Don’t be spooked by confidentiality issues: eSolutions,
October 2011
eSolutions is a monthly e-newsletter bringing you practical solutions and resources on primary and behavioral
healthcare integration from across the United States.
Don't Be Spooked
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 and Accountability Act (HIPAA), 42 CRF Part2, and state-based confidentiality policies can all
be addressed effectively for the partnership to safely and confidentially share information. Contrary to popular belief,
information can be shared with and 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, and/or HIPAA
Privacy and Security Committees.
The Health Insurance Portability and Accountability Act 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:
o
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;
o
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
o
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 then often change their
privacy statements to reflect the OHCDS and may add language to all consents to 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. However, if organizations enter into a Qualified Service Agreement (QSA), they are
often required to share needed substance abuse information for healthcare coordination. The key resources to review
as you develop your 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 Qualified Service Agreement.
Your state-defined confidentiality rules and regulations are the third key element in creating a bidirectional integrated
health delivery system. Your state mental health codes or state alcohol and drug abuse agency may impose
additional confidentiality protections that must be addressed. However, states are addressing these each and every
day as integration project move forward. Michigan’s integrated mental health, substance abuse, and primary
care services confidentiality policy addresses all of these issues and is a useful sample.
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. Copies of Raising the Bar are 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.
Quick Tips: Educating Patients on Information Sharing
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 created a few tips to help you navigate information sharing, including:
1.
Educate 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.
2.
Respect the requests of patients who opt out of sharing their information.
3.
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.
4.
Encourage your patients to expect communication, collaboration, shared treatment plans, and joint decision
making from you and their other providers.
5.
Be transparent.
For more information or technical assistance, visit www.integration.samhsa.org or call 202.684.7457.
New from CIHS:
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.
Hot Topics: News & Resources
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 at 2-3:30pm ET to address three states’
strategies for integrating the full range of physical and behavioral health services. For more information, visit CHCS.
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including web-based videos, iPod videos, handouts, and audio. Information is provided in up to 19 different
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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.