42 CFR Part 2 Updates Would Improve Access To Care Without Compromising Patient Privacy

Mental Health America and Netsmart urge Congressional action to streamline consent process for new models of healthcare

Mental Health America (MHA) and Netsmart recently announced their support for legislation in Congress that would update decades-old 42 CFR Part 2 regulations to streamline the patient consent process for sharing addiction treatment information with their healthcare providers.

“You can’t treat the ‘whole person’ with half the data,” said Paul Gionfriddo, president and CEO of MHA. “It’s critical that these regulations be updated to permit the sharing of addiction treatment medical records, with patient consent, in new integrated care settings like Health Information Exchanges (HIEs), Accountable Care Organizations (ACOs), and Medicaid Health Homes.”

Current complex patient consent requirements make it difficult or impossible for patients and providers in these care settings to share patient data related to substance use disorders (SUD) and co-occurring physical and behavioral health conditions.

In April 2015, the New England Journal of Medicine noted that 42 CFR Part 2 makes it “difficult or impossible” to share addiction medical records [and associated mental health records] among doctors and other health care professionals in Health Information Exchanges (HIEs), some of which are funded under the HITECH Act. NEJM stated that similar problems occur among Medicare ACOs where – in sharing claims data with ACOs – the Centers for Medicare and Medicaid Services (CMS) must redact all records containing substance use treatment information, and in the implementation of the 19 state Medicaid Health Homes.

“Misinformation is rampant about these proposed changes,” said Kevin Scalia, executive vice president, Netsmart. “Patient privacy will still be protected, while consent procedures will be streamlined, enabling people to experience the full benefits of coordinated, integrated care. Patients will still be required to provide consent for their records to be shared with providers, and they could still opt out at any time.”

Besides continued safeguards under 42 CFR Part 2, additional protections for alcohol and SUD treatment information is provided under the Health Insurance Portability and Accountability Act (HIPAA), HIPAA Privacy and Security Regulations, applicable state laws and ethical codes, and federal and state employment laws.

Netsmart and MHA released a memorandum outlining HIPAA protections for SUD information.

Outdated 42 CFR Part 2 regulations are also a concern for patient safety. In a letter to the leadership of the Health Energy and Commerce Committee, the Patient Safety Movement expressed the need for 42 CFR Part 2 changes in the context of a “technology-enabled healthcare system that treats all patients equally, particularly those with substance abuse or mental health problems.” The letter points out that individuals with mental health or SUD often suffer from co-morbidities, and may be prescribed different medications by several different providers.

The letter states that without a way to effectively manage these individuals’ care, they are at a significantly higher risk for adverse events, particularly when mental health and substance abuse patients are unable to benefit from the modern tools that coordinate other patients’ care, such as HIEs.

Several bills that include 42 CFR Part 2 reform provisions have been introduced in the House and Senate.

Last week, the Senate Health, Education, Labor and Pensions Committee held a markup of the Mental Health Awareness and Improvement Act, S. 1893, a mental health reform bill from Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA). The bill requests a GAO report on 42 CFR Part 2, as well as the federal requirements impacting access to mental health and substance use disorder treatment related to integration with primary care, administrative and regulatory issues, quality measurement and accountability, and data sharing.

Also pending hearings in the Senate is the Mental Health Reform Act of 2015, S. 1945, introduced by Sen. Chris Murphy (D-CT) and Sen. Bill Cassidy (R-AL), which also includes provisions for 42 CFR Part 2 consent reform.

In the House, the Helping Families in Mental Health Crisis Act of 2015, H.R. 2646, introduced by Rep. Tim Murphy (R-PA) and Rep. Eddie Bernice Johnson (D-TX), includes provisions for 42 CFR Part 2 consent reform.

MHA has not endorsed S. 1945 or H.R. 2646, but sees both pieces of legislation as a solid start in addressing mental health reform. MHA provided the following feedback on the bills: on H.R. 2646, and on S. 1945.

Netsmart supports 42 CFR Part 2 legislative reform provisions in H.R. 2646 and S. 1945, and the GAO report called for in S. 1893.

About Mental Health America
Mental Health America (MHA) – founded in 1909 – is the nation’s leading community-based nonprofit dedicated to helping all Americans achieve wellness by living mentally healthier lives. Our work is driven by our commitment to promote mental health as a critical part of overall wellness, including prevention services for all, early identification and intervention for those at risk, integrated care and treatment for those who need it--with recovery as the goal.

About Netsmart
Netsmart is healthcare’s largest post-acute EHR provider, and is committed to helping health and human services providers deliver coordinated, integrated, outcomes-based services and care. Netsmart serves more than 20,000 clients across all 50 states, resulting in approximately 450,000 users of its software and technology solutions. Netsmart clients include mental health and addiction services agencies, health homes, psychiatric hospitals, private and group mental health practices, public health departments, social services and child and family services agencies, managed care organizations, and vital records offices.

Netsmart’s CareFabric, a framework of innovative clinical and business solutions and services, supports integrated, coordinated delivery of health services across the spectrum of care.

Netsmart’s HIT Value Model, a vendor-agnostic planning and measurement system, provides a path for health and human services organizations to evaluate where on the healthcare IT spectrum they should focus their efforts, the value associated with that strategic decision and a comparison with peer organizations nationwide.

Netsmart is pleased to support the EveryDay Matters Foundation, which was established for behavioral and public health organizations to learn from each other and share their causes and stories. For more information, visit www.everydaymatters.com.