eSolutions: Substance Abuse Treatment & Confidentiality
eSolutions is a monthly e-newsletter bringing you practical solutions and resources on primary and behavioral healthcare integration from across the United States.
Feature Article: Don’t Be Spooked
Quick Tips: Educating Patients on Information Sharing
New From CIHS
Navigating confidentiality challenges when integrating mental health, substance abuse, and primary care
Kathy Reynolds, Executive Director, CIHS
Confidentiality is one of the key challenges facing bidirectional integrated healthcare partnerships. The Health Information Portability Act (HIPAA), 42 CRF Part2, and state-based confidentiality policies can all be addressed effectively for the partnership to safely and confidently share information. Contrary to popular belief, information can be shared across agencies when proper precautions are taken. Clearly, any policies and/or procedures you consider adopting in this area must be approved by your privacy officer, corporation counsel, and/or HIPAA Privacy and Security Committees.
The Health Insurance Portability and Accountability Act (HIPAA) does allow the sharing of information between organizations for the purpose of healthcare coordination. In order to feel comfortable with sharing information under HIPAA, partnering organizations often become Organized Health Care Delivery Systems (OHCDS). Section 160.103 of HIPAA describes this arrangement. Specifically the law allows:
"A clinically integrated care setting in which individuals typically receive health care from more than one health care provider or an organized system of health care in which more than one covered entity participates, and in which the participating covered entities:
- Hold themselves out to the public as participating in a joint arrangement; and
Participate in joint activities that include at least one of the following:
- Utilization review, in which health care decisions by participating covered entities are reviewed by other participating covered entities or by a third party on their behalf;
- Quality assessment and improvement activities, in which treatment provided by participating covered entities is assessed by other participating covered entities or by a third party on their behalf; or
- Payment activities, if the financial risk for delivering health care is shared, in part or in whole, by participating covered entities through the joint arrangement and if protected health information created or received by a covered entity is reviewed by other participating covered entities or by a third party on their behalf for the purpose of administering the sharing of financial risk.”
To become an OHCDS, the respective chief executive officers send letters to each other confirming their intent to hold themselves out as an OHCDS and identifying the utilization review or quality assessment and improvement activities in which they will jointly participate. To solidify this arrangement organizations often change their privacy statements to reflect the OHCDS and may add language to all consents for treatment reflecting their partnerships and with whom they will be sharing healthcare information.
42 CFR Part II defines the parameters for sharing substance information for organizations that hold themselves out as substance abuse treatment providers. The Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment actively addresses issues related to the sharing of substance abuse treatment information under 42 CFR Part II. If organizations enter into a Qualified Service Agreement (QSA), they are often able to share substance abuse information for healthcare coordination. Key resources to review as you develop a QSA include SAMHSA’s Frequently Asked Questions: Applying the Substance Abuse Confidentiality Regulations to Health Information Exchanges and The Confidentiality of Alcohol and Drug Abuse Regulation and the HIPAA Privacy Rule: Implications for Alcohol and Drug Abuse Programs- June 2004. The latter is a valuable review of the linkages between HIPAA and 42 CFR Part II and helps agencies understand the elements of a QSA.
Your state-defined confidentiality rules and regulations are a third key element in sharing information within a bidirectional integrated health delivery system. Your state mental health code or state alcohol and drug abuse agency may impose additional confidentiality protections that must be addressed. These must be linked with the HIPAA and 42 CFR Part II to create an overarching policy for information sharing. States are addressing these issues every day as integration projects move forward. View a sample integrated mental health, substance abuse, and primary care services confidentiality policy.
Lastly, a diagram published in Raising the Bar: Moving Toward the Integration of Healthcare
provides a succinct look at how the three sets of rules and regulations integrate with other items such as business associate agreements, individual and group release of information forms, privacy statements, individual consents for treatment, and professional ethics. Raising the Bar is available from the National Council for Community Behavioral Healthcare.
In the end, confidentiality laws, regulations, and policies do not preclude the sharing of information for care coordination. If you need more information on confidentiality or assistance addressing confidentiality issues, review CIHS’ confidentiality resources or contact CIHS for technical assistance.
Privacy and confidentiality concerns shouldn’t stop addiction, mental health, or primary care providers from providing quality care to patients. Instead of viewing confidentiality as a barrier, focus on educating patients on information sharing to ensure better quality services. CIHS Health Information Technology Director Mike Lardiere shared a few tips to help you navigate information sharing, including:
- Education patients about informed consent and the importance of sharing information among their other healthcare providers at the time of service. Such communication may prevent many patients from opting out.
- Respect the requests of patients who opt out of sharing their information.
- Implement the use of routine consent forms that include each necessary organization or provider, as well as all information required by state and federal laws and regulations, and make it known to patients. When asking patients to sign consent forms, again, make sure to explain why sharing such information sharing is so important.
- Encourage your patients to expect communication, collaboration, shared treatment plans, and joint decision making from you and their other providers.
- Be transparent.
For more information or technical assistance, visit CIHS or call 202.684.7457.
CIHS Releases New Guide for Providers on the National Health Service Corps
Understanding the National Health Service Corps: A Guide for Community Behavioral Health Providers and Primary Care Partners provides guidance to behavioral health sites interested in applying to become NHSC-approved sites, as well as information for providers interested in participating.
CIHS Releases Strategies to Strengthen the Workforce
Primary and Behavioral Health Integration: Guiding Principles for Workforce shares strategic recommendations to strengthen the behavioral healthcare workforce, as well as articulates the guiding principles for action planning.
National Health Service Corp Triples in Size
The National Health Service Corp plays an important role in addressing the country’s healthcare workforce shortage and is expanding to help meet the need for practitioners. In fact, the U.S. Department of Health and Human Services (HHS) announced this week that NHSC tripled in size in 2011.
Integrated Care Resource Center Brief Highlights Model Integration Options
State Options for Integrating Physical and Behavioral Health Care, a new analysis from CMS’ Integrated Care Resource Center (CHCS), explores promising options for integrating general and behavioral health services within coordinated delivery systems, including examples of current state programs and critical considerations for implementation. It details four models for integration, including: (1) managed care organizations (MCOs); (2) primary care case management programs (PCCMs); (3) behavioral health organizations (BHOs); and (4) MCO/PCCM and BHO partnerships. CHCS will also host a webinar on November 15, 2-3:30 pm (ET) to address three states’ strategies for integrating the full range of physical and behavioral health services. For more information, visit CHCS.
New Multi-Media Resources Cover 100+ Topics
Healthy Roads Media provides access to basic health information on over 100 topics in multiple formats, including web-based videos, iPod videos, handouts, and audio. Information is provided in up to 19 different languages and is easy to understand.
Briefs Examine Each State’s Progress in Setting Up Health Insurance Exchanges
A new series of Kaiser Family Foundation briefs examines states' progress in setting up the state-based health insurance exchanges through which millions of Americans are expected to purchase coverage under the Affordable Care Act. The exchanges, a key component of the law that must be operational by 2014, will offer consumers a selection of qualified health insurance options and will provide subsidies to eligible individuals to make coverage more affordable. These briefs review progress.
Today Marks the Start of Drug Facts Week
National Drug Facts Week is this week. This National Institute on Drug Abuse-sponsored health observance encourages teens to get factual answers from scientific experts about drugs and drug abuse, and works toward debunking myths about drugs and drug abuse. For more information and resources, visit National Drug Facts Week.
Visit the CIHS website regularly for upcoming webinars. Also, Check out CIHS’ webinar recordings and presentations:
Building Behavioral Health Capacity through the National Health Service Corps
Recorded: October 25, 2011
This webinar provided an overview of the National Health Service Corps, explained the application process, and shared providers’ first-hand experiences with the program. It also discussed how CIHS’s new manual, Understanding the National Health Service Corp: A Guide for Community Behavioral Health Providers and Primary Care Partners, can help providers implement or sustain integrated care.
Coordinated Care for Homeless Populations
Recorded: September 22, 12:00-1:30
Brief Behavioral Health Interventions in Primary Care
Recorded: September 14, 2011
Establishing Smoking Cessation Initiatives in Health Centers
Recorded: August 15, 2011
Introduction to Effective Behavioral Health Service Delivery in Primary Care Settings
Recorded: June 1, 2011
Person-Centered Health Homes
Recorded: May 16, 2011
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Our free technical assistance services can help primary and behavioral healthcare providers find integrated health solutions that work. To contact CIHS, visit www.integration.samhsa.gov, e-mail Integration@thenationalcouncil.org, or call 202.684.7457.
SAMHSA–HRSA Center for Integrated Health Solutions
Director: Kathy Reynolds; Deputy Directors: Laura Galbreath and Larry Fricks eSolutions Editor: Heather Cobb
The SAMHSA-HRSA Center for Integrated Health Solutions, operated by the National Council for Community Behavioral Healthcare under a cooperative agreement from the U.S. Department of Health and Human Services, is funded jointly by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration. The CIHS promotes the development of integrated primary and behavioral healthcare services to better address the needs of people with mental health and substance use conditions, whether seen in specialty behavioral health or primary care settings.