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​.​​

Fee Schedule for AD and TBI Waivers

Fee Schedules list rates for Medicaid HCBS Waiver services for the AD an TBI Waivers. Only one fee schedule is effective at a time. Start and end dates are on each schedule. 

Provider Policy Manual for AD and TBI Waivers

The AD TBI Provider Policy Manual outlines requirements and procedures for Medicaid Home and Community-Based (HCBS) waivers with the nursing facility level of care. The policy manual is intended to help providers of AD and TBI Waiver services to deliver quality services and supports, and help ensure the health and safety of those served. All providers of AD and TBI Waiver services must comply with this manual.


Information for AD and TBI Waiver Providers​​​​​

Abuse and Neglect Training - June 2026

​As of July 1, 2026, all waiver providers must have training on Abuse and Neglect. Providers have 60 days to come into compliance with this requirement. 

Free training is available:

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 began in 2023. 

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 DHHS.​​​

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 the Division.

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

Mortality Review

DHHS 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
​
​​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 August 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).

    Registration Links

    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

    ​On 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.

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

    Therap Implementation for Assisted Living Facilities (ALF) - October 2025

    • Training on Transition in Clearinghouse Agreements - June 2025 
    • Complete Therap Provider Contact form to set up account in August 2025.
    • ALF Billing Trainings
      • Recordings are on the Therap support page along with 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


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    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.