Nebraska - Skilled Respite Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Nebraska, "Skilled Respite" is not licensed as a standalone, distinct provider category. Instead, providers delivering respite care that requires licensed nursing interventions must obtain licensure either as a Home Health Agency (HHA) under 175 NAC 11 for in-home services, or as a Respite Care Service (RCS) under 175 NAC 15 for facility-based care, utilizing appropriately credentialed RNs or LPNs. Once licensed, the agency enrolls as a Medicaid Home and Community-Based Services (HCBS) waiver provider under programs such as the Aged and Disabled (AD) Waiver or Developmental Disabilities (DD) waivers.

The single biggest structural barrier to entry for this service in Nebraska is the strict sequencing of state approvals: a provider cannot even initiate the Medicaid enrollment process through the state's Maximus-operated Provider Screening and Enrollment (PSE) portal until the underlying DHHS Division of Public Health license (HHA or RCS) is fully approved and issued. There is no provisional Medicaid enrollment allowed for agencies that have merely applied for their state license.

1. Service Definition and Scope

Skilled Respite provides short-term relief to primary caregivers of Medicaid waiver participants whose complex medical needs exceed the capabilities of an unlicensed caregiver. This service ensures the participant's health and safety are maintained by licensed nursing staff during the primary caregiver's absence.

Because Nebraska does not issue a specific "Skilled Respite" license, the scope of practice is governed by the provider's underlying licensure (Home Health Agency or Respite Care Service) and the specific HCBS waiver definitions outlined by the Nebraska Department of Health and Human Services (DHHS).

• Target Population: Medicaid waiver participants requiring nursing-level care, such as those on the [Nebraska Waiver Factsheet](https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/NE) Aged and Disabled Waiver.
• Service Settings: Delivered in the participant's private residence (via HHA licensure) or in a licensed community facility (via RCS licensure).
• Excluded Providers: Respite may not be provided by the legally responsible person, legal guardian, or members living in the individual's immediate household.
• Clinical Scope: Includes skilled nursing interventions, complex medication administration, and advanced health monitoring that cannot be delegated to unlicensed aides.
• Care Alignment: All skilled respite hours and interventions must strictly align with the participant's DHHS-approved Individualized Service Plan (ISP).

2. Regulatory and Oversight Agencies

Oversight of skilled respite providers in Nebraska is bifurcated between the division that issues the physical license and the division that manages Medicaid funding. Providers must maintain compliance with both entities simultaneously.

Additionally, because Nebraska utilizes a managed care delivery system for many of its Medicaid populations, providers must interact with contracted Managed Care Organizations (MCOs) to receive authorization and payment for services.

• Nebraska DHHS Division of Public Health (Licensure Unit): Issues and regulates the prerequisite Home Health Agency or Respite Care Service licenses and conducts physical plant inspections.
• Nebraska DHHS Division of Medicaid and Long-Term Care (MLTC): Administers the HCBS waivers, sets service standards, and publishes the provider fee schedules.
• Maximus: The contracted vendor that operates the Nebraska Medicaid Provider Screening and Enrollment (PSE) portal for all HCBS providers.
• Heritage Health MCOs: UnitedHealthcare Community Plan of Nebraska, Molina Healthcare of Nebraska, and Nebraska Total Care manage physical and behavioral health benefits and require separate network contracts.
• Nebraska Lifespan Respite Network: Provides regional coordination, mandatory provider orientation, and background check facilitation.

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska operates an open "Any Willing Provider" network for HCBS waiver services, meaning there are no closed procurement windows, Requests for Proposals (RFPs), or moratoria blocking new applicants. Furthermore, Nebraska does not require a Certificate of Need (CON) for Home Health Agencies or Respite Care Services.

However, strict sequential prerequisites exist. The state will outright reject any Medicaid enrollment application that does not already possess a fully approved, active state license from the DHHS Licensure Unit.

• Certificate of Need (CON): Not required in Nebraska for Home Health Agencies or Respite Care Services.
• Procurement/RFP: None; Nebraska allows open enrollment for qualified HCBS waiver providers at any time.
• Licensure Prerequisite: Applicants must hold an active 175 NAC 11 (HHA) or 175 NAC 15 (RCS) license from the DHHS Division of Public Health before accessing the Maximus PSE portal.
• Business Registration: The entity must be registered and in good standing with the Nebraska Secretary of State prior to applying for licensure.
• Federal Identifiers: Providers must obtain a Type 2 National Provider Identifier (NPI) and an IRS Employer Identification Number (EIN) before beginning the state application.

4. Licensure and Certification Requirements

To provide skilled respite, agencies must apply through the DHHS Licensure Unit. In-home skilled nursing respite requires a Home Health Agency license under 175 NAC 11, while facility-based respite requires a Respite Care Service license under 175 NAC 15.

The licensure process involves a comprehensive review of the agency's policies, procedures, and clinical protocols. Facility-based providers must also pass a rigorous physical plant inspection before a license is issued.

• Regulatory Citations: Governed by 175 NAC 11 for Home Health Agencies or 175 NAC 15 for Respite Care Services.
• Application Form: Providers must submit the DHHS Initial License Application for Health Care Facilities/Services along with the required licensure fee.
• Physical Plant Standards: Facility-based RCS providers must pass pre-licensure inspections to determine compliance with 175 NAC 15-007 Physical Plant Standards.
• Policy Manuals: Applicants must submit comprehensive manuals covering participant intake, emergency preparedness, medication administration, and abuse prevention.
• Change of Ownership: Licenses are strictly non-transferable; per [Respite Care Service](https://dhhs.ne.gov/licensure/Pages/Respite-Care-Service.aspx), DHHS requires 10 days' written notice before a service is sold, leased, or relocated.

5. Medicaid Provider Enrollment

Once state licensure is secured, providers must enroll in Nebraska Medicaid to bill for waiver services. This process is entirely managed by Maximus through the state's online portal.

Providers are screened based on federal categorical risk levels. Because skilled respite involves home health or personal care elements, providers are typically screened at the Moderate or High risk level, which may trigger site visits and fingerprint-based background checks.

• Enrollment Portal: Applications must be submitted through the Maximus-operated [Provider enrollment for Home and Community-based Service Providers](https://dhhs.ne.gov/Pages/PSE-for-HCBS-Providers.aspx) portal.
• Risk-Level Screening: Screened under 42 CFR 455.450; Moderate or High risk levels require enhanced screening protocols.
• Application Fee: Subject to the federal Medicaid application fee (adjusted annually, approx. $731) unless the provider is already enrolled in Medicare or another state's Medicaid program.
• Provisional Status Updates: Providers enrolled provisionally under a temporary license must immediately update Maximus once the full license is issued to prevent stranded claims.
• Revalidation: Nebraska Medicaid requires all HCBS providers to revalidate their enrollment every five years through the Maximus portal.

6. Staffing, Training and Background Checks

Because this service is defined as "skilled" respite, direct care must be delivered by licensed nursing professionals. Unlicensed assistive personnel (like CNAs or PCAs) cannot fulfill authorizations specifically coded for skilled respite.

Nebraska mandates strict background screening for all personnel interacting with vulnerable waiver participants, utilizing both state registries and criminal databases.

• Clinical Qualifications: Direct care must be provided by a Registered Nurse (RN) or Licensed Practical Nurse (LPN) holding an active, unencumbered license from the Nebraska Board of Nursing.
• LPN Supervision: LPNs delivering skilled respite must operate under the clinical direction of an RN or a licensed physician.
• Background Checks: Mandatory clearance through the Nebraska Adult and Child Abuse and Neglect Registries, plus State Patrol criminal background checks.
• Basic Certifications: All direct care personnel must maintain current, hands-on CPR and First Aid certifications.
• Provider Orientation: Agency leadership and staff must complete the online orientation provided by the [Providers - Nebraska Lifespan Respite Network](https://respite.ne.gov/providers).

7. Documentation, Policies and Records

Nebraska DHHS MLTC requires meticulous documentation to justify the billing of skilled nursing services under HCBS waivers. Records must clearly demonstrate that the care provided required a licensed nurse.

Agencies must maintain HIPAA-compliant record-keeping systems and adhere to state-mandated retention schedules, making files available for unannounced DHHS or Maximus audits.

• Service Plan Alignment: All skilled interventions must be explicitly documented and authorized in the participant's Individualized Service Plan (ISP).
• Clinical Shift Notes: Nurses must document vital signs, specific skilled interventions performed, medication administration records (MAR), and the participant's response to care for every shift.
• Critical Incident Reporting: Agencies must have policies to immediately report abuse, neglect, or severe injury to DHHS and the waiver service coordinator.
• Personnel Files: Must contain primary source verification of nursing licenses, background check results, and ongoing training certificates.
• Record Retention: Nebraska Medicaid requires providers to retain all clinical and financial records for a minimum of five years from the date of service.

8. Billing, Rates and Claims

Reimbursement for skilled respite is handled either directly through the Nebraska Medicaid Management Information System (MMIS) for fee-for-service participants, or through the respective Heritage Health MCO for managed care members.

Rates are standardized by DHHS MLTC, but providers must ensure they are billing the correct HCPCS codes with the appropriate modifiers to distinguish skilled nursing respite from basic, non-skilled respite.

• Prior Authorization: Services cannot be billed unless they are prior-authorized by the participant's service coordinator and loaded into the billing system.
• Procedure Codes: Billed using specific HCPCS codes (e.g., T1005 or S-codes) designated for skilled nursing respite, as outlined in the waiver fee schedule.
• MCO Contracting: To bill for managed care members, providers must complete separate credentialing and contracting with UnitedHealthcare, Molina, or Nebraska Total Care.
• Fee Schedule: Standardized reimbursement rates are published on the DHHS Provider Rates and Fee Schedules page.
• Claim Submission: Claims are submitted electronically via the Nebraska Medicaid MMIS portal or the specific MCO's designated clearinghouse.

9. Approval Sequence and Timeline

Becoming a fully billable skilled respite provider in Nebraska is a multi-stage process that cannot be expedited by submitting applications concurrently. Each gate must be cleared before the next opens.

From initial business formation to the final MCO contract execution, agencies should plan for a startup timeline of 6 to 9 months.

• Step 1: Register the business entity with the Nebraska Secretary of State and obtain an IRS EIN and Type 2 NPI (1-2 weeks).
• Step 2: Submit the DHHS Licensure application (175 NAC 11 or 15) and pass the readiness/physical plant inspection (60-90 days).
• Step 3: Submit the Medicaid enrollment application through the Maximus PSE portal using the newly issued state license (30-60 days).
• Step 4: Apply for network credentialing and contracting with the three Heritage Health MCOs (90-120 days).
• Total Timeline: Providers should expect a minimum of 6 to 9 months before they are authorized to bill their first claim.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to administrative errors, particularly mismatched data between state and federal databases. DHHS and Maximus enforce strict data consistency.

During post-enrollment surveys, DHHS Licensure Unit inspectors commonly cite agencies for failing to maintain complete personnel files or operating outside the scope of their specific license type.

• Licensure Denials: Facility-based applicants failing the 175 NAC 15-007 physical plant inspection due to inadequate fire safety or accessibility standards.
• Enrollment Rejections: Mismatched legal business names or addresses between the IRS EIN letter, Secretary of State registration, and the Maximus portal.
• Stranded Claims: As noted in the [Nebraska Medicaid Provider Enrollment: 2026 PDMS Guide](https://medsolercm.com/blog/nebraska-medicaid-provider-enrollment), failing to update Maximus when transitioning from a provisional to a full license leaves claims stranded.
• Survey Deficiencies: Missing or expired Nebraska Adult and Child Abuse Registry background checks in direct care staff personnel files.
• Billing Denials: Submitting claims to an MCO for dates of service that occurred before the MCO's official credentialing effective date.

11. Key Contacts and Resources

Navigating the Nebraska Medicaid system requires direct communication with several distinct state divisions and contracted vendors. Providers should utilize these official channels for application support and regulatory guidance.

For waiver-specific questions, contacting the respective DHHS division (e.g., Developmental Disabilities or MLTC) is highly recommended before submitting initial applications.

• DHHS Licensure Unit: Manages 175 NAC 11 and 15 licensing applications, physical plant inspections, and regulatory compliance.
• Maximus Provider Enrollment: Contact at (844) 374-5022 or nebraskamedicaidPSE@maximus.com for assistance with the PSE portal.
• DHHS Division of Developmental Disabilities: Contact at (402) 471-8501 or Dhhs.developmentaldisabilities@nebraska.gov for DD waiver inquiries.
• Nebraska Lifespan Respite Network: Provides local respite coordinator contacts and access to the mandatory online provider orientation.
• Heritage Health MCOs: Provider relations departments for UnitedHealthcare Community Plan, Molina Healthcare, and Nebraska Total Care for network contracting.

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