Nebraska - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Nebraska, services for individuals with intellectual and developmental disabilities (I/DD) are primarily delivered through the Comprehensive Developmental Disabilities Services Waiver and the DD Day Services Waiver. These programs offer a full array of habilitative and non-habilitative supports, ranging from residential and day services to home modifications, managed by the Nebraska Department of Health and Human Services (DHHS) Division of Developmental Disabilities.

The single biggest structural barrier to entry for new I/DD providers in Nebraska is the Resource Developer (RD) referral requirement. A prospective provider cannot simply open the state's Medicaid enrollment portal and apply; they must first secure a direct provider referral from a regional DHHS RD worker, which generates a mandatory referral number required to even create an account in the Maximus Provider Data Management System ([Provider enrollment for Home and Community-based Service Providers](https://dhhs.ne.gov/Pages/PSE-for-HCBS-Providers.aspx)).

1. Service Definition and Scope

Nebraska's I/DD services are authorized under §1915(c) of the Social Security Act to furnish eligible individuals with an array of services in residential and community settings. The Comprehensive Developmental Disabilities Services Waiver and the DD Day Services Waiver dictate the scope of allowable services, which must be delivered according to an Individualized Service Plan (ISP) ([Title 403, Chapter 5 : Comprehensive Developmental Disabilities Services Waiver (2018)](https://govdocs.nebraska.gov/epubs/H8900/R403.0005-2018.pdf)).

Providers are expected to not only deliver care but also actively participate in habilitative program writing, ensuring that services build functional independence rather than just providing custodial supervision ([Developmental Disabilities (DD) Waiver Providers - DHHS](https://dhhs.ne.gov/Pages/DD-Providers.aspx)).

• Target Population: Individuals diagnosed with a developmental disability who meet the Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) level of care.
• Comprehensive DD Waiver: Covers residential habilitation, independent living, and extensive community supports for adults.
• DD Day Services Waiver: Focuses on adult day services, supported employment, and prevocational services.
• Habilitative Program Writing: Providers must be trained and capable of writing and executing formal habilitation programs for participants.
• Home Modifications: Includes physical adaptations to the residence, such as ramp installations, provided they remain within the current footprint of the home.

2. Regulatory and Oversight Agencies

Oversight of I/DD services in Nebraska is divided among several divisions within the Department of Health and Human Services (DHHS). The Division of Developmental Disabilities (DDD) manages the waiver programs, participant eligibility, and service authorizations.

Facility licensure is handled separately by the DHHS Division of Public Health, while the Division of Medicaid & Long-Term Care (MLTC) oversees the overarching Medicaid provider enrollment process in conjunction with their contracted vendor, Maximus ([Centers for Persons with Developmental Disabilities - DHHS](https://dhhs.ne.gov/licensure/Pages/Centers-for-Persons-with-Developmental-Disabilities.aspx)).

• DHHS Division of Developmental Disabilities (DDD): Manages waiver operations, participant ISPs, and issues the required Resource Developer referrals.
• DHHS Division of Public Health: Regulates and issues the Center for Persons with Developmental Disabilities (CDD) license under Title 175 Chapter 3.
• DHHS Division of Medicaid & Long-Term Care (MLTC): Oversees the state Medicaid program and grants final approval for provider agreements.
• Maximus: The state-contracted vendor that operates the Provider Data Management System (PDMS) and conducts initial enrollment screening.
• Nebraska State Fire Marshal: Conducts mandatory life safety code inspections for physical facility locations prior to CDD licensure.

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska imposes a strict structural gatekeeper for HCBS DD waiver enrollment: the Resource Developer (RD) referral. Providers cannot independently initiate a Medicaid enrollment application for these waivers without prior authorization and a referral number from a regional RD worker ([Provider enrollment for Home and Community-based Service Providers](https://dhhs.ne.gov/Pages/PSE-for-HCBS-Providers.aspx)).

While Nebraska does not require a Certificate of Need (CON) for HCBS I/DD waiver services, this RD referral acts as the functional network gate. Additionally, state employees face a hard barrier and cannot enroll as in-home service providers without a specific CEO exception.

• Resource Developer (RD) Referral: An RD worker must make a direct provider referral to Maximus before an application can begin.
• Referral Number Requirement: The provider must use the specific referral number generated by the RD worker to create their Maximus PDMS account.
• State Employee Restriction: State employees are barred from enrolling as in-home service providers unless granted a consumer-specific exception by the DHHS CEO.
• Business Registration: The entity must be registered with the Nebraska Secretary of State and possess an active EIN/TIN prior to RD engagement.
• No Certificate of Need: Nebraska does not utilize a CON process for HCBS waiver services, relying instead on the RD referral process to manage network capacity.

4. Licensure and Certification Requirements

Providers operating physical facilities that offer care, supervision, and habilitation to persons with developmental disabilities must obtain a Center for Persons with Developmental Disabilities (CDD) license. This licensure is governed by Title 175, Chapter 3 of the Nebraska Administrative Code and issued by the DHHS Division of Public Health ([Centers for Persons with Developmental Disabilities - DHHS](https://dhhs.ne.gov/licensure/Pages/Centers-for-Persons-with-Developmental-Disabilities.aspx)).

The licensure process requires a written application, fee submission, and a successful onsite inspection prior to any client use or occupancy.

• CDD License: Required for facilities providing care, supervision, and habilitation to persons with developmental disabilities.
• Licensure Fee: The initial and annual renewal fee for a CDD license is $150.
• Regulatory Citation: Licensure standards are strictly governed by Title 175, Chapter 3 of the Nebraska Administrative Code.
• Onsite Inspection: An initial onsite inspection by DHHS must be passed prior to client use and occupancy.
• Change Notifications: Licensees must notify DHHS in writing within 48 hours of any change in ownership or location, which immediately terminates the current license and requires a new application.

5. Medicaid Provider Enrollment

Medicaid enrollment in Nebraska is processed electronically through the Maximus Provider Data Management System (PDMS). As of June 1, 2025, paper applications are entirely prohibited, and all enrollments must be completed via the web portal ([Nebraska Medicaid Provider Enrollment: 2026 PDMS Guide](https://medsolercm.com/blog/nebraska-medicaid-provider-enrollment)).

Providers must complete Form MC-19, the Nebraska Service Provider Agreement, which serves as the required contract between the provider and the state's waiver programs. A separate agreement is required for each physical location where services are provided ([Nebraska Service Provider Agreement Instructions](https://public-dhhs.ne.gov/Forms/DisplayPDF.aspx?item=2769)).

• Enrollment Portal: All applications must be submitted through the Maximus Provider Data Management System (PDMS).
• Form MC-19: The Nebraska Service Provider Agreement must be electronically signed and approved before any payment is issued.
• Risk-Level Screening: Providers are screened according to 42 CFR 455.450 categorical risk levels (Limited, Moderate, or High).
• Provisional Enrollment: Providers enrolled under a temporary license must close and re-enroll immediately once the full CDD license is issued to avoid stranded claims.
• Location Specificity: A separate Form MC-19 and enrollment record is required for each physical location where services are provided.

6. Staffing, Training and Background Checks

Nebraska DHHS mandates stringent background checks and baseline training for all direct support professionals (DSPs) working under the DD waivers. Maximus assists in reviewing these background checks during the initial enrollment phase ([Nebraska Step-by-Step Licensing Guide for Medicaid Waiver Providers - Waiver Consulting Group](https://help.waivergroup.com/en_US/nebraska-step-by-step-licensing-guide-for-medicaid-waiver-providers)).

Staff must not only pass criminal and registry clearances but also hold basic life safety certifications and receive specific training on executing habilitative programs.

• Registry Clearances: All staff providing services must be cleared through the Nebraska Adult and Child Abuse Registries.
• Criminal Background Checks: Mandatory criminal history checks are required for all direct care workers prior to client contact.
• Basic Certifications: Direct care staff must hold active CPR and First Aid certifications.
• Habilitation Training: Staff must be trained in executing Individualized Service Plans (ISPs) and writing habilitative programs.
• Professional Licensing: Any clinical services (e.g., nursing, therapy) must be provided by staff holding active Nebraska credentials (e.g., CNA, RN).

7. Documentation, Policies and Records

Providers must maintain comprehensive operational policies and participant records that align with DHHS DDD standards. Documentation must definitively prove that the services delivered match the authorized Individualized Service Plan (ISP).

Nebraska places a high emphasis on data security and financial protection; providers must use state-approved secure channels for communication and maintain policies specifically addressing the prevention of financial exploitation ([Developmental Disabilities (DD) Waiver Providers - DHHS](https://dhhs.ne.gov/Pages/DD-Providers.aspx)).

• Individualized Service Plan (ISP): All services must be documented and delivered strictly according to the participant's DHHS-approved ISP.
• Secure Communications: Providers must use the DHHS Secure Mail system for any emails containing confidential participant information.
• Liability Insurance: Providers must maintain and submit proof of general and professional liability insurance during enrollment.
• Policy Manuals: Must include comprehensive policies for patient care, medication management, safety, and financial exploitation prevention.
• W-9 Form: A current IRS W-9 form must be submitted during the Maximus enrollment process for tax reporting.

8. Billing, Rates and Claims

Reimbursement for DD waiver services requires an active, fully approved Medicaid enrollment that perfectly matches the provider's current licensure status. Claims submitted by providers not separately enrolled with the state will be denied, even if they are attempting to bill through a managed care organization ([Nebraska Medicaid Provider Enrollment: 2026 PDMS Guide](https://medsolercm.com/blog/nebraska-medicaid-provider-enrollment)).

While Nebraska utilizes MCOs for general Medicaid, HCBS waiver billing requires strict adherence to the service codes and units authorized by the DHHS DDD in the participant's plan ([Nebraska Medicaid: Enrollment with the state is required for reimbursement | UHCprovider.com](https://www.uhcprovider.com/en/resource-library/news/2025/ne-medicaid-enrollment-for-reimbursement.html)).

• State Enrollment Prerequisite: MCOs (like UnitedHealthcare and Molina) will deny claims if the provider is not first enrolled with Nebraska Medicaid.
• NPI Requirement: Providers must obtain and bill using a Type 2 National Provider Identifier (NPI).
• Claim Stranding: Failing to update Maximus PDMS when transitioning from a provisional to a full license will result in stranded, unpaid claims.
• Service Authorizations: Billing must strictly align with the service codes and units authorized by the DHHS DDD in the participant's plan.
• Electronic Billing: Claims are processed through the state's MMIS or the applicable managed care clearinghouse, requiring electronic submission.

9. Approval Sequence and Timeline

The approval process in Nebraska is linear and cannot be bypassed. It begins with business registration, moves to the critical RD referral, proceeds through Maximus screening, and ends with DHHS Provider Relations final approval ([Provider enrollment for Home and Community-based Service Providers](https://dhhs.ne.gov/Pages/PSE-for-HCBS-Providers.aspx)).

Because vendor screening (Maximus) and state approval (DHHS) are two different events, a completed PDMS submission is not an immediate approval to begin billing.

• Step 1: Register the business entity with the Nebraska Secretary of State and obtain an EIN.
• Step 2: Obtain a provider referral and referral number from a DHHS Resource Developer (RD) worker.
• Step 3: Create a Maximus PDMS account using the RD referral number and submit the electronic application.
• Step 4: Pass the DHHS Division of Public Health onsite inspection for the CDD license (if operating a facility).
• Step 5: Maximus completes the screening and forwards the file to DHHS Provider Relations for final approval.

10. Common Denials and Survey Findings

Applications and licensure surveys frequently fail due to administrative oversights or life safety code violations. DHHS strictly enforces the requirement that enrollment data perfectly matches licensure data ([Nebraska Medicaid Provider Enrollment: 2026 PDMS Guide](https://medsolercm.com/blog/nebraska-medicaid-provider-enrollment)).

Attempting to bypass the regional gatekeeper or failing to report structural changes to the business are the most common reasons for immediate rejection or license termination ([Centers for Persons with Developmental Disabilities - DHHS](https://dhhs.ne.gov/licensure/Pages/Centers-for-Persons-with-Developmental-Disabilities.aspx)).

• Missing RD Referral: Attempting to enroll in Maximus without a valid Resource Developer referral number results in immediate rejection.
• Paper Applications: Submitting paper forms instead of using the Maximus PDMS portal (banned as of June 1, 2025).
• Unreported Changes: Failing to notify DHHS within 48 hours of a change in ownership or location, which voids the CDD license.
• Background Check Gaps: Incomplete clearances from the Nebraska Adult and Child Abuse Registries for direct care staff.
• Life Safety Violations: Failing the initial physical plant inspection for CDD facilities prior to occupancy.

11. Key Contacts and Resources

Providers must interact with multiple state portals and divisions to maintain compliance. The Maximus PDMS and DHHS DDD are the primary touchpoints for ongoing operations and enrollment updates ([Nebraska MLTC Provider Registration Portal](https://nebraskamedicaidproviderenrollment.com/Resources.aspx)).

For general Medicaid enrollment questions, providers should contact the DHHS Provider Screening and Enrollment team directly ([Provider Screening and Enrollment - DHHS - Nebraska.gov](https://dhhs.ne.gov/Pages/Medicaid-Provider-Screening-and-Enrollment-Forms.aspx)).

• Maximus Provider Enrollment: P.O. Box 81890, Lincoln, NE 68501; Phone: (844) 374-5022.
• DHHS Provider Screening and Enrollment: Phone: (402) 471-9018 for general Medicaid enrollment questions.
• DHHS Division of Public Health: Manages the Center for Persons with Developmental Disabilities (CDD) licensure.
• DHHS Secure Mail: Required portal for transmitting confidential participant information to state workers.
• Nebraska Secretary of State: Required for initial legal business entity registration prior to application.

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