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SKILLED NURSING SERVICES PROVIDER IN NEW JERSEY
- Fatumata Kaba
- Sep 5
- 4 min read
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, and 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)
Division of Medical Assistance and Health Services (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/
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEW JERSEY SKILLED NURSING SERVICES PROVIDER
WCG supports agencies in launching Medicaid-compliant Skilled Nursing Services in New Jersey, offering:
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
Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.
Launching skilled nursing services requires careful planning, compliance, and trained staff. Precious Pearls Home Care exemplifies excellence by providing Medicaid-compliant care in New Jersey, ensuring patients receive professional, safe, and compassionate in-home nursing support every step of the way.