Nebraska - Speech & Language Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Nebraska Department of Health and Human Services (DHHS) Division of Public Health issues Speech-Language Pathology licenses required before a practitioner can submit a Form MC-19 to the Division of Medicaid and Long-Term Care (MLTC). In Nebraska, Speech-Language Pathology (SLP) services encompass the evaluation and treatment of communication, cognition, and swallowing disorders for Medicaid beneficiaries across independent practice and Home and Community-Based Services (HCBS) waiver settings.

Approval requires securing an active state license and completing a separate Maximus portal enrollment for every physical practice location, as Nebraska Medicaid mandates location-specific enrollment and strictly prohibits retroactive start dates for HCBS providers.

1. Service Definition and Scope

Nebraska Medicaid defines Speech-Language Pathology services as face-to-face encounters for the evaluation and treatment of speech, hearing, and language disorders. These services can be provided directly by a licensed speech pathologist or under their direct supervision.

The scope of practice is strictly limited to therapeutic and rehabilitative functions and explicitly excludes medical diagnosis or surgical interventions.

• Encounter Definition: A face-to-face visit between a Medicaid-eligible patient and a speech therapist during which services are rendered.
• Scope Exclusions: The practice of Audiology and Speech-Language Pathology does not include medical diagnosis, medical treatment, or surgery.
• Supervision: Services may be provided by or under the supervision of a licensed speech pathologist or audiologist.
• Setting Flexibility: Services are reimbursable in independent clinical settings as well as approved HCBS waiver environments.

2. Regulatory and Oversight Agencies

The Nebraska Department of Health and Human Services (DHHS) oversees both the professional licensure of SLPs and the administration of the Medicaid program. Provider enrollment processing is contracted to Maximus.

Providers must interact with multiple DHHS divisions and external portals to maintain compliance and active billing status.

• Licensure Unit: DHHS Division of Public Health issues and renews SLP licenses (https://dhhs.ne.gov/licensure/pages/audiology-and-speech-language-pathology.aspx).
• Medicaid Agency: DHHS Division of Medicaid and Long-Term Care (MLTC) administers the state plan and waivers (https://dhhs.ne.gov/Pages/Medicaid-Providers.aspx).
• Enrollment Vendor: Maximus operates the Nebraska Medicaid Provider Enrollment portal (https://nebraskamedicaidproviderenrollment.com).
• Background Screening: DHHS Child/Adult Abuse & Neglect Registry (https://ecmp.nebraska.gov/DHHS-CR/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska does not require a Certificate of Need (CON) or regional RFP procurement for independent SLP enrollment. The state operates an open enrollment network for qualified practitioners.

The absolute structural precondition for Medicaid enrollment is holding an active Nebraska SLP license and establishing a distinct physical practice location, as PO Boxes are rejected for practice addresses.

• Licensure Prerequisite: Applicants must hold an active DHHS Speech-Language Pathology license before submitting Form MC-19.
• Location Requirement: Providers must enroll separately for each physical location where services are provided to Medicaid members.
• Network Access: Nebraska Medicaid operates an open enrollment system for SLPs with no current moratoria or closed networks.
• Retroactive Billing Restrictions: HCBS providers cannot receive a retroactive start date; standard billing providers must request retro dates over 180 days with written justification.

4. Licensure and Certification Requirements

SLPs are licensed by the DHHS Licensure Unit under the Audiology and Speech-Language Pathology Practice Act. The state offers a preliminary review process for applicants with criminal histories.

Licenses and assistant credentials must be renewed periodically, with specific timelines enforced by the Licensure Unit.

• Statutory Authority: Governed by Neb. Rev. Stat. §38-1500 et seq.
• Conviction Review: A Preliminary Application Conviction Review is available for applicants to determine if a criminal record disqualifies them prior to full application.
• Assistant Credentials: Audiology & Speech-Language Pathology Assistant credentials expire one year from the date of issuance.
• Renewal Timeline: The Licensure Unit sends renewal notices at least 30 days before expiration; renewals can be completed online or via paper application with a check.

5. Medicaid Provider Enrollment

Enrollment is processed through the Maximus web portal using Form MC-19, the Nebraska Service Provider Agreement. This document establishes the provider's computer files for payment.

Providers must submit all required addenda and tax documentation simultaneously to avoid application rejection.

• Primary Form: Form MC-19 (Nebraska Service Provider Agreement) is required for all initial enrollments, re-enrollments, and revalidations.
• Portal Submission: Providers are encouraged to complete the agreement electronically through the Maximus enrollment web portal.
• Tax Documentation: A W-9 is required for providers enrolling with a Federal Tax Identification Number (FTIN) or Employer Identification Number (EIN).
• Address Rule: Section A of Form MC-19 requires a physical street address; a post office box without a physical location address is not accepted.

6. Staffing, Training and Background Checks

Nebraska Medicaid requires comprehensive background screenings during initial enrollment and periodic revalidation. Providers must ensure all managing employees and owners are disclosed.

HCBS providers face more frequent screening requirements compared to standard medical providers.

• Registry Checks: Clearance through the Nebraska Child/Adult Abuse & Neglect Registry is required.
• Exclusion List: Applicants must not appear on the Nebraska Medicaid Excluded Providers (NMEP) list; removal requires a separate petition to Medicaid Program Integrity.
• Screening Frequency: HCBS providers undergo annual screening; all other providers complete revalidation every 5 years.
• Information Updates: Providers must continuously update household members, owners, and managing employees in the Maximus portal.

7. Documentation, Policies and Records

Providers must maintain accurate records of all face-to-face encounters and ensure their provider agreement reflects current operational data.

Failure to maintain updated records or respond to revalidation notices can result in termination of the provider agreement.

• Agreement Maintenance: Providers must keep name, email, phone, and banking information current in the provider agreement at all times.
• Policy Review: HCBS waiver providers must complete the HCBS and PAS Agency Policy and Procedure Review.
• Encounter Documentation: Records must substantiate a face-to-face visit between the Medicaid-eligible patient and the speech therapist.
• Written Confirmation: Upon approval, providers receive a written confirmation letter detailing their Service Provider Agreement effective date and Provider ID.

8. Billing, Rates and Claims

SLP services are reimbursed according to the Nebraska Medicaid Speech Pathology and Audiology Fee Schedule. Claims must be submitted to the appropriate payer based on the member's enrollment status.

Managed care claims are handled directly by the Heritage Health MCOs, while fee-for-service and waiver claims are processed through the state MMIS.

• Reimbursement Formula: Nebraska Medicaid pays at the lower of the provider's submitted charge or the allowable amount in the fee schedule.
• Allowable Amount Calculation: The allowable amount is calculated as the unit value multiplied by the conversion factor.
• MCO Billing: Claims for managed care members must be submitted directly to the respective Heritage Health Managed Care Organization (MCO).
• License Type Updates: Failure to update a license type in the portal immediately can result in claim rejections or payment at the incorrect rate.

9. Approval Sequence and Timeline

The approval sequence is strictly linear: state licensure must be secured before Medicaid enrollment can begin. The Maximus portal handles the intake and screening of the Medicaid application.

Revalidation notices are sent well in advance to prevent lapses in billing privileges.

• Step 1: Obtain an active Speech-Language Pathology license from the DHHS Licensure Unit.
• Step 2: Submit Form MC-19, W-9, and applicable addenda via the Maximus portal.
• Step 3: Pass program integrity and background screenings conducted by Maximus and DHHS.
• Step 4: Receive the written confirmation letter with the Provider ID and effective date.
• Revalidation Timeline: Maximus sends email notices as early as 180 days before the 5-year revalidation deadline.

10. Common Denials and Survey Findings

Enrollment delays and claim denials frequently occur due to administrative errors on Form MC-19 or failure to communicate changes to Maximus.

Retroactive date requests are a common source of friction if not properly justified.

• License Mismatch: Failure to end an old enrollment and submit a new one when a license type changes leads to claim rejections.
• Address Errors: Applications are denied if a PO Box is used instead of a physical address on Form MC-19.
• Retroactive Denials: Requesting retro dates over 180 days without uploading a written explanation results in automatic delays or denials.
• Communication Failures: Not responding to Maximus requests for additional information during the screening process results in application abandonment.

11. Key Contacts and Resources

Providers must direct licensure inquiries to the DHHS Licensure Unit and enrollment inquiries to Maximus. HCBS-specific questions have a dedicated DHHS contact.

Maintaining access to these portals is essential for ongoing compliance.

• DHHS Licensure Unit: (402) 471-2299, [email protected], https://dhhs.ne.gov/licensure/pages/audiology-and-speech-language-pathology.aspx
• Maximus Provider Enrollment: 844-374-5022, https://nebraskamedicaidproviderenrollment.com
• HCBS Provider Support: (402) 471-0667, [email protected]
• Medicaid Provider Directory: https://mltcfindprovider-dhhs.nebraska.gov/

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