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​.

Transition to Therap

May 1, 2025, AD and TBI waiver providers will transition to Therap for electronic claiming and receiving authorizations, outside of EVV requirements. Read below for more information on how to register for trainings to prepare you for this transition. 

The recording of the webinars will be posted to Therap's help page: Therap for Nebraska ADTBI after approximately one week. Other guides will also be available on their website.

For Assisted Living Facilities (ALF) this is not currently being required and are tentatively scheduled for October 2025 implementation. ALF electronic claiming will have separate trainings.​

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.
  • All Service Authorizations have been ended effective April 30, 2025. They will be reissued from Therap by April 28, 2025 to allow time for provider action.
    • Providers using Netsmart for EVV will have to edit visits and choose the new authorizations.
  • 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.

Connect with Therap

  • Use the following link to identify your contact for setting up a provider account. Agency providers will select your Therap Admin and receive guidelines for the next steps. This also identifies if you want more information on using Therap as your third-party EVV vendor.
  • Share provider contact for Therap Admin
  • Independent and Agency providers will be sent an End User License Agreement (EULA) to sign with Therap.
    • If you are an AD or TBI Independent Provider and have not received your Therap login, email DHHS.TherapADTBI@Nebraska.gov for assistance. Include your provider number.

Training​ Webinars are held Wednesdays at 3:00 PM, CT via Zoom. 

 Register with Therap to Attend​

See the Schedule of Therap Trainings

DateTopic
March 12, 2025Kick Off Webinar
March 19, 2025Billing Introduction and Preparation
Billing training outline and timeline, Billing Workflow Demo
March 26, 2025Acknowledging Service Authorization 
Methods of Data Collection
April 2, 2025Agency Providers: Sites, Programs and EVV
Billing Implications and things to consider
April 9, 2023Deep Dive: Generating Billing Data
Attendance and Case notes
April 16, 2025 - CANCELED due to Zoom issues.

April 23, 2025Claims Management
Generating claims, Sending claims - timelines, replacement/void claims, EOB/835 payment information.
​April 30, 2025
​Billing: Get Ready for Go-Live
30-minute Detailed Billing Demo
30-minute Provider-Focused Q&A
May 7, 2025
Go-Live recap: Bring your questions
May 21, 2025Creating Workflows and Reporting
3Ps, billing summary, unclaimed, reconciliation.
May 28, 2025
Provider Q&A: Bring your questions​​


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​

DDD Meetings with AD and TBI Providers - 2022

In 2022, DDD held informational sessions for all providers of AD and TBI Waiver services, as well as Service Coordination.  

December 6 - Medium Reportable Incidents, part 2

Continued discussion of the concepts and definitions of medium-level reportable incidents. Part 2 of 2.

November 29 - Medium Reportable Incidents, part 1

Introduced the concepts and definitions of medium-level reportable incidents in the Critical Incident Management Process being piloted. Part 1 of 2.

November 8 - High-Level Reportable Incidents

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 - Incident Reporting

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

October 11 - Recognizing Health Status Change

Helped providers understand their role in recognizing health status changes needs. 

September 27 - Overview of General Event Reports (GERs)

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

September 6 - DDD and Liberty

  • 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 - Partnership with Liberty Healthcare

Shared about projects underway and introduced 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 - HCBS Changes

2024 Provider Meetings

DDD hosts quarterly meetings for providers of all HCBS Waivers. Information is on the HCBS Provider Homepage.​

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

​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, 31, 32, 33).

  • TBI Training Flyer - how to sign up for TBI-specific training
  • Links to register for training:

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. 

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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.