New Jersey - Speech & Language Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The New Jersey Division of Consumer Affairs, through the Audiology and Speech-Language Pathology Advisory Committee, licenses Speech-Language Pathologists under N.J.A.C. 13:44C, while the Division of Medical Assistance and Health Services (DMAHS) enrolls them to serve NJ FamilyCare beneficiaries.

Approval to bill Medicaid for HCBS waiver populations requires either contracting directly with the state's five Managed Care Organizations for MLTSS participants or securing Division of Developmental Disabilities (DDD) provider approval for the Supports and Community Care Programs. Independent clinics serving school-aged Medicaid beneficiaries must also secure a Clinic/Agency Approval from the New Jersey Department of Education (NJDOE) before DMAHS will process their FD-20 Medicaid application.

1. Service Definition and Scope

In New Jersey, Speech-Language Pathology services encompass the evaluation, diagnosis, and treatment of speech, language, voice, communication, auditory processing, and swallowing disorders. These services are designed to restore or improve functional communication and swallowing for Medicaid beneficiaries.

Under NJ FamilyCare and its associated HCBS waivers, SLP services can be delivered in clinics, homes, or via approved telehealth modalities. Services must be medically necessary and prescribed by a licensed physician or advanced practice nurse.

• Service Name: Speech-Language Pathology Services
• Target Populations: NJ FamilyCare fee-for-service, MLTSS, and DDD waiver participants
• Covered Modalities: Individual therapy, group therapy, and augmentative/alternative communication (AAC) evaluations
• Exclusions: Educational services not related to a medical or developmental diagnosis
• Setting: In-home, clinic, or telehealth (subject to current DMAHS telehealth guidelines)

2. Regulatory and Oversight Agencies

Multiple state agencies oversee the licensure, enrollment, and utilization of SLP services in New Jersey. The Division of Consumer Affairs handles professional licensure, while DMAHS manages the overarching Medicaid program.

For providers serving specific waiver populations, additional oversight is provided by the Division of Developmental Disabilities (DDD) or the Department of Education (NJDOE) for clinic-based services.

• Licensing Board: NJ Audiology and Speech-Language Pathology Advisory Committee (https://www.njconsumeraffairs.gov/aud)
• Medicaid Authority: Division of Medical Assistance and Health Services (DMAHS) (https://www.nj.gov/humanservices/dmahs/)
• Fiscal Agent: Gainwell Technologies / NJMMIS (https://www.njmmis.com)
• Waiver Oversight (I/DD): Division of Developmental Disabilities (DDD) (https://www.nj.gov/humanservices/ddd/)
• School/Clinic Oversight: NJDOE Office of Special Education (https://www.nj.gov/education/specialed/)

3. Gatekeeping Prerequisites: Who Can Even Apply

New Jersey imposes strict structural prerequisites depending on the target Medicaid population. Providers cannot simply enroll in Medicaid and begin billing; they must first clear specific agency approvals or secure managed care contracts.

For MLTSS, providers are entirely dependent on MCO network adequacy. For DDD waivers, providers must pass a distinct state approval process before Medicaid enrollment is permitted.

• MCO Network Status: MLTSS providers must secure active contracts with Horizon, Wellpoint, UnitedHealthcare, Aetna, or Fidelis Care; out-of-network enrollment is restricted.
• DDD Provider Approval: Agencies serving the Supports Program or Community Care Program must pass the DDD Provider Enrollment process and attend mandatory DDD provider orientation.
• NJDOE Clinic/Agency Approval: Independent clinics treating children must obtain NJDOE approval under N.J.A.C. 6A:14-5.2 before Medicaid enrollment.
• Facility Requirements: Clinic applicants must possess a valid Certificate of Occupancy (CO) and fire/safety inspection certificates for their physical location.
• NPI Requirement: Applicants must obtain a Type 1 NPI (individual) and Type 2 NPI (group/agency) before submitting the FD-20.

4. Licensure and Certification Requirements

Individual practitioners must be licensed by the New Jersey Division of Consumer Affairs under N.J.A.C. 13:44C-3.2. This requires advanced education, clinical experience, and successful examination.

Agencies must ensure that all employed or contracted SLPs maintain active, unencumbered New Jersey licenses.

• Degree Requirement: Master's or doctoral degree from a CAA-accredited program.
• Clinical Experience: Completion of a 9-month full-time clinical fellowship under a licensed SLP.
• Examination: Passing score on the Praxis Examination in Speech-Language Pathology.
• License Fee: $170 initial license fee plus $75 application fee to the Division of Consumer Affairs.
• Continuing Education: 20 hours of continuing education every two-year renewal period.

5. Medicaid Provider Enrollment

Medicaid enrollment is processed through the NJMMIS portal managed by Gainwell Technologies. Providers must submit specific state forms to receive a Medicaid provider number.

Agencies must enroll as group providers and link their individually licensed SLPs to the group's Medicaid ID.

• Application Portal: NJMMIS Provider Enrollment Application (https://www.njmmis.com)
• Required Form 1: FD-20 (Medicaid Provider Application)
• Required Form 2: FD-62 (Medicaid Provider Agreement)
• Ownership Disclosure: CMS-1513 form detailing ownership and control interest
• Application Fee: $731 federal Medicaid application fee (for institutional/agency providers, unless waived by Medicare enrollment)

6. Staffing, Training and Background Checks

New Jersey requires comprehensive background checks for all Medicaid providers. The specific background check routing depends on whether the provider is licensed as a clinic or an individual practitioner.

Staff serving waiver populations must also complete state-mandated training modules regarding abuse, neglect, and incident reporting.

• Criminal History Review: Fingerprint-based background check via IdentoGO for DCA licensure.
• NJDOE CHR: Clinic staff must obtain Criminal History Review approval from the NJDOE Office of Student Protection.
• DDD Training: Staff serving DDD waivers must complete Boggs Center mandatory trainings (e.g., Abuse/Neglect, Danielle's Law).
• CPR/First Aid: Direct care staff must maintain active CPR and First Aid certifications.
• Exclusion Checks: Monthly screening against the OIG LEIE and NJ Medicaid Fraud Division exclusion lists.

7. Documentation, Policies and Records

Providers must adhere to strict documentation standards outlined in N.J.A.C. 10:49. Clinical records must justify the medical necessity of all billed services.

Agencies must maintain comprehensive policy manuals covering HIPAA compliance, telehealth delivery, and incident reporting.

• Plan of Care: Written treatment plan signed by the referring physician or APN, updated at least every 6 months.
• Session Notes: Daily documentation including date, start/stop times, specific interventions, and patient response.
• Record Retention: Clinical and billing records must be retained for a minimum of 5 years.
• Telehealth Policy: Written protocols for HIPAA-compliant telehealth delivery, if applicable.
• Incident Reporting: Compliance with DDD incident reporting protocols (UIRMS) for waiver participants.

8. Billing, Rates and Claims

Reimbursement is handled either through the state's fiscal agent (Gainwell) for fee-for-service claims or through the respective MCOs for MLTSS participants.

Rates for FFS and DDD waivers are published by DMAHS, while MCO rates are negotiated during the contracting phase.

• Common Codes: CPT 92507 (Speech/hearing therapy), 92610 (Swallowing evaluation).
• Prior Authorization: Required for most ongoing therapy beyond initial evaluations via the MCO or DMAHS Medical Exception Process (MEP).
• Claim Format: CMS-1500 professional claim form submitted electronically via NJMMIS or clearinghouse.
• Timely Filing: Claims must be submitted within 365 days of the date of service for FFS, or per MCO contract terms (often 90-180 days).
• DDD Billing: Claims for DDD waiver participants are processed through the Medicaid MMIS or the designated fiscal intermediary.

9. Approval Sequence and Timeline

Becoming a fully billable provider is a sequential process. Professional licensure must be secured before agency approvals, which in turn must precede Medicaid enrollment.

The entire process from initial licensure to MCO contracting can take several months.

• Step 1: Obtain DCA Speech-Language Pathologist license (4-8 weeks).
• Step 2: Secure NJDOE Clinic/Agency approval or DDD provider approval (3-6 months).
• Step 3: Submit FD-20 and FD-62 to Gainwell Technologies via NJMMIS.
• Step 4: Gainwell processing and DMAHS review (60-90 days).
• Step 5: MCO Credentialing and Contracting for MLTSS participation (90-120 days post-Medicaid enrollment).

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to administrative errors or missing documentation.

State audits often target incomplete clinical notes and missing prior authorizations.

• Application Denial: Failure to include the required NJDOE Clinic/Agency approval letter with the FD-20.
• Claim Denial: Billing for services without an active Prior Authorization (PA) on file.
• Audit Finding: Missing start and stop times on daily clinical session notes.
• Audit Finding: Expired physician signatures on the Plan of Care.
• Credentialing Delay: MCO credentialing rejected due to CAQH profile not being fully updated or attested.

11. Key Contacts and Resources

Providers should utilize official state portals and division websites for the most current forms, manuals, and fee schedules.

Direct contact with Gainwell Technologies is required for NJMMIS portal access and FD-20 application status.

• NJ Division of Consumer Affairs (Audiology/SLP): https://www.njconsumeraffairs.gov/aud
• NJMMIS Provider Portal: https://www.njmmis.com
• NJ Division of Medical Assistance and Health Services (DMAHS): https://www.nj.gov/humanservices/dmahs/
• NJ Division of Developmental Disabilities (DDD): https://www.nj.gov/humanservices/ddd/
• NJDOE Office of Special Education: https://www.nj.gov/education/specialed/

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