- The American Hospital Association (AHA) is pushing for passage of HR 3545, the Overdose Prevention and Patient Safety Act, which would curb data privacy rights under 42 Code of Federal Regulations (CFR) Part 2 that prevent healthcare providers from sharing information on a patient’s substance abuse history unless the patient gives consent.
42 CFR Part 2 is designed to protect the confidentiality of people who seek treatment for drug or alcohol abuse. It restricts the disclosure of patient records concerning addiction treatment by any federally assisted alcohol and drug abuse program without the express written consent of the patient. Since most programs receive federal assistance or use a federally controlled substance for detoxification and treatment, the rule has widespread application.
But the AHA believes that the stricter confidentiality requirements under 42 CFR Part 2 than under HIPAA have a negative effect on medical treatment of individuals who are undergoing or have undergone addiction treatment.
“Clinicians treating patients for any condition need access to their complete medical histories, including information related to any substance use disorder (SUD), to ensure their patients’ safety, and delivery of the highest quality care,” observed a letter sent by AHA Executive Vice President Thomas P. Nickels to the chairman and ranking member of the House Energy and Commerce Committee, Rep. Greg Walden (R-Ore.) and Rep. Frank Pallone Jr. (D-NJ).
“Partitioning a patient’s record to keep SUD diagnoses and treatments hidden from the clinicians entrusted to care for the patient, as required by 42 CFR Part 2, is dangerous for the patient, problematic for providers and contributes to the stigmatization of mental and behavioral health conditions,” Nickels wrote.
In a statement issued on its website, AHA urged the committee to take up the bill as part of two days of hearings on bills addressing the opioid crisis through Medicare and Medicaid coverage and payment policies. However, HR 3545 was not one of the bills listed by the committee for discussion during the hearings.
HR 3544 would align 42 CFR Part 2 regulations with HIPAA and also strengthen protections to prevent patient data disclosures that could lead to potential harmful outcomes to the patient.
Rep. Tim Murphy (R-Pa), who introduced the bill, explained its purpose this way: "Right now, information about a patient’s addiction treatment is prohibited from being shared with doctors. This deadly segregation of medical records is wreaking havoc on our nation’s ability to respond to the ongoing opioid crisis." Murphy has since retired from Congress.
In his letter, Nickels gave this example: “We have heard concerns from obstetricians who specialize in treating pregnant women with SUD diagnoses and other clinicians who treat both the physical and SUD diagnoses of patients. To ensure compliance with 42 CFR, Part 2, as currently written, they must maintain two separate computers and two separate medical records.”
Without ready access to that information, an emergency room might inadvertently prescribe an opioid to a patient suffering from opioid addiction, he explained.
“The importance of coordinated care for patients in treatment for opioid use disorder cannot be overstated, and 42 CFR Part 2, enacted more than 40 years ago, is a major barrier to such care,” Nickels stressed.
AHA is one of more than 30 healthcare organizations that have joined together in the Partnership to Amend 42 CFR Part 2. The partnership sent a letter last year to Murphy and Rep. Earl Blumenauer (D-Ore.), a cosponsor of the bill, supporting their efforts.
“We are pleased that your bill would align Part 2 with HIPAA’s consent requirements for the purposes of TPO [treatment, payment, and operations], which will allow for the appropriate sharing of substance use disorder records to ensure persons with opioid use disorder and other substance use disorders receive the integrated care they need,” the partnership wrote.
The group stressed that the final rule issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) did not go far enough in improving access to records of SUD patients. That is why legislation is needed to change the law.