Adult Day Care Regulations in Nebraska

Who regulates adult day care in Nebraska

The Nebraska Department of Health and Human Services (DHHS), through the Division of Public Health Licensure Unit, licenses adult day services. Licensing falls under the Health Care Facility Licensure Act, the definition in Neb. Rev. Stat. 71-404, and the rules in 175 NAC 5 (amended March 2024) and 175 NAC 1. Section 71-404 was most recently amended by LB1057, effective April 15, 2026.

Medicaid pays for adult day health through DHHS home and community-based services (HCBS) waivers. A DHHS roster updated in September 2026 lists 20 licensed adult day services.

Types of adult day programs in Nebraska

• Adult day service: a person or entity that provides care and an array of social, medical or other support services for less than 24 consecutive hours in a community-based group program to four or more people who need or request them due to age or functional impairment (Neb. Rev. Stat. 71-404).
• Free-standing service: needs a license when four or more people receive services at a location not licensed as another type of health care facility (175 NAC 5-003).
• Service inside a licensed health care facility: needs its own adult day service license when it serves four or more people who do not live there, with separate identifiable space during service hours, its own physical address and a separate entrance.
• Adult Day Health: the Medicaid waiver service name for adult day in a licensed setting.

The definition excludes PACE centers and waiver services provided by entities certified as specialized programs under the Developmental Disabilities Services Act.

How to get licensed in Nebraska

1. Submit a complete application on the DHHS form with the licensure fee, which is tiered by capacity: 4 to 16, 17 to 50, or 51 or more people (175 NAC 5-003).
2. Include schematic plans, State Fire Marshal (or delegated authority) approval of occupancy and operation, a current zoning permit, and either construction certifications or a local operational permit or engineer's or architect's structural safety statement (175 NAC 1-003).
3. Do not start construction until DHHS approves it in writing, and do not serve consumers until DHHS gives written approval.
4. DHHS conducts an announced initial onsite inspection after it receives a complete application (175 NAC 1-004).
5. Renew before the license expires. An expired license can be reinstated by letter within 90 days, but the service may not operate in the meantime.
6. To serve waiver participants, enroll as a Nebraska Medicaid provider.

Key requirements

• Administrator: at a free-standing site, the administrator or an equally qualified backup must be on site during hours of operation (175 NAC 5-010).
• Staffing: enough trained staff to meet consumers' needs. The rules set no numeric ratio.
• Screening and training: criminal background checks and registry checks before hiring direct care staff, a health screening, orientation before staff take direct responsibility, and ongoing in-service training.
• Medications: given only as prescribed, kept locked and recorded on individual medication administration records. Unlicensed staff must be registered medication aides.
• Service planning: a written agreement of participation and service plan, based on an assessment by qualified staff, before care begins.
• Restrooms: one toilet fixture for every 10 consumers, with hand-washing sinks nearby (175 NAC 5-007).
• Inspections: DHHS may make unannounced compliance inspections at any time. Five years without an inspection is one trigger.

Medicaid funding for adult day in Nebraska

Adult Day Health is a service of the Medicaid HCBS Aged and Disabled (AD) Waiver, which serves Nebraska Medicaid members who have a disability or are over 65, meet nursing facility level of care and need waiver services. The Traumatic Brain Injury (TBI) Waiver covers TBI Adult Day Health. Service coordinators work through DHHS local offices or, for people 65 and older, Area Agencies on Aging.

Under 480 NAC 5-003, providers must offer or arrange personal care, health assessment and nursing, meals (a noon meal for those present at mealtime and two snacks for a full day), recreational therapy and supportive services. The written service plan is reviewed at least every six months, and the service is not authorized during local school hours.

Billing basics

The DHHS Adult Day Health service summary (July 2026) sets these rules for waiver providers:

• Enrollment: every waiver provider must be a Medicaid provider, have a licensed nurse on staff or under contract, and train staff in CPR, first aid and abuse and neglect.
• Units: billed hourly or daily as set in the person-centered plan. The daily rate applies to six or more hours, and DHHS sets a statewide rate.
• Service codes: DHHS lists NFOCUS service code 9245 for Adult Day Health and 3336 for TBI Adult Day Health.
• Limits: not billable at the same time as companion, personal care, respite, transportation or several other waiver services DHHS lists. Physical, occupational and speech therapy and transportation are excluded.

Other ways centers are paid

Enrolled veterans who meet VA eligibility and clinical criteria can get Adult Day Health Care through the VA, which may be provided at VA medical centers, State Veterans Homes or community organizations.

Official resources

• DHHS Title 175 Health Care Facilities and Services Licensure
• 175 NAC 5, Adult Day Services
• Neb. Rev. Stat. 71-404
• Adult Day Service Roster
• Medicaid HCBS Aged and Disabled Waiver
• AD/TBI Waivers: Adult Day Health Service Summary
• DHHS Title 480 Home and Community-Based Services
• National Adult Day Services Association

Frequently asked questions

Do I need a license to open an adult day center in Nebraska?

Yes, if you serve four or more people in a community-based group program for less than 24 consecutive hours. DHHS issues the license under 175 NAC 5.

Does Nebraska Medicaid pay for adult day care?

Yes. Adult Day Health is covered under the Aged and Disabled Waiver, and TBI Adult Day Health under the TBI Waiver. Providers must be enrolled Medicaid providers.

Who inspects adult day centers in Nebraska?

DHHS. It makes an announced initial inspection after a complete application and may make unannounced compliance inspections at any time.

Can a nursing home or hospital offer adult day services?

Yes. A licensed health care facility that serves four or more people who do not live there needs a separate adult day service license and separate space.