Nebraska - Transitional Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Nebraska, Transitional Assistance Services (often referred to as Transition Services) provide critical, one-time set-up funds and coordination to help Medicaid participants move from institutional settings, such as nursing facilities, into their own community-based homes. Funded through Home and Community-Based Services (HCBS) waivers like the Aged and Disabled Waiver, these services cover essential expenses such as security deposits, basic furnishings, and utility set-up fees that would otherwise prevent a successful transition to independent living.

The single biggest structural barrier to entry for prospective providers in Nebraska is the Resource Developer (RD) referral requirement. Unlike standard Medicaid services where a provider can simply submit an application, HCBS agencies in Nebraska cannot even create an account in the state's enrollment portal without first securing a provider referral number from a Department of Health and Human Services (DHHS) Resource Developer. This gatekeeping step ensures the state only processes applications for providers that meet immediate regional network needs.

1. Service Definition and Scope

Nebraska defines Transition Services as non-recurring, one-time set-up expenses and coordination activities necessary to establish a basic household for an individual transitioning from an institution to a community setting. These services are authorized under specific HCBS waivers and are strictly limited to items and supports that are essential for the health and safety of the participant in their new home.

The scope of this service is highly restricted to prevent overlap with ongoing living expenses. It does not cover monthly rent, mortgage payments, regular utility bills, or food. All expenditures must be pre-approved and documented in the participant's Individualized Service Plan (ISP).

• Covered Expense: Security deposits and first month's rent required to secure a lease for community housing.
• Covered Expense: Essential household furnishings, including a bed, dining table, chairs, and basic kitchen utensils.
• Covered Expense: One-time utility set-up fees and deposits for electricity, water, gas, and basic telephone service.
• Covered Expense: Moving expenses and one-time health and safety assurances, such as initial pest eradication or deep cleaning prior to move-in.
• Exclusion: Ongoing monthly rental or mortgage payments, recurring utility charges, and groceries or food items.
• Service Limit: Expenditures are capped at a specific lifetime or per-transition dollar amount as defined by the specific Nebraska HCBS waiver operating the service.

2. Regulatory and Oversight Agencies

Oversight of Transition Services in Nebraska is divided between the divisions that manage the specific HCBS waivers and the contractor that handles provider enrollment. The Nebraska Department of Health and Human Services (DHHS) (https://dhhs.ne.gov) is the umbrella agency responsible for all Medicaid operations.

Within DHHS, the Division of Medicaid and Long-Term Care (MLTC) (https://dhhs.ne.gov/Pages/Medicaid-and-Long-Term-Care.aspx) oversees the Aged and Disabled Waiver, while the Division of Developmental Disabilities (DDD) (https://dhhs.ne.gov/Pages/Developmental-Disabilities.aspx) oversees DD-specific waivers. The state contracts with Maximus to operate the Nebraska Medicaid Provider Screening and Enrollment portal (https://www.nebraskamedicaidproviderenrollment.com).

• Agency: Nebraska Department of Health and Human Services (DHHS) (https://dhhs.ne.gov) Role: Serves as the primary state health authority administering Medicaid and HCBS waivers.
• Division: DHHS Division of Medicaid and Long-Term Care (MLTC) (https://dhhs.ne.gov/Pages/Medicaid-and-Long-Term-Care.aspx) Role: Manages policy, quality standards, and service delivery for the Aged and Disabled Waiver.
• Division: DHHS Division of Developmental Disabilities (DDD) (https://dhhs.ne.gov/Pages/Developmental-Disabilities.aspx) Role: Oversees transition services provided under the state's developmental disability waivers.
• Contractor: Maximus (https://www.nebraskamedicaidproviderenrollment.com) Role: Operates the state's Provider Screening and Enrollment (PSE) portal and processes all initial Medicaid enrollment applications.
• Federal Agency: Centers for Medicare & Medicaid Services (CMS) (https://www.cms.gov) Role: Provides federal funding and regulatory oversight for Nebraska's 1915(c) HCBS waivers.

3. Gatekeeping Prerequisites: Who Can Even Apply

Nebraska does not require a Certificate of Need (CON) for HCBS Transition Services, nor does it utilize a closed competitive procurement (RFP) process to select providers. However, the state employs a strict operational gatekeeper that blocks unsolicited applications from entering the system.

Before an application is accepted, a prospective HCBS agency must obtain a provider referral from a DHHS Resource Developer (RD worker). Without the specific referral number generated by the RD worker, the Maximus enrollment portal will not allow the provider to create an account or submit an application. There are currently no state-imposed moratoria on this service, provided the RD referral is secured.

• Prerequisite: DHHS Resource Developer (RD) Referral Role: A mandatory precondition where an RD worker must issue a provider referral number before the applicant can access the Maximus enrollment portal.
• Prerequisite: Active Nebraska Business Registration Role: The entity must be registered and in good standing with the Nebraska Secretary of State prior to seeking an RD referral.
• Prerequisite: National Provider Identifier (NPI) Role: Agencies must obtain a Type 2 NPI from the federal NPPES system before initiating the state enrollment process.
• Prerequisite: Certificate of Need (CON) Role: None exists; Nebraska does not subject HCBS transition services to CON review or approval.
• Prerequisite: Enrollment Moratoria Role: None exists; there are no active freezes on new HCBS transition service providers in Nebraska.

4. Licensure and Certification Requirements

Nebraska does not issue a distinct facility or agency license for Transitional Assistance Services through its public health licensure division. Because this is strictly an HCBS waiver service, providers are approved and certified directly through the Medicaid enrollment and waiver credentialing process.

Instead of a traditional license, providers must execute the Nebraska Service Provider Agreement (Form MC-19) and demonstrate compliance with the specific administrative, insurance, and operational standards dictated by the waiver under which they intend to bill.

• Authority: Unlicensed HCBS Service Role: Nebraska does not license this service category; approval is granted via Medicaid waiver certification.
• Requirement: Nebraska Service Provider Agreement (Form MC-19) Role: The core legal contract between the provider and Nebraska Medicaid that must be signed and approved to render services.
• Requirement: General Liability Insurance Role: Providers must maintain active commercial general liability coverage and submit certificates during the Maximus enrollment process.
• Requirement: Professional Liability Insurance Role: Required to protect the agency and state against claims arising from errors in service coordination and transition planning.
• Requirement: W-9 Form Role: Must be submitted to the State of Nebraska to establish the provider in the state's accounting system for payment routing.

5. Medicaid Provider Enrollment

Medicaid enrollment in Nebraska is a sequential process that begins with the state and ends with the Managed Care Organizations (MCOs). Providers must first apply through the Maximus-operated Nebraska Medicaid Provider Screening and Enrollment portal (https://www.nebraskamedicaidproviderenrollment.com) using their RD referral number.

Only after Maximus and DHHS approve the state-level enrollment and issue a Nebraska Medicaid Provider ID can the agency contract with the state's three Heritage Health MCOs. The MCOs will automatically deny credentialing requests from providers who are not already fully enrolled with Nebraska Medicaid.

• Portal: Nebraska Medicaid Provider Screening and Enrollment (https://www.nebraskamedicaidproviderenrollment.com) Role: The mandatory Maximus-operated system for submitting the initial state Medicaid application.
• Step 1: Provider Location Account Creation Role: The applicant uses their DHHS RD referral number to unlock the portal and create their initial business profile.
• Step 2: Application Submission Role: Uploading Form MC-19, ownership disclosures, insurance certificates, and paying the federal Medicaid application fee if applicable.
• MCO Contracting: UnitedHealthcare Community Plan of Nebraska (https://www.uhcprovider.com/en/health-plans-by-state/nebraska-health-plans/ne-comm-plan-home.html) Role: Requires separate credentialing and contracting after state Medicaid ID issuance.
• MCO Contracting: Molina Healthcare of Nebraska (https://www.molinahealthcare.com/providers/ne/medicaid/home.aspx) Role: Requires separate credentialing and contracting after state Medicaid ID issuance.
• MCO Contracting: Nebraska Total Care (https://www.nebraskatotalcare.com) Role: Requires separate credentialing and contracting after state Medicaid ID issuance.

6. Staffing, Training and Background Checks

Because transition coordinators work directly with vulnerable adults and manage state funds for household setups, Nebraska DHHS enforces strict background screening and basic safety training requirements for all direct-contact personnel.

Agencies must maintain a roster of cleared staff and ensure that no employee provides services or contacts a participant until all registry checks and criminal background screenings have been returned and cleared by the state.

• Registry Check: Nebraska Adult Protective Services (APS) Central Registry Role: Mandatory screening to ensure staff have no substantiated findings of abuse, neglect, or exploitation of vulnerable adults.
• Registry Check: Nebraska Child Protective Services (CPS) Central Registry Role: Mandatory screening required for all staff prior to client contact.
• Criminal Check: Nebraska State Patrol Background Check Role: Fingerprint-based or name-based criminal history check required for all direct-care and coordination staff.
• Training: CPR and First Aid Certification Role: Required for staff conducting in-person community transitions and home visits.
• Training: HIPAA and Participant Rights Role: Mandatory agency-led training on privacy, confidentiality, and the rights of waiver participants.
• Exclusion Check: OIG LEIE Screening Role: Agencies must screen all employees monthly against the federal List of Excluded Individuals/Entities.

7. Documentation, Policies and Records

Providers of Transition Services act as financial stewards of waiver funds used to purchase household goods and secure leases. Consequently, the documentation burden is heavily focused on financial tracking, receipt management, and proof of delivery.

Agencies must maintain a comprehensive policy manual detailing their transition protocols. During state or MCO audits, the failure to produce original, itemized receipts that perfectly match the amounts billed to Medicaid is the most frequent cause for fund recoupment.

• Policy: Transition Planning and Coordination Role: Written procedures detailing how the agency assesses needs, sources housing, and procures essential furnishings.
• Policy: Financial Tracking and Receipt Management Role: Strict protocols for retaining original invoices, lease agreements, and store receipts for all waiver-funded purchases.
• Record: Individualized Service Plan (ISP) Role: The state-approved document that authorizes the specific transition goals and the exact budget allocated for the participant.
• Record: Proof of Delivery Role: Signed documentation from the participant confirming they received the purchased furnishings and that utility/lease deposits were paid.
• Policy: Grievance and Incident Reporting Role: Procedures for handling participant complaints and reporting critical incidents to DHHS.

8. Billing, Rates and Claims

Transition Services are reimbursed on a Fee-for-Service (FFS) basis for participants not enrolled in managed care, or directly by the Heritage Health MCOs for managed care members. Claims are submitted through the Nebraska Medicaid Management Information System (MMIS) or the respective MCO clearinghouses.

Reimbursement is strictly capped based on the specific waiver's published fee schedule and the individual's authorized ISP budget. Providers are reimbursed for the actual cost of the approved items and deposits, plus any authorized administrative or coordination fee defined by the billing code.

• System: Nebraska Medicaid Management Information System (MMIS) Role: The state system used for processing FFS claims and maintaining provider payment records.
• Method: Standard HCBS Billing Codes Role: Claims are submitted using designated HCPCS codes (e.g., T2038) indicating community transition services.
• Rate Structure: Cost Reimbursement up to Cap Role: Providers are paid for the actual cost of setup expenses, strictly limited by the lifetime or per-transition maximums set by the waiver.
• Requirement: Prior Authorization (PA) Role: Mandatory approval from the waiver service coordinator must be secured in the MMIS or MCO system before any purchases are made.
• Restriction: Date of Service Rules Role: Providers cannot bill for any transition services or items procured prior to the participant's official waiver enrollment date.

9. Approval Sequence and Timeline

Becoming a fully billable Transition Services provider in Nebraska requires navigating multiple sequential approvals across DHHS, Maximus, and the MCOs. Because each step depends on the completion of the previous one, the entire process typically takes 3 to 6 months.

Providers must factor in the time required to connect with a Resource Developer, as this initial networking and referral phase can vary significantly depending on the region's immediate need for new providers.

• Phase 1: Business Formation and NPI (1-2 weeks) Role: Registering with the Nebraska Secretary of State and obtaining a Type 2 NPI from the federal government.
• Phase 2: DHHS Resource Developer Referral (2-4 weeks) Role: Contacting the regional RD worker to demonstrate capability and securing the mandatory provider referral number.
• Phase 3: Maximus PSE Application (30-60 days) Role: Creating the portal account, submitting Form MC-19, and undergoing the state's background and document review.
• Phase 4: State Approval and Medicaid ID Issuance Role: DHHS finalizes the enrollment and issues the active Nebraska Medicaid Provider ID.
• Phase 5: MCO Credentialing (60-90 days) Role: Applying to join the networks of UnitedHealthcare, Molina, and Nebraska Total Care to serve managed care waiver participants.

10. Common Denials and Survey Findings

Applications for Transition Services are most frequently rejected at the very beginning of the process due to providers attempting to bypass the Resource Developer referral requirement. Without this referral, Maximus will not process the enrollment.

Post-enrollment, providers face strict financial audits. Because Transition Services involve purchasing goods and paying deposits, auditors heavily scrutinize financial records. Recoupments are common when providers fail to maintain a perfect paper trail of expenditures.

• Denial Reason: Missing RD Referral Number Role: Attempting to register in the Maximus portal without first obtaining a referral from a DHHS Resource Developer.
• Denial Reason: Mismatched Identifiers Role: Discrepancies between the Tax ID (TIN), NPI, and legal business name submitted to Maximus versus what is on file with the IRS.
• Audit Finding: Unallowable Purchases Role: Billing the waiver for prohibited items such as ongoing rent, groceries, or entertainment electronics instead of approved setup costs.
• Audit Finding: Missing Original Receipts Role: Failure to maintain and produce the original store receipts or lease agreements that match the exact dollar amounts billed to Medicaid.
• Audit Finding: Premature Service Delivery Role: Allowing staff to coordinate transitions or contact participants before their background checks were fully cleared and documented.

11. Key Contacts and Resources

Prospective providers must utilize the official state portals and MCO provider pages to navigate the enrollment and credentialing process. The Maximus customer service team is the primary point of contact for technical issues within the state enrollment portal.

For waiver-specific policy questions or to initiate the Resource Developer referral process, providers should contact the DHHS Division of Medicaid and Long-Term Care or the Division of Developmental Disabilities directly.

• Nebraska DHHS Medicaid and Long-Term Care: https://dhhs.ne.gov/Pages/Medicaid-and-Long-Term-Care.aspx
• Nebraska DHHS Developmental Disabilities: https://dhhs.ne.gov/Pages/Developmental-Disabilities.aspx
• Maximus Provider Screening and Enrollment Portal: https://www.nebraskamedicaidproviderenrollment.com
• Maximus Customer Service: (844) 374-5022 or nebraskamedicaidPSE@maximus.com
• UnitedHealthcare Community Plan of Nebraska: https://www.uhcprovider.com/en/health-plans-by-state/nebraska-health-plans/ne-comm-plan-home.html
• Molina Healthcare of Nebraska: https://www.molinahealthcare.com/providers/ne/medicaid/home.aspx
• Nebraska Total Care: https://www.nebraskatotalcare.com

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