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
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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
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