An arm of the U.S. Department of Health and Human Services (HHS) may have started a major new fight between patient privacy advocates and substance abuse benefits managers.
The agency, the Substance Abuse and Mental Health Services Administration (SAMHSA), has updated the regulations that govern what exactly happens when patients seek care for problems with tobacco, alcohol or other substances and then sign blanket information release forms.
SAMHSA officials say lawful holders of the patients’ information can share the patient’s information with a wide range of entities involved in paying insurance claims, including billers, medical necessity reviewers, fraud fighters, customer service representatives and insurance underwriters, and those entities’ subcontractors.
SAMHSA says it put that list in the introduction to the regulation, rather than in the official text of the regulation, because it wants the list of entities that can get the information to be flexible, to accommodate changes in how health plans work.
But SAMHSA is not letting lawful information holders share a patient’s information with care coordinators or case managers without getting separate, express consent from the patient.
The patients should be able to decide which of their providers get information about their substance use problems, SAMHSA officials write in the introduction to the official text of the final rule.
The patient’s blanket permission form covers payment and health care operations, but it’s “not intended to encompass substance use disorder patient diagnosis, treatment or referral for treatment,” SAMHSA officials say.
The final rule “is not intended to cover care coordination or case management, and disclosures to contractors, subcontractors, and legal representatives to carry out such purposes are not permitted under this section,” officials write.
SAMHSA is getting ready to publish the final rule in the Federal Register, the U.S. government’s official vehicle for distributing regulations, Wednesday.
A preliminary copy of the final rule is available here.
For three more facts about the final regulations, read on.