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Section 1919(e)(7) of the Social Security Act and Chapter 42 of the Code of Federal Regulations, Sections 483.100 through 483.138 specify the requirements for preadmission screening of all individuals with intellectual and developmental disabilities before they enter a Medicaid certified nursing facility (NF), regardless of payment source.

Federal regulations require the PASRR Level I screenings take place prior to admission in order for a state to receive federal financial participation for Medicaid reimbursement of nursing home care.  Individual determined to require Specialized Services through the PASRR Level II process are prohibited from being admitted to a NF, or remaining in a NF.>

For further information about the Level I process, and forms that are used for that process, please visit the Division of Aging Services / PASSR.

If an individual who is currently living in a NF and who has an intellectual or developmental disability has been identified through the Minimum Data Set 3.0 (MDS 3.0)as having a significant change in condition, then the Division of Developmental Disabilities must be notified via completion and submission of the PASRR Resident Review Referral Form.

Below are documents for preparation of a Division of Developmental Disabilities (DDD) contract application, as well as annual contract reporting. Third-party contract providers should familiarize themselves with the NJ Department of Human Services Contract Policy and Information Manual.  

**NOTE: If you previously had a contract with DDD and are now fully fee-for-service, please email ddd.providerhelpdesk@dhs.nj.gov for assistance.

Items 1-14 are for annual reporting:

  1. Required Documents Checklist
    1. Condensed Annex A
  2. Standard Language Document
    1. Non-State Agency (for provider agencies)
    2. State Agency (for State agencies)
  3. Annex B (Budget Template)
  4. Business Associate Agreement (revised 2023)
  5. Source Disclosure Certification
  6. Standardized Board Resolution
  7. Form AA-302: Affirmative Action Employee Information Report
    1. AA-302 Form
    2. AA-302 Instructions
  8. Business Registration Memo
  9. Notification of Licensed Public Accountant
  10. Equipment Inventory List
  11. Public Law 2005 (only applicable to For-Profit Organizations)
    1. Chapter 51 Form
    2. Certification and Disclosure Form
  12. NJ Charitable Registration (only applicable to Charitable Organizations)
  13. Agency Contact Form
  14. Cluster Designation
    1. Cluster Designation Form
    2. Cluster Policy
  15. P1.10: Contract Modification
    1. P1.10 Form
    2. P1.10 Policy 
  16. ACH/Electronic Payment Authorization
    1. ACH Form
    2. ACH Instructions
  17. W-9 Vendor Questionnaire
  18. Payment Voucher
    1. Payment Voucher Instructions
    2. Payment Voucher Form (Word)
    3. Payment Voucher Form (Excel)