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New Jersey - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New Jersey Department of Human Services (DHS), Division of Developmental Disabilities (DDD) funds case management under the title Support Coordination through its Supports Program and Community Care Program waivers. Agencies seeking to provide this service must navigate the DDD Combined Application process and adhere strictly to the state's Conflict-Free Policy, which prohibits an agency from providing both Support Coordination and direct waiver services to the same individual.

Approval requires securing a Medicaid National Provider Identifier (NPI), completing mandatory orientation, and submitting the application through the Fee-for-Service Provider Portal managed by the state's fiscal intermediary. Providers must maintain specific staffing ratios and ensure all Support Coordinators complete the state-mandated training curriculum through the Boggs Center on Developmental Disabilities before billing.

1. Service Definition and Scope

In New Jersey, Support Coordination encompasses assessment, person-centered service planning, referral, and monitoring across the participant's full service package. Support Coordinators are responsible for developing the Individualized Service Plan (ISP) and ensuring services meet the participant's health and safety needs.

2. Regulatory and Oversight Agencies

Multiple divisions within the New Jersey Department of Human Services oversee this service, managing everything from policy creation to claims processing.

3. Gatekeeping Prerequisites: Who Can Even Apply

New Jersey enforces strict structural preconditions for Support Coordination agencies before an application is reviewed. The state requires adherence to conflict-free mandates and specific business entity registrations.

4. Licensure and Certification Requirements

Support Coordination is not a separately licensed facility type in New Jersey; instead, it requires DDD agency approval through the Combined Application process. Providers must meet the qualifications outlined in the DDD policy manuals.

5. Medicaid Provider Enrollment

Enrollment is processed through the NJMMIS portal using the Combined Application, which routes the provider agreement to the state's fiscal intermediary.

6. Staffing, Training and Background Checks

Staff must meet specific educational and training benchmarks. New Jersey mandates that all Support Coordinators complete a standardized training curriculum before they can carry a caseload.

7. Documentation, Policies and Records

Agencies must maintain comprehensive records in the state's electronic system and develop internal policies that align with HCBS Settings Rules.

8. Billing, Rates and Claims

Services are billed fee-for-service through NJMMIS. Rates are established by DDD and DMAHS and are typically billed in monthly or 15-minute increments depending on the specific waiver definition.

9. Approval Sequence and Timeline

The approval process follows a sequential path from obtaining an NPI to final DDD approval and NJMMIS activation. The timeline varies based on application completeness.

10. Common Denials and Survey Findings

Applications and ongoing compliance often fail due to specific documentation gaps or failure to maintain conflict-free boundaries.

11. Key Contacts and Resources

Essential contacts for prospective Support Coordination agencies include the state divisions and the fiscal intermediary handling enrollment.

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