New Jersey is poised to alter a health care licensing regulation in a way that longtime advocates say will significantly expand people’s access to mental health and substance-use care while enhancing options for patients with serious behavioral health issues.  

The state Department of Health is preparing for public comments on a planned single “integrated care” license that will enable doctors, nurses and other clinicians to work as a team under the same roof to address a patient’s mental health, addiction and medical needs, officials said. The need for this integrated license is clear and grew during the COVID-19 pandemic, federal data shows, with roughly 1 in 5 Americans experiencing anxiety, depression or worse, and higher rates among teens and young adults.   

Advocates who have pushed New Jersey for nearly a decade to change its process say a single license would be a vast improvement over the current system, which siloes care and makes it harder for patients to get the treatment they need — literally sending patients to different locations for care. Currently, health care facilities can be licensed to provide either medical or behavioral health services, with few exceptions. A handful of programs have received waivers to offer a broader mix of treatments, but they are limited in how this care can be integrated, according to those involved.   

Fixing ‘fractured’ health care  

Bergen New Bridge Medical Center, in Paramus, is among those using waivers to help link the current “fractured licensure system,” as president and CEO Deborah Visconi calls it. New Bridge provides a unique mix of residential psychiatric care, acute care and outpatient treatment.  

A single license would allow for more coordinated and holistic care, Visconi said, and patients would benefit from a process that is anchored in primary care. Treatment teams could work together, using the same set of medical records, instead of keeping separate files. “The end result allows us to better treat the disease while caring for the person which translates to better patient outcomes,” she said.  

Studies have long shown that integrated care is better care and a 2016 report from Seton Hall professor John Jacobi found that New Jersey’s overly bureaucratic system made it very hard to deliver that kind of care. Former Gov. Chris Christie elevated these concerns and, in a controversial move during his final months in office, shifted some 200 state workers and $1 billion from the Department of Human Services to the state Health Department to promote health integration.   

Moving workers back and forth 

These shifts did not result in a single, integrated license for health care facilities, an issue that was flagged as a priority by the health care experts on the transition team that briefed incoming Gov. Phil Murphy, who took office in 2018. Murphy reversed much of Christie’s change, returning the majority of those state workers — and their responsibilities and funding — to Human Services, which now oversees a vast network of community-based mental health and addiction programs. The Health Department runs the state psychiatric hospitals and licenses behavioral and medical health facilities.  

Since then, the Health Department has taken steps to improve integration. But advocates for change said the waiver process remains unwieldy, putting holistic care beyond the reach of many small practices, leaving limited options despite the growing need.  

 ‘Our vision for New Jersey is that addiction will be treated like any other chronic disease, like high blood pressure or diabetes…’ – Dr. Kaitlan Baston, commissioner, NJ Department of Health 

“It is simply a fact that the current licensing system has led to disparities in diagnosis, treatment and outcomes because of a lack of coordination between health care and behavioral health units even within the same facility,” Visconi wrote in an editorial for ROINJ (Return on Investment NJ) in November. “Studies have shown that, when these units are integrated, clinical outcomes as well as patient engagement and satisfaction improve.”  

That could soon change. State Health Commissioner Baston told members of the Senate Budget Committee last week her team is working with staff at the Department of Human Services to finalize a plan for a single, integrated health care license. The draft will be released for public comment soon, she said, the first official step in regulatory change.  

Strong support for change 

This is good news to Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, which launched a renewed push for the single license last year with a letter signed by dozens of health care leaders, including Visconi, calling for change. Schwimmer, who served on Murphy’s health care transition team, said integrated care increases patient access, improves their outcomes and reduces the stigma around mental health treatment.  

“We strongly support Commissioner Baston’s leadership in bringing forward the much-needed integrated health facility license. We need to reduce the regulatory barriers to integrated primary care and behavioral health services,” Schwimmer said last week. “We look forward to seeing the proposed regulations and anticipate working closely with the Department of Health to ensure that implementation moves forward as swiftly and smoothly as possible.” 

Schwimmer also praised the department’s choice of Susan Loughery, who was hired in March as deputy director for the Division of Behavioral Health Services. Loughery comes from Catholic Charities, where Schwimmer said she was a champion of primary care.

In addition, Baston said the department is seeking an additional $540,000 in the coming fiscal year — out of the $1.3 billion Gov. Phil Murphy allocates to the Health Department in his $56 billion budget proposal, which lawmakers must approve by July — to enhance the health services branch, which is responsible for licensing and inspections. More staff allows for more efficient reviews, she said, which hopefully will lead to more treatment options.  

While a relatively minor point in her comments, Baston made clear a single, integrated license is important. Nearly 3,000 people died from drug use last year — more than seven people a day — and while fatalities are trending downward overall, she said they continue to rise in Black and brown communities.  

“Any life lost to overdose is too many,” Baston said. “Our vision for New Jersey is that addiction will be treated like any other chronic disease, like high blood pressure or diabetes, and that anyone with substance-use disorder could walk into any clinic, emergency room or harm reduction center, at any time, on any day, and get access to lifesaving interventions and medications.”