Nebraska Department of Health and Human Services
The Nebraska Department of Health and Human Services (DHHS) has partnered with Alvarez & Marsal Public Sector (A&M) to evaluate the implementation of the interRAI needs assessment for Developmental Disability (DD) Waivers.
Alvarez & Marsal will conduct information gathering, stakeholder engagement, data analysis and interactive vetting of the interRAI assessment tool for DD Waivers over the next four months. An independent analysis will provide objective recommendations to optimize Nebraska’s allocation of resources for individuals receiving Home and Community-Based (HCBS) Waivers. At the conclusion of the contract, Alvarez & Marsal will deliver a summary of their findings to DHHS.
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. Alvarez & Marsal will also review public comments given at the Developmental Disabilities Advisory Committee meetings and Olmstead Advisory Committee meetings.
The main objectives of the interRAI implementation evaluation are to assess the effectiveness of the implementation process, evaluate the impact on service delivery and outcomes, identify areas for improvement, and ensure the system is meeting program, operational, and policy objectives. Alvarez & Marsal will:
- Review current practices and the identification of existing challenges,
- Analyze existing data to determine reliability and validity of the Nebraska model,
- Explore peer state practices that could potentially be used to enhance or improve current practice, and
- Identify opportunities to increase the integrity of the assessment process and resulting alignment with budget tiers.
“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,” said Tony Green, Division of Disability and Aging Director.
In 2024, DHHS began the process of selecting a more modern, standardized, person centered, and comprehensive assessment tool. DHHS received input and advice from the DD Advisory Committee, Olmstead Advisory Committee, and Myers and Stauffer. The previous assessment, the ICAP, was no longer being updated or evaluated for effectiveness. Nebraska changed assessment tools to the interRAI to allow a single use tool to serve multiple purposes. The interRAIs are standardized and validated tools ensuring Nebraskans objectively receive services based on an accurate review of current, point in time, behavioral and health-related needs and that appropriate funding amounts are consistently distributed to participants with similar levels of need.
From the launch of the interRAI for DD Waivers on July 1, 2025, DHHS has significantly expanded access to Home and Community-Based Services (HCBS). Approximately 80% of Nebraskans’ funding levels have stayed the same or increased as a result of the interRAI assessments.
Alvarez & Marsal is an international organization that specializes in improving and managing services for government entities with an over 40 year history of evaluating and optimizing government systems. That background was a key reason they were selected to evaluate the Nebraska DHHS implementation of the interRAI for DD Waivers.
The DHHS Division of Disability and Aging service budget will not be impacted or used to cover the cost of an independent evaluation to optimize allocation of resources for HCBS Waivers. The cost of the contract is $420,000. This contract is exempt from competitive bidding pursuant to Nebraska Revised Statute §73-813 by: having been competitively bid by another state or group of states, a group of states and any political subdivision of any other state, a political subdivision of another state, or a cooperative purchasing organization on behalf of a group of states or political subdivisions of other states.
“This evaluation is not coming at a cost to services. 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,” said Green.
interRAI is used by over 25 other states. interRAI has also developed standardized and evidence-based assessment tools with research, clinicians and policy experts spanning more than 35 countries.
Visit the DHHS website for more interRAI information: dhhs.ne.gov/Pages/interRAI.aspx
