Patient advocates cautioned HHS against loosening patient privacy protections surrounding substance use disorder records, warning it could lead people to avoid treatment.
The Substance Abuse and Mental Health Services Administration wants to change the rules to make it easier for providers to address the opioid crisis by removing barriers to coordinated care and allowing them to share more information about substance abuse patients. Comments on the proposed rulemaking were due Friday.
But patient advocates and treatment programs are skeptical that the rule changes will safeguard patient privacy. They think that loosening the restrictions is contrary to the rules' original intent.
"Congress enacted the legislation in the 1970s to encourage individuals with SUDs to enter and remain in treatment," said Mary Linden Salter, executive director of the Tennessee Association of Alcohol, Drug and other Addiction Services.
The advocates also worry that the changes would cause people with substance abuse issues to skip treatment, even if the changes are well-intentioned. They're especially worried about people in heavily policed neighborhoods such as communities of color, immigrant communities and low-income neighborhoods.
It "would lead to further disparate health outcomes for these populations and more unnecessary and harmful interventions with the criminal justice system," said Christine Martin, chairperson of the South Carolina Association for the Treatment of Opioid Dependence." Core protections against law enforcement access and re-disclosure of treatment information are just as critical today as they were" when the rules were enacted.
But providers, health plans, suppliers and state agencies expressed widespread support for the proposed changes because they would make it easier to coordinate care and less complicated to exchange information.
"Our hospitals, especially EDs, struggle with current policies that oftentimes impede our ability to "hand off" non-emergent (substance use disorder) patients to … providers in our communities," said Sarah Terrace, vice president and deputy general counsel of BJC HealthCare in St. Louis. "We believe the rule will greatly remedy this problem."
"One cannot manage a person's healthcare effectively without being aware of and accounting for the addictive, psycho-social and environmental conditions of that individual's circumstances," said David Schwartz, head of global policy for Cigna.
Supporters were keen to point out that while they're in favor of the proposed regulations, they want to make sure that they don't go too far in sacrificing patient privacy or conflict with other laws like HIPAA.
"Any disclosure of medical record information should be limited to information necessary to accomplish the purpose for which disclosure is made," said Dr. John Cullen, board chair of the American Academy of Family Physicians. "Electronic health information communication systems must be equipped with appropriate safeguards … to protect physician and patient privacy and confidentiality."
SAMHSA's proposed changes would increase information-sharing among providers, payers, federal and state agencies, and law enforcement, but require patient consent to share information in most situations. Some organizations don't think that patient consent should be necessary to share information because it could get in the way of providing care.
"We do have some concerns that the proposed rules are not flexible enough to cover the rapid pace of care coordination necessary to address (substance use disorder) treatment in our current environment," said the Tennessee Department of Finance & Administration, the agency that administers Tennessee's Medicaid program.
