1. Program Definition and Services

Case Management Services (formally known as Support Coordination under the Division of Developmental Disabilities) provide administrative care management to help waiver participants navigate long-term healthcare pathways. Services include:

• Assessments & Service Plans: Administering the New Jersey Comprehensive Assessment Tool (NJCAT) and authoring the mandatory Individualized Service Plan (ISP)
• Care Coordination: Linking participants to community healthcare networks, local social services, and specialized therapeutic options
• Advocacy & Quality Tracking: Conducting routine site visits, coordinating emergency crisis intervention, and updating plan goals

2. Regulations

• New Jersey Administrative Code (N.J.A.C.) Title 10, Chapter 49 (State Medicaid Manual)
• NJ DDD Conflict-Free Case Management Mandates (prohibiting agencies from delivering both case management and direct care to the same client)
• Federal HCBS Settings Final Rule (42 CFR § 441.301)

3. Licensing or Certification

Stand-alone case management agencies do not need a Health Care Service Firm license. Instead, they must clear Support Coordination Agency (SCA) Approval directly through the New Jersey Division of Developmental Disabilities (DDD).

4. Responsible State Agency

The New Jersey Department of Human Services (DHS) oversees operations, primarily split between the Division of Developmental Disabilities (DDD) and the Division of Aging Services (DoAS).

5. Application Process

Providers must submit an official Agency Letter of Interest and an Agency Conflict-Free Policy on corporate letterhead to the DDD Provider Helpdesk (DDD.ProviderHelpdesk@dhs.nj.gov). After DDD validation, the agency completes the electronic Combined Application on the NJMMIS.COM portal to lock in active billing codes.

6. Required Documentation

• Certificate of Formation / Articles of Organization (NJ Division of Revenue)
• Federal EIN and a Type 2 Organizational NPI (with matching taxonomy mapping)
• Signed DDD Conflict-Free Policy Approval Letter
• Aligned W-9 and Electronic Funds Transfer (EFT) banking details
• Policy Manual detailing backup coordinator plans, tracking metrics, and iRecord security rules
• Errors & Omissions and Professional Liability insurance (minimum $1,000,000 per occurrence)

7. Timeline for Approval

Typically 90 to 120 days to complete the dual-layered clearing process via DDD and NJMMIS.

8. Pre-Application Process

Providers must establish a legal business entity, obtain an EIN and organizational NPI, write their conflict-free separation disclosures, and set up encrypted, HIPAA-compliant computers.

9. Pre-Application Training

Before taking active assignments, directors and staff must complete technical orientations through The Boggs Center, including Danielle's Law, Stephen Komninos' Law reporting loops, and live iRecord electronic health database onboarding.

10. Additional Notes

• Strict Conflict-Free Rule: Agencies are strictly forbidden from offering direct residential or home care services to any participant for whom they also provide plan coordination
• Staff Education Mandate: Every Support Coordinator must possess a Bachelor's degree or higher in any field and at least one year of full-time, verifiable experience working with individuals with developmental or intellectual disabilities
• All leadership and caseworkers must clear fingerprint-based background checks through IdentoGO

Why Choose Waiver Consulting Group?

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

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