Provider Readiness Checklist

Part One — Lay the foundation

1Establish the business

• Determine the legal business structure (for example: LLC, corporation, nonprofit, or other recognized entity).
• Register the business with the State of New Jersey, as applicable.
• Obtain an Employer Identification Number (EIN) from the IRS.
• Establish the business address, leadership/ownership structure, banking, accounting, payroll, and insurance systems.
• Existing providers: confirm corporate records, insurance, registrations, and leadership information are current before expanding.

2Define the service model

Identify the exact DDD services the agency intends to provide, and review the current service definitions, provider qualifications, staffing expectations, documentation rules, limitations, and billing requirements for each service.

• Individual Supports
• Community Based Supports (CBS)
• Community Inclusion Services
• Day Habilitation
• Respite
• Prevocational Training
• Supported Employment
• Other DDD-approved services

3Obtain the NPI

• Apply for a National Provider Identifier (NPI) through NPPES/CMS.
• Obtain an NPI for each location from which services will be provided, as required by DDD.
• For community-based services not provided through a specific program site, use the administrative/main location NPI as directed by DDD.

4Build core policies & procedures

DDD-approved Medicaid waiver providers must develop, maintain, review, and update agency policies and procedures. The exact content should match the services the agency actually provides.

• Organizational governance and agency operations
• Personnel, staff qualifications, screening, supervision, and training
• Admission, suspension, and discharge
• Incident reporting and investigation
• Complaints and grievances
• HIPAA, confidentiality, and record security
• Emergency preparedness and response
• Medication administration, when applicable
• Medicaid fraud, waste, abuse, exclusion, and debarment
• Human rights
• Financial management, documentation, and billing
• Quality management and internal compliance review
• Behavior support and service-specific procedures, when applicable

Part Two — Choose your path & get approved

5Choose the correct approval path

Use the pathways below to understand what must happen before launch.

6Submit the Combined Medicaid/DDD Provider Application

• Complete the Combined Application to Become a Medicaid/DDD Approved Provider after applicable prerequisites are met.
• Select each service the agency intends to provide.
• Complete Medicaid enrollment, ownership/disclosure, tax/payment, and service-specific documents generated or required by the application.
• For Individual Supports, complete the required Individual Supports Provider Attestation.
• Retain a complete copy of the original application and every attachment submitted.

7Day Habilitation: pre-opening readiness

Before applying to provide Day Habilitation, obtain Provisional Day Habilitation Certification. Each location must be certified separately, and certification is not transferable to another organization or location.

• Develop the Service Delivery Plan/program description and intended outcomes
• Define program capacity, geographic service area, days/hours, and sample activity schedule
• Create the organizational structure, staff qualifications, and job descriptions
• Establish background-check and staff-training procedures
• Develop admission, suspension, discharge, emergency, and transportation procedures
• Identify and prepare the program location
• Complete the required facility review for the service location
• Receive provisional certification before completing the Day Habilitation enrollment pathway
• Prepare for the full audit before the provisional certification expires

8Group home / licensed residential readiness

A provider-managed residence is not opened simply by adding Individual Supports to the agency. Residential licensing and development are additional processes.

• Become approved by DDD/Medicaid to provide Individual Supports
• Document at least 24 months of direct-care service history with individuals with I/DD, including requested survey/audit history and plans of correction
• Engage the appropriate DDD residential development and licensing offices
• Consult DDD housing/resource development guidance before acquiring housing
• Complete the residential licensing application
• Develop residential-specific policies, staffing, emergency/evacuation, medication, health, safety, and operational systems
• Prepare the physical residence for licensing review and required inspections
• Correct any deficiencies identified during review
• Receive the required residential license/approval before operating the setting

Part Three — Get ready to operate

9Location & physical site readiness

• Confirm zoning and allowable use
• Confirm building, fire, occupancy, and local requirements that apply
• Verify accessibility and safe emergency egress
• Plan participant capacity, privacy, bathrooms, activity areas, staff work space, and secure records
• Plan medication storage and food preparation areas when applicable
• Review transportation access and parking
• Review HCBS Settings Rule requirements
• Do not assume a commercially available or residential property automatically meets program requirements

10Build operational infrastructure

• Participant referrals, intake, admission, and record setup
• ISP review and service authorization verification
• Service documentation and progress notes
• Incident reporting and internal investigation
• Emergency and medical information systems
• Medication documentation, when applicable
• Staff scheduling and supervision
• Transportation systems
• Electronic Visit Verification (EVV), when applicable
• Medicaid billing and internal claim review
• Quality assurance and routine compliance auditing
• Complaints, grievances, human rights, HIPAA, and records security

11Recruit, clear & train staff

• Determine the staffing model and supervisory structure
• Create service-appropriate job descriptions and verify qualifications
• Complete required criminal-history and registry checks
• Complete exclusion/debarment checks and drug testing when applicable
• Complete DDD-mandated training and CPR/First Aid as required
• Train employees on agency policies and emergency procedures
• Complete participant-specific training before staff provide services
• Maintain personnel files that demonstrate continued compliance

12Complete a pre-launch readiness review

• Is the agency approved for this exact service?
• Is the correct service location enrolled and/or approved?
• Has any required licensing or certification been completed?
• Are required facility inspections/reviews complete?
• Are service-specific policies operational?
• Are all scheduled staff cleared, qualified, and trained?
• Are intake, documentation, incident, emergency, and billing systems functioning?
• Are transportation and EVV systems ready, if applicable?
• Has the agency completed an internal mock compliance review before serving the first participant?

At a glance

Quick pathway guide

Simple launch roadmap

The usual order of work, depending on whether you are starting out, adding a service, or adding a location.

Official New Jersey resources

Use these to verify current requirements before submitting an application, acquiring a site, or launching a service.

• DDD — Apply to Become a Provider (opens in a new tab)
• DDD — Day Habilitation Certification (opens in a new tab)
• DDD — Mandatory Provider Policies & Procedures (opens in a new tab)
• DDD — Provider Compliance Requirements (opens in a new tab)
• DDD — Policy Manuals (opens in a new tab)
• DHS Office of Program Integrity & Accountability — Office of Licensing (opens in a new tab)
• NPPES — Apply for an NPI (opens in a new tab)

This checklist is a general educational and organizational resource created by Wildflower & Rose, and is not an official publication of the New Jersey Division of Developmental Disabilities. Requirements may change and may vary by service, setting, funding source, participant needs, and location. Confirm the most current requirements directly with DDD, Medicaid, OPIA/Office of Licensing, and other applicable authorities before making operational or financial decisions. Requirements reviewed against NJ guidance available September 23, 2026.