Integration of Behavioral and Physical Health Care: Licensing and Reimbursement Barriers and Opportunities in New Jersey

Abstract

People with behavioral health conditions suffer from missed health care opportunities. Research has shown that people with serious mental illness suffer from increased burdens of sickness and early death as a result of poorly managed physical illness. People with less significant behavioral conditions too often remain unconnected to mental health or substance use disorder care because such services are unavailable in primary care settings. Clinicians responding to these system deficits advocate care integration through bringing primary care and behavioral health under one roof.

Innovative New Jersey clinicians have worked toward behavioral health integration. The clinical difficulties such integration entails can be daunting, but models from around the country, as well as home-grown efforts, point the way toward success. The Nicholson Foundation has funded several care integration efforts around New Jersey. Clinicians reported, however, that their efforts are impeded by legal barriers in New Jersey’s licensure and reimbursement systems. The Nicholson Foundation asked Seton Hall Law School’s Center for Health & Pharmaceutical Law & Policy to examine those legal barriers, and to propose solutions that would facilitate appropriate behavioral health integration.

This Report reviews the clinical behavioral health literature and describes the statutory and regulatory law on licensure and reimbursement. It reflects extensive conversations with many primary care and behavioral health providers, academics, advocates, and government representatives.

The goals of this Report are several. First, the statutory and regulatory framework is complex, and the regulated community experiences confusion that impedes efforts to extend care. One goal, therefore, is to describe in clear terms both the “black letter” law and, equally as important, authoritative interpretations of that law as applied to behavioral health integration.

Second, the Report describes those instances in which current law impedes the development of integrated care. In some instances New Jersey law appears to lag the clinical developments in this area, suggesting that modifications in the law could benefit all. This Report details such areas in the licensure and reimbursement areas.

Finally, this Report offers recommendations for adjustments to the regulatory framework governing reimbursement and licensure, which recommendations are intended appropriately to balance the consumer protection missions of the Departments of Human Services and Health on the one hand with the imperative to facilitate the move to clinically integrated behavioral health and primary care services.

Keywords: behavioral health integration, barriers, coordinated care, primary and behavioral health integration