Nebraska home health agency license: 175 NAC 14, fees, counties and Medicare

One license, triggered by a single service

Nebraska has one license for in-home health care, and the threshold is low. Under Neb. Rev. Stat. 71-417, a home health agency is any person or entity that provides skilled nursing care “or a minimum of one other therapeutic service as defined by the department” in a client’s home, whether full-time, part-time or intermittent ⁠⁵. DHHS has defined those services in 175 NAC 14, which was rewritten effective May 5, 2024. The list is skilled nursing care, physical therapy, speech-language pathology, occupational therapy, respiratory care, home health aide services, social work services, intravenous therapy and dialysis ⁠².

The item that catches most founders is home health aide services. The rule defines them as “the use of a trained, supervised paraprofessional to provide one or more of the following: personal care, assistance with activities of daily living, or basic therapeutic care” ⁠². The aide statute fills in the terms:

• Personal care: hair care, nail care, shaving, dressing and oral care.
• Activities of daily living: help with walking, bathing, toileting and feeding.
• Basic therapeutic care: procedures such as taking vital signs, hot and cold applications and nonsterile dressings ⁠⁷.

Read together, the rule and statute mean that a Nebraska agency built around aides who bathe, dress or toilet clients is working inside the home health definition. Nebraska has no separate personal care or home care license to fall back on. The DHHS list of licensed facility and service types shows home health agencies but no non-medical home care license ⁠¹³.

Nebraska also has no published ruling on agencies that offer only companionship, housekeeping, errands or meal preparation, with no hands-on care. The rule’s definition of medication reminders gives one fixed line. Reminders are verbal only and “do not include touching or handling of the medication or the container” ⁠². If your service model sits near the line, put the question to the Office of Outpatient & In-Home Care Services at (402) 471-4967 before you hire ⁠¹.

The rule also sorts visits by length. Intermittent means under 4 hours in any 24-hour period, part-time means more than 4 but under 24 hours, and full-time means a continuous 24-hour period ⁠². All three are covered by the same license.

If you plan to care for people in a building rather than in their own homes, you need a different license. See the Nebraska assisted living facility license and the Nebraska adult day service license. Nebraska also licenses respite care services separately under 175 NAC 15 ⁠².

Pick your county first: the contiguous-county rule

Nebraska licenses one parent office and a list of counties. Under 175 NAC 14, the geographic area you serve is limited to “all counties pre-approved by the Department,” and those counties “must be contiguous with the county where the parent home health agency is located” ⁠². You must provide services only in approved counties ⁠². The initial application asks you to list the counties you will serve ⁠⁴.

The parent office’s county therefore sets the edge of your market. An office in a Lincoln or Omaha suburb reaches only the counties that touch its own. Moving the office does not end the license. But DHHS must get written notice before you move, and if the new office is in a different county, that county must be contiguous with the service area DHHS already approved ⁠¹.

Branch offices give you a way to cover more of your area, with limits. A branch has to be approved by DHHS before it opens. It must offer the full range of services the parent offers, within part of the parent’s approved area, and it must be close enough to share administration and supervision with the parent every day ⁠². The administrator or their designee must make an onsite supervisory visit to each branch at least once a month and keep the records at the parent office ⁠². Deficiencies cited at any branch apply to every location on the license ⁠². To add a branch or a new service after licensure, notify DHHS in writing at least 30 working days ahead ⁠².

Who can run the agency

The licensee has to hire both an administrator and a back-up administrator, and both must meet the same qualifications ⁠². Each must be one of the following:

• a practitioner (nurse practitioner, physician, osteopathic physician or physician assistant) holding an active Nebraska credential;
• a registered nurse licensed in Nebraska, or practicing in Nebraska under the Nurse Licensure Compact;
• a nursing home administrator licensed in Nebraska; or
• a person with a bachelor’s degree in health care administration, physical therapy, occupational therapy, speech-language pathology, respiratory therapy or a related field, plus at least 2 years of full-time work in home health care or a related health care program ⁠².

The administrator’s written duties include monthly branch supervision. They also include keeping inactive policies, procedures and forms for at least 7 years, and making sure every policy is specific to your agency and carries effective and revision dates ⁠². At the initial inspection, the owner, administrator and back-up administrator must be ready to show compliance using agency-specific organizational charts, job descriptions, policies, procedures and forms ⁠¹.

If you provide respiratory care through a respiratory care practitioner, you also need a medical director who meets Neb. Rev. Stat. 38-3214 ⁠². Whenever skilled nursing or aide services are being provided, a supervising registered nurse must be available or on call ⁠².

Staff you must have and how you screen them

175 NAC 14 sets no fixed staffing ratio. You must keep enough trained staff to deliver every service listed on your license and to meet each accepted client’s needs safely and on time ⁠². Each discipline has its own credential rule:

• Nursing: skilled nursing is done by RNs or LPNs. An RN does the initial assessment visit, reevaluations and supervision of other nursing staff ⁠².
• IV therapy and dialysis: provided only by registered nurses, and for dialysis, RNs trained in dialysis ⁠².
• Social work: a certified social worker with a master’s or doctoral degree and 1 year of social work experience in a health care setting ⁠².
• Therapy: PT, OT and speech-language pathology are delivered by licensed therapists of that discipline, each of whom makes the initial evaluation visit and writes the plan of care for the practitioner’s approval ⁠².

Screening before hire. For each direct care staff member, keep proof of a pre-employment criminal background check and of checks on four Nebraska registries: the Nurse Aide Registry, the Adult Protective Services Central Registry, the Central Registry of Child Protection Cases and the Sex Offender Registry ⁠². You cannot employ anyone with an adverse finding on the Sex Offender Registry or the Nurse Aide Registry. For other findings, you may hire if you document why the person does not threaten client safety or property ⁠². A health screening is required before a new hire has contact with any client ⁠².

Records and contracts. Each staff file needs a performance evaluation within 6 months of hire and annually after that, plus documented orientation on duties, organization, client rights, care and personnel policies, and abuse, neglect and exploitation reporting ⁠². Clinicians who work per visit or per hour need a written contract. That contract must state that clients are accepted only by the parent agency. Keep discontinued contracts for seven years ⁠².

Home health aides: Nebraska’s statutory rules

Aides are regulated by statute (Neb. Rev. Stat. 71-6601 to 71-6615), and 175 NAC 14 builds on it. An aide must be at least 18. The aide must not have a conviction carrying more than a year’s imprisonment that is rationally related to fitness for the work. The aide must also be able to speak and understand English or the client’s language ⁠⁸. Training qualifications include completing a course that meets 71-6608.01, graduating from a school of nursing, or completing an approved nurse aide course plus a competency evaluation. Equivalent qualifications from another state also count ⁠⁸.

The training course must total at least 75 hours. At least 16 of those hours must be supervised practical training, taken after the trainee has finished at least 16 hours of classroom work ⁠¹¹. The supervised practical portion must be taught by or under an RN with at least two years of nursing experience, at least one of them in home health, who has supervised aides for at least six months ⁠¹¹. An aide who has not worked as an aide for 3 years must repeat the 75-hour course ⁠².

Before an aide works in a client’s home, an RN must verify and document the aide’s competency. The RN does this by observation and a written or oral exam covering the items listed in 71-6608.01 ⁠². After hire, you must offer each aide four one-hour in-service programs a year ⁠⁹. Unlicensed staff who give medications must be registered medication aides ⁠².

The aide care plan must be written by a Nebraska-licensed RN and reviewed at least every 62 days ⁠¹⁰. One detail matters for agencies built on personal care: if an aide provides only personal care or ADL help, the clinical record does not need a practitioner’s order for that care ⁠².

Policies DHHS reviews at the inspection

Before inspection you need written policies for:

• the range of services and the approved geographic area;
• personnel, with job descriptions and minimum qualifications for each position;
• admission, discharge and transfer criteria that admit only people your staff can serve;
• taking and recording practitioner orders, written and verbal;
• client care;
• disposal of controlled drugs left in a client’s home after they expire or are no longer needed;
• use, removal and release of records ⁠².

175 NAC 1 adds four programs: a complaint and grievance process with set response timeframes; a quality assurance and improvement program that records results quarterly and reports them to the governing authority annually; an infection control program; and a disaster preparedness program ⁠³.

The care rules in 175 NAC 14 also go into your forms:

• Each client gets a written plan of care, approved by their practitioner, after an initial home visit. An RN or other qualified professional reviews it at least every 62 days ⁠².
• The clinical record must hold copies of the written summary reports sent to the practitioner ⁠².
• Clinical notes are written within 24 hours and filed in the record within 7 working days ⁠².
• Verbal orders are signed within 30 days ⁠².
• You keep a daily client roster ⁠².
• Clients get a written bill of rights before care begins, including at least 2 weeks’ notice before services end, with some exceptions ⁠².
• With the client’s written consent, DHHS staff may visit the home to assess care ⁠².

The 2024 rule defines “practitioner” as a nurse practitioner, osteopathic physician, physician or physician assistant ⁠². In 2021, DHHS had said it would revise 175 NAC 14 so that nurse practitioners and physician assistants could write orders and sign plans of care ⁠²⁰. The 2024 definition carries that change into the rule.

The office itself

Nebraska does not license the building the way it does for residential care. 175 NAC 14 states that the construction and environmental requirements of 175 NAC 1 do not apply to a home health agency ⁠². The rule still sets a few office requirements:

• If you share space with an unrelated business, you need your own physical address so mail is secure, and a separate entrance so conversations stay private ⁠².
• Records must be protected from the other occupants ⁠².
• A sign on your entrance door must show the agency name and physical address exactly as they appear on the license ⁠².
• Clinical records must be kept in locked storage, and electronic records must be password protected ⁠².

The general chapter, 175 NAC 1-003.02, lists initial documents for all facility types, including schematic plans, State Fire Marshal approval, a zoning permit and building safety documentation ⁠³. 175 NAC 14 exempts home health agencies only from the construction and environmental requirements of 175 NAC 1, and the DHHS application form lists no attachments ⁠²⁠⁴. The sources do not say which of those documents DHHS asks an office-only agency to file, so ask the Licensure Unit at (402) 471-4967 whether it wants a zoning permit and State Fire Marshal approval for your office before you sign a lease. Every applicant must document lawful presence under Neb. Rev. Stat. 4-108 to 4-111 ⁠³. Under 4-111, that means attesting to US citizenship or lawful presence, and the statute provides a route for work-authorized applicants who hold an employment authorization document ⁠¹².

Applying, in the order DHHS works

1. Settle the parent office and county list

   The county list on your application is your licensed service area ⁠²⁠⁴.

2. Hire the administrator and back-up administrator,

   and write your policies, job descriptions, forms and organizational chart ⁠¹⁠².

3. Complete the initial application

   You can fill it in online, but you must print it, sign it with original signatures and mail it with the $650 fee ⁠¹⁠⁴. The form asks for the services you will provide, counties served, branch addresses, the planned start date, any accreditor (it lists JCAHO and CHAP) and any intended Medicare or Medicaid certification ⁠⁴. Signatures follow Neb. Rev. Stat. 71-433: the owner signs for an individual or partnership, two members for an LLC, two officers for a corporation ⁠⁴.

4. Tell DHHS in writing when you are ready

   DHHS schedules the announced initial inspection after it has both your complete application and that written notice. Unless you ask for a later date, it has 30 working days from receiving the complete application to inspect ⁠¹.

5. Pass the onsite inspection without having started service

   DHHS expects you to be ready to operate but not operating, and you may not operate without an active license ⁠¹.

6. Then apply for Medicare and Medicaid, if you will bill them

   Only after the state license is issued ⁠¹.

Nebraska does not require a certificate of need for a home health agency. DHHS states that CON “only applies to rehabilitation and nursing home beds” ⁠¹³.

Fees, renewal and ownership changes

By statute, a license fee is a $50 base fee plus an additional fee capped at $1,000 for home health agencies ⁠⁶. If DHHS denies your application, it refunds the fee minus up to $25. It may keep the whole fee if it already inspected before denying ⁠⁶.

Every license expires January 31 ⁠². DHHS mails a renewal notice and application. You return it with the owner signatures, titles, dates and fee, and DHHS mails back an updated license card ⁠¹. If the license lapses, you have 90 days to ask for reinstatement by letter. You must stop operating until it is reinstated ⁠³. After licensure, DHHS may inspect without notice at any time, at the parent office and at branches. Its compliance inspection rule specifically mentions five years without an inspection as a trigger ⁠²⁠³.

A license covers only the premises and persons named on it, and you cannot transfer it. A sale of stock, title or assets, a lease, or closing the business terminates the license. DHHS must be told in writing 10 days in advance ⁠¹. A buyer files its own initial application; the form has a “Change of Ownership” checkbox ⁠⁴. You must also notify DHHS within 24 hours of a client’s death from suicide, a violent act or drowning, or one that happens during or right after restraint or seclusion, when your staff were present or scheduled to be ⁠².

Getting paid: Medicare and Nebraska Medicaid

Medicare. A Nebraska license is a precondition for Medicare certification, not a substitute for it. DHHS notes that you must meet the Medicare Conditions of Participation in 42 CFR Part 484 and show you can transmit OASIS data before the initial certification survey ⁠¹. Medicare patients must get the Nebraska Medicare home health hotline brochure at admission ⁠¹. Federally, a new home health agency must hold “initial reserve operating funds” covering three months after Medicare billing privileges begin ⁠¹⁹.

The federal freeze. CMS imposed a nationwide moratorium on enrolling new home health agencies, branches and practice locations in Medicare, effective May 13, 2026, for six months. CMS can extend it in six-month increments ⁠¹⁷. While it lasts, CMS denies initial applications, and accreditation by a CMS-approved accreditor does not qualify an agency for Medicare participation ⁠¹⁸. As of October 12, 2026 we found no Federal Register notice extending or lifting it.

Why the freeze also blocks Medicaid in Nebraska. Nebraska Medicaid requires home health agencies to be enrolled in Medicare to join and stay in Medicaid. It checks this through PECOS and requires the organization name, tax IDs, practice location, 5%-or-greater owners and managing employees to match across both enrollments ⁠¹⁴. 471 NAC 9 lists the DHHS home health license and “participant in the Medicare home health program” among the Medicaid provider requirements ⁠¹⁵. It also requires prior authorization for all home health agency services, and practitioner recertification at least every 60 days ⁠¹⁵. Since June 1, 2025, Nebraska Medicaid takes provider enrollments only electronically, through the Maximus Provider Data Management System ⁠¹⁶.

A new Nebraska agency licensed during the moratorium can still serve private-pay clients and other payers that do not require Medicare enrollment. Under the rules above, it cannot bill Medicare or Nebraska Medicaid home health until CMS reopens enrollment and its Medicare enrollment is approved.

Recent changes and open items

• May 5, 2024: 175 NAC 14 was replaced. The rule now defines “practitioner” to include nurse practitioners and physician assistants. It sets fees at 14-003.01 and 003.02, ties renewal fees to annual unduplicated admissions, and states the contiguous-county rule in its definitions ⁠². The DHHS web page still points to the old section numbers ⁠¹.
• January 20, 2025: the general chapter, 175 NAC 1, took effect in its current form ⁠³.
• June 1, 2025: Nebraska Medicaid stopped accepting paper enrollment applications ⁠¹⁶.
• May 13, 2026: the CMS Medicare enrollment moratorium for new home health agencies began. Its first six-month term ends in November 2026 unless CMS extends it ⁠¹⁷.

Sources

1. 1
   Nebraska Department of Health and Human Services, Licensure Unit, Home Health Agencies Checked 12 Oct 2026 · Back to text ↑
2. 2
   Nebraska Secretary of State, Rules and Regulations, 175 NAC 14, Home Health Agencies (effective May 5, 2024) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Nebraska Secretary of State, Rules and Regulations, 175 NAC 1, General Facility and Services Regulations (effective January 20, 2025) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Nebraska Department of Health and Human Services, Licensure Unit, Home Health Agency Licensure Application Checked 12 Oct 2026 · Back to text ↑
5. 5
   Nebraska Legislature, Neb. Rev. Stat. 71-417, Home health agency, defined Checked 12 Oct 2026 · Back to text ↑
6. 6
   Nebraska Legislature, Neb. Rev. Stat. 71-434, License fees Checked 12 Oct 2026 · Back to text ↑
7. 7
   Nebraska Legislature, Neb. Rev. Stat. 71-6602, Terms, defined (home health aides) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Nebraska Legislature, Neb. Rev. Stat. 71-6603, Home health aide; requirements Checked 12 Oct 2026 · Back to text ↑
9. 9
   Nebraska Legislature, Neb. Rev. Stat. 71-6606, Home health agencies; employ qualified aides Checked 12 Oct 2026 · Back to text ↑
10. 10
    Nebraska Legislature, Neb. Rev. Stat. 71-6607, Home health agency; provide supervision; care plan Checked 12 Oct 2026 · Back to text ↑
11. 11
    Nebraska Legislature, Neb. Rev. Stat. 71-6608.01, Home health aide training course Checked 12 Oct 2026 · Back to text ↑
12. 12
    Nebraska Legislature, Neb. Rev. Stat. 4-111, Verification of lawful presence; attestation Checked 12 Oct 2026 · Back to text ↑
13. 13
    Nebraska Department of Health and Human Services, Licensure Unit, Facilities, Services and Establishments Checked 12 Oct 2026 · Back to text ↑
14. 14
    Nebraska Department of Health and Human Services, Medicaid and Long-Term Care, Provider Bulletin 20-04: Home Health and Hospice Agency Medicare Enrollment Requirement Checked 12 Oct 2026 · Back to text ↑
15. 15
    Nebraska Secretary of State, Rules and Regulations, 471 NAC 9, Home Health Agencies and Skilled Nursing Services (effective May 5, 2024) Checked 12 Oct 2026 · Back to text ↑
16. 16
    Nebraska Department of Health and Human Services, Medicaid and Long-Term Care, Provider Screening and Enrollment Checked 12 Oct 2026 · Back to text ↑
17. 17
    Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies (HHAs), 2026-09717 Checked 12 Oct 2026 · Back to text ↑
18. 18
    Centers for Medicare & Medicaid Services, QSO-26-11-HHA & Hospice: Six-Month National Moratoria on Hospice and HHA Enrollment Checked 12 Oct 2026 · Back to text ↑
19. 19
    Electronic Code of Federal Regulations, 42 CFR 489.28, Special capitalization requirements for HHAs Checked 12 Oct 2026 · Back to text ↑
20. 20
    Nebraska Department of Health and Human Services, Licensure Unit, Title 175 NAC 14 Frequently Asked Questions Checked 12 Oct 2026 · Back to text ↑

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