Nebraska - Personal Emergency Response System — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Nebraska Department of Health and Human Services (DHHS) Division of Developmental Disabilities funds Personal Emergency Response System (PERS) services through the Family Support, Developmental Disabilities Adult Day (DDAD), and Comprehensive Developmental Disabilities (CDD) waivers. Approval to bill for this service requires enrolling as a Medicaid vendor through the Maximus Provider Screening and Enrollment portal, as Nebraska does not require a distinct facility license for PERS operators.

Providers must demonstrate the capacity to maintain 24/7 response center operations, replace malfunctioning units within 24 hours, and conduct monthly system tests. Applications are accepted on a rolling basis, but HCBS providers are strictly prohibited from receiving retroactive enrollment start dates, meaning all Maximus screening and Managed Care Organization (MCO) credentialing must be fully approved before any equipment is installed or billed.

1. Service Definition and Scope

Under Nebraska's DD waivers, PERS is defined as an electronic device that connects a participant to a designated responder or call center in an emergency. The service is strictly non-habilitative and is designed to increase independence for participants living in their own homes or independent settings.

The scope of the service extends beyond providing the hardware. Vendors are responsible for initial instruction, ongoing performance checks, and maintaining an updated list of emergency contacts for the participant.

• Hardware: Installed or wearable electronic device used to call for help.
• Response Requirement: Must ensure response to device signals 24 hours per day, 7 days per week.
• Maintenance: Malfunctioning devices must be replaced within 24 hours of notification.
• Testing: Providers must conduct and document monthly testing of the PERS device.
• Contact Management: The list of responders and contact names must be updated at least twice a year.
• Setting Limitations: Cannot be authorized for participants in provider-owned, leased, or controlled settings unless a six-month transition plan to an independent setting is in place.

2. Regulatory and Oversight Agencies

PERS providers operate under the joint oversight of the Nebraska DHHS Division of Developmental Disabilities (DDD) and the Division of Medicaid and Long-Term Care (MLTC). Because PERS is considered a vendor service rather than a direct-care health facility, there is no separate state licensing board for the agency itself.

Medicaid enrollment and screening are outsourced to Maximus Health Services, which manages the state's provider portal. Claims and authorizations are managed through the state's MMIS and the contracted Managed Care Organizations (MCOs).

• Nebraska DHHS Division of Developmental Disabilities: Administers the DD waivers and oversees provider compliance (https://dhhs.ne.gov/Pages/Developmental-Disabilities.aspx).
• Nebraska DHHS Division of Medicaid and Long-Term Care: Manages the overarching Medicaid state plan and HCBS waiver authorities (https://dhhs.ne.gov/Pages/Medicaid-and-Long-Term-Care.aspx).
• Maximus Health Services: Operates the Nebraska Medicaid Provider Screening and Enrollment portal (https://www.nebraskamedicaidproviderenrollment.com).
• Nebraska Total Care: One of the state's Medicaid Managed Care Organizations requiring separate credentialing (https://www.nebraskatotalcare.com).

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska does not impose Certificate of Need (CON) requirements, closed network moratoria, or competitive procurement (RFP) restrictions on PERS vendors. The state maintains an open enrollment model where any qualified business can apply at any time through the Maximus portal.

However, there are strict structural exclusions regarding who can provide the service. The service cannot be self-directed, and specific familial or legal relationships automatically disqualify an applicant from being authorized for a given participant.

• Network Status: Open enrollment; no RFP, RFA, or moratorium restricts new vendor applications.
• Relationship Exclusions: PERS may not be provided by a participant's relative, Legal Guardian, or Legally Responsible Individual.
• Self-Direction: The state explicitly prohibits PERS from being self-directed by the participant.
• Setting Exclusions: Providers cannot bill for PERS if the participant resides in a setting owned, leased, or controlled by a waiver provider, barring a documented six-month transition plan.
• Retroactive Billing: HCBS providers cannot receive a retroactive start date; enrollment must be completed prior to service delivery.

4. Licensure and Certification Requirements

Nebraska does not issue a specific PERS License or require DD provider certification for this service. Instead, the state classifies PERS operators as vendors—companies enrolled as Medicaid providers but exempt from the full developmental disabilities agency certification process.

Because there is no distinct state facility license, the primary regulatory hurdle is meeting the vendor standards outlined in the Division of Medicaid and Long-Term Care Service Provider Agreement and the DD Policy Manual.

• Facility Licensure: None required; Nebraska does not license PERS agencies as healthcare facilities.
• DD Certification: Exempt; PERS is explicitly categorized as a vendor service that does not require standard DD provider certification.
• Business Registration: Must maintain standard Nebraska Secretary of State corporate registration to operate legally in the state.
• Universal Precautions: Vendors must agree to use universal precautions when interacting with participants in their homes.
• Compliance Agreement: Must adhere to standards described in the Division of Medicaid and Long-Term Care Service Provider Agreement.

5. Medicaid Provider Enrollment

All prospective PERS vendors must enroll through the Maximus Nebraska Medicaid Provider Screening and Enrollment portal. The state utilizes a Fee-for-Service (FFS) model for initial enrollment, though providers must also credential with MCOs.

Providers must enroll separately for each physical location where they practice or dispatch services. The DHHS Provider Relations team reviews and approves the enrollment only after Maximus completes the required federal background screens.

• Enrollment Portal: Applications must be submitted online via the Maximus portal (https://www.nebraskamedicaidproviderenrollment.com).
• Location Requirement: Providers must submit separate enrollments for each physical location they operate.
• Screening Contractor: Maximus Health Services conducts the initial screening, background checks, and data validation.
• Final Approval: The DHHS Provider Relations team holds final authority to approve the Medicaid enrollment.
• MCO Credentialing: Following Maximus approval, vendors must separately credential with MCOs like Nebraska Total Care to receive authorizations.

6. Staffing, Training and Background Checks

Because PERS is a vendor service rather than direct hands-on care, the state does not mandate specific clinical degrees or medical licenses for installation staff. However, all personnel interacting with participants must clear state-mandated background checks.

The state requires vendors to complete specific DHHS trainings upon request. Staff must be competent in instructing participants on device usage and conducting system performance checks.

• Background Checks: Maximus completes specific screens and background checks as required by federal regulations during enrollment.
• Registry Checks: Staff must be screened against the Nebraska Child and Adult Abuse and Neglect Registry.
• Training Mandate: Providers must complete any DHHS-mandated trainings upon request from the state.
• Participant Instruction: Staff must be trained to provide clear instruction to the participant on how to use the PERS device.
• Call Center Staffing: The vendor must maintain sufficient staffing or subcontracting to ensure 24/7 response to device signals.

7. Documentation, Policies and Records

PERS vendors must maintain strict documentation to prove service delivery and justify billing. The most critical document is the participant's Person-Centered Plan (PCP), which must explicitly authorize the PERS service and name the provider.

Operational records must demonstrate compliance with the state's testing and maintenance mandates. Auditors will look for signed receipts and logs of monthly tests.

• Authorization Record: The chosen waiver service and provider must be documented in the participant’s Person-Centered Plan (PCP).
• Delivery Receipt: Providers must obtain and keep the participant’s or authorized representative’s signature verifying receipt of the PERS unit.
• Testing Logs: Must maintain documentation of the required monthly testing of the PERS device.
• Contact Lists: Must keep records showing the participant's list of responders and contact names is updated at least twice a year.
• Maintenance Records: Must document that any reported malfunctions were addressed with a replacement device within 24 hours.

8. Billing, Rates and Claims

PERS is reimbursed through a combination of a one-time installation fee and an ongoing monthly rental fee. The total cost of the service must fit within the participant’s annual individual budget amount as determined by DHHS.

Nebraska enforces a strict usual and customary pricing rule for PERS vendors. Providers cannot charge the Medicaid program more than they charge the general public, and any discounts offered to specific groups must be extended to Medicaid participants in those groups.

• Fee Structure: Reimbursed via a one-time installation fee and a monthly rental fee.
• Budget Limit: All PERS purchases and rentals must be accommodated within the participant’s annual individual budget amount.
• Pricing Parity: Vendors cannot charge Medicaid more than their usual and customary rate for the general public.
• Discount Mandate: Any public discounts offered to groups like senior citizens must be applied to eligible Medicaid participants.
• Duplication of Services: Claims will be denied if PERS overlaps with, replaces, or duplicates other similar services provided through Medicaid.
• Rate Publication: Specific reimbursement rates are published on the DHHS Provider Rates and Fee Schedules page.

9. Approval Sequence and Timeline

The pathway to becoming a billable PERS provider in Nebraska follows a linear sequence, starting with business formation and ending with MCO credentialing. Because there is no state facility license required, the process is faster than for traditional residential or day program providers.

Paper applications significantly delay the process, so online submission through Maximus is strongly encouraged. Once Maximus completes the screening, DHHS finalizes the enrollment, allowing the provider to begin MCO contracting.

• Step 1: Establish a legal business entity and obtain an NPI number.
• Step 2: Submit the Medicaid provider application online through the Maximus portal.
• Step 3: Maximus conducts federal background screens and registry checks.
• Step 4: DHHS Provider Relations reviews the Maximus screening and approves the Medicaid enrollment.
• Step 5: Apply for credentialing and contracting with Nebraska Medicaid MCOs.
• Step 6: Receive authorization via the participant's Person-Centered Plan before installing equipment.

10. Common Denials and Survey Findings

While PERS vendors do not undergo traditional health facility surveys, they are subject to program integrity audits by DHHS and the MCOs. Audits primarily focus on billing compliance and the physical functionality of the deployed units.

Enrollment applications are most frequently delayed or denied due to incomplete location data or attempting to request a retroactive start date, which is strictly prohibited for HCBS providers.

• Retroactive Date Denials: Applications requesting a retroactive start date are automatically rejected for HCBS providers.
• Missing Signatures: Auditors frequently cite providers for failing to obtain the participant's signature verifying initial receipt of the unit.
• Testing Failures: Recoupment of funds can occur if the provider cannot produce logs proving the device was tested monthly.
• Response Delays: Findings are issued if a provider fails to replace a malfunctioning unit within the mandated 24-hour window.
• Setting Violations: Claims are denied if the participant lives in a provider-controlled setting without a documented six-month transition plan.

11. Key Contacts and Resources

Prospective PERS vendors should utilize the Maximus portal for all enrollment activities and direct policy questions to the DHHS Division of Developmental Disabilities.

MCO-specific billing and credentialing questions must be routed directly to the respective managed care plans.

• Maximus Provider Enrollment Portal: https://www.nebraskamedicaidproviderenrollment.com
• Maximus Customer Service: [email protected] or (844) 374-5022.
• Nebraska DHHS Division of Developmental Disabilities: https://dhhs.ne.gov/Pages/Developmental-Disabilities.aspx
• Nebraska DHHS HCBS Provider Support: [email protected] or (402) 471-0667.
• Nebraska Total Care (MCO): https://www.nebraskatotalcare.com
• Nebraska Child and Adult Abuse and Neglect Registry: https://ecmp.nebraska.gov/DHHS-CR/

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