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

Last reviewed: 2026-09-10

Nebraska's Aged and Disabled (AD) Waiver and the Special Health Care Needs program fund respite care for participants requiring nursing-level interventions, though the Department of Health and Human Services (DHHS) does not issue a distinct "Skilled Respite" license. Instead, providers must either hold a Nebraska Home Health Agency license or enroll as independent licensed nurses (RN/LPN) to deliver these skilled interventions under the waiver's respite service definition.

The approval sequence requires securing the underlying clinical license from the DHHS Division of Public Health before submitting a Medicaid Home and Community-Based Services (HCBS) enrollment application. Applications are processed by Maximus, the state's enrollment broker, and providers must subsequently contract with Heritage Health managed care organizations to serve enrolled beneficiaries.

1. Service Definition and Scope

In Nebraska, respite provides a temporary break for the primary caregiver of a waiver participant. When the participant's medical needs exceed what an unlicensed caregiver can safely manage, the service must be delivered by licensed nursing staff.

Because Nebraska does not categorize "Skilled Respite" as a standalone waiver service, these interventions are billed under the standard Respite service category but delivered by qualified medical personnel (RNs or LPNs) operating within their clinical scope of practice.

2. Regulatory and Oversight Agencies

The Nebraska Department of Health and Human Services (DHHS) is the umbrella agency overseeing Medicaid and facility licensure. Responsibilities are divided between the Division of Public Health for clinical licensing and the Division of Medicaid and Long-Term Care for waiver administration.

Provider enrollment is outsourced to Maximus, which operates the state's Medicaid provider portal. Managed care organizations, such as Nebraska Total Care, oversee network adequacy and claims for Heritage Health enrollees.

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska operates an open enrollment model for HCBS waiver providers. There are no Certificate of Need (CON) laws, closed networks, or Request for Proposal (RFP) procurement mandates blocking new respite providers from entering the market.

The primary structural precondition is clinical licensure. Because there is no "Skilled Respite" agency license, an entity must first obtain a Home Health Agency license from the DHHS Division of Public Health, or an individual must hold an active Nebraska RN/LPN license, before Maximus will accept a Medicaid enrollment application.

4. Licensure and Certification Requirements

To deliver nursing-level respite, corporate entities must be licensed as Home Health Agencies under Title 175 of the Nebraska Administrative Code. This ensures the agency has the clinical oversight structure required to deploy nurses into the community.

Independent providers do not need an agency license but must maintain their individual professional nursing licenses. Medicare certification is not strictly required for Medicaid HCBS waiver respite, though it is standard for full home health agencies.

5. Medicaid Provider Enrollment

Medicaid enrollment is processed by Maximus. Providers must submit their application either online through the Maximus portal or via a paper application mailed to their Lincoln office.

Applicants must select the appropriate provider type (Agency or Independent) and submit a signed Medical Assistance Provider Agreement along with proof of their underlying clinical licensure.

6. Staffing, Training and Background Checks

Staff delivering skilled respite must practice strictly within their nursing scope of practice as defined by the Nebraska Board of Nursing. Agencies are responsible for verifying credentials prior to deploying staff.

All direct care personnel must pass comprehensive background checks, including state registries, and complete DHHS-mandated HCBS training covering abuse, neglect, and exploitation reporting.

7. Documentation, Policies and Records

Providers must maintain rigorous documentation proving both the medical necessity of the skilled interventions and the exact times the respite service was delivered to relieve the primary caregiver.

Records must be retained for a minimum of five years and be readily available for DHHS or MCO audits. Timesheets must include caregiver signatures verifying the relief period.

8. Billing, Rates and Claims

Services are billed to the Nebraska Medicaid MMIS or the participant's managed care organization (e.g., Nebraska Total Care) if the individual is enrolled in the Heritage Health program.

Rates are established by DHHS and published on the HCBS fee schedule. Providers must secure prior authorization before delivering services, and claims cannot exceed the hours allotted in the service plan.

9. Approval Sequence and Timeline

The approval process is linear and sequential. Providers cannot begin the Medicaid enrollment phase until their clinical licensure is fully approved by the Division of Public Health.

Once Maximus approves the Medicaid enrollment, agencies must complete credentialing and contracting with the Heritage Health MCOs before they can bill for managed care enrollees.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied when providers fail to include proof of their underlying clinical license or submit incomplete background check documentation.

During audits, surveyors commonly cite providers for billing hours that exceed the authorized amount or failing to document the specific skilled nursing tasks that justified the use of licensed personnel for respite.

11. Key Contacts and Resources

Providers should direct enrollment inquiries to Maximus and licensure questions to the DHHS Division of Public Health. Waiver policy and rate information are managed by the Division of Medicaid and Long-Term Care.

For participants enrolled in managed care, providers must also utilize the provider relations departments of the respective Heritage Health MCOs.

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