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

Last reviewed: 2026-09-10

Nebraska's Division of Developmental Disabilities (DDD) approves agencies to deliver habilitation, supported living, and day services through three distinct Medicaid authorities: the Comprehensive Developmental Disabilities (CDD) Waiver, the Developmental Disabilities Adult Day (DDAD) Waiver, and the Family Support Waiver (FSW). Approval requires passing a state-mandated Prospective Provider Orientation and executing a Medicaid provider agreement through the Maximus enrollment portal, as Nebraska does not issue a standalone "HCBS License" for non-facility-based waiver services.

The state currently enforces a strict geographic moratorium on new agency applications for the CDD and DDAD waivers within Lancaster, Douglas, and Sarpy counties. Agencies seeking to operate in these high-density areas are blocked from applying, though applications for the FSW remain open statewide.

1. Service Definition and Scope

Nebraska divides its intellectual and developmental disability services across three specific Medicaid HCBS waivers, each targeting a different level of need and living situation. Providers must specify which waivers and specific services they are applying to deliver, as qualifications and billing codes vary between them.

Services range from intermittent community integration supports to 24-hour continuous residential habilitation. Providers can enroll as either Agency Providers, who manage their own staff, or Independent Providers, who are directly employed by the waiver participant.

• Comprehensive Developmental Disabilities (CDD) Waiver: Funds 24-hour residential habilitation, supported employment, and day services for individuals requiring continuous support.
• Developmental Disabilities Adult Day (DDAD) Waiver: Covers day habilitation, supported employment, and prevocational services for adults who do not require 24-hour residential care.
• Family Support Waiver (FSW): Provides limited funding for independent living, respite, and personal care for children and adults living in their family home.
• Agency Provider: A business entity enrolled with Nebraska Medicaid that hires, trains, and supervises direct support professionals to deliver waiver services.
• Independent Provider: An individual enrolled directly with Medicaid who is selected and employed by the waiver participant, requiring a Service Coordinator referral to initiate enrollment.

2. Regulatory and Oversight Agencies

Oversight of I/DD waiver services in Nebraska is split between the division that manages the waiver populations and the division that handles Medicaid financing. Facility-based services require additional oversight from the state's public health division.

Providers must interact with multiple state portals for enrollment, background checks, and claims submission, relying heavily on contracted vendors for the Medicaid enrollment process.

• Division of Developmental Disabilities (DDD): Manages waiver operations, provider orientation, and policy compliance (https://dhhs.ne.gov/Pages/DD-Providers.aspx).
• Division of Medicaid and Long-Term Care (MLTC): The state Medicaid agency responsible for overall waiver authority and financing (https://dhhs.ne.gov/Pages/Medicaid-and-Long-Term-Care.aspx).
• Maximus Provider Screening and Enrollment (PSE): The contracted vendor and portal for all Nebraska Medicaid provider enrollment applications (https://www.nebraskamedicaidproviderenrollment.com).
• DHHS Division of Public Health: Licenses assisted living facilities and manages the Medication Aide Registry required for staff administering medications (https://dhhs.ne.gov/Pages/public-health.aspx).
• Nebraska Association of Service Providers (NASP): The primary trade association providing community guidance and advocacy for DD providers (https://www.neserviceproviders.org).

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska strictly controls the entry of new I/DD agency providers through geographic restrictions and mandatory pre-application training. Attempting to submit a Medicaid enrollment application without clearing these gates will result in immediate rejection.

Independent providers face a different gate: they cannot simply enroll and look for clients; they must be selected by a participant first.

• Geographic Moratorium: DHHS currently rejects all new agency provider applications for the CDD and DDAD waivers in Lancaster, Douglas, and Sarpy counties.
• Prospective Provider Orientation: Agency applicants must email DHHS to register for and attend this mandatory orientation before they are permitted to begin the enrollment process.
• Participant Selection: Independent providers must be chosen by a waiver participant and have the participant's Service Coordinator submit a referral form before Medicaid enrollment can begin.
• Business Registration: Agency providers must be registered as a legal entity with the Nebraska Secretary of State and possess an active EIN.
• Liability Insurance: Agencies must secure general and professional liability insurance meeting DHHS minimum coverage requirements prior to application.

4. Licensure and Certification Requirements

Nebraska does not issue a generic "HCBS License." Instead, non-facility-based I/DD providers are certified directly by the Division of Developmental Disabilities through the Medicaid enrollment and policy review process.

If a provider intends to operate a specialized facility, such as an Assisted Living Facility or an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), they must obtain a formal license from the DHHS Division of Public Health before applying for waiver certification.

• DDD Certification: Granted upon successful completion of the Prospective Provider Orientation, policy review, and Maximus Medicaid enrollment.
• Title 404 Regulations: Providers must comply with Nebraska Administrative Code Title 404, which governs services for individuals with developmental disabilities.
• Assisted Living Licensure: Required from the Division of Public Health if the provider operates a facility where participants live and receive support services in a home-like environment.
• Medication Aide Registry: Any staff member administering medication must be on the Nebraska Medication Aide Registry, overseen by the Division of Public Health.
• Adult Family Home Sponsorship: Providers operating adult family homes must meet specific environmental and sponsorship requirements outlined in the waiver appendices.

5. Medicaid Provider Enrollment

All provider enrollment for Nebraska Medicaid is processed through the Maximus Provider Screening and Enrollment (PSE) portal. Providers must submit their applications online and cannot bill for services provided prior to their official enrollment effective date.

The enrollment process categorizes providers by risk level, which dictates the intensity of the screening, including site visits and fingerprinting requirements.

• Maximus PSE Portal: The mandatory online system for submitting the Medicaid provider application, ownership disclosures, and supporting documents.
• Application Fee: Institutional providers must pay the federal Medicaid application fee (or provide proof of Medicare payment) during the Maximus enrollment process.
• Risk-Based Screening: HCBS providers are typically categorized as moderate or high risk, requiring unannounced pre-enrollment site visits by the state or its vendor.
• Revalidation: Enrolled providers must revalidate their Medicaid enrollment through the Maximus portal every five years.
• Taxonomy Codes: Providers must select the correct HCBS taxonomy codes matching the specific DD waiver services they are approved to deliver.

6. Staffing, Training and Background Checks

Nebraska requires comprehensive background screening for all agency owners, independent providers, and direct support professionals before they have contact with waiver participants. Agencies are responsible for maintaining these records for state audit.

Training requirements are strictly enforced, with specific modules mandated by the state that must be completed prior to delivering billable services.

• Criminal Background Checks: Required through the Nebraska State Patrol for all direct care staff and independent providers.
• Registry Clearances: Staff must be cleared through the Nebraska Adult Protective Services (APS) and Child Protective Services (CPS) registries.
• OIG LEIE Screening: Agencies must check all employees against the federal Office of Inspector General List of Excluded Individuals/Entities prior to hire and monthly thereafter.
• Basic Training: All direct support professionals must hold current certifications in CPR and First Aid.
• Medication Administration: Staff administering medications must complete state-approved Medication Aide training and pass the registry exam.
• HCBS Settings Rule Training: Staff must be trained on participant rights, privacy, and community integration mandates under the federal HCBS Settings Rule.

7. Documentation, Policies and Records

During the approval process, DHHS requires agencies to submit a comprehensive policy manual demonstrating how they will meet Title 404 regulations and waiver standards. These policies must be operationalized immediately upon approval.

Participant records must be maintained in accordance with state guidelines, tying directly to the individual's Person-Centered Plan developed by their Service Coordinator.

• Hiring and Reporting Policies: Must be submitted to DHHS during the initial approval phase, detailing background check procedures and staff qualifications.
• Incident Reporting Policy: Must outline the procedures and timeframes for reporting abuse, neglect, exploitation, and critical incidents to DHHS and law enforcement.
• Person-Centered Plan (PCP): Providers must maintain documentation showing that all delivered services align with the participant's state-approved PCP.
• Service Documentation: Daily notes must include the date, start and end times, specific activities performed, and the signature of the staff member delivering the service.
• Financial Records: Agencies must maintain auditable financial records, including IRS W-9 forms and payroll documentation, subject to DHHS review.

8. Billing, Rates and Claims

Nebraska Medicaid utilizes a fee-for-service model for the I/DD waivers, with rates established by DHHS. Providers must verify participant eligibility and service authorizations in the state's NFOCUS system before delivering care.

Claims are submitted through the Medicaid MMIS portal, and providers must comply with federal Electronic Visit Verification (EVV) mandates for applicable personal care services.

• NFOCUS System: The state's case management and eligibility system where providers verify participant waiver status and authorized service units.
• Rate Schedule: DHHS publishes the DD waiver fee schedule annually; providers cannot bill in excess of the published maximum allowable rates.
• Electronic Visit Verification (EVV): Required for personal care and specific in-home services; providers must use the state-sponsored EVV system or an approved alternate vendor.
• Claim Submission: Claims are submitted electronically via the Maximus/MMIS portal using standard CMS-1500 formats and specific HCBS procedure codes.
• Prior Authorization: All waiver services must be prior-authorized by the participant's Service Coordinator; claims submitted without authorization will be denied.

9. Approval Sequence and Timeline

The pathway to becoming a DD waiver provider in Nebraska is sequential. Skipping steps, such as applying through Maximus before attending the orientation, will result in application rejection.

The entire process for an agency provider typically takes 4 to 6 months, depending on the speed of policy development and Maximus processing times.

• Step 1: Orientation Registration: Email DHHS to register for and attend the mandatory Prospective Provider Orientation.
• Step 2: Policy Submission: Develop and submit required hiring, reporting, and operational policies to DDD for review and approval.
• Step 3: Maximus Enrollment: Complete the Medicaid provider application through the Maximus PSE portal, including fee payment and background disclosures.
• Step 4: Site Inspection: If applicable based on risk level or facility type, pass a pre-enrollment site visit.
• Step 5: Provider Agreement: Sign the Medicaid provider agreement and receive an official Medicaid ID number.
• Step 6: Service Authorization: Begin accepting participant referrals and receiving service authorizations through NFOCUS.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to failure to observe the geographic moratorium or incomplete background disclosures. DHHS strictly enforces the moratorium boundaries.

During post-enrollment audits, providers commonly face recoupments for failing to maintain continuous training records or delivering services outside the scope of the Person-Centered Plan.

• Moratorium Violations: Submitting an application for CDD or DDAD services in Lancaster, Douglas, or Sarpy counties without an exemption.
• Incomplete Background Checks: Failing to run APS/CPS registry checks or OIG LEIE screenings prior to a staff member's first day of participant contact.
• Policy Deficiencies: Submitting generic policy manuals that do not specifically reference Nebraska Title 404 regulations or DHHS incident reporting timeframes.
• Lapsed Training: Allowing CPR, First Aid, or Medication Aide certifications to expire while staff continue to provide direct care.
• EVV Non-Compliance: Failing to capture required electronic visit verification data for in-home personal care services, leading to claim denials.

11. Key Contacts and Resources

Providers should rely on official DHHS portals and designated help desks for accurate, up-to-date information regarding enrollment status and policy changes.

Joining the state provider association is highly recommended for new agencies to navigate the complexities of Nebraska's waiver system.

• DDD Provider Relations: Contact for questions regarding orientation, policy review, and waiver service definitions (https://dhhs.ne.gov/Pages/DD-Providers.aspx).
• Maximus PSE Help Desk: Support for technical issues with the Medicaid enrollment portal and application status (https://www.nebraskamedicaidproviderenrollment.com).
• Nebraska Association of Service Providers (NASP): Industry group offering advocacy, training, and peer support for DD agencies (https://www.neserviceproviders.org).
• Nebraska Resources and Referral System (NRRS): Database where approved providers can list their services for participants and Service Coordinators (https://nrrs.ne.gov).
• DHHS Division of Public Health: Resource for Assisted Living licensure and the Medication Aide Registry (https://dhhs.ne.gov/Pages/public-health.aspx).

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