DELIVERING MEDICAL CARE AND SUPPORT IN THE HOME AND COMMUNITY

Skilled Nursing Services in New Jersey provide medical care and support to individuals with chronic conditions, disabilities, or age-related health needs. These services are delivered by licensed nurses and include health monitoring, medication administration, wound care, and more. Skilled Nursing Services are authorized under New Jersey Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: New Jersey Department of Human Services (DHS)
Role: Administers Medicaid waiver funding for Skilled Nursing Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Division of Medical Assistance and Health Services (DMAHS)
Role: Oversees quality standards, service delivery, and compliance for Skilled Nursing Services under HCBS waiver programs.

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Skilled Nursing Services meet HCBS quality, person-centered planning, and participant protection standards.

2. SKILLED NURSING SERVICES OVERVIEW

Skilled Nursing Services are designed to provide medical care and health monitoring for individuals who require clinical support in their home or community settings.

Approved providers may deliver:

• Health Assessments: Monitoring vital signs, assessing physical and mental health.
• Medication Management: Administering medications and managing complex medication schedules.
• Wound Care: Dressing changes, infection monitoring, and wound management.
• Chronic Disease Management: Diabetes care, blood pressure monitoring, and respiratory therapy.
• Tube Feeding and IV Therapy: Administering nutrition and medications through feeding tubes and intravenous methods.
• Catheter and Ostomy Care: Maintenance, monitoring, and hygiene support.
• Post-Surgical Care: Monitoring recovery and managing post-operative symptoms.
• Health Education: Teaching patients and families to manage conditions effectively.
• Emergency Care Plans: Developing and implementing care protocols for medical emergencies.

All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s medical and support needs.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register the business entity with the New Jersey Division of Revenue and Enterprise Services.
• Obtain EIN from the IRS and NPI (Type 2).
• Enroll as a Medicaid Waiver Skilled Nursing provider via the New Jersey Medicaid Provider Enrollment Portal.
• Obtain licensure as a Home Health Agency from the New Jersey Department of Health (NJDOH).
• Maintain general liability and professional liability insurance.
• Develop policies for clinical care, medication management, and safety protocols.
• Ensure staff meet background checks, health screenings, and professional licensure requirements.

4. NEW JERSEY PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Complete the Provider Enrollment Application through the New Jersey Medicaid Provider Enrollment Portal for Skilled Nursing Services under HCBS waivers.

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, nursing licenses, insurance certificates, and policy manuals.

Program Readiness Review:

• DHS and DMAHS evaluate provider readiness, including clinical protocols, safety measures, and staff qualifications.

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for Skilled Nursing Services using designated billing codes.

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (New Jersey Division of Revenue)
• IRS EIN confirmation
• NPI confirmation
• Home Health Agency License (if applicable)
• Proof of general and professional liability insurance

Skilled Nursing Services Policy & Procedure Manual including:

• Health assessment, care planning, and medication management protocols
• Staff credentialing, background checks, and ongoing training records
• Documentation standards for clinical care tracking and Medicaid billing
• HIPAA compliance, patient rights, and grievance handling
• Infection control, safety protocols, and emergency response procedures
• Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Skilled Nursing Program Director
Requirements: Bachelor’s or Master’s degree in nursing; RN license in New Jersey; supervisory experience in clinical care.

Role: Registered Nurses (RNs)
Requirements: Valid RN license in New Jersey; experience in home healthcare; CPR/First Aid certification; background clearance.

Role: Licensed Practical Nurses (LPNs)
Requirements: Valid LPN license in New Jersey; experience in skilled nursing; CPR/First Aid certification; background clearance.

Role: Nursing Assistants (if applicable)
Requirements: CNA certification; supervised by an RN; background clearance.

All staff must complete:

• Training in clinical protocols, medication management, and infection control
• HIPAA compliance and patient rights education
• Ongoing professional development and licensure renewal
• Annual competency evaluations and safety protocol updates
• CPR/First Aid and emergency response training

7. MEDICAID WAIVER PROGRAMS

Skilled Nursing Services are available under the following New Jersey Medicaid Waivers:

• Community Care Program for the Elderly and Disabled (CCPED)
• Supports Program Waiver
• Acquired Brain Injury (ABI) Waiver
• Personal Care Assistant (PCA) Waiver
• Home and Community-Based Services (HCBS) Waiver

Services may include:

• Health monitoring and chronic disease management
• Medication administration and adherence support
• Wound care and post-surgical monitoring
• Tube feeding and catheter management
• Emergency medical interventions and crisis care

8. TIMELINE TO LAUNCH

Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months

Phase: New Jersey Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days

Phase: Medicaid Billing Setup and Skilled Nursing Service Launch
Timeline: 30–45 days

9. CONTACT INFORMATION

New Jersey Department of Human Services (DHS)
Website: https://www.state.nj.us/humanservices/

Division of Medical Assistance and Health Services (DMAHS)
Website: https://www.state.nj.us/humanservices/dmahs/

New Jersey Department of Health (NJDOH)
Website: https://www.nj.gov/health/

New Jersey Medicaid Provider Enrollment Portal
Website: https://www.njmmis.com/

Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/

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10. SCOPE OF WORK

• Business registration, Medicaid enrollment, and licensing assistance
• Policy manual development for clinical care and patient safety
• Staff credentialing, training program templates, and compliance documentation
• Medicaid billing setup and audit-prepared financial management
• Branding, website development, and community outreach strategies
• Quality assurance systems for clinical care and compliance monitoring
• Collaboration with healthcare providers and community organizations

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW JERSEY SKILLED NURSING SERVICES PROVIDER

We support agencies in launching Medicaid-compliant Skilled Nursing Services in New Jersey.

To get started, click the link to request portal access