1. GOVERNING AGENCIES

Agency: Nebraska Department of Health and Human Services (DHHS)
Role: Administers Medicaid waiver funding for Skilled Nursing Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Nebraska Medicaid and Long-Term Care (MLTC) Division
Role: Ensures quality standards, service delivery, and compliance for Skilled Nursing Services under HCBS waiver programs.

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Skilled Nursing Services meet HCBS quality, person-centered planning, and participant protection standards.

2. SKILLED NURSING SERVICES OVERVIEW

Skilled Nursing Services involve medical care provided by licensed nurses in the individual’s home, focusing on complex medical needs and health maintenance.

Approved providers may deliver:

• Medication Management: Administration, monitoring, and education on prescribed medications
• Wound Care: Dressing changes, wound assessment, and infection control
• Chronic Disease Management: Monitoring and support for conditions like diabetes, COPD, and heart disease
• IV Therapy: Intravenous medication administration and fluid management
• Post-Surgical Care: Monitoring recovery, pain management, and mobility support
• Vital Sign Monitoring: Regular tracking of blood pressure, heart rate, respiration, and oxygen levels
• Patient Education: Teaching self-care practices for chronic condition management
• Palliative and End-of-Life Care: Providing comfort and support for terminally ill patients

All services are provided based on the Individualized Service Plan (ISP) and must be ordered by a licensed physician.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register the business entity with the Nebraska Secretary of State
• Obtain EIN from the IRS and NPI (Type 2)
• Enroll as a Medicaid Waiver Skilled Nursing provider via the Nebraska Medicaid Provider Enrollment Portal
• Obtain a Home Health Agency License from DHHS
• Maintain general liability and professional liability insurance
• Develop comprehensive policies for nursing care, infection control, and health monitoring
• Ensure nursing staff meet licensing, background checks, and health screenings

4. NEBRASKA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Complete the Provider Enrollment Application through the Nebraska Medicaid Provider Enrollment Portal for Skilled Nursing Services under HCBS waivers

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, nursing licenses, insurance certificates, and policy manuals

Program Readiness Review:

• DHHS evaluates provider readiness, including clinical protocols, safety procedures, and staff qualifications

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for Skilled Nursing Services using designated billing codes

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Nebraska Secretary of State)
• IRS EIN confirmation
• NPI confirmation
• Home Health Agency License
• Proof of general and professional liability insurance

Skilled Nursing Services Policy & Procedure Manual including:

• Medication administration and management protocols
• Wound care and infection control procedures
• Chronic disease management and monitoring guidelines
• IV therapy and medical equipment handling protocols
• Patient education and self-care training methods
• Staff credentialing, background checks, and ongoing training requirements
• Documentation standards for patient care and Medicaid billing
• HIPAA compliance, patient rights, and grievance handling
• Emergency preparedness and health crisis management

6. STAFFING REQUIREMENTS

Role: Skilled Nursing Program Director
Requirements: Bachelor’s or Master’s degree in nursing (BSN/MSN); Licensed Registered Nurse (RN); supervisory experience preferred.

Role: Registered Nurses (RNs)
Requirements: Active Nebraska RN license; CPR/First Aid certification; experience in home healthcare.

Role: Licensed Practical Nurses (LPNs)
Requirements: Active LPN license, supervised by an RN, experience in skilled nursing care

Role: Certified Nursing Assistants (CNAs)
Requirements: State certification, supervised by RN/LPN, experience in personal care support

All staff must complete:

• Safety, infection control, and clinical competency training
• HIPAA compliance and patient rights education
• Annual competency evaluations and professional development
• Ongoing training in chronic disease management and emergency response

7. MEDICAID WAIVER PROGRAMS

Skilled Nursing Services are available under the following Nebraska Medicaid Waivers:

• Aged and Disabled (AD) Waiver
• Traumatic Brain Injury (TBI) Waiver
• Developmental Disabilities (DD) Waiver
• Children with Disabilities Waiver
• Home and Community-Based Services (HCBS) Waiver

Services may include:

• Skilled nursing care for chronic conditions
• IV medication and infusion therapy
• Wound care and post-surgical monitoring
• Health assessments and vital sign monitoring
• Palliative care and comfort management

8. TIMELINE TO LAUNCH

Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months

Phase: Nebraska Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days

Phase: Medicaid Billing Setup and Skilled Nursing Service Launch
Timeline: 30–45 days

9. CONTACT INFORMATION

Nebraska Department of Health and Human Services (DHHS)
Website: https://dhhs.ne.gov/

Nebraska Medicaid and Long-Term Care (MLTC) Division
Website: https://dhhs.ne.gov/Pages/Medicaid.aspx

Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/

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SCOPE OF WORK

• Business registration, Medicaid enrollment, and licensing support
• Policy manual development tailored to skilled nursing and chronic care
• Staff credentialing, training program templates, and clinical protocols
• Medicaid billing setup and audit-prepared financial management
• Branding, website development, and community outreach strategies
• Quality assurance systems for infection control and safety monitoring
• Collaboration with healthcare providers and hospital networks for client referrals