Providers For Aged & Disabled (AD) Waiver and Traumatic Brain Injury (TBI) Waiver

 
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Medicaid HCBS AD Waiver
Developmental Disabilities
https://public.govdelivery.com/accounts/NESTATE/subscriber/new?category_id=NESTATE_789
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What you need to know

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​This page helps you provide important services to Medicaid HCBS AD and TBI Waiver participants. Resources can be used at any time as long as you are providing services. Be sure to also use the HCBS Provider Homepage, the Training page, and the Resources page.

You are also responsible to know information from MLTC Provider Bulletins​​​ and DDD Provider Bulletins​.​

AD/TBI Waiver Policy Open Houses

Sessions will be scheduled at a later date. They will be an opportunity to discuss potential changes and gather feedback to ensure that the Aged & Disabled (AD) Waiver and Traumatic Brain Injury (TBI) Waiver remain responsive and supportive of participant needs. Input is important as we prepare for the 5-year renewal of the AD Waiver and the planned amendment of the TBI Waiver in August 2026. 


Transition to Therap

May 1, 2025, AD and TBI waiver providers transitioned to Therap for electronic claiming and receiving authorizations, outside of EVV requirements. 

Recordings of the webinars are posted on the Therap help page: Therap for Nebraska ADTBI. Other guides are also available on their website.

​Assisted Living Facilities (ALF) are tentatively scheduled for October 2025 implementation. ALF electronic claiming will have separate trainings with Therap starting August 6, 2025. See the ALF implementation section for more information.​

Assisted Living Facility (ALF) Implementation

  • Training on Transition in Clearinghouse Agreements - June 2025 
  • Complete Therap Provider Contact form to get connected with Therap for account set up in August 2025.
  • ALF Billing Trainings: 
    • These are held every Wednesday in August at 11:00 AM, Central Time. 
    • The Therap billing team will teach you how to document and bill using Therap. 
    • Recordings will be on the Therap support page approximately one week after each training, in addition to instruction guides. 
    • ​Date
      		​Topic
      ​August 6, 2025
      		​Billing Introduction
      ​August 13, 2025
      		​Generating Billing Data and Claims
      ​August 20, 2025
      		​Claims Management and Reporting
      ​August 27, 2025
      		​Go-Live Recap
      ​September 10, 2025
      		​Provider Q&A
      ​October 15, 2025
      		​Provider Q&A
​

Provider Impact

  • ​New specific provider login to the for the AD and TBI waiver side of Therap (this is separate from existing DD waiver logins)
  • Paper claims will not be accepted for services delivered after May 1, 2025.
  • Providers must log in to Therap to access Service Authorizations. 
    • They are no longer mailed.
    • It is important for providers to electronically acknowledge authorizations.
  • All claims will be submitted through Therap (except EVV)
    • Providers are still expected to utilize Therap for other functionality if they have a third-party EVV vendor.
    • Providers could choose Therap as their 3rd Party EVV vendor for waiver participants at no additional cost.
  • Parental Portion will be changing for Extra Care for Children with Disabilities, also referred to as Disability Related Childcare (service codes 2500 and 9704).
    • Instead of noting customer obligation on claims, the rates will have the parental portion reduced upfront. 
    • This process change will streamline claim submission for providers.​

Provider Benefits

  • Access to Service Authorizations electronically.
  • Electronic claim submission.
  • Electronic Explanation of Payments for all services.
  • Enhanced Share of Cost information for participants.
  • Secure Communication capabilities.
  • Available for providers to document information for waiver participants at no cost.
  • No more Parental Portion forms required when submitting claims.


Information for AD and TBI Waiver Providers​​​

AD Waiver Workforce Stabilization

Critical Incident Management Process (CIMP) and Targeted Analysis

HCBS providers are required to complete incident reports in Therap. AD and TBI Waiver reporting begins in 2023. 

Reportable Incidents: Definitions and How to Respond - Training on the necessary actions when an incident occurs.

Targeted Analysis – Introductory training regarding the process.

Incident Management Committee - Committee reviewing incidents and trends

Questions about the process can be submitted to NeGERHelp@libertyhealth.com​

Electronic Visit Verification (EVV)

The Federal 21st Century Cures Act includes a Medicaid requirement for Electronic Visit Verification (EVV). EVV allows in-home care providers to check in and out electronically. 

Forms

  • ​Physical Exam Form - May be used for any HCBS participant's annual exam, but use is not required. 
  • Request for Fair Hearing - File an appeal when you do not agree with a decision about provider enrollment or payment made by DDD.​​​

HCBS Final Settings Rule Assessments 

​AD and TBI providers have an assessment completed by their Resource Development worker when they enroll as a new provider and during their annual review. AD and TBI providers may complete the heightened scrutiny worksheet as requested by DDD.

For more information on the plan for home and community-based services, visit the Final Settings Rule page.

Mortality Review

DDD partners with Liberty Healthcare, an independent quality improvement company. Liberty Healthcare is working with DDD to review operations and make recommendations for improvements to its systems and practices. For more information on mortality review:

Rate Study for AD Waiver, TBI Waiver, and PAS Services - Sept 2023

DHHS contracted with CBIZ Optumas and their subcontractor Myers and Stauffer, LC to complete a rate study for the Aged and Disabled Waiver and Personal Assistance Services in 2022. The goal was to establish a rate model for services provided to the aged and individuals with disabilities.

This rate study included opportunities for direct care providers and other stakeholders to provide feedback on the cost of doing business in delivering services. Services reviewed: 

  • Assisted Living
  • Adult Day Health
  • Personal Care
  • Respite Care
  • Chore
  • Companion
  • Extra Care for Children with Disabilities (sometimes called Disability-Related Childcare)
  • Home Again Service
  • Independence Skills Building
  • Transportation
  • Home Delivered Meals
  • Personal Assistance Services (PAS) through the Medicaid State Plan

Presentations


​​Final Recommendations - Sept 2023
Recommendations are intended to help DHHS set future rates, and are subject to appropriates from the legislature and approval from federal partners.​

TBI Waiver - Specialized Training - ON HOLD until January 2026

​TBI Specialized Training will resume January 2026.

All TBI Waiver providers and their employees, are required to have specialized training on traumatic brain injuries to provide the following services: TBI Adult Day Health (3336), Supported Employment – Individual (2207), Supported Employment – Follow-Along (8190), Community Connection (2202), Personal Care (6222), Companion (7934), Respite (3471, 6688), and Supported Residential Living* (30, 3​1, 32, 33).

    Information for Agency Providers and Assisted Living Providers

    • DHHS will issue a certificate of completion, which must be loaded in Maximus. 
    • You may use an alternative TBI-specific training, if approved by the Division of Developmental Disabilities. When you use an alternative TBI-specific training plan, it must be loaded in Maximus.
    • You must have Policies and Procedures for direct care employees to complete training before serving TBI Waiver participants. 
      • Employees must complete training and have their certificate of completion before providing services.
      • You must keep certificates of completion for each employee providing services to TBI Waiver participants.
      • Files will be reviewed by DHHS at annual renewal meetings and by request.      
    • In addition to TBI-specific training, you must comply with other provider enrollment requirements.

    Therap - the State-Mandated Single Case Management System

    ​Therap is used for many things, including incident reports and secure communication. 

    ​

    Adding Services on a DD Waiver

    When you are a current Medicaid provider for the AD or TBI Waiver and want to offer services on a DD Waiver, see our Prospective​ Provider page for information.