BEHAVIORAL SUPPORT SERVICES PROVIDER IN NEW JERSEY

PROMOTING POSITIVE BEHAVIORS AND WELL-BEING THROUGH STRUCTURED INTERVENTIONS

Behavioral Support Services in New Jersey provide therapeutic interventions to help individuals experiencing behavioral challenges or developmental disabilities. These services focus on enhancing coping strategies, reducing maladaptive behaviors, and promoting positive social interactions. Behavioral Support 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 Behavioral Support Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Division of Developmental Disabilities (DDD)

Role: Ensures quality standards, service delivery, and compliance for Behavioral Support Services under HCBS waiver programs.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight ensuring Medicaid-funded Behavioral Support Services meet HCBS quality, person-centered planning, and participant protection standards.

2. BEHAVIORAL SUPPORT SERVICES OVERVIEW

Behavioral Support Services help individuals develop coping mechanisms and positive behaviors, fostering personal growth and community integration.

Approved providers may deliver:

• Behavioral Assessment: Identifying triggers, patterns, and underlying causes of challenging behaviors.

• Behavioral Intervention Planning: Developing individualized strategies to address maladaptive behaviors.

• Positive Behavior Support (PBS): Implementing structured plans to encourage appropriate behaviors.

• Crisis Intervention: De-escalating situations and implementing safety measures during behavioral crises.

• Skill Building: Teaching coping skills, social interactions, and self-regulation techniques.

• Family and Caregiver Training: Educating families on behavior management strategies.

• Behavioral Monitoring: Tracking progress and adjusting intervention plans as needed.

• Social Skills Development: Fostering communication, relationship building, and problem-solving abilities.

All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s behavioral health 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 Behavioral Support provider via the New Jersey Medicaid Provider Enrollment Portal.

• Obtain licensure from DHS as a behavioral health service provider if applicable.

• Maintain general liability and professional liability insurance.

• Develop comprehensive policies for behavioral intervention, crisis management, and caregiver support.

• Ensure staff meet background checks, health screenings, and behavioral support training 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 Behavioral Support Services under HCBS waivers.

Application and Documentation Submission:

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

Program Readiness Review:

• DHS and DDD evaluate provider readiness, including behavioral support protocols, safety measures, and staff qualifications.

Approval & Medicaid Enrollment:

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

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (New Jersey Division of Revenue)

• IRS EIN confirmation

• NPI confirmation

• Professional Licenses (e.g., Licensed Behavioral Analyst, Social Worker)

• Proof of general and professional liability insurance

• Behavioral Support Services Policy & Procedure Manual, including:

  • Behavioral assessment, intervention planning, and crisis management protocols

  • Staff credentialing, background checks, and ongoing training records

  • Documentation standards for behavioral tracking and Medicaid billing

  • HIPAA compliance, client rights, and grievance handling

  • Safety protocols for therapeutic settings and participant interactions

  • Crisis de-escalation, safety planning, and emergency response measures

  • Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Behavioral Support Program Director

Requirements: Master’s degree in psychology, social work, or applied behavior analysis; state licensure; experience in program management.

Role: Behavioral Support Specialists

Requirements: Licensed Behavioral Analysts (LBA), Licensed Clinical Social Workers (LCSW), or Licensed Mental Health Counselors (LMHC); background clearance.

Role: Behavioral Technicians

Requirements: Certification in behavioral analysis or related field; supervised by a licensed professional; experience in direct behavioral support.

Role: Family Support Coordinators

Requirements: Experience in training caregivers and providing behavioral guidance; background clearance.

All staff must complete:

• Training in behavioral intervention techniques and positive behavior support

• HIPAA compliance and client rights education

• Annual competency evaluations and ongoing professional development

• Crisis management and de-escalation techniques

• Ongoing training in therapeutic approaches and behavior monitoring

7. MEDICAID WAIVER PROGRAMS

Behavioral Support 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:

• Individual and group therapy focusing on behavior management

• Crisis intervention and behavioral de-escalation

• Social skills training and communication enhancement

• Caregiver education and family support sessions

• Ongoing behavioral monitoring and adjustment of care plans

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 Behavioral Support 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 Developmental Disabilities (DDD)

Website: https://www.state.nj.us/humanservices/ddd/

New Jersey Medicaid Provider Enrollment Portal

Website: https://www.njmmis.com/

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW JERSEY BEHAVIORAL SUPPORT SERVICES PROVIDER

WCG supports agencies in launching Medicaid-compliant Behavioral Support Services in New Jersey, offering:

Scope of Work:

• Business registration, Medicaid enrollment, and licensing assistance

• Policy manual development for behavioral support and crisis management

• Staff credentialing, training program templates, and compliance documentation

• Medicaid billing setup and audit-prepared financial management

• Branding, website development, and caregiver support strategies

• Quality assurance systems for behavior tracking and therapeutic outcomes

• Collaboration with mental health professionals and community resources

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.