IN-HOME AND COMMUNITY-BASED SERVICES PROVIDER IN NEW JERSEY

PROMOTING INDEPENDENCE AND WELL-BEING THROUGH PERSON-CENTERED SUPPORT IN THE COMMUNITY

In-Home and Community-Based Services (HCBS) in New Jersey provide essential support to individuals with disabilities, chronic conditions, or age-related challenges. These services are designed to promote independence and enhance quality of life by offering assistance in the home or community setting. HCBS are authorized under New Jersey Medicaid Home and Community-Based Services Waiver programs.

1. GOVERNING AGENCIES

Agency: New Jersey Department of Human Services (DHS)

Role: Administers Medicaid waiver funding for In-Home and Community-Based Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Division of Aging Services (DoAS)

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

Agency: Division of Developmental Disabilities (DDD)

Role: Oversees service coordination, eligibility, and quality for individuals with developmental disabilities.

Agency: Centers for Medicare & Medicaid Services (CMS)

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

2. IN-HOME AND COMMUNITY-BASED SERVICES OVERVIEW

HCBS provide support services tailored to the needs of individuals in their own homes or community settings, helping them maintain independence and participate in their communities.

Approved providers may deliver:

• Personal Care Assistance: Support with Activities of Daily Living (ADLs) like bathing, grooming, feeding, and mobility.

• Homemaker Services: Light housekeeping, meal preparation, laundry, and grocery shopping.

• Respite Care: Temporary relief for family caregivers.

• Skilled Nursing: Health monitoring, medication administration, and basic medical care.

• Behavioral Support: Addressing behavioral challenges and promoting positive social interactions.

• Case Management: Coordinating care and connecting individuals with community resources.

• Transportation Services: Safe and reliable transport to medical appointments, community activities, and social engagements.

• Day Habilitation: Structured activities to build social, cognitive, and physical skills.

• Supported Employment: Assistance with finding and maintaining community-based jobs.

• Home Modifications: Installing ramps, handrails, and accessibility features.

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

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 HCBS provider via the New Jersey Medicaid Provider Enrollment Portal.

• Obtain required licenses or certifications for specific services (e.g., nursing, behavioral support).

• Maintain general liability and professional liability insurance.

• Develop policies for service planning, health monitoring, and client safety.

• Ensure staff meet background checks, health screenings, and 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 HCBS.

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, staff qualifications, and service-specific licenses.

Program Readiness Review:

• DHS and DoAS/DDD evaluate provider readiness, including safety protocols, care plans, and staff qualifications.

Approval & Medicaid Enrollment:

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

5. REQUIRED DOCUMENTATION

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

• IRS EIN confirmation

• NPI confirmation

• Licenses for specialized services (e.g., nursing, behavioral support)

• Proof of general and professional liability insurance

• HCBS Policy & Procedure Manual including:

  • Participant intake, assessment, and service planning protocols

  • Personal care assistance, homemaker tasks, and respite care guidelines

  • Staff credentialing, background checks, and training requirements

  • Documentation standards for service tracking and Medicaid billing

  • HIPAA compliance, participant rights, and grievance handling

  • Safety protocols, emergency response, and infection control measures

  • Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: HCBS Program Director

Requirements: Bachelor’s degree in healthcare, human services, or related field; supervisory experience preferred.

Role: Direct Support Professionals (DSPs)

Requirements: High school diploma or GED; CPR/First Aid certification; training in ADLs and IADLs support; background clearance.

Role: Nurses (if applicable)

Requirements: Valid RN or LPN license in New Jersey; experience in home healthcare; background clearance.

Role: Behavioral Specialists (if applicable)

Requirements: Certification in behavioral analysis or related field; experience in therapeutic interventions; background clearance.

All staff must complete:

• Training in client safety, personal care, and infection control

• HIPAA compliance and participant rights education

• Annual competency evaluations and ongoing professional development

• Safety training, including emergency preparedness

7. MEDICAID WAIVER PROGRAMS

HCBS 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:

• In-home personal care and health monitoring

• Community-based support and engagement activities

• Skilled nursing and health-related services

• Behavioral interventions and case management

• Transportation and mobility support

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 HCBS 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 Aging Services (DoAS)

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

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 IN-HOME AND COMMUNITY-BASED SERVICES PROVIDER

WCG supports agencies in launching Medicaid-compliant HCBS in New Jersey, offering:

Scope of Work:

• Business registration, Medicaid enrollment, and licensing assistance

• Policy manual development for care planning and safety management

• Staff credentialing, training program templates, and compliance documentation

• Medicaid billing setup and audit-prepared financial management

• Branding, website development, and community engagement strategies

• Quality assurance systems for care delivery and safety compliance

• Collaboration with healthcare and community organizations for coordinated support

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.