April 11, 2016
Ms. Kana Enomoto
Substance Abuse and Mental Health Services Administration
5600 Fishers Lane
Rockville, MD 20852
RE: Comments on Confidentiality of Substance Use Disorder Patient Records Proposed Rule (SAMHSA-4162-20)
Dear Ms. Enomoto:
The Association for Community Affiliated Plans (ACAP) is an association of 56 not-for-profit Safety Net Health Plans in 26 states that serve more than 15 million Americans in Medicaid, Medicare, the Children’s Health Insurance Program, and low-income persons receiving coverage through the health insurance Marketplaces. As you know, there is a much higher prevalence of people suffering from SUD within the Medicaid and low-income population than in the general population. As such, this issue is of particular importance to health plans and providers seeking to provide the most effective and efficient care to this high-need population. We appreciate this opportunity to comment on the proposed changes to 42 CFR Part 2 on the confidentiality of substance use disorder (SUD) patient records.
States and the Federal government have turned to managed care organizations (MCOs) to provide coordinated, integrated care for people with Medicaid, Medicare, and CHIP coverage. These MCOs integrate care to assess member needs, identify treatment gaps, engage members, develop individualized care plans, and coordinate care. These programs are particularly important to facilitate physical and behavioral health care and social services for enrollees with SUD.
Those who suffer from SUD and go untreated are among the highest utilizers of health care services, requiring twice as much health care as those without SUD being treated for the same disorders. Unfortunately, outdated federal regulations that predate the development of current models of care create significant barriers to holistic care for people with SUD. These barriers – found in 42 CFR Part 2 and requiring individualized and specific patient consent before federallyassisted providers and plans can disclose a SUD to coordinate care – undermine efforts to integrate behavioral and physical health services for people with SUD, ultimately leading to worse health outcomes. Moreover, we are genuinely concerned that in some instances the requirements of 42 CFR Part 2 (often referred to simply as “Part 2”) as currently exist and the proposed changes actually put patients in harm’s way.
ACAP strongly supports the privacy and confidentiality of members who live with a SUD. However, the federal requirement for patient consent for disclosure of Part 2 information has a 2 negative impact on patient health outcomes by undermining health plans and their provider networks’ ability to efficiently access the information they need about members with SUD, sharing that information when they receive it with the members’ care management team, and coordinating their care. Surely, the Administration does not intend to make it harder to coordinate services for people with SUD than other chronic conditions.