SAMHSA Updating Substance Abuse Confidentiality Regs

Dr. Elinore F. McCance-Katz, the nation's first assistant secretary for Mental Health and Substance Use, said the new final rule will allow health care providers, with patients' consent, to more easily conduct activities such as quality improvement, claims management, patient safety, training, and program integrity efforts.

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) has published a final rule to update the Confidentiality of Substance Use Disorder Patient Records regulation, 42 CFR Part 2, saying the changes support payment and health care operations activities while protecting the confidentiality of patients. SAMHSA said the rule builds on changes to 42 CFR Part 2 made last year in a rule allowing patients to provide a general disclosure for substance abuse information, rather than limiting authorization to a specific provider.

The law protects the confidentiality of records relating to the identity, diagnosis, prognosis, or treatment of any patient records that are maintained in connection with the performance of any federally assisted program or activity relating to substance use disorder education, prevention, training, treatment, rehabilitation, or research. Under Part 2, a federally assisted substance use disorder program may release patient-identifying information only with the individual's written consent, pursuant to a court order, or under a few limited exceptions.

The Part 2 regulations were written in 1975 out of concern that the information could cause people to avoid seeking needed treatment. But the regulation as written required a patient to consent every time his or her data were shared or accessed, which health information exchanges and health care organizations have found very difficult to implement, according to the agency.

The agency's news release said Dr. Elinore F. McCance-Katz, the nation's first assistant secretary for Mental Health and Substance Use, said the new final rule will allow health care providers, with patients' consent, to more easily conduct activities such as quality improvement, claims management, patient safety, training, and program integrity efforts. "This final rule underscores our commitment to ensuring persons with substance use disorders receive integrated and coordinated care," she added.

Major provisions in the new rule include these:

  • It permits additional disclosures of patient-identifying information to certain contractors, subcontractors, and legal representatives for the purpose of conducting a Medicare, Medicaid, or CHIP audit or evaluation.
  • It will assist users of electronic health records by permitting use of an abbreviated notice of prohibition on re-disclosure more easily accommodated in EHR text fields.

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