Home care billing in Nebraska

Key facts for Nebraska home care billing

Programs that pay for home care in Nebraska¹

• HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00)

  Adult day health, personal care, respite, assistive technology, chore, companion, extra care for children with disabilities, home again, home delivered meals, home modifications, independence skills building, LRI personal care, non-medical transportation, personal emergency response, supported residential living and vehicle modification, for people 65 and older and people up to 64 with physical disabilities who meet a nursing facility level of care.

  Known as the Aged and Disabled waiver in 480 NAC 5, which requires the need for each waiver service to show up in an assessment area of the participant's person-centered plan and does not cover the same service from two paid caregivers at once (480 NAC 5-002, cited below).

• Traumatic Brain Injury Waiver (40199.R05.00)

  TBI personal care, TBI respite, TBI adult day health, TBI companion, TBI supported residential living, chore, caregiver training, community connections, home delivered meals, home modifications, LRI personal care, non-medical transportation, personal emergency response, supported employment and vehicle modification, for adults 18 and older with a traumatic brain injury who meet a nursing facility level of care.

• CDD Waiver (4154.R07.00)

  Residential, day and in-home supports for people of any age with autism, an intellectual disability or a developmental disability who meet an ICF/IID level of care, including LRI personal care, respite, homemaker, independent living, supported family living, behavioral and medical in-home habilitation, continuous home, host home, shared living, residential habilitation, day supports, supported employment and transportation.

  Nebraska's CMS-approved application for amendment NE.4154.R07.03, effective July 1, 2026, calls this all-ages developmental disabilities services waiver the CDD waiver (Medicaid.gov waiver 4154 entry, cited below).

• Developmental Disabilities Day Services Waiver for Adults (0394.R04.00)

  LRI personal care, respite, independent living, supported family living, adult day, day supports, community integration, prevocational services, supported employment, remote supports, home and vehicle modifications and transportation, for adults 21 and older with autism, an intellectual disability or a developmental disability who meet an ICF/IID level of care.

• Family Support Waiver (2366.R00.00)

  LRI personal care, respite, homemaker, independent living, supported family living, child day habilitation, community integration, family and peer mentoring, family caregiver training, health maintenance monitoring, remote supports, home and vehicle modifications and non-medical transportation, for children and young adults up to 21 with autism, an intellectual disability or a developmental disability who meet an ICF/IID level of care.

• Personal Assistance Services (Medicaid state plan)

  Help with the tasks a client needs someone else to perform and that are essential to remaining at home, as listed on the client's service plan, delivered by agency or individual providers.

  Set out in 471 NAC 15: the services must be authorized before they are delivered, are capped at 40 hours in a seven-day period unless the Department prior authorizes more, and every visit is documented in the provider's EVV system (471 NAC 15, cited below).

Common rejections in Nebraska, and the fix

• Personal assistance hours that do not match the EVV record

  The fixMedicaid will not pay for services that were not performed during the actual hours the provider recorded in EVV. The biller compares each claim line with the visit's recorded start and end times, sends visits with missing or edited times back to the scheduler for correction, and bills only what the record supports.

• Alternate EVV vendor visits missing from Netsmart

  The fixAn alternate system counts only after the vendor meets the technical specifications and completes integration with Netsmart, starting from a provider survey for each managed care organization. The biller keeps the agency on Netsmart or an approved vendor until integration is approved and then spot-checks that every scheduled visit arrives.

• Fee-for-service claim received after six months

  The fix471 NAC 3-003 counts six months from the date of service to the date the Department receives the claim, and late claims pay only for delays beyond the provider's control. The biller submits personal assistance claims on the weekly-to-monthly cycle the rule sets, ages every open claim from the date of service, and documents any delay that the agency did not cause.

• Personal assistance hours over 40 in seven days with no prior authorization

  The fixThe rule caps personal assistance at 40 hours in a seven-day period unless the Department prior authorizes more. The biller totals hours per client per seven-day period before claims go out and asks for the authorization before the agency schedules past the cap.

• Waiver service billed before the consent form and eligibility were in place

  The fixNo Aged and Disabled or TBI waiver service may be authorized until the participant signs the waiver consent form and Medicaid eligibility is approved. The biller records both dates on the account and holds any visit dated before the later of the two.

• Heritage Health home health claim filed after 180 days

  The fixNebraska Total Care allows 180 calendar days from the date of service, 365 days as secondary payer and 90 days from the payment or denial notice for a corrected claim. The biller checks the member's plan on each date of service, files plan claims by that plan's window, and logs every remittance date to keep corrections inside 90 days.