The Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), is seeking comments by April 11, 2016 on a proposed rule¹ to make significant changes to 42 CFR Part 2, the Confidentiality of Alcohol and Drug Abuse Patient Records (Part 2), which governs the substance abuse records of certain federally funded alcohol and drug abuse treatment programs (Programs).

Health information exchanges (HIEs), accountable care organizations (ACOs), clinically integrated networks (CINs) and other integrated/coordinated care entities that believe the current restrictions contained in Part 2 have hampered their efforts to improve quality of care and decrease costs through integration and coordination of care should consider the proposed changes carefully to determine whether the proposed rule adequately addresses the current barriers to necessary information sharing. These entities should carefully consider whether the general designation provisions in a consent form are sufficient to permit necessary data sharing and whether implementation of the accounting-like requirements will be operationally and financially feasible.

These entities should also evaluate whether the changes to the medical emergency exception are sufficient or whether additional guidance is needed. HIEs will need to evaluate whether the requirement to provide information about the medical emergency back to the Part 2 program immediately after the disclosure can be accomplished without incurring significant costs, or whether continuing to impose such requirements will effectively restrict HIEs from obtaining and transmitting critical Part 2 information to providers in a medical emergency.

Consent Requirements

The Part 2 regulations were written to encourage individuals with substance abuse disorders to seek needed treatment by protecting the information in their substance abuse records so that such individuals would not be made more vulnerable than individuals who do not seek treatment.

Medical Emergency Exception

Currently, many coordinated care entities rely on the current Part 2 medical emergency exception to obtain necessary Part 2 information in emergency circumstances. SAMHSA proposes to give providers more discretion in determining when a medical emergency exists such that a patient’s Part 2 information can be disclosed without prior consent. 

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^{1 81 Fed. Reg. 6988 (February 9, 2016); https://federalregister.gov/a/2016-01841}