution standards.

• Agency Certification: Must be certified by DHHS to provide DD services if operating as an agency.
• Business Registration: Must register the business entity with the Nebraska Secretary of State.
• Tax Identification: Must obtain an Employer Identification Number (EIN) from the IRS.
• NPI Requirement: Must obtain a National Provider Identifier (Type 2 for agencies, Type 1 for independents).

5. Medicaid Provider Enrollment

After securing the RD worker referral, providers complete their enrollment through the Maximus Nebraska Medicaid Provider Enrollment portal. Maximus handles the collection of documents, background check reviews, and initial screening.

Following Maximus's review, the DHHS Provider Relations team conducts the final approval of the enrollment. Providers must enroll separately for each physical location where they practice or manage services.

• Enrollment Portal: Maximus Nebraska Medicaid Provider Enrollment (https://www.nebraskamedicaidproviderenrollment.com/).
• Account Creation: Requires the RD referral number to initiate the online or paper application.
• Location Specificity: Providers must submit separate enrollments for each practice location.
• Final Approval: Granted by the DHHS Provider Relations team after Maximus completes screening.

6. Staffing, Training and Background Checks

DD agency providers are responsible for hiring, supervising, and training employees who deliver homemaker services. Agencies must employ staff based on qualifications, experience, and demonstrated abilities to meet the participant's level of care.

Maximus reviews background checks during the enrollment process. DHHS requires all waiver providers to use universal precautions and complete specific DHHS trainings upon request, making their training plans available for state review.

• Background Screening: Processed and reviewed by Maximus during the provider enrollment phase.
• Training Plans: Agencies must agree to make staff training plans available to DHHS upon request.
• Safety Standards: All staff must be trained in and utilize universal precautions.
• Supervision: Agency providers bear full responsibility for supervising employees working with participants.

7. Documentation, Policies and Records

Providers must maintain comprehensive documentation to adhere to the Division of Medicaid and Long-Term Care Service Provider Agreement. This includes maintaining active policies for household assistance, safety management, and emergency response.

Agencies must keep records of staff qualifications, background check clearances, and completed training. Client records must reflect that services are delivered according to the person-centered Individualized Service Plan (ISP).

• Service Provider Agreement: Must sign and adhere to the MLTC Service Provider Agreement standards.
• Training Records: Must document staff completion of required DHHS trainings and universal precautions.
• Policy Manual: Must maintain policies covering client intake, safety protocols, and grievance handling.
• ISP Alignment: Documentation must prove homemaker tasks align with the participant's Individualized Service Plan.

8. Billing, Rates and Claims

Homemaker services are reimbursed under a Fee-for-Service (FFS) model, meaning providers are paid separately for each authorized service they perform. Rates are established by DHHS and published on the Provider Rates and Fee Schedules page.

Providers bill using the specific NFOCUS service codes assigned to their provider type (9769 for agencies, 9393 for independents). Because HCBS providers cannot receive retroactive start dates, no claims can be submitted for dates of service prior to official enrollment approval.

• Reimbursement Model: Fee-for-Service (FFS) based on DHHS published fee schedules.
• Agency Billing Code: NFOCUS Service Code 9769.
• Independent Billing Code: NFOCUS Service Code 9393.
• Claim Restriction: No billing permitted for services provided before the official Maximus/DHHS enrollment date.

9. Approval Sequence and Timeline

The approval sequence begins outside the enrollment portal. The prospective provider must first connect with a Resource Developer (RD) worker to secure a referral and the necessary referral number.

Once the referral is made, the provider creates a Maximus account, submits the application and background checks, and undergoes screening. Maximus then forwards the screened application to DHHS Provider Relations for final authorization and issuance of the Medicaid ID.

• Step 1: Obtain a provider referral and referral number from a DHHS Resource Developer (RD) worker.
• Step 2: Create an account on the Maximus portal using the RD referral number.
• Step 3: Submit the Medicaid enrollment application, business documents, and background checks to Maximus.
• Step 4: DHHS Provider Relations reviews the Maximus screening and grants final Medicaid enrollment approval.

10. Common Denials and Survey Findings

Applications are frequently rejected at the very first step if a provider attempts to enroll through Maximus without a valid RD worker referral number. Another common administrative denial occurs when providers request a retroactive start date, which is strictly prohibited for HCBS services in Nebraska.

During readiness reviews or audits, agencies often face citations for failing to make staff training plans available to DHHS or lacking documentation that staff are trained in universal precautions. State employees also face automatic denials unless they have secured a formal CEO exception.

• Missing RD Referral: Immediate rejection of enrollment attempts lacking a valid Resource Developer referral number.
• Retroactive Date Requests: Denials issued when HCBS providers request start dates prior to approval.
• Training Documentation: Audit findings for failing to provide DHHS with requested staff training plans.
• State Employee Conflicts: Enrollment denial for state employees lacking a documented DHHS CEO exception.

11. Key Contacts and Resources

Providers must interact with both DHHS and its enrollment contractor, Maximus, to maintain compliance. The Maximus customer service team handles all technical portal issues and background check submissions.

For questions regarding the initial referral process or specific waiver requirements, providers should contact the DHHS HCBS Provider Relations team or the Division of Disability and Aging.

• Maximus Provider Enrollment Portal: https://www.nebraskamedicaidproviderenrollment.com/
• Maximus Customer Service: [email protected] or (844) 374-5022.
• DHHS HCBS Provider Relations: [email protected] or (402) 471-0667.
• Nebraska DHHS Division of Disability and Aging: https://dhhs.ne.gov/Pages/Developmental-Disabilities.aspx

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