New Jersey - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In New Jersey, Adult Companion Services provide non-medical socialization, supervision, and community integration support to adults with intellectual and developmental disabilities (I/DD) or age-related functional impairments. These services are primarily funded through the Division of Developmental Disabilities (DDD) Supports Program and Community Care Program, or the Division of Aging Services (DoAS) Managed Long Term Services and Supports (MLTSS) waiver. Because New Jersey does not issue a distinct facility or agency license for companion care, providers are authorized directly through Medicaid waiver enrollment and program-specific certification.

The single biggest structural barrier to entry for this service in New Jersey is the Division of Developmental Disabilities (DDD) gatekeeping process. A prospective provider cannot simply apply through the state's Medicaid portal; they are strictly blocked from the New Jersey Medicaid Management Information System (NJMMIS) until they first submit an Agency Letter of Interest and an Agency Conflict-Free Policy directly to the DDD Provider Helpdesk. Only after DDD reviews and accepts these documents is the agency permitted to utilize the mandatory DDD Combined Application pathway. For MLTSS providers, the equivalent barrier is the requirement to secure closed-network contracts with New Jersey FamilyCare Managed Care Organizations (MCOs).

1. Service Definition and Scope

Adult Companion Services in New Jersey are defined as non-medical care, supervision, and socialization provided to a functionally impaired adult. The service is designed to assist the participant in successfully residing in their home and community by preventing isolation and ensuring safety.

This service is strictly non-medical. It explicitly excludes hands-on personal care (such as bathing or dressing), medication administration, and medical treatments. If a provider wishes to offer hands-on personal care alongside companion services, they must seek separate licensure as a Health Care Service Firm (HCSF).

• Target Population: Adults 21 and older enrolled in DDD waivers, or seniors and adults with physical disabilities enrolled in the MLTSS waiver.
• Covered Activities: Socialization, supervision, light assistance with community integration, and monitoring for safety.
• Excluded Activities: Hands-on Activities of Daily Living (ADLs), nursing tasks, and medication administration.
• Service Setting: The participant's private residence or integrated community settings within New Jersey.
• Regulatory Distinction: Companion care is distinct from Personal Care Assistant (PCA) services, which require clinical oversight and HCSF licensure.

2. Regulatory and Oversight Agencies

The New Jersey Department of Human Services (DHS) is the umbrella agency responsible for Medicaid and HCBS waiver programs. Within DHS, oversight is divided based on the target population being served.

The Division of Medical Assistance and Health Services (DMAHS) administers the overarching NJ FamilyCare (Medicaid) program. Day-to-day operational oversight of companion services is handled by the Division of Developmental Disabilities (DDD) for the I/DD population, and the Division of Aging Services (DoAS) for the MLTSS population.

• Primary State Agency: New Jersey Department of Human Services (DHS) oversees all Medicaid waiver operations.
• I/DD Waiver Oversight: Division of Developmental Disabilities (DDD) manages the Supports Program and Community Care Program.
• Aging/Physical Disability Oversight: Division of Aging Services (DoAS) manages the MLTSS waiver.
• Medicaid Authority: Division of Medical Assistance and Health Services (DMAHS) holds the ultimate authority for Medicaid rules under N.J.A.C. 10:49.
• Fiscal Agent: Gainwell Technologies (formerly Molina) operates the New Jersey Medicaid Management Information System (NJMMIS).

3. Gatekeeping Prerequisites: Who Can Even Apply

New Jersey employs strict structural preconditions that block standard Medicaid enrollment for companion services. Providers cannot use the standard online NJMMIS enrollment portal to become a companion agency. Instead, they must clear specific programmatic gates depending on the waiver they intend to serve.

For DDD services, the absolute prerequisite is the submission of an Agency Letter of Interest and an Agency Conflict-Free Policy to the DDD Provider Helpdesk. Without this, the application is not accepted. For MLTSS, providers face a managed care gatekeeping barrier, requiring them to secure network participation with MCOs that frequently operate closed networks.

• DDD Prerequisite 1: Submission of an Agency Letter of Interest on company letterhead to DDD.ProviderHelpdesk@dhs.nj.gov.
• DDD Prerequisite 2: Submission of an Agency Conflict-Free Policy demonstrating separation between service delivery and support coordination.
• Application Pathway Gate: Providers must use the paper-based DDD Combined Application; standard online NJMMIS applications for this provider type will be rejected.
• MLTSS Prerequisite: Must secure a network contract with at least one of the five NJ FamilyCare MCOs (e.g., Horizon NJ Health, UnitedHealthcare Community Plan).
• Business Prerequisite: Must hold a valid New Jersey Business Registration Certificate issued by the Department of the Treasury.
• Identifier Prerequisite: Must obtain a Type 2 (Organizational) National Provider Identifier (NPI) prior to initiating the state process.

4. Licensure and Certification Requirements

New Jersey does not issue a specific "Adult Companion Agency" license. Because the service is non-medical and does not involve hands-on personal care, providers are authorized through a certification process directly tied to their Medicaid waiver enrollment.

If an agency intends to provide both companion services and hands-on personal care, they cross the regulatory threshold requiring licensure as a Health Care Service Firm (HCSF) by the New Jersey Division of Consumer Affairs (DCA). For strictly companion services, the DDD Approved Provider designation serves as the operating authority.

• Operating Authority (Companion Only): DDD Approved Provider status via the Combined Application process.
• Operating Authority (Mixed Services): Health Care Service Firm (HCSF) registration issued by the Division of Consumer Affairs (DCA) if personal care is provided.
• Medicaid Provider Agreement: Mandatory execution of the DMAHS Provider Agreement (Form FD-20) binding the agency to N.J.A.C. 10:49 rules.
• Conflict of Interest Certification: Formal attestation that the agency will not provide both Support Coordination and direct companion services to the same individual.
• Insurance Requirements: Must maintain commercial general liability, professional liability, and workers' compensation insurance as dictated by DDD policy.

5. Medicaid Provider Enrollment

Enrollment is processed through the New Jersey Medicaid Management Information System (NJMMIS), managed by the state's fiscal agent, Gainwell Technologies. However, DDD providers must bypass the standard online portal and submit a specialized packet.

The DDD Combined Application packet consolidates the Medicaid FD-20 application and DDD-specific addendums. This packet must be mailed directly to the Provider Enrollment Unit in Trenton for manual processing.

• Enrollment System: New Jersey Medicaid Management Information System (NJMMIS).
• Application Packet: DDD Combined Application (PDF format).
• Primary Form: FD-20 (New Jersey Medicaid Provider Application).
• Disclosure Form: Ownership and Control Interest Disclosure form (mandatory for all owners with 5% or more interest).
• Submission Address: Gainwell Technologies Provider Enrollment Unit, P.O. Box 4804, Trenton, NJ 08650-4804.
• Application Fee: Subject to the federal Medicaid/Medicare institutional application fee (approximately $709), unless waived by existing Medicare enrollment.

6. Staffing, Training and Background Checks

Direct Support Professionals (DSPs) providing companion services must meet strict background check and training requirements mandated by the Department of Human Services. Agencies cannot deploy staff until all clearances are officially returned and documented.

Training is highly centralized in New Jersey. Providers must utilize the Boggs Center on Developmental Disabilities at Rutgers University for mandatory foundational training modules before staff can work independently with participants.

• Age Requirement: Companion staff must be at least 18 years of age.
• Background Check 1: Fingerprint-based Criminal History Record Information (CHRI) processed through IdentoGO.
• Background Check 2: Clearance through the DHS Central Registry of Offenders Against Individuals with Developmental Disabilities.
• Background Check 3: Child Abuse Record Information (CARI) check, required even for adult services under DHS rules.
• Mandatory Training: Completion of Boggs Center modules, including "Preventing Abuse, Neglect, and Exploitation" and "Shifting Expectations."
• Safety Training: Current certification in standard First Aid and Cardiopulmonary Resuscitation (CPR).

7. Documentation, Policies and Records

Companion service providers must maintain rigorous documentation to support claims billed to NJMMIS or MCOs. The state strictly enforces Electronic Visit Verification (EVV) for all in-home companion services to prevent fraud and ensure service delivery.

All services must be directly tied to the participant's Individualized Service Plan (ISP), developed by their independent Support Coordinator. Providers must maintain daily progress notes that reflect the goals outlined in the ISP.

• EVV Mandate: Must utilize a state-approved Electronic Visit Verification (EVV) system (e.g., HHAeXchange) to capture check-in and check-out times.
• Service Authorization: Services must be explicitly authorized in the DDD eRecord system or MCO portal based on the approved ISP.
• Progress Notes: Daily documentation must include date, start/end times, specific socialization activities provided, and the participant's response.
• Incident Reporting: Mandatory use of the DHS Incident Reporting Management System (IRMS) for any critical incidents, injuries, or allegations of abuse.
• Record Retention: Clinical and financial records must be retained for a minimum of five years from the date of service, per N.J.A.C. 10:49.

8. Billing, Rates and Claims

Reimbursement for Adult Companion Services depends on the participant's waiver program. For DDD participants, claims are submitted directly to the state's fiscal agent via NJMMIS. For MLTSS participants, claims are submitted to the specific MCO's clearinghouse.

Rates for DDD services are established by DHS and published annually in the Supports Program and Community Care Program fee schedules. Services are typically billed in 15-minute increments.

• Billing System (DDD): Claims are submitted fee-for-service through the NJMMIS provider portal.
• Billing System (MLTSS): Claims are submitted via MCO-specific portals (e.g., Availity for Horizon NJ Health).
• Procedure Code: Typically billed using HCPCS code S5135 (Companion care, adult, per 15 minutes).
• Rate Structure: Fixed fee-for-service rates published by DDD; MCO rates are negotiated but generally align with the state Medicaid fee schedule.
• Prior Authorization: Claims will deny if the service is not prior-authorized and linked to the participant's Medicaid ID and ISP.
• EVV Linkage: Claims submitted without matching EVV data will be automatically denied by the Medicaid system.

9. Approval Sequence and Timeline

Becoming an approved companion provider in New Jersey is a sequential, multi-agency process that typically takes 6 to 9 months from initial inquiry to final approval. Providers cannot skip steps or apply to Gainwell before DDD authorizes the application.

The process begins with DDD policy review, moves to Gainwell for Medicaid financial and background vetting, and returns to DDD for final programmatic approval and inclusion in the provider directory.

• Step 1: Submit Agency Letter of Interest and Conflict-Free Policy to DDD (1-4 weeks for review).
• Step 2: Receive and complete the DDD Combined Application packet.
• Step 3: Mail the Combined Application to Gainwell Technologies for FD-20 processing and background vetting (3-6 months).
• Step 4: Gainwell issues a Medicaid Provider Number and notifies DDD.
• Step 5: DDD finalizes the agency's Approved Provider status and grants access to the eRecord system (2-4 weeks).
• Step 6 (MLTSS Only): Apply for credentialing and contracting with NJ FamilyCare MCOs (an additional 3-6 months).

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to failure to follow the strict sequential gatekeeping process, particularly attempting to enroll via the standard NJMMIS portal instead of using the DDD Combined Application.

During post-enrollment audits by DDD or DMAHS, providers frequently face recoupment of funds for failing to maintain compliant EVV records or allowing staff to work before all background checks are fully cleared.

• Application Denial: Attempting to submit an FD-20 without first clearing the DDD Letter of Interest prerequisite.
• Application Delay: Incomplete Ownership and Control Interest Disclosure forms, particularly missing secondary owners or board members.
• Audit Finding: Billing for companion services without corresponding, compliant Electronic Visit Verification (EVV) data.
• Audit Finding: Deploying DSPs before receiving official clearance from the DHS Central Registry and IdentoGO fingerprinting.
• Audit Finding: Progress notes that are generic, repetitive, and fail to document the specific socialization goals outlined in the ISP.
• Audit Finding: Providing hands-on personal care (ADLs) under the companion billing code without an HCSF license.

11. Key Contacts and Resources

Prospective providers must rely on official New Jersey Department of Human Services portals and the state's fiscal agent for accurate, up-to-date application materials and policy manuals.

The DDD Provider Helpdesk is the critical first point of contact for initiating the companion service enrollment process.

• DDD Provider Helpdesk: DDD.ProviderHelpdesk@dhs.nj.gov (Required for initial Letter of Interest submission).
• Medicaid Fiscal Agent: Gainwell Technologies Provider Enrollment Unit, P.O. Box 4804, Trenton, NJ 08650-4804.
• Provider Portal: NJMMIS.com (For downloading the FD-20, billing supplements, and N.J.A.C. 10:49 manuals).
• Training Resource: The Boggs Center on Developmental Disabilities at Rutgers RWJMS (For mandatory DSP training modules).
• Regulatory Code: N.J.A.C. 10:49 (Administration Manual for New Jersey Medicaid).
• Division Website: NJ Department of Human Services, Division of Developmental Disabilities (nj.gov/humanservices/ddd).

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