After at least a decade of discussion and years drafting regulations, New Jersey is poised to revise its license requirements for outpatient treatment to allow for truly integrated outpatient care.

“This is a huge win for our residents and providers, one that has been years in the making,” Dr. Kaitlan Baston, New Jersey’s health commissioner, told lawmakers at a hearing on the Department of Health’s budget proposal last week.

Under the current system, behavioral health providers — who offer mental health and addiction treatments — face different licensing requirements than medical facilities, making it a challenge for clinics to offer all services under one roof. Facilities now need three separate licenses granted by two different state agencies to provide comprehensive care at a single location. And each license comes with its own regulations and inspection process.

As a result, patients are often forced to visit multiple places to receive complete care. Concerns have only grown in the wake of the COVID-19 pandemic, which increased rates of anxiety, depression and other mental health challenges nationwide.“Mental health is health. Patients deserve to get the care they need in a fully coordinated way, and without having to jump through unnecessary hoops of an overcomplicated system,” Baston said in a statement the department released early this month. The changes will improve patient outcomes and satisfaction, she said, and reduce health care spending.

Why streamline access to care?

The hope is that a single integrated care license will make it easier for clinical practices to offer a broader suite of services, so a patient seeking birth control could get help at the same office for PTSD, or vice versa.

In addition to streamlining the application process for providers, the reform will enable facilities to unify filing systems, treatment spaces and public entrances. Currently, providers must maintain separate files, rooms and doorways for behavioral health and medical patients, requirements that hinder integration. State officials expect to publish draft licensing regulations on April 21 after which the public will have 60 days to provide comment.

Ann Nguyen, a research professor with the Rutgers Center for State Health Policy who has studied integrated care efforts in New Jersey, said these requirements — especially the need for multiple licenses — have been a barrier to comprehensive care. Her team recently published findings in the Journal of the American Board of Family Medicine based on a six-year pilot program designed to expand behavioral care options at community clinics in New Jersey.

‘These regulations will reduce barriers and stigma around treating and receiving mental health.’ — Linda Schwimmer, New Jersey Health Care Quality Institute

“For some clinics, especially smaller ones, the cost and administrative hurdles weren’t worth it,” Nguyen told NJ Spotlight News in an email. The integrated care license is “a huge step forward in the right direction,” she said, and the need is clear. “Over 70% of primary care visits have a behavioral health component, so we aren’t treating the whole person unless we are treating both physical and behavioral health together,” Nguyen said.

A handful of health care providers — including Integrity House, a longtime behavioral health system based in Newark — have received waivers from the state enabling them to offer more integrated services. Experts say the integrated license could be a big help for people with serious mental health or addiction issues, who may have a trusted behavioral health provider but are uncomfortable visiting a primary care doctor they don’t know.

How the new system would work

Under the new system, these patients could receive diabetes care or flu shots when they come for psychiatric medications, for example. The new regulations would also codify changes included in a Health Department waiver designed to expand access to addiction medicine, officials said.

The integrated license is “a crucial step forward in enhancing our state’s behavioral health system and ensuring that all New Jerseyans receive the compassionate, coordinated care they deserve,” said Human Services Commissioner Sarah Adelman, whose department oversees behavioral care and collaborated with state health officials on the new regulations.

The news was also welcomed by leaders at the New Jersey Health Care Quality Institute, a nonprofit policy group that has long advocated for a single, integrated care license. In a November 2023 letter to Baston and signed by some three dozen stakeholders, the Quality Institute highlighted the “voluminous research over the past two decades” showing the benefits of comprehensive care.Work to develop an integrated care license has spanned multiple administrations, however. Waivers allowing for clinical space to be “shared” by medical and behavioral providers were first issued in 2015, the Quality Institute noted in its letter. In 2017, then-Gov. Chris Christie shifted regulatory oversight of mental health and addiction from Human Services to the Health Department, a move he said would make it easier to integrate care.

The Legislature also got involved, passing two separate laws aimed at encouraging integration, in 2017 and 2018, according to the Quality Institute. But officials at Human Services and the Health Department failed to draft the regulations needed by the deadlines listed in the laws, the letter noted. “Action must be taken without further delay,” the advocates wrote in 2023.

Linda Schwimmer, the Quality Institute’s president and CEO, said last week she was “thrilled that the day has come” and praised Baston and others for their work. “These regulations will reduce barriers and stigma around treating and receiving mental health. We look forward to reviewing the full proposal soon,” Schwimmer said in an email.