Seton Hall Report Identifies Pathway to Integrating Behavioral Health and Primary Care in New Jersey
Newark, N.J. – A comprehensive new report from Seton Hall Law's Center for Health & Pharmaceutical Law & Policy may serve as a roadmap for integrating behavioral health (mental health and substance abuse treatment) and primary care in New Jersey.
Such integration could greatly improve overall healthcare for patients in New Jersey. Traditionally, behavioral health has been separated from the physical healthcare delivery system. Yet a solid research and clinical consensus has existed for decades that integrated clinics that treat the “whole person” result in better outcomes for the individuals and lower total costs to the system.
In the report, titled “Integration of Behavioral and Physical Healthcare: Licensing and Reimbursement Barriers and Opportunities in New Jersey,” co-authors John Jacobi, J.D., Tara Adams Ragone, J.D., and Kate Greenwood, J.D. of Seton Hall University School of Law analyze the legal, policy, regulatory, and fiscal barriers currently inhibiting integrated care, and recommend concrete steps the state can take to facilitate integration.
“The integration of care saves both lives and dollars. Too often, New Jersey’s regulations continue to reflect a previous era of separation, and create significant barriers to enacting current clinical norms,” said principal co-author John Jacobi, the Dorothea Dix Professor of Health Law & Policy and director of the Center for Health & Pharmaceutical Law & Policy. “Our report shows that there is a clear path forward, and the open engagement of representatives of state agencies demonstrates both leadership and cooperation on the part of the state.”
The report is sponsored by The Nicholson Foundation, which conceived of the need for this project due to their experience funding care integration pilots at five clinics throughout New Jersey. “We initially anticipated that our pilot projects would focus mainly on leadership, cultural, clinical and workflow issues, with a goal that the clinics would be able to bill for their new services through current reimbursement systems and become self-sustaining within one to two years,” said Joan Randell, chief operating officer of The Nicholson Foundation. “Unfortunately, our grantees found that their efforts were significantly impeded by New Jersey’s complex and confusing policy environment.” The Nicholson Foundation asked the Seton Hall team to examine and clarify the licensing and reimbursement situation, and work with the state agencies and healthcare stakeholders to conceive workable solutions that would facilitate behavioral health integration.
To craft the report, the report’s authors delved into both the clinical literature on behavioral health and the dense thicket of statutory and regulatory law on licensure and reimbursement. As mental health/ substance abuse treatment providers are regulated and funded by different departments within state government from primary care providers (the Department of Human Services (DHS) and Department of Health (DOH) respectively), the team closely consulted with officials from both departments throughout the process. They also conducted extensive conversations with primary care and behavioral health practitioners, academics, and advocates.
The report closes by laying out eight specific, actionable recommendations for change. The authors recommend that the DHS and DOH collaborate to facilitate the dual licensure of providers to operate integrated care facilities, and over time move to a single license. Most of the current regulatory requirements for separation of behavioral and primary care services (such as those requiring the physical separation of facilities and waiting rooms) should be eliminated, while only those legally-necessary requirements (such as records maintenance) should be maintained. The authors recommend that Federally Qualified Health Centers be permitted to add services for mild to moderate behavioral health conditions to their suite of primary care without applying to change their Medicaid reimbursement status through the filing of a Change of Scope application. Finally, to clear up the significant confusion that exists in the provider community, it is recommended that the DHS and DOH collaborate to create user-friendly tools to disseminate accurate information about regulations surrounding integration, including expanded public outreach and improved websites.
The strength of the approach of closely collaborating with government officials in the creation of the report is that key decision-makers became increasingly aware of the problems – and solutions. In October of 2015, the DHS and DOH announced the joint creation of a “Shared Space Waiver” which would allow providers to offer both behavioral and primary care in the same facility. “The Departments’ movement in creating the Waiver is consistent with our recommendations in this report, and demonstrates that they are interested in continuing regulatory advances to accommodate integrated care,” Jacobi said.
To view the report, "Integration of Behavioral and Physical Healthcare: Licensing and Reimbursement Barriers and Opportunities in New Jersey," visit law.shu.edu/behavioralhealth.
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About The Nicholson Foundation: The Nicholson Foundation works to improve the quality and affordability of healthcare for vulnerable populations in New Jersey by transforming how it is paid for and delivered. The Foundation’s approach emphasizes partnerships and performance-based grant making; its goal is sustainable systems reform. For more information about the Foundation, visit www.thenicholsonfoundation.org.
About Seton Hall University School of Law: Seton Hall University School of Law is New Jersey’s only private law school. The Law School’s mission emphasizes social justice, advocacy, scholarship, and direct legal services to secure equality, civil rights, and legal protection for individuals and communities in need. For more information, visit law.shu.edu.