Confidentiality of Substance Use Disorder Patient Records
2019-09-19 2019-10-22 2019-10-22 2019-10-22 2019-10-22 2019-10-22 2019-10-01 2019-10-01 2019-09-19
HHS-OS-2019-0011-0020 HHS-OS-2019-0011-0376 HHS-OS-2019-0011-0380 HHS-OS-2019-0011-0391 HHS-OS-2019-0011-0400 HHS-OS-2019-0011-0428 HHS-OS-2019-0011-0353 HHS-OS-2019-0011-0361 HHS-OS-2019-0011-0004
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https://api.regulations.gov/v4/comments/HHS-OS-2019-0011-0020 https://api.regulations.gov/v4/comments/HHS-OS-2019-0011-0376 https://api.regulations.gov/v4/comments/HHS-OS-2019-0011-0380 https://api.regulations.gov/v4/comments/HHS-OS-2019-0011-0391 https://api.regulations.gov/v4/comments/HHS-OS-2019-0011-0400 https://api.regulations.gov/v4/comments/HHS-OS-2019-0011-0428 https://api.regulations.gov/v4/comments/HHS-OS-2019-0011-0353 https://api.regulations.gov/v4/comments/HHS-OS-2019-0011-0361 https://api.regulations.gov/v4/comments/HHS-OS-2019-0011-0004
Bill Jennifer Michael Anonymous Donna Jamie V Laura Kevin
Barnard bs Lambert Schaffrinna Anonymous Beers Jacobs Z Hollister Catney
Gentlemen:I have read the proposed changes to 42 CFR. These proposed changes will weaken the confidentiality of 42 CFR.  It is a crack in the door making it easier to finally destroy 42 CFR.  There are far too many government regulations now.  Bureaucratscreate power for themselves with more regulations.  I urge you to put these proposed in file 13 where they belong. This proposal is abominable. Patient confidentiality is an extremely important human rights issue, especially in the case of mental health and substance abuse. If this proposal passes, it will discourage addicts from seeking treatment for fear of privacy violations.I repeat: If this proposal passes, ADDICTS WILL NOT SEEK TREATMENT.This proposal is a step in the wrong direction in terms of privacy and harm reduction.  As a physician dedicated to the treatment of patients with addiction, I understand and respect the need for special regulations that protect our patients.  However, current requirements under 42 CFR Part 2 present huge barriers for essential communications between providers of health care.  As an example, successful treatment of patients with opioid addiction requires the collaboration of physicians with substance abuse counselors.  Failure to do so limits the effectiveness of the treatment program and places the patient at greater risk for recidivism.  I have seen the challenge of getting information to understand what treatments were provided at a detox and rehabilitation center as well as communication with agencies that specialize in mental health.  Over the past decade, governmental agencies have tried to decrease barriers in sharing of information.  Health Information Exchanges have been created to support those efforts.  As it is currently written, 42 CFR Part 2 would require recurrent permission to share information with any such exchange.  Please Please reduce the barriers in the exchange of information between those caring for the same patient.  It is an unnecessary burden and will harm patients.   As if being a chronic pain patient isnt stigmatizing enough....Now there seems to be a push to profit off of our painful conditions by opening our medical files to anyone who wants to see them.  It is no different for someone who takes medications for stigmatizing disorders like AIDS or HIV or herpes. Although no one can say that our problems with pain are caused through our own fault, we are stigmatized nonetheless.  I strongly disapprove of actions that seek to reduce patient confidentiality for chronic pain patients like me.   October 21, 2019Re:42 CFR Part 2  Confidentiality of Substance Use Disorder Patient Records Proposed Rule (SAMHSA 4162-20; RIN 0930-AA32)Dear Ms. Avula: I strongly support patient privacy rights and the confidentiality of substance use disorder (SUD) treatment records, and offerAsthe following comments regarding the proposed modifications to 42 CFR Part 2 (Part 2) in the August 26, 2019 Notice of Proposed Rulemaking (NPRM).  As an addictions nurse with over 30 years of providing direct clinical care to persons with substance use disorders, I can say that patients will not feel comfortable sharing openly about their struggles and challenges if they fear that disclosures were not private and protected from access by law enforcement.  To keep people alive, we need to keep them in care; to keep them in care, we need to provide a safe space for them. I have serious concern over the proposals to weaken patient confidentiality in favor of law enforcement, insurance companies, and other third parties who do not provide care. These proposals, together with the recent SAMHSA proposal of RIN 0930-AA30 to amend Section 2.63 and permit greater law enforcement access to confidential communications,  would greatly compromise patients privacy rights and conflict with the stated purpose of the regulations: to ensure that a patient receiving treatment for a substance use disorder in a Part 2 program is not made more vulnerable to civil and criminal legal consequences, or discrimination than an individual with a substance use disorder who did not seek treatment. Moreover,  SAMHSAs proposed changes in both sets of rulemaking would discourage people from seeking or staying in treatment, particularly for individuals living in areas that are already heavily policed (e.g., communities of color, immigrant communities, and low-income neighborhoods), which would lead to further disparate health outcomes for these populations and more unnecessary and harmful interventions with the criminal justice system: I agree with SAMHSA that coordinating care for patients with substance use disorders should be a priority.  As such, I do support the rules proposal to amend the consent form requirements, which would permit patients to authorize disclosures outside of healthcare settings by simply naming the entity authorized to receive information, and without needing to name every individual within that entity. I have observed that the current consent requirements (naming individual recipients) frequently interfere with a patients ability to authorize disclosures to a number of non-healthcare actors that assist people living with SUD, including supportive housing services, social workers, lawyers and advocates, courts, and criminal justice officials.  I do support this proposed change. However, I am extremely concerned that, if finalized, other numerous provisions of the NPRM would significantly weaken patient privacy protections and prevent many people from seeking lifesaving SUD care.  As a result, I strongly urge SAMHSA to withdraw these sections of the NPRM as detailed below:  Statement Opposing Proposed Change to Orders Authorizing the Use of Undercover Agents and Informants (Section2.67)I oppose the proposed change to place undercover officers in a treatment setting for up to 12 months, since it profoundly compromises the confidentiality of all patients in treatment and serves as another disincentive for people needing SUD services to seek treatment, especially in communities that routinely have a significant law enforcement presence (such as, communities of color, low-income neighborhoods, and immigrant communities). Further, SAMHSA did not include any data or analysis in the NPRM from the Department of Justice to document the need for this change. This proposal is particularly concerning given the simultaneous proposal by SAMHSA to weaken the requirements for court orders authorizing disclosure of confidential communications, and statements made by SAMHSA indicating that extremely serious crimes may include any range of crimes that fall within the definition of drug trafficking.  I agree with SAMHSA on the importance of coordinated care and that more clarification is needed about how Part 2s privacy rules apply to integrated care settings. I would welcome an ongoing discussion with all SUD stakeholders and revised proposals by SAMHSA to promote care integration without sacrificing Part 2s guarantee of patient confidentiality protections.Thank you for your attention to these comments. I also wish to indicate support for the comments on the NPRM submitted by the Legal Action Center.Donna Beers MSN, RN-BC, CARNAssociate Director, Care Continuum HEALing Communities Study MassachusettsBoston Medical Center617 414.6633 As a representative of Reintegration Support Network, a youth-focused recovery community organization, we urge SAMHSA TO WITHDRAW THESE SECTIONS OF THIS NOTICE OF PROPOSED RULEMAKING: Greater disclosures of patient records without consent to entities not involved in direct patient carePlacing undercover officers in a treatment setting for up to 12 monthsIncluding opioid treatment program (OTP) patient records in prescription drug monitoring programs (PDMPs), because of the level of law enforcement involvement in PDMPsExpanding access to states central registries, which would permit providers to request information from the database about a patients medication for opioid use disorderChanging the definition of records to exclude records disclosed orally to a patients primary care providerThese changes would discourage people from seeking or staying in treatment, particularly individuals living in areas that are already heavily policed.  As a Clinician that works primary with the SUD population, I would strongly advocate AGAINST this. I have found that many of my SUD clients refrain from really engaging in treatment, out of fear that their confidentiality will be at risk. While this is currently not true, it can create feelings of mistrust on the part of the client and can prevent the client from actively engaging in treatment.  For a SUD client opening up fully while in treatment can prevent or even delay the process of growth, development, and overcoming an SUD issue. I BEG YOU TO PLEASE RECONSIDER THIS!!!!. If for no other reason, please put yourself in the shoes of an SUD client. Would you want your confidentiality compromised? What is the real purpose of this? and most importantly who is this helping and how is it helping? As a licensed mental health counselor in the state of Maryland, I am writing to speak against any weakening of current laws protecting the privacy of mental health clients struggling with substance use disorders. It is of primary importance that all such individuals know that their privacy will be protected when they seek counseling--and, it is of primary importance for their well-being and recovery prospects, that substance-addicted persons do seek the support that counseling provides. Please stand for the privacy of all persons seeking help for their mental health, including those who who are addicted to one or more substances. Thank you. Public health experts agree that people living with substance use disorders are more likely to seek out and stay in treatment if they know their treatment records will not be unnecessarily disclosed to others without their knowledge or permission. My states P.D.M.P. is now routinely being used by some medical providers as part of pre-employment physical examinations and D.O.T. medical examinations.  Individuals using M.A.T. (medication assisted treatment) are routinely being denied employment or denied renewal of their D.O.T. examination card, on the basis of information contained in the P.D.M.P.  This use of the P.D.M.P. runs contrary to the very intent of 42 C.F.R. Part 2.   I request that the proposed rule directly address the appropriateness of utilizing the P.D.M.P. in occupational medicine.  Thank you for your consideration of this issue. 