On October 25, NACo submitted comments in response to the Notice of Proposed Rulemaking released by the Substance Abuse and Mental Health Services Administration (SAMHSA) under the U.S. Department of Health and Human Services (HHS), which would revise regulations under 42 CFR Part 2.
42 CFR Part 2 is a federal confidentiality law that restricts the disclosure of patient records connected to federally assisted alcohol and drug abuse programs, which include behavioral and mental health facilities that are county-owned and operated.
Under current 42 CFR Part 2 rules, when a person is identified as having a substance abuse disorder, no information, even confirmation that the person is being treated, may be released without a written authorization by the client or guardian. The Health Insurance Portability and Accountability Act (HIPAA) privacy rule, on the other hand, permits the disclosure of health information needed for patient care and other important purposes (i.e., coordination of care, consultation between providers and referrals). Continued lack of congruence between these two standards would lead to continued confusion over what can be shared and by whom. Moreover, patients are likely to face increased safety risks when providers are not able to access their complete records.
The proposed revisions released by SAMHSA intend to facilitate better coordination of care for substance use disorder (SUD) patients between health care providers and specialists and are an essential component of the federal response to the opioid epidemic. The revised rules would make it easier for patients to consent to the disclosure of their information to a wide range of entities and allows providers to note a patient’s treatment history directly on their electronic health record (EHR). Additionally, the rule aides in improving data sharing in the case of declared emergencies and makes allowances for states to share and access data on individuals being treated for opioid use disorder (OUD).
NACo urges SAMHSA to fully align Part 2 requirements with the Health Insurance Portability and Accountability Act (HIPAA) to further harmonize privacy provisions to protect individuals with substance abuse disorders so counties can continue to make advancements towards ending the substance use disorder crisis. Additionally, recognizing the importance of ensuring patient confidentiality, the comments call for clarification on how rule changes will impact privacy and protections for individuals seeking treatment at a Part 2 program.
Without additional changes to the proposed rule that fully align 42 CFR Part 2 with HIPAA, counties will not be able to fully provide coordinated, quality systems of care for people with substance abuse disorders while still protecting the patients right to treatment.
Additional resources on SAMHSA’s proposed rule:
- Confidentiality of Substance Use Disorder Patient Records (Federal Register rule text)
- HHS Proposes Rule to Modernize Data Sharing in Response to the Opioid Epidemic (Blog)
- Policy Brief: Enhance Counties’ Ability to Treat Mental Illness and Substance Abuse Disorders