October 3, 2012 TO: NCC Special Policy Group on Adolescent Confidentiality FROM: Ashley Coffield Please find below a summary of recent efforts to reform confidentiality protections for adolescents and young adults receiving sensitive health care services. In April, we sent you a summary of the issues and efforts to address confidentiality that had been pursued to date. You can find that document on the NCC website at this link: http://prevent.org/data/files/ncc/ncc%20spg%20paper%20on%20confidentiality%20fnl.pdf. Please let us know if you are aware of other efforts we can share in addition to those described below. We think continued updates are very important, but let us know if you have other ideas for this group. We will explore hosting a webinar or conference call in the spring if any notable progress is made and can be shared. In the meantime, we’ll continue to provide you with updates. Health Plan & State Insurance Commissioners Roundtables Regarding Confidentiality and Explanation of Benefits (EOBs) CDC has contracted with AHIP (America’s Health Insurance Plans) to conduct two roundtables to assess potential confidentiality issues around Explanation of Benefit (EOB) statements. The first roundtable will include representatives from health plans with covered lives in different states to discuss potential policy options regarding confidential EOBs, along with their barriers and challenges to implementation. The second roundtable will gather state insurance commissioners or their representatives to discuss potential barriers for health plan implementation of confidentiality-related changes to EOBs, and discuss possible solutions. AHIP will provide a summary of the roundtable discussion with action steps. AHIP will turn the roundtable recommendations into a plan with viable options to provide to commercial plans for potential implementation, and disseminate the plan to its members. The EOB May Be a HIPAA Violation for Young Adults Ryan Cramer, an attorney, and Lauren Slive, a law student, in the Division of STD Prevention at CDC have analyzed the confidentiality issue from a legal perspective and concluded that 1 sending an EOB to the parent policyholders of adult dependents ages 18-26 is potentially a HIPAA violation when the parent policyholder does not have remaining financial liability. HIPAA offers much stronger confidentiality protections to adults than to minors. If there are ways to prevent fraud and abuse that do not breach confidentiality for adults, then HIPAA requires health plans to use them based on its “minimum necessary” standard for exceptions to the general privacy rule. In the case of adult dependents, EOBs could be sent directly to the patient when there is no liability for payment. Parent policyholders are not liable for payment when services are covered by insurance without cost-sharing or when the patient pays any balance in full at the time of service. Ryan and Lauren will be working with the National Center and others at CDC to prepare a letter for the Office of Civil Rights at HHS, which interprets and enforces HIPAA. If HHSS interprets this practice to violate HIPAA, then this could be a catalyst for broader confidentiality reforms within this population. If you have questions, contact Ryan Cramer at uxj0@cdc.gov. Guttmacher Report: Confidentiality for Individuals Insured as Dependents: A Review of State Laws and Policies This new Guttmacher report reviews state-level legal requirements related to confidentiality in private insurance. It assesses state statutes and regulations that can have the effect of abrogating confidentiality through a number of different avenues and examines steps some states have taken to protect confidential access to care for individuals insured as dependents. At least eight states have adopted statutes or regulations that could provide a starting point for giving dependents the confidentiality protection they need. However, it is important that the extent to which these existing policies protect confidentiality in actual practice be fully investigated before they are looked to as approaches that might be adopted more broadly. http://www.guttmacher.org/pubs/confidentiality-review.pdf An article’s in yesterday’s Washington Post puts a human face on the issue and summarizes the confidentiality issue: http://www.washingtonpost.com/national/health-science/insurance-dependents-can-facespecial-challenges-on-privacy/2012/10/01/3ca4d254-6a2d-11e1-acc6-32fefc7ccd67_story.html A post today on NPR’s health blog by the same writer provokes further discussion: http://www.npr.org/blogs/health/2012/10/02/162145030/how-some-parents-could-learnadult-daughters-birth-control-habits 2