Part 2 workarounds encumber safety net plans

A report by the Association for Community Affiliated Health Plans (ACAP), supports the position that 42 CFR Part 2, a federal rule meant to protect the privacy of patients with substance use disorders (SUD), continues to interfere with care coordination and can result in increased healthcare costs. ACAP represents members of safety net health plans.

More than 40 years after Part 2 was enacted, critics say it inhibits care for the most vulnerable patients. Nearly 12% of Medicaid patients had substance abuse disorders in 2011, and the numbers appear to be rising. Those with SUD utilize twice as many health services as those without, according to the ACAP report. 

“Our plans’ experience finds that these regulations are in some ways impeding patient care by segregating SUD records from the rest of the healthcare system,” says Margaret A. Murray, CEO of ACAP, which represents plans in 24 states. “This leads to worse health outcomes—and, ironically, may exacerbate the very stigma that the regulations intended to prevent for people receiving treatment for SUD.”

Working under a grant aimed at care coordination efforts, ACAP consequently found that Part 2 fails to recognize a stigma that can be associated with treating SUD conditions differently than other acute and chronic conditions. Patient harm can arise as a result of uncoordinated care.

ACAP believes HIPAA is sufficient protection that balances the need for privacy with the need for optimal care through coordinated clinical efforts.

Consent forms as routine protocol

Though some safety net plans are able to incentivize behavioral health providers and come up with protocols for Part 2, the majority find it difficult to get data access.

“Plans will continue with their best efforts to have SUD providers seek consents to share the information, as examples show,” Murray says. “But as we note in the paper, this is unwieldy and not 100% successful.”

Inland Empire Health Plan, serving Riverside and San Bernardino counties in California, has been able to release substance abuse records 80% of the time over the past six years. The health plan incentivizes primary care physicians to seek the Part-2-required explicit patient consent during initial visits for inclusion in treatment plans. Physicians are paid at an enhanced rate for that initial visit. 

L.A. Care Health Plan in Los Angeles County created a universal consent form that is presented to SUD patients when treated for substance use. The form is used by hospitals, primary care physicians and behavioral healthcare providers. Though the whole county doesn’t use the consent forms, L.A. Care is in the process of persuading the county to make them mandatory.

Despite frustrations, changes to Part 2 might emerge as care coordination gains traction in the healthcare system at large. Murray says that ACAP is looking forward to revisions of Part 2 by the Substance Abuse and Mental Health Services Administration later this year, and is providing feedback on any proposals. In the meantime, health plans are trying to find solutions to help patients.

“Any improvements we can make that will help us to better integrate care and maintain privacy at the same time will be very welcome developments,” Murray says.