Providers are required to have a criminal background check process for their staff. This form acknowledges that all staff having direct contact with youth has completed, at minimum, criminal background checks, and if required by law, a Child Abuse Registry Index (CARI) check.

Providers working directly with CFC youth and families must attend an annual mandatory Wraparound Training.  This form confirms that providers will attend a WrapAround Training.

Criminal background check reports of clinical supervisors should be dated within 1 year of submission. Clinical Supervisor's name on background check should match the licensure submitted.

Note: BA/IIC agencies may no longer complete background checks independently using private companies. All background checks will be processed by the Employment Controls and Compliance Unit (ECCU) within the Office of Program Integrity & Accountability (OPIA) at the Department of Human Services. Find more information here.

Licenses of clinical supervisory staff should match the names on the submitted background check report. Licensed professionals (psychiatrist, nurse practitioners, etc) performing specific professional services (psychiatric evaluation) credentials should also be submitted in addition to supervising staff's credentials. 

Ensure that credentials are not expired. Submitted credentials should have a minimum of 2 months left before expiration. 

General Liability and Professional Liability Insurance are required. Your required insurance coverage minimum is $1,000,000 for each claim & $3,000,000 for the general aggregate. Coordinated Family Care MUST be listed as a certificate holder on both insurances. 

If you are providing CSOC services, a Medicaid approval letter must detail the specific services for which you have been approved. If your organization provides both IIC and IIH services, approval letters for each service line must be submitted.

This Memorandum of Understanding (MOU) outlines the roles and responsibilities of each agency as we work in partnership to provide services to children and families served through the New Jersey Children’s System of Care (NJCSOC). Please list the specific services you provide that will be listed on your Services & Rates Sheet. 

Complete this form with your company’s current contact information. If there are any future updates to your contact details, please notify us promptly.

The Services and Rates sheet should outline the services you currently offer and their corresponding fees, formatted on your company’s official letterhead. Please only include services that can be currently provided.

NOTE: For services requiring a licensed professional (e.g evaluations), ensure that the professional is listed on your Staff Listing AND include a copy of their license when submitting to complete the MOU.

Clinical Supervisors must be identified on the staff listing. For services that require a licensed professional, ensure the individual is included in your Staff Listing, and provide a copy of their valid license as part of the MOU submission.

Example: If your company offers psychiatric evaluations, a licensed psychiatrist must be listed on your Staff Listing, and their psychiatric license must be submitted to complete the MOU process.

Pro Tip: Complete your ResourceNet Page & upload your staff when you're completing this form.

1. Create a personal account on Middlesex ResourceNet.
2. Create a page for your business by submitting a resource.

Agencies providing CSOC services are Health Providers.

Your creation of this page will make you the administrator for that RN business page. This can be reassigned as needed. Once your business page is created, populate your staff. This is how Care Managers will explore options for referrals*.

1. Go to 'My Dashboard'. You should see the pages you have submitted. Find your agency’s page.
2. Once you’ve scrolled to your agency’s page you should see the option to click on “Agency Staff” 
3. Click on “Add New Staff” and proceed to add your IICs, BAs, IIHs etc.
4. Be sure to include credentials and languages! In-Person services are required for CSOC services.
5. Confirm the agency’s staff.

*Clinical supervisor at your agency will make final determination of staff assignment.