P&P August 2016

legislative update

By Leigh Edwards

APHSA Issues Comment on Confidentiality of Substance Use Disorder Patient Records NPRM

I n February, the U.S. Department of Health and Human Services (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) published the §42 CFR Part 2 Confidentiality of Substance Use Disorder Patient Records Notice of Proposed Rule Making (NPRM), or “Part 2,” in the Federal Register. The NPRM aims to modernize and update the regulations at §42 CFR Part 2 to afford patients with substance use disorders (SUDs) the opportunity to benefit from emerging multiservice care models that require enhanced exchange of health information. In 1970, Congress passed the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act, and in 1972, passed the Drug Abuse Prevention, Treatment, and Rehabilitation Act; these applied general rules establishing the con- fidentiality of alcohol abuse patient records to drug abuse patient records. In 1987, the HHS secretary issued regu- lations, referred to as “Part 2,” that describe the circumstances in which information about a substance abuse patient’s treatment could be disclosed and used, with or without a person’s consent. While the two acts and Part 2 regulation limited the availability of substance abuse records to insure that patients in a treatment program are not more vulnerable with regard to their privacy than those who do not seek treatment, SAMHSA noted that the new proposal is necessary because of the significant changes that have occurred over the past 25 years. The current regulations are not aligned to fit the advances in the U.S. health care delivery system,

Among APHSA’s recommendations were that SAMHSA: „ „ Expand the definition of “Treatment Provider Relationship” to encompass the full care con- tinuum, explicitly including those providing related social services as part of that relationship. Human or social service providers, in addition to substance use, medical, mental health, and developmental disability/intellectual disability providers, may all be involved in different aspects of an individual’s care plan, and as such, a part of promoting recovery, resiliency, and ensuring the safety of individuals living and dealing with substance use. With the appropriate safe- guards, access to this information has the potential to enable a better

including new models of integrated care, and could put patients at risk of adverse consequences surrounding privacy protections. The proposal was also prompted to make the regula- tions more understandable and less burdensome. Developed through state and local members of APHSA’s National Collaborative for Integration of Health and Human Services, as well as other affinity groups of the association, APHSA submitted formal comments to the NPRM noting the overall align- ment of the NPRM with APHSA’s policy and practice framework, Pathways . 1 Pathways outlines the desired future state of a transformed health and human service system. In doing so, the NPRM takes a step forward, toward enhancing the provision of holistic services for individuals with SUDS and balancing important security with privacy concerns.

See Confidentiality on page 41

Illustration via Shutterstock

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August 2016 Policy&Practice