Dear NH Professionals,
The NH Alcohol & Drug Abuse Counselors Association is gravely concerned about the proposed changes to the regulations governing the confidentiality of alcohol & drug abuse patient records.
42 C.F.R. Part 2’s core privacy protections MUST be maintained. While behavioral health care should be integrated with physical health care, and communication between health care providers should be encouraged, the regulations’ protections are as necessary today as they were when they were issued in the 1970s in light of ongoing stigma and discrimination faced by people with substance use disorders.
42 C.F.R. Part 2 enables people with substance use disorders to seek treatment without fear of exposure of their treatment records—without their permission—to law enforcement, employers, insurers, other health care providers, or others. Changes to the regulations would threaten these critical patient protections.
We submit the letter below with our concerns.
Dianne Pepin, MEd., MLADC
June 23, 2014
NH Alcohol & Drug Abuse Counselors Association
130 Pembroke Road, Suite 100
Concord, NH 03301
U.S. Substance Abuse and Mental Health Services Administration
1 Choke Cherry Road
Rockville, MD 20857
RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913.
To Whom It May Concern:
The NH Alcohol & Drug Abuse Counselors Association (NHADACA) is a non-profit membership organization of approximately 220 members. Since 1986, NHADACA has worked to advance the addiction profession in New Hampshire. We accomplish our mission through education and advocacy. By providing relevant, quality training on substance abuse treatment, intervention and prevention NHADACA has improved the skills of working addiction professionals and those preparing to enter the profession. NHADACA is an affiliate of NAADAC, the National Association of Addiction Professionals, a national leader in setting standards for the treatment and prevention of addictive disorders and for the training and qualifications of professionals.
While NHADACA supports updating the mechanics of the federal alcohol and drug confidentiality regulations to facilitate more effective integration of care and needed communication in the electronic age, 42 C.F.R. Part 2’s core privacy protections MUST be maintained.
We provide ethics and confidentiality trainings for persons working within the substance abuse professions as well as other professions that have involvement with alcohol and drug-impacted or addicted persons. The frustration that some people experience when they cannot get the information they want immediately or without a release of information is minor in comparison to the security and protection the regulations afford alcohol and drug abuse patients. It is vital to keep these legal regulations in or to best assure clients that their privacy concerns are respected.
With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 2014 Notice of Public Listening Session (79 Fed. Reg. 26929), the NH Alcohol & Drug Abuse Counselors Association supports the following principles:
- Addiction treatment should be integrated with mental and physical health care, and communication among health care providers should be encouraged. We support maximizing inclusion of substance use disorder (SUD) records in electronic health record (EHR) systems and health information exchanges (HIEs) while maintaining 42 C.F.R. Part 2’s core privacy protections.
- 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were when they were enacted more than 40 years ago, and a move toward HIPAA’s looser privacy standards would not sufficiently protect people seeking and receiving substance use disorder treatment. If patient records can be easily accessed in order to criminally investigate or prosecute or patient, or deny them insurance or a job, or be used against them in a divorce or child custody proceeding, many patients will be afraid to enter treatment in the first place.
- We agree with the Legal Action Center in the belief that patients in alcohol and drug programs should retain the power to decide when and to whom their records are disclosed, even for treatment and payment purposes, given the continued prevalence of discrimination in our society. This includes disclosures to the general health care system, HIEs, health homes, ACOs, and CCOs. The best way for patients to retain that power is by requiring patient consent for most disclosures, together with a strong prohibition on redisclosure.
- It is both necessary and technologically possible to integrate addiction and other health care and effectively exchange addiction treatment data while maintaining the core protections of 42 C.F.R. Part 2. We urge the continued development of technical solutions for consent management.
- Since HIPAA requires compliance with state and federal laws that mandate greater privacy protections, electronic health record systems (EHRs) must be designed so as to comply with the many state statutes that require heightened protections for information related to mental health, HIV/AIDS, reproductive health, domestic violence and other types of sensitive health information, as well as with 42 C.F.R. Part 2. It is important to keep in mind, therefore, that EHRs would be required to accommodate enhanced protections for the medical records of some illnesses in order to be HIPAA-compliant even if 42 C.F.R. Part 2 did not exist.
Thank you for your consideration.
Dianne Pepin, MEd., MLADC Peter DalPra, LADC, LCS
Executive Director President