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

Medicaid HCBS AD Waiver
Developmental Disabilities

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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 main Provider page, the Training page, and the Resources page.

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

​Presentation: Updated TBI Waiver and Provider Enrollment

​DDD held a meeting is to introduce changes to the TBI Waiver for providers, including updates to provider requirements and expectations.

TBI Waiver Approved by CMS

Nebraska DHHS has received approval from the Centers for Medicare and Medicaid Services (CMS) for the Traumatic Brain Injury (TBI) Waiver Renewal. This waiver is effective October 1, 2023.

Information for AD and TBI Waiver Providers​​

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

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. 


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

Therap - the State-Mandated Single Case Management System

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

DDD Administration​ and AD and TBI Provider Meetings

DDD holds informational sessions for all providers of AD and TBI Waiver services, as well as our Service Coordination entities. Slides and videos are available after presentations.  

To join virtual meetings, go to the calendar on the DDD Homepage.

​Past Meetings​​​​​​

December 6, 2022 - Medium Reportable Incidents, part 2

This meeting continued discussion of the concepts and definitions of medium-level reportable incidents. This is part 2 of 2.

November 29, 2022 - Medium Reportable Incidents, part 1

This meeting introduced the concepts and definitions of medium-level reportable incidents in the Critical Incident Management Process being piloted. This is part 1 of 2.

November 8, 2022 - High-Level Reportable incidents

This meeting introduced the concepts and definitions of high-level reportable incidents in the Critical Incident Management Process being piloted. Includes discussion of the pilot. 

October 25, 2022 - Incident Reporting

This meeting introduced the Critical Incident Process for providers to learn about upcoming changes and expectations for AD and TBI waiver providers.

October 11, 2022 - Recognizing Health Status Change

This meeting helped providers understand their role in recognizing health status changes needs. 

September 27, 2022 - Overview of General Event Reports (GERs)

This meeting introduced and provided background on General Event Reports and a demonstration in Therap on how to enter a General Event Report.

September 6, 2022 - DDD & Liberty

​DDD and Liberty meeting for AD Waiver providers.

  • Presentation video​
  • Flyer: Understanding Incident Reporting - Provides background on federal Center for Medicaid and Medicare (CMS) requirements driving innovation in DDD's incident reporting process. In 2018 The Office of Inspector General (OIG) completed a report and studies around the health and safety and civil rights for individuals in group homes. The health and safety and civil rights aspects of these reports are applicable for all individuals who need waiver funded services to reside safely in the community requirements.

July 14, 2022 - Partnership with Liberty Healthcare

The purpose of this meeting was to share about projects underway and introduce upcoming changes, including enhanced incident reporting requirements for all waiver providers. 

  • Progress with Liberty Healthcare in planning and implementing changes that will help Nebraska move toward National Best Practices in quality with emphasis on the Health and Welfare of all waiver participants. The ultimate goal is to improve the quality of life of our participants.
  • One outcome of the quality partnership includes educational material regarding specific topics that impacts the health and welfare of participants.
  • Presentation slides
  • Presentation video​

April 13, 2022 - HCBS Changes