SC/SCS Tools and Guidance

• Avoiding Service Gaps
• Claiming for Support Coordination Services for Individuals Enrolled in SP or CCP-FFS
• Email Validation Process: SC Training (11/28/2018)
• Entering Supported Employment–Individual Employment Support Services Into the ISP
• Camp Funding Assistance 2019
• Camp Contacts 2019
• Case Transfer Form
• Communication Protocol
• Community Care Program (CCP) FAQs
• Guidance on ISP Signature
• Guidance on Waiver Program Transitions
• ISP Review Checklist for Support Coordination Supervisors
• ISP Review Tool for SCAs
• ISP Review Tool User Guide for SCAs
• ISP Submission Criteria
• Request for Intensive Case Management (ICM)
• Retroactive Change Request Process
• Retroactive Change Request Form
• Speech Consult Referral
• Speech Consult Referral Instructions
• Seeking Out Support (SOS) Form
• Tips for Preparing an ICM Referral
• Transitioning Individuals from Institutional Settings
• Transportation Services in Fee for Service

Incident Reporting

• Unusual Incident Report (UIR) Procedure for SCAs
• UIR Updoc Instructions
• UIR Community Category List
• UIR Internal Contacts

Service Delivery Documents

• Community Based / Individual Supports Log
• Community Inclusion Activities Log
• Community Inclusion Individualized Goals Log
• Community Inclusion Annual Update
• Day Habilitation Activities Log
• Day Habilitation Individualized Goals Log
• Day Habilitation Annual Update
• Natural Supports Training Log
• Prevocational Training Activities Log
• Prevocational Training Individualized Goals Log
• Prevocational Training Annual Update
• Supported Employment Pre-Employment Service Log
• Supported Employment Intervention Plan and Service Log

Other Documents and Forms

• Addressing Enhanced Needs Form
• AT/EM Evaluation Request Form
• AT/EM/VM Purchase Request Form
• Continuation of Prevocational Training Justification Form
• DVRS/CBVI Determination Form
• Goods and Services Request Form
• HIPAA Form Approved for Use by SC Agencies
• Individual Supports Request Form
• ISP Quality Review Checklist
• ISP Revision Worksheet and Meeting Minutes
• ISP Worksheet for Day Service Providers
• ISP Worksheet for Residential Providers
• Medicaid Eligibility Troubleshooting Form
• Monthly Monitoring Tool
• Move to Discharge Form
• Participant Enrollment Agreement- English
• Participant Enrollment Agreement-Spanish
• Participant Rights and Responsibilities-English
• Participant Rights and Responsibilities-Spanish
• Retirement Request Form
• Quick Guide to Mandated Training for Self-Directed Employees
• Single Passenger Rate Transportation Request Form
• Speech Consult Referral
• Speech Consult Referral Instructions
• Support Coordination Agency Selection Form
• Supported Employment Funding Request Form

Residential Placement and Transition Forms

Transfer Requests and Pre-Placement Requirement WEBINAR SLIDES

• Residential Transfer Referral Form
• Residential Provider Response Form
• Residential Placement Offer Form
• Pre-placement Transition Plan

Interim Support Coordination

• Interim Policy Guide to Support Coordination
• Support Coordinator's Guide to Unusual Incident Reporting
• Conflict-Free Policy (revised 01.2015)

To become a Division-approved Support Coordination Agency, a provider must complete and submit the Combined Application to Become a Medicaid/DDD Approved Provider (Combined Application) found on the Provider Portal page of the Division's website.

Prior to submitting the Combined Application, agencies interested in providing Division-funded Support Coordination services must

• Review the Division's revised Conflict-Free Policy (revised 01.2015)
• Review the Support Coordinator's Guide to Unusual Incident Reporting
• Submit an Agency Letter of Interest and an Agency Conflict-Free Policy (both on agency letterhead ) to the Provider Helpdesk at: mailto:DDD.SuppProgHelpDesk@dhs.nj.gov