Nebraska DHHS hiring third party to evaluate implementation of Developmental Disability waivers

The Nebraska Department of Health and Human Services said Tuesday that it’s partnering with a third party to evaluate how the new implementation is going for the interRAI needs assessment for Developmental Disability waivers.

Before Nebraska used the interRAI implementation method, it utilized the ICAP assessment, which was essentially discontinued. DHHS said it’s “significantly expanded access” to Home and Community-Based Services since switching to the interRAI assessment in July 2025.

The third party looking into the assessment is Alvarez & Marsal Public Sector (A&M), and DHHS said its contract with the company will cost $420,000. The agency said the contract was exempt from the competitive bidding process, but the agency won’t use its Division of Disability and Aging service budget to cover the contract’s expenses.

“This evaluation is not coming at a cost to services,” Tony Green, the director of DHHS’ Division of Disability and Aging said. “As we continuously have an increase in the number of Nebraskans receiving waiver services, an independent and in-depth evaluation will allow Nebraska to optimize service delivery and allocation of resources to ensure the needs of all are being met while the program remains sustainable.”

Alvarez & Marsal is a company frequently used by state and federal agencies to “solve complex problems” for its partners. The third party will analyze the DD waiver process over the next four months, and then the company will deliver its findings to DHHS, according to a Tuesday news release.

“The evaluation process will include several activities, including stakeholder engagement with families, providers, clients, and DHHS employees, to assess the effectiveness, usability, performance, and overall value,” the release said.

“Before launching the interRAI in July 2025, the state intended to conduct an independent evaluation of the interRAI implementation for DD Waivers based on feedback. The interRAI was selected with input from stakeholders and is a nationally accredited tool to determine services based on a cost-to-serve model. Since the launch, DHHS has continuously monitored the output of interRAI assessments to ensure participants are receiving an appropriate determination,” Green said.

DHHS’ revisit of the DD waivers comes about eight months after the agency considered making changes to a similar waiver – the Aged and Adult and Children with Disabilities Waiver, more commonly called the Aged and Disabled (AD) Waiver. It received widespread scrutiny from waiver enrollees. In December, DHHS proposed changes in the AD waiver that would cap the number of billable hours per week for “live-in caregivers” to 40 hours and institute an additional 30-hour cap per week for other caregivers.