Nebraska - Medical Supply Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Nebraska Department of Health and Human Services (DHHS) Division of Medicaid and Long-Term Care (MLTC) covers Medical Supply Services and Durable Medical Equipment (DME) under Title 471 Nebraska Administrative Code (NAC) Chapter 7 for participants in the Aged and Disabled (AD) and Developmental Disabilities (DD) waivers.

Prospective agency providers seeking to supply these items to DD waiver participants face a strict geographic moratorium. DHHS currently restricts new Comprehensive Developmental Disabilities (CDD) and Developmental Disabilities Adult Day (DDAD) provider applications in Lancaster, Douglas, and Sarpy counties, accepting applications only for the Family Support Waiver (FSW) or in unrestricted counties.

1. Service Definition and Scope

In Nebraska, Medical Supply Services and Durable Medical Equipment (DME) include medical devices and disposable supplies designed to assist waiver participants with medical conditions, disabilities, or injuries. These items are built for repeated use or necessary daily care and are intended to improve mobility, safety, and overall well-being in the community.

Under Title 471 NAC Chapter 7, Medicaid does not cover the purchase, rental, or repair of multiple DMEPOS items used for the same or similar purposes, nor does it cover back-up equipment.

• Mobility Aids: walkers, wheelchairs, crutches, canes, and scooters
• Hospital Beds: adjustable beds, bed rails, and pressure mattresses
• Respiratory Equipment: oxygen concentrators, CPAP machines, and nebulizers
• Orthopedic Supports: braces, prosthetics, and orthotic devices
• Bathroom Safety: shower chairs, commodes, and grab bars
• Monitoring Devices: blood pressure monitors, glucose meters, and infusion pumps

2. Regulatory and Oversight Agencies

The Nebraska Department of Health and Human Services (DHHS) Division of Medicaid and Long-Term Care (MLTC) (https://dhhs.ne.gov/Pages/Medicaid-and-Long-Term-Care.aspx) is the primary state authority governing DMEPOS coverage and waiver administration. The DHHS Division of Developmental Disabilities (DDD) (https://dhhs.ne.gov/Pages/Developmental-Disabilities.aspx) oversees providers specifically serving the DD waivers.

Provider enrollment and screening are contracted to Maximus (https://www.nebraskamedicaidproviderenrollment.com/), which operates the Nebraska Medicaid Provider Screening and Enrollment (PSE) portal.

• DHHS Division of Medicaid and Long-Term Care: sets DMEPOS policies, rates, and coverage limits
• DHHS Division of Developmental Disabilities: manages DD waiver provider orientations and approvals
• Maximus: processes all Medicaid provider enrollment applications and background screenings
• Area Agencies on Aging (AAA): assists with provider referrals for the Aged and Disabled (AD) Waiver

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska imposes a strict geographic moratorium on new Developmental Disabilities agency providers. Currently, DHHS is only accepting new CDD and DDAD provider applications outside of Lancaster, Douglas, and Sarpy counties, though Family Support Waiver (FSW) applications are accepted statewide.

Additionally, prospective DD agency providers must attend a mandatory Prospective Provider Orientation before submitting a Letter of Intent. DMEPOS providers must also typically hold active Medicare enrollment or an exemption, as Nebraska Medicaid aligns its DMEPOS screening with federal Medicare standards.

• Geographic Moratorium: no new CDD/DDAD agency providers accepted in Lancaster, Douglas, or Sarpy counties
• Prospective Provider Orientation: mandatory attendance required before a DD waiver application is accepted
• Letter of Intent: must be electronically submitted and approved by DHHS DDD before enrollment
• Medicare Enrollment: required as a baseline for most DMEPOS providers to bill Medicaid
• Business Registration: must be registered and in good standing with the Nebraska Secretary of State

4. Licensure and Certification Requirements

Nebraska does not issue a distinct state-level DME License for medical supply businesses. Instead, providers are approved through the Medicaid enrollment process and must meet federal DMEPOS supplier standards.

To qualify as a Medicaid DMEPOS provider, agencies must obtain and maintain accreditation from a CMS-approved national accrediting organization, such as the Accreditation Commission for Health Care (ACHC) or The Joint Commission, unless explicitly exempted by federal rules.

• State Licensure: no specific state DME facility license exists in Nebraska
• National Accreditation: required from a CMS-approved body like ACHC or BOC
• Surety Bond: must maintain a minimum $50,000 surety bond as required by CMS for DMEPOS
• Local Permits: must hold any standard municipal business licenses required by the city or county
• Facility Requirements: must maintain a physical facility accessible to the public with posted hours

5. Medicaid Provider Enrollment

All Medical Supply Service providers must enroll through the Maximus Nebraska Medicaid Provider Screening and Enrollment portal (https://www.nebraskamedicaidproviderenrollment.com/). Providers cannot receive a retroactive start date for HCBS services.

Applicants must submit a complete application, pay the ACA-mandated application fee if not already paid to Medicare, and sign the Nebraska Medicaid Provider Agreement.

• Enrollment Portal: Maximus PSE system handles all initial applications and revalidations
• Application Fee: subject to the annual CMS institutional provider fee unless waived via Medicare proof
• Retroactive Dates: HCBS providers are strictly prohibited from receiving retroactive enrollment start dates
• Separate Locations: providers must enroll separately for each physical location where services are provided
• Provisional Enrollment: must be closed and re-enrolled once full accreditation or status is achieved

6. Staffing, Training and Background Checks

Agencies providing medical supplies and DME to waiver participants must ensure all staff interacting with participants or handling billing pass comprehensive background checks. Nebraska DHHS requires screening through multiple state and federal registries.

Providers must submit their agency hiring and reporting policies to DHHS, verifying that no staff have substantiated reports of abuse or neglect.

• Criminal History: fingerprint-based background checks required for high-risk DMEPOS providers
• Adult Protective Services (APS) Registry: mandatory check for all direct-contact staff
• Child Abuse/Neglect Central Registry: mandatory check for all direct-contact staff
• Sex Offender Registry: mandatory screening prior to hire
• OIG LEIE: monthly screening required to ensure no staff are excluded from federal healthcare programs
• Training: staff must be trained on proper equipment usage, maintenance, and safety protocols

7. Documentation, Policies and Records

Medical Supply providers must maintain rigorous documentation to support every claim billed to Nebraska Medicaid. This includes valid prescriptions or recommendations from a healthcare provider and detailed proof of delivery.

For DD waiver providers, a comprehensive Policies and Procedure Worksheet must be submitted during the application phase, explaining exactly how the agency will comply with Title 471 and Title 417 regulations.

• Prescriptions: must have a valid order from a licensed healthcare provider prior to dispensing
• Proof of Delivery: signed and dated documentation confirming the participant received the exact item billed
• Policies and Procedure Worksheet: required for DD agency applicants to demonstrate regulatory compliance
• Background Check Verification: must keep records proving all required registry checks were completed
• Equipment Maintenance Logs: required for any rental equipment serviced by the provider
• Record Retention: all Medicaid records must be kept for a minimum of five years

8. Billing, Rates and Claims

DMEPOS and medical supplies are reimbursed under a Fee-for-Service (FFS) model or through the participant Managed Care Organization (MCO), depending on the specific waiver and item. Provider reimbursement rates are published on the DHHS Provider Rates and Fee Schedules page.

Under Title 471 NAC Chapter 7, Medicaid strictly prohibits billing for back-up equipment. Providers may supply back-up equipment at their own expense, but it cannot be claimed.

• Fee Schedule: rates are determined by DHHS and published on the Medicaid Provider Rates page
• Back-up Equipment: explicitly non-billable to Nebraska Medicaid under Title 471 NAC 7-004
• Prior Authorization: many high-cost DME items require prior approval from DHHS or the MCO before dispensing
• Multiple Items: Medicaid will not pay for multiple items used for the same or similar purposes
• Billing Codes: claims must use standard HCPCS codes matching the authorized service
• MCO Contracting: providers may need separate contracts with Heritage Health plans for non-waiver supplies

9. Approval Sequence and Timeline

The approval sequence begins with the mandatory Prospective Provider Orientation for DD waivers, followed by the submission of a Letter of Intent and policy worksheets to DHHS. Once DHHS approves the programmatic elements, the provider applies through Maximus.

The Maximus screening process typically takes 30 to 60 days, provided all Medicare enrollments, accreditations, and background checks are already in place.

• Step 1: Attend the DHHS Prospective Provider Orientation (for DD waivers)
• Step 2: Submit the Letter of Intent, application form, and Policies & Procedure Worksheet to DHHS
• Step 3: Obtain national accreditation and Medicare enrollment (if not already completed)
• Step 4: Submit the Medicaid enrollment application through the Maximus PSE portal
• Step 5: Pass Maximus background screening and registry checks
• Step 6: Receive the final Medicaid Provider ID and execute the Provider Agreement

10. Common Denials and Survey Findings

Applications are frequently delayed or denied if a provider attempts to apply for DD waiver services in the restricted counties (Lancaster, Douglas, Sarpy) without an exemption. Enrollment will also be rejected if the applicant fails to pay the application fee or lacks required accreditation.

During audits, the most common recoupment findings involve missing proof of delivery signatures or dispensing equipment without a valid, dated prescription on file.

• Geographic Moratorium Violations: applying in restricted counties results in immediate rejection
• Missing Proof of Delivery: leads to full claim recoupment during program integrity audits
• Unpaid Application Fees: halts the Maximus enrollment process entirely
• Lapsed Accreditation: results in suspension or termination of the Medicaid provider agreement
• Invalid Prescriptions: dispensing supplies before the physician signs the order causes claim denials
• Incomplete Background Checks: failing to check the APS/CPS registries prior to hire triggers survey citations

11. Key Contacts and Resources

Providers should direct enrollment questions to the Maximus Customer Service team and programmatic questions to the DHHS Division of Medicaid and Long-Term Care or the Division of Developmental Disabilities. The DHHS website hosts all current fee schedules, policy manuals, and orientation schedules.

For HCBS specific billing issues, providers can contact the DHHS ACCESSNebraska team.

• Maximus PSE Portal: https://www.nebraskamedicaidproviderenrollment.com/
• Maximus Customer Service: [email protected] or (844) 374-5022
• DHHS Medicaid Provider Enrollment: [email protected] or (402) 471-9018
• DHHS HCBS Billing Support: [email protected] or (402) 471-0667
• DHHS Developmental Disabilities: https://dhhs.ne.gov/Pages/Developmental-Disabilities.aspx
• Nebraska Secretary of State Rules: https://rules.nebraska.gov/rules?agencyId=37&titleId=226

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