HHS hints at cutting 'onerous' substance abuse record rules

Rebecca Pifer@RebeccaMPifer

March 13, 2019

Dive Brief:

• HHS wants to reform a decades-old law protecting disclosure of medical records for patients with substance abuse disorder, Deputy Secretary Eric Hargan said in his Wednesday opening speech at AHIP's 2019 National Health Policy Conference.
• The regulations, known as 42 CFR 2 or simply Part 2, are meant to protect patient privacy and prevent discrimination. Under the 1975 federal law, federally assisted programs need patient consent before releasing their personal health information to family members, caregivers and other parties.
• "Reforming Part 2 and clarifying the many points of confusion around the regulation will be a boon to providers and payers," Hargan said. "Watch this space very carefully."

Dive Insight:

The legislation is intended to encourage individuals with SUD to enter and remain in treatment by combating patient fears around the social stigma, potential discrimination or legal consequences of drug and alcohol addiction. 

More than 130 Americans die every day from the opioid crisis, according to the National Institute on Drug Abuse.

"Just to put this in context, this is going to be the third year in a row we're going to see a lower life expectancy for Americans. The driver of this is the opioid crisis," Hargan said.

Industry has been vocal in its opposition to the confidentiality law, however, with critics of the regulations arguing it stops providers from being able to coordinate care. Part 2 has become more of a problem as silos between care have started to blur, Hargan said, noting that it's currently acting as a barrier to coordination of behavioral, mental and physical health services for a patient with SUD.

Experts, including the American Medical Association, back medication-assisted treatment for SUD. Since that route uses medications, counseling and behavioral therapies, an integrated care model is key. But Part 2 can heap "onerous" burden on a care team, Hargan said, and result in worse patient outcomes.

Congress has taken note. Reps. Markwayne Mullin, R-Okla., and Earl Blumenauer, D-Ore., are expected to introduce legislation in the House to align the SUD privacy scheme with the sweeping patient privacy law HIPAA sometime this month.

The Partnership to Amend 42 CFR Part 2, a 40-organization coalition that includes America's Health Insurance Plans and the American Hospital Association, also advocates for aligning Part 2 with less stringent HIPAA requirements to loosen restrictions to patient records. The Bipartisan Policy Center and the Healthcare Leadership Council also support the move.

Last year, the House of Representatives passed the Overdose Prevention and Patient Safety Act to do just that: make it easier for providers and payers to access patient information while stipulating penalties for unlawful use or disclosure. The bill stalled in the Senate.

Last week, 13 senators sent a letter to HHS secretary Alex Azar urging him to modernize Part 2. "The barriers presented by Part 2 can result in the failure to integrate services and can lead to potentially dangerous medical situations for patients," they wrote.

https://www.healthcaredive.com/news/hhs-hints-at-cutting-onerous-substance-abuse-record-rules/550403/