Coalition Letter to Align 42 CFR Part 2 With HIPAA to Allow Appropriate Access to Patient Information That is Essential for Providing Whole-Person Care

“We applaud this effort to expand the care team’s ability to coordinate appropriately and deliver high-value, accessible care – as well as steps to enhance trust between patient and clinicians. If behavioral health and substance use disorder treatment are going to be effectively integrated into a team-based system empowering patients and their primary care clinicians to manage both physical and behavioral health, we need to move forward on passage to allow better sharing of health information for persons in these treatment programs.” -- Ann Greiner, President and CEO, Patient- Centered Primary Care Collaborative

PARTNERSHIP TO AMEND 42 CFR PART 2

A COALITION OF NEARLY 50 HEALTH CARE STAKEHOLDERS COMMITTED TO ALIGNING 42 CFR PART 2 (PART 2) WITH HIPAA FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS (TPO) TO ALLOW APPROPRIATE ACCESS TO PATIENT INFORMATION THAT IS ESSENTIAL FOR PROVIDING WHOLE-PERSON CARE.

March 1, 2019
The Honorable Lamar Alexander, Chairman
Senate Committee on Health, Education, Labor, and Pensions
428 Dirksen Senate Office Building
Washington, DC 20510

Dear Chairman Alexander:

On behalf of the Partnership to Amend 42 CFR Part 2 (Partnership), I appreciate the opportunity to respond to your request for recommendations to help address America’s rising health care costs.

The Partnership is a coalition of nearly 50 national health care organizations representing a range of stakeholders, including patients, clinicians, hospitals, biopharmaceutical companies, pharmacists, electronic health record (EHR) vendors, and insurance providers. The Partnership is committed to aligning 42 CFR Part 2 (Part 2) with the Health Insurance Portability and Accountability Act (HIPAA) for the purposes of treatment, payment, and health care operations (TPO) to allow appropriate access to patient information that is essential for providing whole-person care while protecting patient privacy. See attached position paper for more information and a full list of Partnership members.

As you address the rising health care costs in this country, modernizing Part 2 – by aligning it with HIPAA for TPO – will reduce barriers to innovation and coordinated care, thereby contributing to decreased health care costs, particularly for substance use disorders (SUD).

Part 2, Federal Confidentiality of Substance Use Disorder Patient Records, sets requirements limiting the use and disclosure of patients’ substance use records from certain substance use treatment programs. Patients must submit written consent prior to the disclosure of their SUD record. Obtaining multiple consents from the patient is challenging and creates barriers to whole-person, integrated approaches to care, which are part of our current health care framework. In situations where the patient does not give consent, Part 2 regulations may lead to a doctor treating a patient and writing prescriptions for opioid pain medication for that individual without knowing the person has a SUD. Separation of a patient’s addiction record from the rest of that person’s medical record creates obstacles and prevents patients from receiving safe, effective, high quality substance use treatment and coordinated care.

Part 2 was created to reduce stigma associated with SUDs and encourage people to seek treatment without fear of prosecution by law enforcement. These important goals can still be addressed while modernizing the regulations. Part 2 is not compatible with the way health care is currently delivered; and in order to bring the regulations in line with 21st Century health care, Part 2 needs to harmonize with HIPAA to allow for the transmission of SUD records without written consent for TPO. This will promote integrated care and enhance patient safety, protect against prosecution by law enforcement, and provide health care professionals with one federal privacy standard for all of medicine.

Health care is constantly evolving, and our coalition members are able to use technology and data to improve care delivery and outcomes and reduce costs for the toughest chronic diseases, with the exception of SUDs. The ability to share patients’ entire medical records by aligning Part 2 with HIPAA for TPO will lead to better health care, reduced costs, and improved safety.

Last year, the House of Representatives passed the Overdose Prevention and Patient Safety (OPPS) Act, H.R. 6082, by an overwhelmingly bipartisan vote of 357-57. This bill would align Part 2 with HIPAA for TPO and strengthen protections against the use of addiction records in criminal, civil, or administrative proceedings. This bill further amplifies patient protections by incorporating antidiscrimination language, significantly enhanced penalties for any breach of a person’s substance use record, and breach notification requirements. Senators Shelley Moore Capito (R-WV) and Joe Manchin (D-WV) have championed this issue in the Senate, and they plan to introduce the language from H.R. 6082 this year. The Administration has also indicated that it will be addressing Part 2 as the last phase of the Department of Health and Human Services’ (HHS) “regulatory sprint”.

Thank you for considering our recommendation. If you have any questions, please contact me at (202) 449-7660 or klein@abhw.org.
Sincerely,

Rebecca Murow Klein, Chair
Partnership to Amend 42 CFR Part 2
Attachment: Partnership to Amend 42 CFR Part 2

Academy of Managed Care Pharmacy ∙ Alliance of Community Health Plans ∙ American Association on Health and Disability ∙ American Dance Therapy Association ∙ American Health Information Management Association ∙ American Hospital Association ∙ American Psychiatric Association ∙ American Society of Addiction Medicine ∙ American Society of Anesthesiologists ∙ America’s Essential Hospitals ∙ America’s Health Insurance Plans ∙ AMGA ∙ Association for Ambulatory Behavioral Healthcare ∙ Association for Behavioral Health and Wellness ∙ Association for Community Affiliated Plans ∙ Association of Clinicians for the Underserved ∙ Blue Cross Blue Shield Association ∙ The Catholic Health Association of the United States ∙ Centerstone ∙ College of Healthcare Information Management Executives ∙ Confidentiality Coalition ∙ Corporation for Supportive Housing ∙ Employee Assistance Professionals Association ∙ Global Alliance for Behavioral Health and Social Justice ∙ Hazelden Betty Ford Foundation ∙ Health Innovation Alliance ∙ Healthcare Leadership Council ∙ InfoMC ∙ The Joint Commission ∙ The Kennedy Forum ∙ Medicaid Health Plans of America ∙ Mental Health America ∙ National Alliance on Mental Illness ∙ National Association for Behavioral Healthcare ∙ National Association for Rural Mental Health ∙ National Association of ACOs ∙ National Association of Addiction Treatment Providers ∙ National Association of Counties ∙ National Association of County Behavioral Health and Development Disability Directors ∙ National Association of State Mental Health Program Directors ∙ National Rural Health Association ∙ Netsmart ∙ OCHIN ∙ Otsuka America Pharmaceutical, Inc. ∙ Patient-Centered Primary Care Collaborative ∙ Pharmaceutical Care Management Association ∙ Premier Healthcare Alliance ∙ Smiths Medical ∙ Strategic Health Information Exchange Collaborative