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Nebraska - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Nebraska Department of Health and Human Services (DHHS) funds Respite Care Services primarily through the Aged and Disabled (AD) Waiver and licenses facility-based respite providers under Title 175 NAC 15. This service delivers short-term, temporary relief care on an intermittent basis to individuals with special needs, allowing unpaid primary caregivers to step away without compromising the individual's supervision or support.

Because Nebraska Medicaid strictly prohibits retroactive start dates for Home and Community-Based Services (HCBS), an applicant's Medicaid enrollment through the Maximus portal and any required facility licensure must be fully approved before a single billable service can be provided. Furthermore, as of May 12, 2026, respite care is carved out of managed care organizations like Nebraska Total Care and transitioned directly to DHHS waiver programs, requiring providers to coordinate directly with state waiver service coordinators rather than MCOs.

1. Service Definition and Scope

In Nebraska, a Respite Care Service (RCS) is defined as short-term temporary care provided on an intermittent basis to persons with special needs when the primary caregiver is unavailable. This service is designed to prevent institutionalization by supporting the informal caregiving arrangement.

The service can be delivered by agency providers or independent direct care providers, depending on the specific waiver and setting. It is a statutory service under the state's 1915(c) HCBS waivers, including the Aged and Disabled Waiver.

2. Regulatory and Oversight Agencies

The Nebraska Department of Health and Human Services (DHHS) is the primary umbrella agency overseeing both the licensure of health facilities and the administration of the Medicaid program. Different divisions within DHHS handle specific aspects of provider approval and oversight.

Medicaid provider enrollment is contracted out to a third-party vendor, Maximus, which operates the state's provider screening and enrollment portal.

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska operates as an "any willing provider" state for Medicaid services, meaning there are no Certificate of Need (CON) laws, closed networks, or competitive procurement (RFP) mandates blocking new respite providers from applying. Any provider who meets the necessary qualifications and complies with state requirements can participate.

However, structural prerequisites do exist depending on the delivery model. Facility-based providers must secure a state license before enrolling in Medicaid, and all HCBS providers are barred from receiving retroactive enrollment start dates.

4. Licensure and Certification Requirements

Providers operating a physical facility dedicated to respite care must be licensed as a Respite Care Service (RCS) under Title 175 NAC 15 by the DHHS Division of Public Health. The department inspects the RCS prior to and following licensure to determine compliance with Standards of Operations, Care and Treatment (175 NAC 15-006) and Physical Plant Standards (175 NAC 15-007).

In-home respite providers or independent direct care providers may be exempt from facility licensure under 175 NAC 15-001.02, but must still meet all waiver-specific qualifications outlined in the approved 1915(c) waiver appendices.

5. Medicaid Provider Enrollment

All respite providers must enroll through the Maximus Nebraska Medicaid Provider Enrollment portal. Providers must enroll all business locations separately where services are provided to Medicaid members.

If a provider initially enrolls under a provisional license, they must close their provisional enrollment and re-enroll based on their permanent license as soon as it is issued.

6. Staffing, Training and Background Checks

Nebraska Medicaid categorizes providers by risk level to determine background check requirements. High-risk providers require stringent background checks, while all providers are subject to routine database screenings.

Any provider needing fingerprint-based background checks or additional scrutiny is routed to Nebraska Medicaid Provider Relations for a manual state review.

7. Documentation, Policies and Records

Providers must maintain comprehensive records for all Nebraska Medicaid beneficiaries and make them readily available upon DHHS request. This includes adherence to the Division of Medicaid and Long-Term Care Service Provider Agreement.

Agencies must also comply with applicable state and federal requirements regarding advance directives and maintain a detailed plan of care for each participant.

8. Billing, Rates and Claims

HCBS waiver respite services are reimbursed under the Fee-for-Service (FFS) model, meaning providers are separately paid for each service unit they perform. Rates are published on the DHHS Provider Rates and Fee Schedules page.

Effective May 12, 2026, respite services are explicitly carved out of Managed Care Organizations (MCOs) like Nebraska Total Care for waiver members, meaning claims must be routed through the state's FFS waiver system rather than the MCO.

9. Approval Sequence and Timeline

The approval sequence begins with obtaining a Title 175 NAC 15 license from the Division of Public Health, if operating a facility. Once licensed, or if exempt, the provider submits an enrollment application through the Maximus portal.

Maximus conducts primary source verification and background checks. If flagged for high risk, the application goes to DHHS Provider Relations for state review. Finally, Maximus assigns a Medicaid ID.

10. Common Denials and Survey Findings

Enrollment applications are frequently delayed or denied due to mismatched information between Medicare (if applicable) and Medicaid applications, or failure to clear background checks. The state may deny enrollment during any part of the process.

Providers have 90 days to appeal a denial or submit additional information to comply with requirements. Operating a facility without an active license or failing to report a change of ownership within 10 days will result in licensure termination.

11. Key Contacts and Resources

Providers should direct enrollment portal questions to Maximus Customer Service, while policy and high-risk review questions go to DHHS Provider Relations. Waiver-specific billing inquiries should be directed to the HCBS claims team.

Licensure forms, including the Change or Correction Request Form, must be printed, signed, and mailed to the DHHS Licensure Unit.

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