I am astounded to find that this injustice may happen against MAT patients. Why would you change the 

42 CFR Part 2? They have enough stigma and prejudice to deal with without this happening. If MAT 

patients are put into a 50 state system pegged as drug addicts they will never have the opportunity to 

live a normal life. I hate to think if a MAT patient broke his leg and went to a hospital and came up on a 

prejudicial software database labeled a drug addict. I believe that the hospital would not help that 

person in the way that every other person is treated. And older people often need pain medicine. Do 

you think if a patient labeled a MAT patient even if it is from 50 years earlier, they would be given the 

same pain medications others would get? This is so unfair and unnecessary. Why now if it was not 

needed before? We are crossing the lines with people's civil liberties here. This is terribly wrong. 
 

 

 

 

 

 

Dear SAMHSA: 

I understand that you are considering changing the confidentiality regulations for methadone 

treatment. It is important that the confidentiality regulations remain as they are and not be changed. 

I am a methadone patient and I am concerned what could happen if my status as a methadone patient 

were known. I know that I would have trouble getting medical care because doctors always blame any 

medical problem on the methadone. Doctors and nurses don't understand methadone and they tell me 

to get off. 

I am also concerned that employers and schools will be able to find out that I am a methadone patient if 

changes to the confidentiality regulations happen. 

Please don't change the confidentiality regulations that has protected me and all patients from the 

discrimination against us. 

Thank you. 
 

 

 

Why after 50 some years of MAT recovery is it even remotely necessary to make MAT patients medical 

records open to persons in a nationwide database. If these patients were on insulin you would not be 

considering this. You are opening them up to unfair treatment and surveillance by police who constantly 

monitor on the state prescription monitoring systems. This is also against their civil liberties. I would 

think the NAACP would be opposed to this. No one needs access to these records. They have not before 

and do not now. This is prejudicial and I believe against the law. I will withhold my name because I'm 

afraid of repercussions. If I'm afraid to sign my name, can you imagine how it would be for patients if 

their records were in a nationwide database. 
Allina Health~ 

June 23, 2014 

Sent electronically 

Cathy J. Friedman, Public Health Analyst 

The Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Rm 5-1011 

Rockville, MD 20857 

Dear. Ms. Friedman; 

On behalf of Allina Health, thank you for the opportunity to provide early input into the potential 

for change in the current 42CFR Part 2 rules governing records protections for patients in 

substance abuse programs. 

Allina Health is a family of 12 urban and rural hospitals, 80 clinics with over 800 physicians, and 

specialty care services dedicated to meeting the lifelong health care needs of communities 

throughout Minnesota and western Wisconsin. We provide a continuum of care, from disease 

prevention programs, to technically advanced inpatient and outpatient care, to medical 

transportation, pharmacy, durable medical equipment, home care, palliative care, and hospice 

services. The organization has 3 hospital based substance abuse programs as part of the 

comprehensive mental health service line. Allina Health was an early adopter of the electronic 

health record and our 12 hospitals and 800 eligible providers have successfully attested to 

receive the Electronic Health Record (EHR) incentive payments for the past three years. 

Allina Health takes patient privacy very seriously and as a covered entity has implemented a 

comprehensive privacy and security program in order to meet the many requirements of the 

Health Insurance Portability and Accountability Act (HIPAA) to protect patient information and 

uphold patient trust. 

Although Part 2 rules were established at a time when there were no protections to the records, 

the HIPAA rules now provide a firm foundation for the protection of all patient records, not just 

those of patients in substance abuse treatment programs. Allina Health believes that the Part 2 

rules are no longer necessary and should be eliminated or revised to mirror HIPAA rules. We 

support the application of one set of rules providing the essential protections for all patients. The 

administrative burden of complying with both Part 2 and HIPAA rules is ominous and creates 

many issues in our ability to manage all the needs of our patients across the continuum of care. 

We appreciate that SAMHSA recognizes the limitations of the current Part 2 rules and seeks 

input into potential revisions. However, we firmly believe that revisions to the rule will not 

address the issues our patients and providers experience. We ask that SAMHSA work with 

Mailing Address: PO Box 43, Mail Route 10811, Minneapolis, MN 55440-0043
 
 

An Equal Opportunity Employer
 
 

 


 

Mailing Address: PO Box 43, Mail Route 10811, Minneapolis, MN 55440-0043
 

An Equal Opportunity Employer
 

Congressional leaders to remove the Part 2 rules, or at minimum, to revise the rule to explicitly 

defer to HIPAA PHI protections for all HIPAA covered entities. 

HIPAA rules already provide parameters for protections in all areas in which SAMHSA seeks 

input for revisions. By continuing to segment the substance abuse patients from the general 

patient population we serve to perpetuate the stigma of substance abuse and prevent the ability to 

serve the whole patient and coordinate all essential care. This is a disservice to the patient and 

does not fit into a new care model where the industry is working to break down barriers between 

primary care and specialty providers and all locations of care delivery. By continuing to segment 

the condition of substance abuse with different rules, we cannot support an integrated approach 

to care delivery and are creating significant unnecessary resource utilization and cost for 

providers, patients, and payers, including the federal government. 

Applicability 

In an environment where most providers have implemented the electronic health record, it 

becomes extremely difficult to facilitate the application of specific restrictions based on 

condition, service or program/facility. Allina Health vehemently opposes any change in current 

rule that would shift the Part 2 applicability to specific services provided. This approach would 

be nearly impossible to operationalize in an organization with an integrated health record and 

integrated care delivery model. 

Consent Requirements 

We agree that these requirements need to be addressed. We support revisions that would mirror 

HIPAA rules or that these requirements are eliminated fully for all covered entities that must 

comply with the consent requirements under HIPAA. 

Re-Disclosure Prohibitions 

These prohibitions create significant barriers to our ability to facilitate comprehensive care for 

our patients. We support disclosure for treatment, payment, and operations as specified under 

the HIPAA rule. The disclosure authorization informs patients that re-disclosure is a risk. We 

support the preservation of the current restrictions to law enforcement. 

Medical Emergency Exception 

Allina Health supports the application of the HIPAA rule parameters that support disclosures for 

treatment, payment, and operations purposes. 

Requirements Related to Qualified Service Organizations 

Although we see this provision rarely used, Allina Health can support broadening to include care 

coordination, but would prefer to see the HIPAA and HITECH rules applied that would require 

business associate agreements and covered entities to fully comply with the those rules. 

Research 

Allina Health supports the application of existing HIPAA protections in regard to records access 

and disclosures for research purposes. 
Again, thank you for the opportunity to provide input. We greatly appreciate that SAMHSA is 

considering revisions. We hope that you consider our comments as you work to move this old 

rule into the new world of integrated care delivery and electronic health records. 

Sincerely, 

Nancy G. Payne, RN, MA 

Director Organizational Integrity and Regulatory Affairs 

Mailing Address: PO Box 43, Mail Route 10811, Minneapolis, MN 55440-0043
 

An Equal Opportunity Employer
 
DASPOP 1 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Drug & Alcohol Service Providers Organization of Pennsylvania 

Cathy J. Friedman 

SAMHSA, Public Health Analyst 

Substance and Abuse & Mental Health Services Administration 

1 Choke Cherry Road 

Rockville, MD 20857 

Via Email: PrivacyRegulations@SAMHSA.hhs.gov 

RE: Docket No. 2014-10913 - Confidentiality of Alcohol & Drug Abuse Patient 

Records, 42 C.F.R., Part 2, Fed. Reg/Volume 79, No. 91, pages 26929­

26932 

Dear Cathy Freedman, 

Thank you for the opportunity to join in the SAMHSA discussion of the 

Federal confidentiality rules (Title 42 CFR of the code of the Federal regulations, 

Part 2) in relation to the major changes in our national health care system. 

Please accept these comments submitted on behalf of the Drug and 

Alcohol Service Providers Organization of Pennsylvania. We are a statewide 

association of alcohol and drug addiction treatment and prevention programs 

providing addiction treatment services to all sixty-seven counties in the state. We 

represent the full continuum of these drug and alcohol services, including 

prevention, education, hospital and inpatient non-hospital detoxification, 

inpatient residential treatment, outpatient, intensive outpatient, partial 

hospitalization, halfway houses, transitional living, criminal justice treatment and 

dual-diagnosis programs. 

The Federal confidentiality rules have long played a critical role in 

ensuring that people with untreated alcohol and other drug addictions are 

able to seek treatment for this often fatal illness that effects 1 in 4 of our 

families. 

We are deeply concerned that many of the issues under discussion will 

dramatically loosen confidentiality protections which currently, stalwartly 

protect the privacy of thousands of patients and frightened families seeking 

help for addiction to alcohol and other drugs. 
DASPOP 2 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The unmet need for addiction treatment in the country is frighteningly 

high and is estimated by SAMHSA at over 20 million individuals. (SAMHSA, 

2012 National Survey on Drug Use and Health, September 2013). Many of 

these individuals stay out of treatment because of concerns regarding 

privacy. We are concerned that loosening of confidentiality protections may 

make this situation worse. 

Already, we pay a horrific price for this unmet treatment need both in 

dollars and family devastation. In fact, over thirty years of research and 

studies have demonstrated with mind-numbing consistency that untreated 

alcohol and other drug problems cause a hemorrhage of uncontrollable 

spending in both the health care and the criminal justice systems. A similarly 

mind-numbing number of studies have demonstrated that proper treatment of 

addiction reaps a harvest of financial savings in the health care and criminal 

justice systems and assists in stabilizing our families and communities. 

There are many obstacles to entering addiction treatment. However, the 

chasm between the numbers of Americans receiving treatment and the 

numbers estimated to be in need is shocking. The chasm broadcasts loudly 

that stigma and shame – life endangering stigma and shame – continue to 

enshroud people with alcohol and other drug addictions. 

SAMHSA's own publications make this case as well. According to data 

from the 2010 National Household Survey on Drug Use and Health, about 

one­ third of those not going to treatment stayed out because they feared 

what others would think of them both in their place of employment and in their 

neighborhood. 

In this context, how could anyone doubt the importance of maintaining 

the strictest of confidentiality protections? 

If I may, the national health care delivery system has indeed changed. 

However, the nature of alcohol and other drug addictions has not. 

For this reason, we must take care that the design of our health care 

policy and systems meet the patient's need, not the reverse. In fact, if we fail 

to meet the patient where he/she is, we shall fail famously, expensively (in 

health care costs and crime) and, we shall fail quite predictably. 
DASPOP 3 

 

 

 

a. Intake and screening services, like federally assisted addiction treatment 

facilities, should be covered under the requirements of 42 CFR, Part 2. 

However, we are concerned about the meaning of "other similar pre-treatment 

services". What are these services? 

 

 

 

 

 

 

b. Maintain patient written consent requirements. This is a necessity. The 

statement in this section that HIEs, ACOs, CCOs, etc., have a growing number 

of providers and "generally do not have sophisticated consent management 

capabilities," makes the case that individual "To Whom" consent requirements 

must be maintained. The lack of "sophistication" of these entities is not an 

acceptable argument to compel changes that could endanger the patient's ability 

to get help. 

1 . Background 

Indeed, there have been "significant changes" in the U.S. health care 

system over the last 25 years, including the advent of electronic records 

electronic infrastructure and other technology. This is reality. At the same time, 

the nature of stigma and the nature of this shame-based illness remain 

unchanged. This is also reality. 

For this reason, we are alarmed by #1 , #2 and #4 and urge you to reject 

these ideas. The patient must not be asked to sign away consent to a world of 

interconnected health care systems, unknown future entities and vendors with 

one general consent and signature. One consent each time, to one individual, 

for specified information, for a defined period of time – this must be the rule. 

The Background document notes that the consent requirements "make it 

difficult" for the new health care organizations to share patient information . 

Indeed. That is exactly the point. Given the sensitivity of this information, such 

sharing shouldn't be easy and must never be casual. 

The Background document itself delineates the importance of 

confidentiality – “Behavioral health is essential to overall health and the costs of 

untreated substance abuse disorders, both personal and societal, are enormous. 

However, treatment for substance abuse disorders is still associated with 

discrimination. In addition, there may be potential serious civil and criminal 

consequences for the disclosure of this information beyond the health care 

context. There continues to be a need for confidentiality protections that 

encourage patients to seek treatment without fear of compromising their privacy." 
DASPOP 4 

 

 

 

 

 

 

c. Redisclosure – We recommend making no changes to the current rules on 

redisclosure. Limitations on redisclosure are at the heart of the confidentiality 

rules. 

d. Medical Emergency – We are not aware of any problems with the current 

rule. 

 

 

 

 

 

e. QSO – We urge you to reject the idea of allowing care coordinators (an 

ambiguous and in many cases, contradictory term) and payers from accessing 

patient information through QSOs. Almost by definition, a QSO can be any type 

of entity, and could potentially include managed care organizations. This leaves 

the barn door wide open. 

f. Research – We urge you to maintain current rules and regulations. 

 

 

 

g. Prescription Drug Monitoring Programs – This problem illustrates the need 

for a uniform set of strong federal privacy protections, not a need to weaken 

those protections . 

 

 

 

Would the changes being considered maintain privacy protections for 

patients? ABSOLUTELY NOT. 

Would these changes address the concerns of the HIEs, ACOs, etc.? 

Probably, but for what purpose are we designing the health care system, the 

proper care of the patient or the convenience of the acronym? 

In closing, deciding to go to treatment for addiction is hard enough now. 

Let's not make things worse – and let's not sacrifice a patient's access to 

treatment on the altar of administrative convenience. 

Sincerely, 

Deb Beck 

President/DASPOP 

6/23/14 
 

 

 

 

 

 

 

 

 

 

COMMENTS OF THE LEGAL ACTION CENTER IN RESPONSE TO

U.S. DEPT. OF HEALTH & HUMAN SERVICES,
 

SUBSTANCE ABUSE & MENTAL HEALTH SERVICES ADMINISTRATION, 

NOTICE OF PUBLIC LISTENING SESSION, 

79 FED. REG. 26929 (MAY 12, 2014)
 

DOCKET NO. FR DOC. 2014-10913
 

(SUBMITTED JUNE 25, 2014)
 

I. Introduction to LAC Comments

The Legal Action Center (LAC) is the only non-profit law and policy organization in the United 

States whose sole mission is to fight discrimination against people with histories of addiction, 

HIV/AIDS or criminal records, and to advocate for sound public policies in these areas. 

LAC staff regularly consults about confidentiality and related legal issues with alcohol and drug 

prevention and treatment professionals around the country, as well as health, mental health, 

public health and managed care providers, welfare and child welfare systems, lawyers and law 

enforcement officials, courts and other criminal justice agencies, employment assistance 

programs, and federal, state and local policy makers. Over three decades of experience and 

expertise in applying and interpreting the federal law and regulations (42 C.F.R. Part 2) are 

reflected in the comments we submit in response to the Substance Abuse and Mental Health 

Services Administration’s (SAMHSA) May 12, 2014 Notice of Public Listening Session (79 

Fed. Reg. 26929). As you consider these and other comments from stakeholders, we urge you to 

give the greatest weight to the comments made by patients and consumers, as it is their rights and 

access to their sensitive health information that will affected by any changes to 42 C.F.R. Part 2. 

LAC believes that behavioral health care should be integrated with physical health care, and that 

communication between health care providers should be encouraged. At the same time, LAC 

believes that 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were 

when they were enacted more than 40 years ago, and that a move toward the looser privacy 

standards of the Health Insurance Portability and Accountability Act (HIPAA) would not 

sufficiently protect people seeking and receiving substance use disorder (SUD) treatment. 

Patients seeking and receiving SUD treatment should retain the right to control how their records 

are disclosed, even for health and payment purposes, given the continued prevalence of prejudice 

and discrimination in our society. LAC believes that it is both necessary and technologically 

possible to integrate SUD and other health care and to effectively exchange SUD treatment data 

while maintaining the core protections of 42 C.F.R. Part 2. 

Our recommendations concerning the critical issues SAMHSA poses can be summarized as 

follows: 

• LAC supports maximizing inclusion of SUD records in electronic health record (EHR)

systems and health information exchanges (HIEs) while maintaining privacy protections
 

 

 

 

 

 

that are as essential today as they were when enacted in the 1970s. People with SUDs 

still face loss of employment, housing, and child custody; insurance and health care 

discrimination; criminal arrest, prosecution and incarceration; and a host of other 

negative consequences. 42 C.F.R Part 2’s privacy protections greatly minimize the 

possibility that a patient’s own treatment records could be used against them in all those 

situations. In order to encourage people with SUDs to seek treatment, 42 C.F.R. Part 2’s 

more stringent privacy protections must be maintained rather than accede to HIPAA 

standards, which many have criticized for their insufficient protection of patient privacy, 

and which would allow many more disclosures that would lead to those harmful 

consequences for patients. 

• LAC supports the goals set out in the request for comments and many of the specific

suggestions for adjusting how the regulations currently operate. LAC believes that the

current regulations, together with existing plus additional guidance from SAMHSA, can

accomplish many (if not all) of the intended goals of integrating substance use disorder

and other health care and improving communication between them more effectively.

• Since HIPAA requires compliance with state and federal laws that mandate greater

privacy protections, EHRs must be designed so as to comply with the many state statutes

that require heightened protections for information related to mental health, HIV/AIDS,

reproductive health, domestic violence and other types of sensitive health information, as

well as with 42 C.F.R. Part 2. In addition, EHRs must also be designed to comply with

the HITECH Act, which provides that individuals have a right to restrict the disclosure of

health information in electronic or any other form when they pay out of pocket for

services provided. It is important to keep in mind, therefore, that EHRs would be

required to accommodate enhanced protections for the medical records of some illnesses

in order to be HIPAA and HITECH-compliant even if 42 C.F.R. Part 2 did not exist.

1 

II. Why the HIPAA Standard is Insufficient to Protect Patient Privacy

Before we answer the specific questions posed by SAMHSA in its May 12, 2014 Notice of 

Public Listening Session (“Notice”), we would like to address the suggestion by some 

stakeholders that a potential solution to the challenges posed by 42 C.F.R. Part 2 (hereinafter 

referred to as “Part 2”) to initiatives such as new models of integrated care and electronic health 

information exchange is to do away with Part 2’s heightened privacy protections in favor of a 

HIPAA standard. 

Acceding to a HIPAA standard for SUD patient information would eviscerate the core 

protections of Part 2 – in particular the requirements for patient consent, the prohibition on 

redisclosure, and the heightened standards for disclosure to law enforcement and judicial and 

administrative bodies – and would likely lead to dire consequences for Part 2 patients and their 

families. While Part 2 requires patient consent for most disclosures, thus allowing patients to 

control the flow of information that holds the potential to do them great harm in the wrong 

hands, HIPAA does not require consent for disclosures made for the purposes of treatment, 

1 45 C.F.R. § 164.522(a)(1)(vi). 
 

 

 

 

 

 

 

 

 

2 For example, under 42 C.F.R. Part 2, a court ordinarily may not even order disclosure of treatment records for the 

purpose of prosecuting a patient. See 42 C.F.R. §§ 2.61-2.65. 

 

3 

payment, and health care operations (TPO). HIPAA’s definition of TPO is so broad as to allow 

virtually unfettered access to patient’s health information by those in the health care system; such 

an exception would be a death knell for Part 2’s patient consent requirement and prohibition on 

redisclosure. Furthermore, where Part 2 requires a special court order for disclosures to law 

enforcement and to judicial or administrative bodies (such as divorce and child custody 

proceedings)2 with heightened review standards, HIPAA permits such disclosures in whatever 

manner is required by state law, meaning as soon as a health care provider receives a subpoena, 

judicial or administrative order, or even a discovery request. Given the disastrous consequences 

patients often face when their SUD histories are disclosed to law enforcement or judicial or 

administrative bodies, adopting this standard for SUD patient records would do great harm to 

patients and their families. 

While allowing all SUD patient information to flow to all parts of the health care system without 

restriction may seem benign or even desirable at first blush, we believe it is likely that such a 

change would backfire, resulting in disclosures that damage the lives of patients and their 

families more often than improve their care. Allowing virtually unfettered disclosure of SUD 

patient records without consent to the full range of individuals and organizations involved in 

health care (including payment and operations) and law enforcement, and allowing those entities 

to redisclose those records without restriction, as HIPAA does, would result in many people not 

obtaining the care they need for fear of being arrested and prosecuted, losing custody of their 

children, and suffering employment, insurance and other discrimination. 

In its 40 years serving SUD treatment providers and SUD patients, LAC has seen these 

consequences first-hand time and again. Although we hope to see the day when prejudice and 

discrimination are no longer the reality for people with SUDs, that day has unfortunately not yet 

arrived. In just the past several months LAC has received numerous requests for assistance from 

people facing SUD-based prejudice and discrimination. For example, we have heard from: 

• a young father in recovery who was being denied visitation with his children because he

was in methadone treatment, despite the fact that he was not using any illegal substances;

• a mother in recovery who had her 2-month-old infant removed from her custody after the

hospital where she gave birth reported her for having legally prescribed methadone in her

system;

• a young mother who was being threatened with eviction from a shelter because she was

taking prescribed methadone for her opioid addiction (another young mother had already

been evicted from the same facility for the same reason, and had become homeless;

neither woman was using illegal substances); and

• a young man whose employer refused to allow him to return to work after he successfully

completed treatment for alcoholism, saying that he was a safety threat even though his

physician had cleared him to return to work with no restrictions.

In addition, since January 1, 2012, LAC has received 93 requests for assistance from SUD 

treatment programs whose patient records were being sought by law enforcement or a court 
 

 

 

 

 

 

 

 

 

4 

 

without obtaining appropriate court orders as required by Part 2. This represents requests from 

only the 10 states to which we provide hotline assistance. 

LAC is not alone in recognizing the importance of patient privacy protections. When the U.S. 

Department of Health and Human Services (HHS) issued the HIPAA Privacy Rule in 2000, it 

stated, “While privacy is one of the key values on which our society is built, it is more than an 

end in itself. It is also necessary for the effective delivery of health care, both to individuals and 

to populations.”3 HHS also said that, “Unless public fears are allayed, we will be unable to 

obtain the full benefits of electronic technologies.”4

Yet the issuance of the HIPAA Privacy Rule has done little to allay fears of sharing health 

information through electronic health systems, and in fact those concerns are growing. A 2010 

study in the Journal of the American Medical Informatics Association5

 found that of the 

outpatient mental health clinicians surveyed: 

• 83% disagreed with including their own psychiatric records among routinely accessed

EHR systems;

• 80% said that if they were a patient, they would not want health care providers to have

the ability to routinely access their mental health records; and

• 63% said they are less willing to record highly confidential information in EHRs

compared with paper records.

According to a report issued by the American National Standards Institute in 2012, an online poll 

of 2,000 adults revealed that 97% of the public believe that health care providers and insurers 

should not be able to share their health information without their consent. 6 A 2013 study found 

that that about two-thirds of U.S. adults were concerned about a breach in the security of their 

protected health information (PHI) during transfer between health care professionals by fax or 

electronically, and concerns over the safety of PHI was associated with higher likelihood of 

withholding medical information from a health care professional. 7

The fears that these professionals and adults have regarding electronic health information privacy 

breaches are unfortunately well founded. According to HHS, more than 1,000 medical record 

breaches involving 500 or more people have been reported to HHS since federal reporting 

requirements took effect nearly five years ago.

8 In total, large health data breaches reported by 

3 65 Fed. Reg. 82462, 82467 (Dec. 28, 2000). 4 65 Fed. Reg. 82462, 82466 (Dec. 28, 2000). 5 See Ronald M. Salomon et al., “Openness of patients' reporting with use of electronic records: psychiatric

clinicians' views,” J. of Am. Med. Informatics Ass’n (2010);17:54-60, doi:10.1197/jamia.M3341, available at 

http://jamia.bmj.com/content/17/1/54.full. 6 Am. Nat’l Standards Inst. et al., The Financial Impact of Breached Protected Health Information (Mar. 2012), p. 

23. 

7 I. Agaku, et al., Concern About Security and Privacy, and Perceived Control Over Collection and Use of Health 

Information Are Related to Withholding Health Information from Healthcare Providers, J. of Am. Med. Informatics 

Ass’n (Aug. 2013). 8 Joseph Conn, “Major medical records breaches pass 1,000 milestone as enforcement ramps up,” Modern 

Healthcare (June 13, 2014), available at 

http://www.modernhealthcare.com/article/20140613/BLOG/306139996/major-medical-records-breaches-pass1000-milestone-as-enforcement#src=serp. 
 

 

 

 

 

 

 

 

 

 

 

 

5 

health care providers and their business associates have affected the medical records of about one 

in ten U.S. residents, or 31.7 million people.9

The very real risks to and breaches of individuals’ privacy resulting from adoption of the HIPAA 

standard and the development of interoperable EHR systems have led many to call for the 

adoption of broader protections for all health information, giving it protections like those 

afforded by Part 2. The reports and recommendations issued by the National Committee on Vital 

Health Statistics in its consensus-driven Recommendations on Privacy and Confidentiality, 2006­

2008 advocate for this type of change, as do numerous other stakeholders.10

HHS seemed to recognize the risks that could come when health care payers are given access to 

health information when, in the final rule implementing the HITECH Act (which amended 

HIPAA in 2009), it provided that individuals have the right to restrict the disclosure of health 

information in electronic or any other form when they pay out of pocket for services provided. 

This right should not be limited to people who have the financial means to pay for health care out 

of pocket, but should be afforded to all individual, regardless of the means of payment. 

Below are the Legal Action Center’s comments on the specific questions posed by SAMHSA in 

its May 12, 2014 Notice. 

III. LAC Comments

a. Applicability of 42 C.F.R. Part 2

LAC agrees with SAMHSA that the current definition of which providers fall under Part 2 has 

been the source of some confusion. It makes no sense for the application of Part 2 to depend on 

whether entities “hold themselves out” as proving substance abuse services, rather than on what 

substance abuse treatment services they are providing. Thus we welcome a new definition of the 

applicability of Part 2 that clarifies which providers and what information is covered by Part 2. 

Such clarification would help HIEs, HIT vendors, etc. to understand what information is covered 

by Part 2 and requires heightened protection. 

The definition suggested by SAMHSA, that Part 2 would apply to any federally assisted health 

care provider that provides a patient with “specialty substance abuse treatment services,” 

removes the “holds itself out” language and is a step in the right direction. However, this 

proposed definition raises new questions. What is the difference between a “specialty substance 

abuse treatment service” and a “non-specialty substance abuse treatment service”? Is the 

provision of buprenorphine a “specialty substance abuse service”? It would certainly seem so, 

and in fact we cannot see how the provision of buprenorphine could be considered otherwise. If 

that is the case, then would all physicians who prescribe buprenorphine be covered by Part 2? 

9 “One in 10 U.S. Residents Affected by Large Health Data Breaches,” iHealthBeat (June 16, 2014), available at 

http://www.ihealthbeat.org/articles/2014/6/16/one-in-10-us-residents-affected-by-large-health-data-breaches. 10 U.S. Dep’t of Health & Human Svcs, Nat’l Comm. on Vital & Health Statistics, Privacy Report: 

Recommendations on Privacy & Confidentiality, 2006-2008 (May 2009), available at 

http://www.ncvhs.hhs.gov/privacyreport0608.pdf. 
 

 

 

 

 

 

 

 

 

 

 

6 

The definition suggested by SAMHSA also states that “providers would not be covered [by Part 

2] if they provided only substance abuse screening, brief intervention, or other similar pretreatment substance abuse services.” This makes clear that providers who only provide SBIRT

services “would not be covered by Part 2.” However, in order to for this provision not to run

afoul of Part 2’s authorizing statute, which explicitly extends confidentiality protections to SUD

prevention,11 “screening, brief intervention, or other similar pre-treatment substance abuse

services” would have to be differentiated from other types of prevention services. We think an

attempt at such differentiation would be difficult to impossible, and would create a large amount

of confusion. It is important to maintain the statute’s protection of SUD prevention records, as

prevention programs around the country depend on these protections to reassure their program

participants that information shared will be held in confidence.

b. Consent Requirements

Before we address SAMHSA’s specific suggestion for possible changes to Part 2’s consent 

requirement, we note that we are very gratified that SAMHSA continues to support and 

appreciate the importance of obtaining patient consent for the release of patient information. 

Based on our nearly 40 years of experience advising SUD programs and their patients, LAC 

continues to believe that patients in SUD programs should retain the power to decide when and 

to whom their records are disclosed, including disclosures to the general health care system, 

HIEs, health homes, ACOs, and CCOs, and that the best way for patients to retain that power, 

and to ensure that care is, in fact, patient centered, is by requiring patient consent for most 

disclosures, together with a strong prohibition on redisclosure. 

Like SAMHSA, we also believe that there are ways to resolve some concerns that have been 

raised about Part 2’s consent requirements in order to facilitate “the flow of information within 

the health care context while ensuring the patient is fully informed and the necessary protections 

are in place.” In addition, we agree with SAMHSA’s assessment that “technical solutions for 

managing consent collection are possible” – in fact, such solutions are already under 

development. As such, we urge the continued development of technical solutions for consent 

management as well as the development of organizational policies and procedures that provide 

patients with meaningful consent options. 

Comments on First and Second Suggested Consent Changes: 

SAMHSA’s first suggested change is, “Allow the consent to include a more general description 

of the individual, organization, or health care entity to which disclosure is to be made.” Its 

second suggested change is, “Require the patient be provided with a list of providers or 

organizations that may access their information and be notified regularly of changes to the list.” 

11 See 42 U.S.C. § 290dd-2(a) (“Records of the identity, diagnosis, prognosis, or treatment of any patient which are 

maintained in connection with the performance of any program or activity related to substance abuse education, 

prevention, training, treatment, rehabilitation, or research, which is conducted, regulated, or directly or indirectly 

assisted by any department or agency of the United states shall, except as provided in subsection (e) of this section, 

be confidential....” (emphasis added)). 
 

 

 

 

 

 

 

 

7 

With respect to the first suggested change, we believe that there is a simple way to address 

concerns raised by some stakeholders that Part 2’s current “to whom” provision is too narrow. 

Part 2 currently requires that a consent form must list the “name or title of the individual or the 

name of the organization to which disclosure is to be made.”12 We believe that “title of the 

individual” to whom disclosure is to be made could be interpreted as allowing “treating 

provider” to be listed as the title of the individual to whom disclosure is to be made. 

In addition, patients could consent to the disclosure of their alcohol and drug information to their 

future treating providers, in addition to their current treating providers. With respect to the 

second suggested change, in order for consent to disclosure to future providers (such as providers 

that join an HIE or ACO after the date consent is signed) to be informed and meaningful, we 

suggest that a consent that permits disclosure to future providers should be accompanied by: 

• a limitation on disclosures only to future providers to with a treating relationship with the

patient;

• effective notification of the patient when any new provider is added to an entity to which

they have provided such consent;

• an easy opt-out mechanism that is always available but is also reiterated each time

patients are notified that a provider has been added.

We believe implementation of this interpretation of the “to whom” requirement could be 

accomplished by a change to the regulations or by sub-regulatory guidance. 

We believe our recommendation permitting patients to consent to the disclosure of their alcohol 

and drug information to their treating providers, including future treating providers, 

appropriately balances the concerns of HIEs, ACOs, and other health care entities with the need 

to provide patients with meaningful consent options. Permitting disclosure to treating providers 

and future treating providers maintains the core protections of 42 C.F.R. Part 2 – the prohibition 

on disclosing, and redisclosing, patients’ SUD records without their consent – while at the same 

time making it easier for patients who choose to consent to such disclosures to participate in 

integrated care models and HIT, including HIEs. Such an interpretation is consistent with both 

Part 2 and statutory language. 

A potential additional benefit of this change is that fewer health care providers will need to 

access patient information by “breaking the glass” (accessing a patient’s SUD information 

without consent in a medical emergency, as permitted by Part 2), since most providers treating a 

patient in a medical emergency will be covered by a treating provider (including future treating 

providers) consent. Currently, when Part 2-protected records are accessed without consent in a 

medical emergency, they lose the protections of Part 2. An expanded consent interpretation that 

allows providers to access SUD records in a medical emergency by consent, rather than by 

“breaking the glass,” will ensure that more alcohol/drug records remain protected by Part 2. 

To the extent that SAMHSA is considering allowing an HIE or ACO together with all of its 

affiliated/member providers to be listed as an “organization” in the consent form’s “to whom” 

field, we strongly urge against such a change. Allowing an HIE, ACO, or other new health care 

12 42 C.F.R. § 2.31. 
 

 

 

 

 

 

 

 

 

 

 

8 

model to call itself an “organization” would have broad implications, namely the proliferation of 

disclosures of SUD records without meaningful patient consent. Depending on the size of the 

HIE or ACO, potentially vast networks of health care providers (and other personnel) would 

have access to patients’ alcohol and drug records after the patient signs a single consent form. In 

the ACO context, member providers and personnel would be free to redisclose the SUD records 

amongst themselves without patient consent; in the HIE context, any provider affiliated with the 

HIE would be able to redisclose SUD records with any other affiliated provider without patient 

consent. This is particularly worrisome given widespread lack of knowledge of Part 2’s 

protections – and the reasons for those protections – among non-Part 2 providers, and the risks 

associated with freely flowing electronic health information, including breaches. 

Another possible consequence of defining or reinterpreting the meaning of “organization” in the 

context of Part 2 consent is that the expanded meaning of “organization” may apply elsewhere in 

the regulations, such as in reference to Qualified Service Organizations (QSOs). If, for example, 

an HIE along with all of its affiliated providers could be considered a QSO, then patients’ SUD 

records could be disclosed without consent by a Part 2-covered program to the HIE as well as all 

of its affiliated providers, as long as a QSO Agreement (QSOA) was in place. Because Part 2 

contains no requirement that patients be notified of a Part 2 program’s QSOAs, patients would 

not even be aware that these consent-less disclosures were occurring. The implications of this 

type of re-interpretation of QSOs and QSOAs would be a virtual gutting of Part 2’s consentbased patient protections. 

Comments on Third and Fourth Suggested Consent Changes: 

With regard to SAMHSA’s proposals regarding changes to the “by whom” consent 

requirements, we are not familiar with a current challenge that such a change would address, and 

would have concerns that such changes may only serve to make the consent process more 

onerous. We believe that the current language regarding the description of the programs or 

people permitted to make disclosures is sufficiently clear. 

Comments on Fifth Suggested Consent Change: 

We are unclear about what is meant by “explicitly describe the substance abuse treatment 

information that may be disclosed,” and what concern this suggestion is meant to address. The 

current regulations require written patient consent to describe the amount and type of 

information to be disclosed, and the purpose of the disclosure.13 In addition, current regulations 

require that “any disclosure made under these regulations must be limited to that information 

which is necessary to carry out the purpose of the disclosure.”14 We believe the current 

regulations provide sufficient specificity with regard to what information will be disclosed and 

for what purpose. 

13 42 C.F.R. § 2.31. 14 42 C.F.R. § 2.13(a). 
 

 

 

 

 

 

 

 

 

9 

c. Redisclosure

SAMHSA is considering revising the redisclosure provision (42 C.F.R. § 2.32) “to clarify that 

the prohibition on redisclosure only applies to information that would identify an individual as a 

substance abuser, and allows other health-related information shared by the Part 2 program to be 

redisclosed, if legally permissible.” SAMHSA gives as the reason for such a revision that “most 

EHRs do not support data segmentation,” and that such a revision will “allow HIT systems to 

more easily identify information that is subject to the prohibition on redisclosure enabling them 

to utilize other technological approaches to manage redisclosure.” We support further 

clarification that Part 2’s Prohibition on Redisclosure does not apply to information that does not 

identify an individual as having an SUD or being in SUD treatment, including how that relates to 

and can facilitate communications between substance use treatment providers and HIT systems. 

The possible revision SAMHSA is suggesting would restate exactly what the current regulations 

allow. The current prohibition on redisclosure states that information cannot be redisclosed 

unless it is permitted by written consent “or as otherwise permitted by 42 CFR Part 2 [emphasis 

added].”15 Part 2’s restrictions on disclosure only apply to information that “would identify a 

patient as an alcohol or drug abuser....”16 Thus, currently under Part 2, information that does not 

identify a patient as a “substance abuser” is not protected and can be redisclosed. Therefore, no 

revision to Part 2’s redisclosure provision is necessary. SAMHSA can clarify any confusion 

about the applicability of Part 2’s redisclosure provision through the issuance of sub-regulatory 

guidance. 

Moreover, adoption of SAMHSA’s proposed revision would not ease the technological challenge 

of data implementation. Data segmentation would still be necessary to ensure proper 

implementation and adherence to the prohibition against redisclosing information that would 

identify an individual as a substance abuser. Thus we do not see any reason why Part 2’s 

prohibition on redisclosure should be revised. 

d. Medical Emergency

We do not see the need to change Part 2’s definition of medical emergency, and worry that 

broadening that definition to encompass situations that are not emergencies would create an 

impermissible end-run around Part 2’s requirement to obtain consent from the patient. At the 

same time, we strongly support further guidance making clear that health care providers can 

“break the glass” and disclose information in situations where a patient is not able to give 

consent and information in a patient’s medical records is needed to treat a medical emergency, 

including medications s/he is taking that could dangerously cross-react with a medication that 

might be prescribed to treat the emergency. 

LAC does not believe there should be a changes to Part 2’s current medical emergency exception 

that states that information may be disclosed without consent “for the purpose of treating a 

condition which poses an immediate threat to the health of any individual and which requires 

15 42 C.F.R. §2.32. 16 42 C.F.R. §2.12(a)(i) 
 

 

 

 

 

 

 

 

 

10 

immediate medical intervention,” and opposes any revision that would allow providers to use the 

medical emergency provision to prevent emergencies. 

As SAMHSA noted, the statute only allows disclosure, without a patient’s written consent, “to 

medical personnel to the extent necessary to meet a bona fide medical emergency.”17 A 

speculative concern that an emergency might happen in the future does not and should constitute 

a bona fide medical emergency that allows for an unconsented-to disclosure. Invoking the 

medical emergency exception and accessing a patient’s protected SUD records without consent 

should be allowable only when: (1) there is an actual emergency in which a patient’s prior 

consent cannot be obtained by the provider treating the emergency – because the individual is 

actually unconscious or incapacitated/unable to give consent; and (2) there is need for immediate 

action requiring immediate access to the person’s records. 

The current rule already gives providers the discretion they need to interpret it appropriately in 

fact-specific situations. We do not believe that there should be any attempt to try to write into 

regulatory language specific scenarios (such as the example SAMHSA offers of changing the 

existing standard in order to “prevent emergencies or to share information when a patient is 

unable to provide informed consent due to their level of intoxication”), because attempting to 

anticipate and spell out all of the potential scenarios that might conceivably arise would be an 

exercise in futility, and would rob those faced with such a list of the crucially important 

discretion the current standard must continue to afford them. 

e. Qualified Service Organization (QSO)

In its May 12 Notice, SAMHSA states that it has “heard concerns from payers and health 

management organizations related to disclosing information that is subject to 42 C.F.R. Part 2 to 

health care entities (ACOs/CCOs) for the purpose of care coordination and population health 

management; helping them to identify patients with chronic conditions in need of more intensive 

outreach” (emphasis added). SAMHSA proposes expanding the definition of a QSO to allow for 

Qualified Service Organization Agreements (QSOAs) for the purposes of care coordination and 

population health management. 

SAMHSA has always taken the position that a QSOA is a two-way agreement between two 

parties – one a Part 2 program and the other a Qualified Service Organization (QSO) that is 

providing a service to that Part 2 program. We strongly support that position and urge 

SAMHSA not to open up the QSOA exception so as to allow Part 2 information to flow between 

multiple entities. To do so would be a complete evisceration of Part 2’s consent requirements. 

To the extent that, for the purpose of care coordination and population health management, there 

might be one entity that is gathering data from difference data sources, a QSOA would be an 

acceptable tool for a Part 2 program to disclose protected information to that information 

gathering entity. If, however, Part 2 information would need to flow to all entities involved in 

care coordination and population health management, then a QSOA should not be allowed for 

such a purpose, and SAMHSA should remain staunch in its position that patient consent would 

17 42 U.S.C. § 290dd-2 (b)(2)(A) 
 

 

 

 

 

 

 

 

 

 

 

 

 

11 

be needed. Indeed it is quite simple for a consent to be drafted that allows communication 

among multiple parties. 

Should SAMHSA also be proposing that a QSOA can be used for payment purposes, Part 2 

currently requires that a consent be used for such a purpose, and we strongly agree that consent 

should remain the only option for disclosing information for payment purposes. This 

interpretation is the only one that is consistent with Part 2’s authorizing statute. 

Finally, we are not sure if, when SAMHSA proposed that “One potential solution includes ... to 

allow a ... QSOA to be executed between an entity that stores Part 2 information, such as a payer 

or an ACO that is not itself a Part 2 program, and a service provider,” SAMHSA meant the term 

“service provider” to refer to a program covered by Part 2, or to another type of entity. We 

strongly believe that a QSOA should remain an agreement only between a Part 2 program and an 

entity that provides a service to that program. 

In sum, to the extent that SAMHSA may be suggesting any significant broadening of the rules 

surrounding QSOAs, we believe this would not only run afoul of Part 2’s authorizing statute, but 

it would also create an end-run around Part 2’s core protections – namely the requirement that 

patient consent be obtained before making a disclosure of SUD information, and the prohibition 

on redisclosure. Allowing QSOs to disclose Part 2 information to one another would eviscerate 

Part 2’s consent and redisclosure protections and damage patient trust. 

f. Research

If SAMHSA is suggesting that third party payers, HIEs, etc., should be able to disclose Part 2 

information already in their possession to researchers, we support the underlying rationale for 

this suggested change, i.e., that researchers should have the ability to get access to information 

for research purposes. However, we are concerned that the protections contained in Part 2’s 

research exception (found at 42 C.F.R. §2.52) will not be enforceable if entities other than Part 2 

treatment providers have the authority to release Part 2 information in their possession to 

researchers. How will HIEs, third party payers, etc., be able to determine that a researcher will 

maintain the Part 2 information in accordance with the security requirements set out in 

§2.52(a)(2)? How will they be able to assess whether the potential benefits of the research

outweighs any risks to confidentiality as required by §2.52(a)(3)? Who at these organizations

will be the equivalent of a “program director” and have the authority to make these decisions?

Will they know enough about §2.52 to inform the researchers about the limitation about how the

Part 2 information can be redisclosed under §2.52(b)?

In sum, we would support qualified researchers gaining access to Part 2 information for scientific 

research purposes, from sources other than Part 2 programs, if there is a way to ensure that all of 

Part 2’s research protections in §2.52 will be complied with. 
 

 

 

 

 

 

 

 

 

12 

g. Addressing Potential Issues With Electronic Prescribing and Prescription Drug

Monitoring Programs (PDMPs)

LAC understands, and finds both justifiable and necessary in light of the current regulation, 

SAMHSA’s current interpretation requiring Part 2 programs to obtain patients’ proper written 

consent before disclosing patients’ electronic prescription information to a pharmacy, requiring 

the pharmacy to obtain proper patient consent before disclosing the Part 2-protected information 

to a PDMP, and requiring the PDMP to obtain proper patient consent before re-disclosing Part 2­

protected information to others. As stated earlier in these comments, it is critical that SUD 

patients retain control over who has access to their records in light of ongoing prejudice and 

discrimination, and the potential unintended consequences of permitting widespread disclosure 

of those records. 

According to the National Alliance for Model State Drug Laws, as of December 2013, 18 states 

allow law enforcement to access their PDMPs with a search warrant, subpoena, court order, or 

other judicial process. Furthermore, 13 states allow law enforcement to be registered users of 

their PDMPs.18 Law enforcement attempts to access SUD patient records, and the deterrent 

impact of law enforcement access against people seeking SUD treatment, was a primary reason 

for creating Part 2’s protections in the first place. Any change to Part 2 that would allow law 

enforcement to access patients’ SUD information without their consent would directly 

contravene the most basic purposes of Part 2, and would violate Part 2’s authorizing statute.19

Furthermore, discrimination by non-Part 2 health care providers and insurers continue to cause 

real concern among SUD patients. Any change to Part 2 that would allow patients’ SUD 

information to flow without their consent to pharmacies, PDMPs, and all those with access to 

PDMPs would not only violate Part 2’s authorizing statute but could also cause damage to 

patients, including discrimination by health care providers, insurers, and others. We support 

SAMHSA’s continued interpretation of Part 2 as requiring patient consent for disclosure of their 

SUD prescription information to pharmacies, PDMPs, and those with access to PDMPs, and for 

redisclosure by any of those entities. 

IV. Conclusion

The health care environment is changing rapidly, moving toward more integrated care and the 

electronic exchange of health information. It is important for behavioral health to be included in 

integrated care and HIE in order to provide the best care for the millions of individuals in the 

U.S. who suffer from substance use disorders, and also to reduce costs associated with those 

disorders. At the same time, the privacy protections afforded to SUD information by Part 2 

remain as critical today as they were when enacted in the 1970s. People with substance use 

disorders still face loss of employment, housing, and child custody; insurance discrimination; 

criminal arrest, prosecution, and incarceration; and a host of other negative consequences. In 

18 Nat’l Alliance of Model State Drug Laws, Law Enforcement Access to State PMP Data (2013), available at 

http://www.namsdl.org/library/C4AA9EA3-65BE-F4BB-AAFBAB1F5736F070/. 19 42 C.F.R. Part 2’s authorizing statute states: “Except as authorized by a [Part 2] court order ... no [Part 2] record 

... may be used to initiate or substantiate any criminal charges against a patient or to conduct any investigation of a 

patient.” 42 U.S.C. § 290dd-2(c). 
 

 

 

13 

order to encourage people with substance use disorders to seek treatment, we strongly urge that 

Part 2’s privacy protections be maintained. We also urge that, where possible, the issues 

identified by SAMHSA as causing confusion be addressed through additional and revised subregulatory guidance by SAMHSA, without the need for regulatory change. 

LAC also encourages the continued development of technology, along with corresponding 

policies and procedures, that will enable patients with SUD records – and other types of sensitive 

health records – to maintain control and choice regarding disclosures of their health information. 

We believe granular control in health information technology (HIT) is possible and imminent. 

We also hope that incentives for the adoption of HIT will be extended to behavioral health 

providers, and that SAMHSA and other departments of HHS will continue to pilot cutting-edge 

behavioral health HIT initiatives. Finally, we agree with stakeholders who stressed at the June 

11, 2014 Listening Session the importance of educating health care providers, Part 2 programs, 

and Part 2 patients about consent, Part 2, and substance use disorders generally. 
-----Original Message-----

From: Babak Imanoel [mailto:babakimanoel@gmail.com]
 

Sent: Wednesday, June 25, 2014 3:34 PM
 

To: Privacy Regulations (SAMHSA)
 

Subject: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. Part 2. 79 Fed.
 

Reg. 26929; Docket No. 2014-10913
 

To Whom It May Concern: 

My name is Babak Imanoel, DO and I am writing on behalf of BH Health Services, which is a Methadone 

Maintenance Program located in Westminster, Maryland. 

While BH Health Services supports updating the mechanics of the federal alcohol and drug 

confidentiality regulations to facilitate more effective integration of care and needed communication in 

the electronic age, 42 C.F.R. Part 2’s core privacy protections MUST be maintained. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 2014 Notice of 

Public Listening Session (79 Fed. Reg. 26929), BH Health Services, Inc. supports the following principles: 

 

 

• Addiction treatment should be integrated with mental and physical health care, and communication

among health care providers should be encouraged. We support maximizing inclusion of substance use

disorder

(SUD) records in electronic health record (EHR) systems and health information exchanges (HIEs) while

maintaining 42 C.F.R. Part 2’s core privacy protections.

 

 

 

• 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were when they were

enacted more than 40 years ago, and a move toward HIPAA’s looser privacy standards would not

sufficiently protect people seeking and receiving substance use disorder treatment.

If patient records can be easily accessed in order to criminally investigate or prosecute a patient, or deny

them insurance or a job, or be used against them in a divorce or child custody proceeding, many

patients will be afraid to enter treatment in the first place.

• LAC continues to believe that patients in alcohol and drug programs should retain the power to decide

when and to whom their records are disclosed, even for treatment and payment purposes, given the

continued prevalence of discrimination in our society. This includes disclosures to the general health

care system, HIEs, health homes, ACOs, and CCOs. The best way for patients to retain that power is by

requiring patient consent for most disclosures, together with a strong prohibition on redisclosure.

• It is both necessary and technologically possible to integrate addiction and other health care and

effectively exchange addiction treatment data while maintaining the core protections of 42 C.F.R.

Part 2. We urge the continued development of technical solutions for consent management.

 

• Since HIPAA requires compliance with state and federal laws that mandate greater privacy

protections, electronic health record systems

(EHRs) must be designed so as to comply with the many state statutes that require heightened

protections for information related to mental health, HIV/AIDS, reproductive health, domestic violence

and other types of sensitive health information, as well as with 42 C.F.R. Part 2. It is important to keep in
mind, therefore, that EHRs would be required to accommodate enhanced protections for the medical



records of some illnesses in order to be HIPAA-compliant even if 42 C.F.R.



Part 2 did not exist. We also support the comments submitted by the Legal Action Center.



Thank you for your consideration.



Sincerely,



Babak Imanoel,D.O.



Medical Director and President,

BH Health Services, Inc.



450 East Main Street



Westminster, MD 21157

Tel: 410-871-3005



Fax: 443-293-8711



Babak Imanoel, D.O. 

This email or facsimile transmission may contain CONFIDENTIAL, PRIVILEGED and or PROTECTED 

INFORMATION intended solely for the use of the individual or entity to whom it is addresses. If you are

not the intended recipient, please notify the sender by email or fax immediately. Please do no 

disseminate or copy and delete or destroy immediately. 
 

 

 

 

 

South Carolina Association for the 

Treatment of Opioid Dependence 

June 25, 2014 

South Carolina Association for the Treatment of Opioid Dependence 

5 Charleston Center Drive 

Charleston, SC 29401 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 

C.F.R. Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

The South Carolina Association for the Treatment of Opioid Dependence (SCATOD) is a 

provider’s association representing all 17 Opioid Treatment Program’s (OTP’s) in the 

state and we treat thousands of patients with an opioid use disorder (primarily) and other 

substance use/mental health disorders. I am the current President and I am speaking on 

behalf of the association. 

While SCATOD supports updating the mechanics of the federal alcohol and drug 

confidentiality regulations to facilitate more effective integration of care and needed 

communication in the electronic age, 42 C.F.R. Part 2’s core privacy protections 

MUST be maintained. 

All too often, our patients are subjected to stigmatization by other people and systems 

due to their substance use disorder. This is enhanced when people are on Medication 

Assisted Treatment (MAT), especially methadone, and can impact several facets of one’s 

life. We already deal with patients hesitant to share their treatment status with employers 

for fear of getting fired. We have patients that struggle to find adequate health care once 

their status is known as being on methadone. We live in a state that insurers already find 

ways to limit treatment for people with a substance use disorder, which is a chronic 

disease, which does not happen with other chronic diseases like diabetes, hypertension, 

etc. We believe that the core privacy protections need to be maintained to reduce any 

intentional/unintentional stigma and or barrier to the population that is dealing with a 

substance use disorder. 
 

 

 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 

2014 Notice of Public Listening Session (79 Fed. Reg. 26929), SCATOD supports the 

following principles: 

•	 Addiction treatment should be integrated with mental and physical health care, 

and communication among health care providers should be encouraged. We 

support maximizing inclusion of substance use disorder (SUD) records in 

electronic health record (EHR) systems and health information exchanges (HIEs) 

while maintaining 42 C.F.R. Part 2’s core privacy protections. 

•	 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they 

were when they were enacted more than 40 years ago, and a move toward 

HIPAA’s looser privacy standards would not sufficiently protect people seeking 

and receiving substance use disorder treatment. If patient records can be easily 

accessed in order to criminally investigate or prosecute or patient, or deny them 

insurance or a job, or be used against them in a divorce or child custody 

proceeding, many patients will be afraid to enter treatment in the first place. 

•	 SCATOD continues to believe that patients in alcohol and drug programs should 

retain the power to decide when and to whom their records are disclosed, even for 

treatment and payment purposes, given the continued prevalence of 

discrimination in our society. This includes disclosures to the general health care 

system, HIEs, health homes, ACOs, and CCOs. The best way for patients to 

retain that power is by requiring patient consent for most disclosures, together 

with a strong prohibition on redisclosure. 

•	 It is both necessary and technologically possible to integrate addiction and other 

health care and effectively exchange addiction treatment data while maintaining 

the core protections of 42 C.F.R. Part 2. We urge the continued development of 

technical solutions for consent management. 

•	 Since HIPAA requires compliance with state and federal laws that mandate 

greater privacy protections, electronic health record systems (EHRs) must be 

designed so as to comply with the many state statutes that require heightened 

protections for information related to mental health, HIV/AIDS, reproductive 

health, domestic violence and other types of sensitive health information, as well 

as with 42 C.F.R. Part 2. It is important to keep in mind, therefore, that EHRs 

would be required to accommodate enhanced protections for the medical records 
of some illnesses in order to be HIPAA-compliant even if 42 C.F.R. Part 2 did not 

exist. 

We also support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Sincerely, 

W. Jonas Coatsworth MA, LPC, CAC-II

South Carolina Association for the Treatment of Opioid Dependence (SCATOD)

President 

(843) 958-3364 
 

 

 

 

 

June 25, 2014 

Harm Reduction Coalition 

22 W. 27th Street, 5th Floor 

New York, NY 10001 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. Part 2. 79 

Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

On behalf of the Harm Reduction Coalition, a national organization addressing the intersection of 

substance use and health, I am writing to comment on regulations regarding federal drug confidentiality 

protections. 

While Harm Reduction Coalition supports updating the mechanics of the federal alcohol and drug 

confidentiality regulations to facilitate more effective integration of care and needed communication in the 

electronic age, 42 C.F.R. Part 2’s core privacy protections MUST be maintained. 

Harm Reduction Coalition works with a broad array of partners and stakeholders, particularly communitybased syringe exchange and harm reduction programs which serve marginalized and stigmatized people 

with substance use histories. We routinely hear concerns from these programs and their participants about 

their fraught relationship and engagement with the health care system, which they experience as 

stigmatizing towards people who use drugs. We recognize and support efforts to better integrate substance 

use screening and treatment into primary care, and appreciate the value of ensuring that patients’ substance 

use treatment needs and histories are recognized and responded to by their health care providers. At the 
 

 

 

same time, we feel strongly that the stigma which persists among health care providers jeopardizes access 

and quality of care for these vulnerable populations. The privacy protections conferred under 42 C.F.R. 

Part 2 remain critical for people with substance use histories wishing to retain confidentiality and 

autonomy in their health care. 

To take one example, many people with chronic hepatitis C struggle to obtain effective treatment from 

clinicians who actively discourage, dissuade, or refuse to treat their hepatitis C due to the patient’s 

substance use history. Moreover, with newer and more effective hepatitis C treatments now available, a 

number of payers are restricting reimbursement for hepatitis C treatment through prior authorization 

requirements to people with substance use disorders, in some cases requiring drug testing. These 

restrictions are not based on evidence or sound clinical care, and indeed are just one manifestation of the 

overwhelming biases across all parts of the health care system towards people with substance use histories. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 2014 Notice of 

Public Listening Session (79 Fed. Reg. 26929), Harm Reduction Coalition supports the following 

principles: 

•	 Addiction treatment should be integrated with mental and physical health care, and communication 

among health care providers should be encouraged. We support maximizing inclusion of 

substance use disorder (SUD) records in electronic health record (EHR) systems and health 

information exchanges (HIEs) while maintaining 42 C.F.R. Part 2’s core privacy protections. 

•	 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were when they were 

enacted more than 40 years ago, and a move toward HIPAA’s looser privacy standards would not 

sufficiently protect people seeking and receiving substance use disorder treatment. If patient 

records can be easily accessed in order to criminally investigate or prosecute or patient, or deny 

them insurance or a job, or be used against them in a divorce or child custody proceeding, many 

patients will be afraid to enter treatment in the first place. 

•	 LAC continues to believe that patients in alcohol and drug programs should retain the power to 

decide when and to whom their records are disclosed, even for treatment and payment purposes, 

given the continued prevalence of discrimination in our society. This includes disclosures to the 

general health care system, HIEs, health homes, ACOs, and CCOs. The best way for patients to 

retain that power is by requiring patient consent for most disclosures, together with a strong 

prohibition on redisclosure. 
 

•	 It is both necessary and technologically possible to integrate addiction and other health care and 

effectively exchange addiction treatment data while maintaining the core protections of 42 C.F.R. 

Part 2. We urge the continued development of technical solutions for consent management. 

•	 Since HIPAA requires compliance with state and federal laws that mandate greater privacy 

protections, electronic health record systems (EHRs) must be designed so as to comply with the 

many state statutes that require heightened protections for information related to mental health, 

HIV/AIDS, reproductive health, domestic violence and other types of sensitive health information, 

as well as with 42 C.F.R. Part 2. It is important to keep in mind, therefore, that EHRs would be 

required to accommodate enhanced protections for the medical records of some illnesses in order 

to be HIPAA-compliant even if 42 C.F.R. Part 2 did not exist. 

We also support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Sincerely, 

Daniel Raymond 

Policy Director 
Hour House 
 

635 Division St. 
 

Charleston, IL 
 

61920 
 

(217) 348-8108 
 

(217) 348-0154 
 

1501Y2 18th St. 
 

Charleston. IL 
 

61920 
 

(217) 348-5444 
 

726 4th St. 
 

Charleston, IL 
 
 

61920 
 

(217) 348-8118 
 

(217) 348·8591 
 

720 4th St. 
 

Charleston, IL 
 

61920 
 

(217) 348-8651 
 

A NOT-FOR-PROFIT CORPORATION 

SINCE 1972 
 

SERVING CENTRAL ILLINOIS 

ADMINISTRATIVE OFFICES• 635 Division St., P.O. Box 532 • Charleston, Illinois 61920 

Telephone: (217) 348-8108 • Fax (217) 345-6794 
 

TDD: (217) 348-81 16 
 

8500 E. Co Rd. 150N 

Lerna, IL 

62440 

(217) 235-1303


513 N. 13th St. 

Mattoon, IL 

61938 

(217} 258-6018 

521 N. 13th St. 

Mattoon, IL 

61938


(217} 258-6137 

416 N. 19th St.

Mattoon, IL 
 

61938 
 

217} 258-2968


55 South Morgan 

Shelbyville, IL 

62565


(217} 774-5566 

(

1

June 25, 2014 	 	 

U.S. Substance Abuse and Mental Health Services Administration 	 	 

1 Choke Cherry Road 

Room 5-1011 
 

Rockville, MD 20857 

Submitted via email: PrivacyRegulations@SAMHSA.hhs.gov 

RE: Confidentiality ofAlcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. 

Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

Central East Alcoholism and Drug Council (CEAD) Council is a community based, not-for-profit 

Corporation offering a full array of services for alcohol and drug abuse and dependency across a 

large rural area ofcentral Illinois. As a "stand-alone" provider ofprevention, intervention, 

treatment, and recovery support services since 1972, we have repeatedly found the provisions 

within 42 CFR Part 2 to be foundational in our ability to successfully provide services. Especially 

in the rural areas where "everyone knows everyone" the protections afforded to patients via 42 

CFR are extremely important to both existing and potential patients. It is because ofthe 

protections that exist in the regulations that clients are willing to enter treatment and to openly 

participate in the treatment process with confidence that their privacy will be protected. Though 

obtaining written consent for disclosure of information may present some problems in the current 

environment ofunlimited electronic exchange ofdata, it is of utmost importance to continue the 

protections afforded to patients that requiring written consent maintains. Effective integration of 

care can readily occur while maintaining 42 CFR's privacy protections. Effective treatment of 

substance abuse cannot occur without the protections that currently exist in 42 CFR. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA's May 12, 2014 

Notice ofPublic Listening Session (79 Fed. Reg. 26929), Central East Alcoholism and Drug 

Council supports the following principles: 

• 	 Addiction treatment should be integrated with mental and physical health care when 
 
 

determined to be clinically indicated in individual cases and communication among those 
 
 

1 
 
individually relevant health care providers should be encouraged as applies to the current 

circumstances ofthe patient and with the patient's full informed consent. That can 

readily occur within the existing regulations. 

• 42 C.F.R. Part 2's heightened privacy protections are as critical today as they were when 

they were enacted more than 40 years ago, and a move toward JUPAA's looser privacy 

standards would not sufficiently protect people seeking and receiving substance use 

disorder treatment. Ifpatient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny them insurance or a job, or be used against 

them in a divorce or child custody proceeding, many patients will be afraid to enter 

treatment in the first place. Even ifpeople seeking and receiving substance use disorder 

treatment perceive that the confidentiality restrictions have been relaxed, their fear of 

unwanted release ofinformation may create barriers to treatment access and acceptance. 

• Central East Alcoholism and Drug Council continues to believe that patients in alcohol 

and drug programs should retain the power to decide when and to whom their records are 

disclosed, even for treatment and payment purposes, given the continued prevalence of 

discrimination in our society. This includes disclosures to the general health care system, 

HIEs, health homes, ACOs, and CCOs. The best way for patients to retain that power is 

by requiring patient consent for disclosures, together with a strong prohibition on redisclosure. 

• It is both necessary and technologically possible to integrate addiction and other health 

care and effectively exchange addiction treatment data while maintaining the core 

protections of42 C.F.R. Part 2. We urge the continued development oftechnical 

solutions for consent management and significant testing ofthose solutions prior to 

premature and unnecessary changes in the regulations. 

• The nature ofsubstance abuse treatment requires that patients discuss and disclose the 

very-most intimate details oftheir thoughts, emotions, lifestyle, past behaviors, family 

issues, and more. The patient record contains information that was shared with a 

counselor with the understanding that such information would remain confidential within 

the treatment team and/or program. Effective substance abuse treatment requires a 

practitioner/patient relationship that has a foundation in honesty and transparency that 

will only occur in a setting that promotes patient control ofthe limits ofdisclosure ofthat 

information. Unlike medical records that more readily record only pieces of"data," the 

content ofsubstance abuse treatment records was never written from the perspective that 

it would someday be thrown into a public electronic exchange where it would await the 

next access by some entity unknown to the patient and without the patient's full informed 

consent. 

• The substance abuse treatment field has also experienced extensive workforce issues 

since inception that continue to this day. Retaining qualified clinical staff is an ongoing 

2 
issue. The confidentiality protections afforded via 42 CFR have been instrumental in 

fostering excellent clinical practice that is extremely important to clinicians working in 

the substance abuse field and that they want to retain. I would predict a significant 

exodus of experienced clinical staff away from the substance abuse field if the core 

protections in 42 CFR cease to exist. 

• ] Additionally, many organizations in the substance abuse field, including CEAD Council, 

have strong connections with the self-help fellowships of Alcoholics Anonymous and 

Narcotics Anonymous. Similar philosophical approaches support our mutual efforts to 

encourage long-term recovery. The protections of 42 CFR foster our mutual efforts and 

beliefs regarding anonymity, privacy, personal choice, and informed consent. 

It appears that the primary entities who might advocate for changes to 42 CFR Part 2, i.e., 

computer programmers, health information exchanges, CCO's, ACO's, etc., are not from the 

substance abuse treatment field. I have worked in the substance abuse treatment field for over 37 

years in an organization that has served over 22,000 individuals. I do not know of a single 

professional or patient in the substance abuse field that has expressed a desire for these 

regulations to be relaxed. I know of thousands of "stories" wherein these regulations have been of 

benefit. 

Thank you for your consideration. 

Sincerely, 

Pamela P. Irwin, Ph.D., CADC 

Executive Director 

Central East Alcoholism and Drug Council 

635 Division Street 

P.O. Box 532 

Charleston, IL 61920 

217-348-8108

3 
 CAADPE 


 

 

 

 

 

CALIFORNIA ASSOCIATION OF ALCOHOL AND DRUG PROGRAM EXECUTIVES, INC.
 

1127 - 11th Street, Suite 208, Sacramento, CA 95814 

(916) 329-7409 FAX (916) 442-4616 caadpe@pacbell.net 

June 25, 2014 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. 

Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

The California Association of Alcohol and Drug Program Executives, Inc. (CAADPE) is a 

statewide association of community-based nonprofit substance use disorder treatment 

agencies. Its members provide substance use disorder services, including co-occurring 

disorder services, at over 300 sites throughout the state and constitute the 

infrastructure of the state’s publicly funded substance use disorder treatment network. 

It is the only statewide association representing all modalities of substance disorder use 

treatment programs 

While CAADPE supports updating the mechanics of the federal alcohol and drug 

confidentiality regulations to facilitate more effective integration of care and needed 

communication in the electronic age, 42 C.F.R. Part 2’s core privacy protections MUST 

be maintained. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 

2014 Notice of Public Listening Session (79 Fed. Reg. 26929), CAADPE supports the 

following principles: 

BOARD OF DIRECTORS 

OFFICERS 

President 

Albert M. Senella 

Tarzana Treatment Centers, Inc. 

Kern, Los Angeles, Orange, 

Ventura Counties 

Vice President 

Trisha Stanionis 

Family Service Agency 

Yolo County 

Secretary 

Shawn Jenkins 

WestCare California 

Fresno, El Dorado, Kern, 

Sacramento Counties 

Treasurer 

Norman Sprunck 

Western Pacific Med Corp 

Los Angeles, Orange, Ventura Counties 

BOARD MEMBERS 	

Jack Bernstein 

CRI-HELP, Inc. 

Los Angeles County
 

Christine Bierdrager -Salley, Ph.D. 
 Inland Behavioral & Health Services, Inc. 

Riverside and San Bernardino Counties 

Kimberly Bond 

Mental Health Systems 

San Diego, San Bernardino, 

Imperial, Riverside, Santa Barbara, 

San Luis Obispo, Kern, 

Stanislaus, Fresno and Orange Counties
 

Vitka Eisen, MSW, Ed.D. 

HealthRIGHT 360 

Kings, Los Angeles, Madera, 

Riverside, San Francisco, 

and Sutter Counties 

Mark Faucette 

Amity Foundation 

Los Angeles, Madera, San Bernardino 

and San Diego Counties 

Cassandra Loch 

Prototypes 

Los Angeles, Orange, 

Ventura Counties 

RuthAnn Markusen, 

Didi Hirsch Community Mental Health

Center 

Los Angeles County 

Stephen Maulhardt 

Aegis Medical Systems 

Butte, Fresno, Kern, Los Angeles 

Merced, Placer, San Bernardino, 

San Joaquin, San Luis Obispo, 

Santa Barbara, Stanislaus, Sutter, 

Ventura, Yuba Counties 

Luis Montes 

Narcotics Prevention Association Inc. 

Los Angeles County 

Patrick Gauthier 

Volunteers of America 

Los Angeles County 

Elvia Torres 

SPIRITT Family Services 

Los Angeles County 

Elizabeth Stanley-Salazar 

Phoenix Houses of California, Inc. 

Kings, Los Angeles, Madera, Orange, 

San Bernardino, San Diego, 

Ventura Counties 

Shirley Summers 

Behavioral Health Services, Inc. 

Los Angeles, Orange Counties 

Sushma Taylor, Ph.D. 

Center Point, Inc. 

Contra Costa, Marin, Riverside, 

Sacramento, San Diego, San Joaquin, 

Solano, Tuolomne Counties 

Brenda Wiewel 

Los Angeles Centers for Alcohol & Drug Abuse 

Los Angeles County 

In memoriam 

Dale Shimizu 

	 Addiction treatment should be integrated with mental and physical 

health care, and communication among health care providers should be 

encouraged. We support maximizing inclusion of substance use 

disorder (SUD) records in electronic health record (EHR) systems and 

health information exchanges (HIEs) while maintaining 42 C.F.R. Part 2’s 

core privacy protections. 

	 42 C.F.R. Part 2’s heightened privacy protections are as critical today as 

they were when they were enacted more than 40 years ago, and a move 

toward HIPAA’s looser privacy 
	 Standards would not sufficiently protect people seeking and receiving substance use 

disorder treatment. If patient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny them insurance or a job, or be used 

against them in a divorce or child custody proceeding, many patients will be afraid to 

enter treatment in the first place. 

	 LAC continues to believe that patients in alcohol and drug programs should retain the 

power to decide when and to whom their records are disclosed, even for treatment 

and payment purposes, given the continued prevalence of discrimination in our 

society. This includes disclosures to the general health care system, HIEs, health 

homes, ACOs, and CCOs. The best way for patients to retain that power is by 

requiring patient consent for most disclosures, together with a strong prohibition on 

redisclosure. 

	 It is both necessary and technologically possible to integrate addiction and other 

health care and effectively exchange addiction treatment data while maintaining the 

core protections of 42 C.F.R. Part 2. We urge the continued development of technical 

solutions for consent management. 

	 Since HIPAA requires compliance with state and federal laws that mandate greater 

privacy protections, electronic health record systems (EHRs) must be designed so as 

to comply with the many state statutes that require heightened protections for 

information related to mental health, HIV/AIDS, reproductive health, domestic 

violence and other types of sensitive health information, as well as with 42 C.F.R. 

Part 2. It is important to keep in mind, therefore, that EHRs would be required to 

accommodate enhanced protections for the medical records of some illnesses in 

order to be HIPAA-compliant even if 42 C.F.R. Part 2 did not exist. 

We also support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Sincerely, 

Albert Senella 

President 
Colonial Management Group, LP 


8529 SouthPark Circle • Suite 270 • Orlando, FL 32819 

(407) 35 1-7080 

SUBMITTED VIA EMAIL 

June 25, 2014 

U.S. Substance Abuse and Mental Health Services Administration 


1 Choke Cherry Road 


Room 5-1011 


Rockville, MD 20857 


RE: 	 Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. 

Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

We support 63 opiate treatment programs in 18 states. 

While Colonial Management Group, LP supports updating the mechanics ofthe federal alcohol 

and drug confidentiality regulations to facilitate more effective integration of care and needed 

communication in the electronic age, 42 C.F.R. Part 2's core privacy protections MUST be 

maintained. 

We strongly believe that fear on the part ofpotential patients that their involvement with an 

opiate treatment program will be disclosed to others is a strong deterrent that prevents many 

from seeking treatment. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA's May 12, 2014 

Notice ofPublic Listening Session (79 Fed. Reg. 26929), Colonial Management Group, LP 

supports the following principles: 

• 	 Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. We support 

maximizing inclusion of substance use disorder (SUD) records in electronic health record 

(EHR) systems and health information exchanges (HIEs) while maintaining 42 C.F.R. 

Part 2's core privacy protections. 
•	@42 C.F.R. Part 2's heightened privacy protections are as critical today as they were when 

they were enacted more than 40 years ago, and a move toward HIPAA's looser privacy 

standards would not sufficiently protect people seeking and receiving substance use 

disorder treatment. If patient records can be easily accessed in order to criminally 

investigate or prosecute a patient, or deny them insurance or a job, or be used against 

them in a divorce or child custody proceeding, many patients will be afraid to enter 

treatment in the first place. 

•	@LAC continues to believe that patients in alcohol and drug programs should retain the 

power to decide when and to whom their records are disclosed, even for treatment and 

payment purposes, given the continued prevalence of discrimination in our society. This 

includes disclosures to the general health care system, HIEs, health homes, ACOs, and 

CCOs. The best way for patients to retain that power is by requiring patient consent for 

most disclosures, together with a strong prohibition on redisclosure. 

•	@It is both necessary and technologically possible to integrate addiction and other health 

care and effectively exchange addiction treatment data while maintaining the core 

protections of 42 C.F.R. Part 2. We urge the continued development of technical 

solutions for consent management. 

•	@Since HIP AA requires compliance with state and federal laws that mandate greater 

privacy protections, electronic health record systems (EHRs) must be designed so as to 

comply with the many state statutes that require heightened protections for information 

related to mental health, HIV/AIDS, reproductive health, domestic violence and other 

types of sensitive health information, as well as with 42 C.F.R. Part 2. It is important to 

keep in mind, therefore, that EHRs would be required to accommodate enhanced 

protections for the medical records of some illnesses in order to be HIP AA-compliant 

even if 42 C.F.R. Part 2 did not exist. 

We also support the comments submitted by the Legal Action Center. Thank you for your 

consideration. 

Sincerely, 

Colonial Management Goup, LP 

John L. Steinbrun 

CEO 

2 
 

 

 

 

 

 

 

 

 

 

From: Chip Roberts [mailto:croberts@cmglp.com]
 

Sent: Wednesday, June 25, 2014 9:44 PM
 

To: Privacy Regulations (SAMHSA)
 

Subject:
 

June 25, 2014 

Colonial Management Group 

8529 South Park Circle 

Suite 270 

Orlando, FL 32819 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. 

Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

While Colonial Management Group (CMG) supports updating the mechanics of the federal 

alcohol and drug confidentiality regulations to facilitate more effective integration of care and 

needed communication in the electronic age, 42 C.F.R. Part 2’s core privacy protections 

MUST be maintained. 

Many patients are afraid to even tell their treating physicians about being prescribed methadone 

for fear of being dropped as a patient. To somehow lower the threshold that protects their 

information would only serve to be another deterrent for patients wanting to enter in treatment. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 2014 

Notice of Public Listening Session (79 Fed. Reg. 26929), CMG supports the following 

principles: 

•	 Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. I support 

maximizing inclusion of substance use disorder (SUD) records in electronic health record 

(EHR) systems and health information exchanges (HIEs) while maintaining 42 C.F.R. 

Part 2’s core privacy protections. 

•	 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were when 

they were enacted more than 40 years ago, and a move toward HIPAA’s looser privacy 

standards would not sufficiently protect people seeking and receiving substance use 

disorder treatment. If patient records can be easily accessed in order to criminally 
 

 

 

 

 

 

investigate or prosecute or patient, or deny them insurance or a job, or be used against 

them in a divorce or child custody proceeding, many patients will be afraid to enter 

treatment in the first place. 

•	 LAC continues to believe that patients in alcohol and drug programs should retain the 

power to decide when and to whom their records are disclosed, even for treatment and 

payment purposes, given the continued prevalence of discrimination in our society. This 

includes disclosures to the general health care system, HIEs, health homes, ACOs, and 

CCOs. The best way for patients to retain that power is by requiring patient consent for 

most disclosures, together with a strong prohibition on redisclosure. 

•	 It is both necessary and technologically possible to integrate addiction and other health 

care and effectively exchange addiction treatment data while maintaining the core 

protections of 42 C.F.R. Part 2. We urge the continued development of technical 

solutions for consent management. 

•	 Since HIPAA requires compliance with state and federal laws that mandate greater 

privacy protections, electronic health record systems (EHRs) must be designed so as to 

comply with the many state statutes that require heightened protections for information 

related to mental health, HIV/AIDS, reproductive health, domestic violence and other 

types of sensitive health information, as well as with 42 C.F.R. Part 2. It is important to 

keep in mind, therefore, that EHRs would be required to accommodate enhanced 

protections for the medical records of some illnesses in order to be HIPAA-compliant 

even if 42 C.F.R. Part 2 did not exist.

 We also support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Sincerely, 

Paul Roberts, DO 

Program Sponsor 

Colonial Management Group 
 

 

 

 

Illinois Association for Medication Assisted Addiction Treatment 

June 25, 2014 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: 42 C.F.R. Part 2 

Confidentiality of Alcohol & Drug Abuse 

Patient Records Regulations 

Docket No. 2014-10913 

Dear Colleagues: 

As the president of the Illinois Association for Medication Assisted Addiction 

Treatment (IAMAAT), I am writing on behalf of the nearly 12,000 patients 

that are currently enrolled in Opioid Treatment Programs in more than 60 

different OTPs throughout our state. Our patients and providers have been 

following much of the discussion about potential changes to the law which 

protects the privacy of addiction treatment records. We are quite concerned 

that SAMHSA might be pressured to eliminate some of the essential privacy 

protections that are critical to patients currently enrolled in treatment as well 

as for individuals struggling with addiction who might be contemplating 

accessing treatment at some point in the future. 

As a statewide provider association, we have been in touch not only with our 

members and patients currently enrolled in Illinois OTPs, but also with 

treatment advocates from across the country. We have yet to meet a 

treatment provider who does not have a host of examples of external 

systems attempting to access protected health information of patients in 

OTPs and patients who have experienced discrimination in healthcare, legal 

systems, employment arenas, the child welfare system and other aspects of 

our society. It is incumbent upon us as treatment advocates to be the 

champions of both current and future patients. 
 

 

 

 

While IAMAAT understands your interest in updating the mechanics of the 

federal alcohol and drug confidentiality regulations to facilitate more 

effective integration of care and needed communication in this electronic 

age, 42 C.F.R. Part 2’s core privacy protections MUST be maintained. 

SAMHSA’s May 12, 2014 Notice of Public Listening Session (79 Fed. Reg. 

26929) proposed modifications to 42 C.F.R. Part 2. Regarding those 

proposed modifications, IAMAAT supports the following principles: 

 42 C.F.R. Part 2’s heightened privacy protections are as critical today

as they were when they were enacted more than 40 years ago, and a

move toward HIPAA’s looser privacy standards would not sufficiently

protect people seeking and receiving substance use disorder

treatment. If patient records can be easily accessed in order to

criminally investigate or prosecute a patient, or deny them insurance

or a job, or be used against them in a divorce or child custody

proceeding, many patients will fear entering treatment at all.

 Addiction treatment should be integrated with mental and physical

health care, and communication among health care providers should

be encouraged. We support maximizing inclusion of substance use

disorder (SUD) records in electronic health record (EHR) systems and

health information exchanges (HIEs) while maintaining 42 C.F.R. Part

2’s core privacy protections.

 We agree with the Legal Action Center (LAC) that patients in addiction

treatment programs should retain the power to decide when and to

whom their records are disclosed, even for treatment and payment

purposes, given the continued prevalence of discrimination in our

society. This includes disclosures to the general healthcare system,

HIEs, health homes, ACOs, and CCOs. The best way for patients to

retain that power is by requiring patient consent for most

disclosures, together with a strong prohibition on re-disclosure.
 We recognize the benefits in terms of patient care and cost savings of

using electronic health record systems. It is both necessary and

technologically possible to integrate addiction and other healthcare

and effectively exchange addiction treatment data while maintaining

the core protections of 42 C.F.R. Part 2. The Illinois Association for

Medication Assisted Addiction Treatment strongly urges the

continued development of technical solutions for consent

management.

 Since HIPAA requires compliance with state and federal laws that

mandate greater privacy protections, electronic health record systems

(EHRs) must be designed so as to comply with the many state statutes

that require heightened protections for information related to mental

health, HIV/AIDS, reproductive health, domestic violence and other

types of sensitive health information, as well as with 42 C.F.R. Part 2.

It is important to keep in mind, therefore, that EHRs would be required

to accommodate enhanced protections for the medical records of some

illnesses in order to be HIPAA-compliant even if 42 C.F.R. Part 2 did

not exist. However, we strongly believe that 42 C.F.R. Part 2 and

the specific privacy protections it provides must continue to

exist.

IAMAAT supports the very comprehensive comments submitted by both the 

Legal Action Center and the American Association for the Treatment of 

Opioid Dependence. 

Thank you for your consideration. 

Sincerely, 

Kate Mahoney, LCSW 

President 

Illinois Association for Medication Assisted Addiction Treatment 
Marsha Weissman, Ph.D. 

EXECUTIVE DIRECTOR 

Christine Abate 

DEPUTY DIRECTOR 

Josefina Bastidas, Esq. 

DEPUTY DIRECTOR 

Alan Rosenthal, Esq. 

CO-DIRECTOR OF JUSTICE STRATEGIES 

ND COUNSEL 

Patricia Warth, Esq. 

CO-DIRECTOR OF JUSTICE STRATEGIES 

Joseph C. Scro 

CONTROLLER 

BOARD OF DIRFCTORS 

Bonnie Catone 

PPRESIDENT 

Steven Belenko, Ph.D. 

Leonard Berman 

Carole Eady 

Paula Freedman 

Deborah Creehan 

Michelle A. Henry 

Susan R. Horn, Esq. 

Kwame Johnson 

Gretchen Purser 

Sheila Rule 

A

June 12, 2014 

Substance Abuse and mental Health Services Administration 

1 Choke Cherry Road, Room 5-1011 

Rockville, MD 20857 

Re: SAMHSA Notice of Public Listening Session 

Rule Change to 42 CFR Pan 2, FR Doc. 2014-10913 

Dear SAMHSA: 

Please accept these comments submitted on behalf of the Center for 

Community Alternatives (CCA). 

While we support updating the mechanics of the federal alcohol and 

drug confidentiality regulations to facilitate more effective integration of care 

and needed communication in the electronic age, 42 C.F.R. Part 2's core privacy 

protections must be maintained. 

CCA's recommendations to SAMHSA regarding changes to 42 C.F.R. Part 2 

are based on the following principles: 

• Addiction treatment should be integrated with mental and physical

health care, and communication among health care providers should be 

encouraged.

• At the same time, 42 C.F.R. Part 2's heightened privacy protections are 

as critical.today as they were when they were enacted more than 40 years 

ago, and a move toward HIP AA' s luoser privacy standards would not 

sufficiently protect people seeking and receiving substance use disorder 

treatment. If patient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny them insurance or a job, or be 

used against them in a divorce or child custody proceeding, many 

patients will be afraid to enter treatment in the first place. 

• CCA believes that patients in alcohol and drug programs should retain 

the power to decide when and to whom their records are disclosed, even 

for treatment and payment purposes, given the continued prevalence of 

discrimination in our society. This includes disclosures to the general 

D 115East Jefferson Street, Suite 300, Syracuse, NY 13202 T. 315.122.3638 E. 313.171.1921

D 25 Chapel Street, 7th Floor, Brooklyn. NY 11201 T. 718.838.9638 E. 718.838.9670

D 100 Pennsylvania Avenue, 2nd Floor, Brooklyn, NY, 11207 T. 929.231.3636 E. 929.231.3613

0 228 South Plymouth Avenue, Rochester, NY 14608 T. 383.328.8230 E. 383.328.8232

www.communityalternatives.org | A United Way Agency
health care system, HIEs, health homes, ACOs, and CCOs. The best way for patients to retain 

that power is by requiring patient consent for most disclosures, together with a strong prohibition 

on redisclosure. 

• It is both necessary and technologically possible to integrate addiction and other health 

care and effectively exchange addiction treatment data while maintaining the core 

protections of 42 C.F.R. Part 2. 

CCA's Recommendations: 

• We support maximizing inclusion of substance use disorder (SUD) records in electronic 

health record (EHR) systems and health i.nformation exchanges (HIEs) while maintaining 

privacy protections that are as essential today as they were when enacted in the 1970s. People 

with substance use disorders still face loss of employment, housing, and child custody; 

insurance and health care discrimination; criminal arrest, prusecuti0n and incarceration; and 

a host ofother negative consequences. 42 C.F.R Part 2's privacy protections greatly 

minimize the possibilities that a patient's own treatment records could be used against them 

in all those situations. In order to encourage people with SUDs to seek treatment, 42 C.F.R. 

Part 2's more stringent privacy protections must be maintained rather than accede to HIP AA 

standards which would allow many more disclosures that could lead to those harmful 

consequences for patients.

• We support the goals set out in the request for comments and many of the specific 

suggestions for tweaking how the regulations currently operate. LAC believes that the 

current regulations, together with existing plus additional guidance from SAMHSA, can 

accomplish many (if not all) of the intended goals of integrating substance use disorder and 

other health care and improving communication between them more effectively. Since HIP 

AA requires compliance with state and federal laws that mandate greater 

privacy protections, electronic health record systems (EHRs) must be designed so as to 

comply with the many state statutes that require heightened protections for information 

related to mental health, HIV IAIDS, reproductive health, domestic violence and other 

types of sendtive health information, as well as with 42 C.F.R. Part 2. It is important to 

keep in mind, therefore, that EHRs would be required to accommodate enhanced 

protections for the medical records of some illnesses in order to be HIP AA-compliant 

even if 42 C.F.R. Part 2 did not exist. 

• We urge the continued development of technical solutions for consent management. 

Very truly yours, 

Marsha R. Weissman, Ph.D. 

Executive Director 
-

es, 

A's 

ial 

o 

ve 

42 

BUILDING PARTNERSHIPS I REBUILDING LIVES 

The New Jersey Association of Mental Health and Addidion Agencies, Inc. 

3575 Quakerbridge Road, Suite l 02, Mercerville, NJ 08619 www.njomhoo.org 

[p] 609.838.5488 

[f] 609.838.5489 

June 30, 2014 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records 

Regulations, 42 C.F.R. Part 2. 79 Fed. Reg. 26929; Docket No. 2014

10913. 

To Whom It May Concern: 

The New Jersey Association of Mental Health and Addiction Agenci

Inc. (NJAMHAA) is a statewide trade association representing 180 

hospital-based and freestanding providers of mental health and 

substance use treatment services throughout New Jersey. NJAMHA

mission is to promote the value of its member organizations by 

providing advocacy, visibility and professional development to 

facilitate their economic viability, which is essential to ensure their 

ongoing capacity to deliver quality, cost-effective healthcare and soc

services and supports to those they serve. NJAMHAA is committed t

recovery and wellness for all individuals. 

While NJAMHAA supports updating the mechanics of the federal 

alcohol and drug confidentiality regulations to facilitate more effecti

integration of care and needed communication in the electronic age, 

C.F.R. Part 2's core privacy protections MUST be maintained. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in 

SAMHSA's June 11, Public Listening Session (79 Fed. Reg. 26929),

NJAMHAA supports the following principles: • Addiction treatment should be integrated with mental and physical 

health care, and communication among health care providers should be 

encouraged. We support maximizing inclusion of substance use 

disorder (SUD) records in electronic health record (EHR) systems an d 

health information exchanges (HIEs) while maintaining 42 C.F.R. Pa rt 

2's core privacy protections. • 42 C.F.R. Part 2's heightened privacy protections are as critical today as 

they were when they were enacted more than 40 years ago, and a move 

toward the Health Insurance Portability and Accountability Act's 

(HIPAA's) looser privacy standards would not sufficiently protect 

people seeking and receiving substance use disorder treatment. If 

patient records can be easily accessed in order to criminally investigate 

or prosecute a patient, or deny them insurance or a job, or be used 

against them in a divorce or child custody proceeding, many patients 

will be afraid to enter treatment in the first place. 

,. r -r'f. 

NJAMHAA 

FY 2014 

Board of Directors 

President 

Deborah Megaro, MS, MBA 

Vice President 

Manuel Guantez, PsyD, LCADC 

Treasurer 

David Lazarus, Esq 

Secre tary 

Anthony Difabio, PsyD 

A t-Large Members 

Robert Budsock, LCADC 

Robert N. Davison, MA, LPC 

Alan DeStefano, MSW 

Deborah Hartel, MSW, ACSW 

Christopher 0. Kosseff, MS 

Linda Leyhane, CDA 

Horry J. Marmorstein, MA, MBA 

Horry Postel, MSW, LSW 

Paula Sabreen, ACSW, LCSW 

Pete Scerbo, MSW, LCSW 

Greg Speed, MSW, LCSW 

Cheryl Marks Young 

Mary Gay Abbott-Young, MEd, LCADC 

Past Presidents 

J. Michael Armstrong, MA, MBA 

James M. Cooney, MSW, LCSW 

Daniel Martin, EdD 

Joseph Masciandaro, MA 

John Monahan, ACSW, LCSW 

Robert L. Parker, MPA 

Victoria Sidrow, MPA 

Chief Executive Officer 

Debra L. W entz, PhD 

Associate Executive Director 

Shauna L. Moses 

Chief Operating Officer 

Director, IT Project 

June A. Noto 
NJAMHAA 

.r'I Individuals in alcohol and drug treatment programs should retain the 

power to decide when and to whom their records are disclosed, even for 

treatment and payment purposes, given the continued prevalence of 

discrimination in our society. This includes disclosures to the general 

health care system, HIEs, health homes and Accountable Care 

Organizations. The best way for individuals to retain that power is by 

requiring patient consent for most disclosures, together with a strong 

prohibition on re-disclosure. • It is both necessary and technologically possible to integrate addiction 

and other health care and effectively exchange addiction treatment data 

while maintaining the core protections of 42 C.F.R. Part 2. We urge the 

continued development of technical solutions for consent management. • Since HIP AA requires compliance with state and federal laws that 

mandate greater privacy protections, EHRs must be designed so as to 

comply with the many state statutes that require heightened protections 

for information related to mental health, HIV IAIDS, reproductive 

health, domestic violence and other types of sensitive health 

information, as well as with 42 C.F.R. Part 2. It is important to keep in 

mind, therefore, that EHRs would be required to accommodate 

enhanced protections for the medical records of some illnesses in order 

to be HIPAA-compliant even if 42 C.F.R. Part 2 did not exist. 

We also support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Sincerely, 

Debra L. Wentz, PhD 

Chief Executive Officer 

BUILDING PARTNERSHIPS I REBUILDING LI1'ES 

The New Jersey Association of Mental Health and Addirtion Agencies, Inc. 

3575 Quokerbridge Rood, Suite 102, Mercerville, NJ 08619 [p] 609.838.5488 www.njamhoo.org [f] 609.838.5489 
 

 

 

15 West 36th Street, Suite 901, New York, New York 10018 

phone: 212-255-9252 | fax 212-255-9253 

NationalAdvocatesforPregnantWomen | @NAPW 

www.advocatesforpregnantwomen.org 

SUBMITTED VIA EMAIL 

June 25, 2014 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 

C.F.R. Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

National Advocates for Pregnant Women (NAPW) is a nonprofit dedicated to ensuring 

the human and civil rights and dignity of pregnant and parenting women, particularly 

those who are most vulnerable, like low-income women, women of color, and drug using 

women. 

While NAPW supports updating the mechanics of the federal alcohol and drug 

confidentiality regulations to facilitate more effective integration of care and needed 

communication in the electronic age, 42 C.F.R. Part 2’s core privacy protections 

MUST be maintained. 

42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were when 

they were enacted more than 40 years ago because, very unfortunately, there has not been 

a significant reduction in drug-related stigma or discrimination in this country. 

We specifically want to bring to your attention punitive and counterproductive child 

welfare proceedings across the United States in which pregnant women and parents are 

threatened or charged with civil child abuse and neglect for receiving medication-assisted 

treatment (MAT). Despite the fact that child welfare proceedings are generally 

confidential and do not come to public attention, NAPW has identified numerous cases in 

which state authorities have sought to punish pregnant women because they obtained 

medically approved methadone treatment. 
 

 

 

15 West 36th Street, Suite 901, New York, New York 10018 

phone: 212-255-9252 | fax 212-255-9253 

NationalAdvocatesforPregnantWomen | @NAPW 

www.advocatesforpregnantwomen.org 

 

 

 


 

 
 

 

 

 


 


 


 

1 Email from A.F. to NAPW (Aug. 8, 2013) (on file with NAPW); Email from R.N. to NAPW

(Sept. 27, 2013) (on file with NAPW).

2 Email from V.L. to NAPW (Jan. 15, 2013) (on file with NAPW).

3 Brief of Amici Curiae in Support of Defendant-Petitioner’s Petition for Certification, N.J. Div.

of Youth & Family Servs. v. Y.N., A-5880-11T2, 66 A.3d 237 (App. Div. 2013) (Aug. 1, 2013),
 

available at http://www.advocatesforpregnantwomen.org/main/publications/brief_bank/.
 

In Tennessee, in the past 10 months, two women contacted NAPW because judges 

overseeing child welfare cases demanded that mothers “detox from methadone” if they 

wanted to maintain or regain custody of their children. In both cases, the mothers were 

receiving therapeutic methadone maintenance treatment as prescribed by their 

physicians.1 

In Arizona, a mother who had been participating in a methadone maintenance program 

for nearly six months, and who had been fully compliant with child protective services, 

contacted NAPW to explain her dilemma: 

I am required to partake in substance abuse treatment and CPS ok’d the clinic I go 

to and simply asked for monthly reports, which I’ve submitted. They knew I was 

being medically treated for opioid addiction, however, they must have just 

realized it was methadone maintenance. Now, just two weeks prior to court, [CPS 

is] trying to discredit the treatment I’m undergoing and they are saying my drug 

screens that are positive for methadone are being counted as dirty even though I 

have a prescription.2 

In Ohio, a woman reached out to NAPW because she was charged with civil child abuse 

and neglect because she received prescribed subutex during the course of her pregnancy. 

Her story was recently featured on NBC.com in the article, Pregnant on Opiates: When 

Following Doctors’ Orders Breaks the Law. 

In New Jersey, the appellate court in N.J. Div. of Youth & Family Servs. v. Y.N., A-5880-

11T2, 66 A.3d 237 (App. Div. 2013), upheld a lower court ruling that a newborn was 

abused and neglected because, after birth, he experienced NAS. The child’s mother, 

while pregnant, obtained federally recommended, medically approved, and supervised 

methadone treatment from a methadone treatment program. The ruling, if not overturned 

by the New Jersey Supreme Court, will effectively ban pregnant women from receiving 

methadone treatment in the state. The mother is currently seeking review by the state 

supreme court, supported by 48 national and international experts and organizations in an 

amicus brief.3 

NAPW has also identified or been contacted about numerous other cases in Alabama, 

Florida, Kentucky, Michigan, New York, Pennsylvania, South Carolina, and Texas, 

where pregnant women and parents have been threatened with loss of custody of their 

children or have actually lost custody of their children because they have been receiving 

some form of MAT. These are just a few of the many cases that have come to NAPW’s 

attention that demonstrate the ways in which pregnant women and parents who seek drug 
 

 

 

15 West 36th Street, Suite 901, New York, New York 10018 

phone: 212-255-9252 | fax 212-255-9253 

NationalAdvocatesforPregnantWomen | @NAPW 

www.advocatesforpregnantwomen.org 

	 

 

	 

treatment are not provided the full protections that 42 C.F.R. Part 2 requires. And as a 

result, one of the primary purposes of the regulations—to encourage people to seek 

treatment for substance addiction—is undermined. 

Moreover, in the 2013 study, “Arrests of and Forced Interventions on Pregnant Women 

in United States, 1973-2005: Implications for Women's Legal Status and Public Health,” 

Lynn Paltrow and Jeanne Flavin identified more than 400 cases (while acknowledging 

that this is a substantial undercount) in which a woman’s pregnancy was a necessary 

factor leading to attempted and actual deprivations of liberty by state authorities. In 276 

(about two-thirds) of those 413 cases, they were able to identify the mechanism by which 

the case came to the attention of police, prosecutors, and courts. And of those 276 cases 

in which they identified the disclosure of information that led to the arrest or detention, 

112 of those disclosures were made by health care providers. 

The study confirms that gross violations of these regulations are happening, but 

unfortunately, the women who suffer as a result of these violations have no private right 

of action to redress these violations. In fact, far from protecting patient privacy and 

confidentiality, the study found that health care and other professionals are sometimes the 

very people gathering information about drug treatment from pregnant women and new 

mothers and disclosing it to police, prosecutors, and court officials.4 

Until these types of routine violations cease, NAPW insists that 42 C.F.R. Part 2’s core 

privacy protections must not only be maintained, but also enforced. With regard to the 

modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 2014 Notice of Public 

Listening Session (79 Fed. Reg. 26929), NAPW supports the following principles: 

•	 Addiction treatment should be integrated with mental and physical health care, 

and communication among health care providers should be encouraged. We 

support maximizing inclusion of substance use disorder records in electronic 

health record systems and health information exchanges while maintaining 42 

C.F.R. Part 2’s core privacy protections. 

•	 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they 

were when they were enacted more than 40 years ago, and a move toward 

HIPAA’s lesser privacy standards would not sufficiently protect people seeking 

and receiving substance use disorder treatment. If patient records can be easily 

accessed in order to criminally investigate or prosecute a patient, or deny them 

insurance or a job, or be used against them in a divorce or child custody 

proceeding, many patients will be afraid to enter treatment in the first place. 

4 See Ferguson v. City of Charleston, 532 U.S. 67 (2001). 
 

 

 

15 West 36th Street, Suite 901, New York, New York 10018 

phone: 212-255-9252 | fax 212-255-9253 

NationalAdvocatesforPregnantWomen | @NAPW 

www.advocatesforpregnantwomen.org 

 

 

 

 

 

 

	 

	 

•	 Patients in alcohol and drug programs should retain the power to decide when and 

to whom their records are disclosed, even for treatment and payment purposes, 

given the continued prevalence of discrimination in our society. This includes 

disclosures to the general health care system, health information exchanges, 

health homes, and accountable care organizations. The best way for patients to 

retain that power is by requiring patient consent for most disclosures, together 

with a strong prohibition on redisclosure. 

•	 SAMHSA should strengthen protections for people receiving treatment, not lessen 

them, including revisiting and rescinding the exception for suspected abuse and 

neglect to child welfare authorities.5 It is clear that there is just as much need 

today, if not more than when the regulations were first enacted, to protect the 

privacy of people receiving drug treatment. 

Thank you for your consideration. 

Sincerely, 

Lynn M. Paltrow, Executive Director 

Kylee Sunderlin, Soros Justice Fellow 

5 42 C.F.R. § 2.12 (c) (6) Reports of suspected child abuse and neglect. The restrictions on 

disclosure and use in these regulations do not apply to the reporting under State law of incidents 

of suspected child abuse and neglect to the appropriate State or local authorities. However, the 

restrictions continue to apply to the original alcohol or drug abuse patient records maintained by 

the program including their disclosure and use for civil or criminal proceedings which may arise 

out of the report of suspected child abuse and neglect. 
Center Point, Inc. 

CORPORATE OFFICE 

135 PAUL DRIVE 

SAN RAFAEL, CA 94903 

P 415 492 4444 F 415 492 8844 

WWW.CPINC.ORG 

June 23, 2014 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. 

Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

Center Point is a health and social services provider with facilities and programs in the states of 

California, Oklahoma and Texas. Center Point is a not-for-profit corporation providing social 

and human services to at-risk individuals and families. Center Point mission is "To provide 

comprehensive social, educational, vocational, medical, psychological, housing, and 

rehabilitation services to combat social problems such as substance abuse, poverty, 

unemployment, and homelessness." 

As a national organization and as a member of Therapeutic Communities of America we support 

updating the mechanics of the federal alcohol and drug confidentiality regulations to facilitate 

more effective integration of care and needed communication in the electronic age, 42 C.F.R. 

Part 2's core privacy protections MUST be maintained. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA's May 12, 2014 

Notice of Public Listening Session (79 Fed. Reg. 26929), Center Point, Inc. supports the 

following principles: 

• Addiction treatment should be integrated with mental and physical health care, and

communication among health care providers should be encouraged. Center Point

supports maximizing inclusion of substance use disorder (SUD) records in electronic 

health record (EHR) systems and health information exchanges (HIEs) while maintaining 

42 C.F.R. Part 2's core privacy protections. 

• 42 C.F.R. Part 2's heightened privacy protections are as critical today as they were when

they were enacted more than 40 years ago, and a move toward HIP AA' s looser privacy

standards would not sufficiently protect people seeking and receiving substance use 

disorder treatment. If patient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny them insurance or a job, or be used against 
them in a divorce or child custody proceeding, many patients will be afraid to enter 

treatment in the first place. 

• Center Point, Inc., continues to believe that patients in alcohol and drug programs should

retain the power to decide when and to whom their records are disclosed, even for

treatment and payment purposes, given the continued prevalence of discrimination in our

society. This includes disclosures to the general health care system, HIEs, health homes,

ACOs, and CCOs. The best way for patients to retain that power is by requiring patient

consent for most disclosures, together with a strong prohibition on redisclosure.

• It is both necessary and technologically possible to integrate addiction and other health

care and effectively exchange addiction treatment data while maintaining the core

protections of 42 C.F.R. Part 2. Center Point's urge the continued development of

technical solutions for consent management.

• Since HIP AA requires compliance with state and federal laws that mandate greater

privacy protections, electronic health record systems (EHRs) must be designed so as to

comply with the many state statutes that require heightened protections for information

related to mental health, HIV IAIDS, reproductive health, domestic violence and other

types of sensitive health information, as well as with 42 C.F .R. Part 2. It is important to

keep in mind, therefore, that EHRs would be required to accommodate enhanced

protections for the medical records of some illnesses in order to be HIP AA-compliant

even if 42 C.F.R. Part 2 did not exist.

Center Point also support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Sincerely, 

Sushma D. Taylor, PH.D

President and Chief Executive Officer 

2 
N,JA1'01) 

NEW JE.RSliT ASSOCIATlON 

·

fOIII 'TNI! "JlllEAT"liNT OF 

OPtolD OEPENl>SNCli 

808 Market Str:eet 

C:11mde,n. NJ 08102' · 

Ptlone(8.s6)22S-050S 

Mobile (973) 76,·S828 

m (ffi) 22s-0J 11 

1

06/25/201< 09:47 8552250317 LINDA VOORHIS 

U.S. Substance Abuse and Mental Health Services Ad.ministration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

Jmie 25, 2014 

PAGE 01 

RE: Confidentiality of Alcohol & Dr11g Abuse Patient Reeords 

Regulatigns, 42 C.F.R. Part 2. 79 Fed. Reg. 26929; Docket No. 

2014-10913. 

To Whom It May Concern: 

The New Jersey Association For The Treatment of Opioid Dependence 

(NJATOD) is the provider' association which represents all opioid treatment 

providers in the State of New Jersey. Our mission is to enhance the quality of 

patient care in treatment programs by promoting the growth and development 

of comprehensive opioid treatment services through the State of New Jersey. 

While NJATOD supports updating the mechanics of the federal alcohol and 

drug confidentiality regulations to facilitate more effective integration of care 

and needed communication in the electronic age, 42 C.F.R. Part l's core 

privacy protections MUST be maintained. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA 's 

May 12, 2014 Notice of Public Listening Session (79 Fed. Reg. 26929), 

NJ A TOD supports the following principles: 

• Addiction treatment should be integrated with mental and physical

health care, and communication among health care providers should be

encouraged, We support maximizing inclusion of suhstance use

disorder (SUD) records in electronic health record (EHR) systems and

health information exchanges (HIEs) while maintain.mg 42 C.F.R Part

2's core privacy protections.

• 42 C.F.R. Part 2's heightened privacy protections are as critical today

as they were when they were enacted more than 40 years agot and a

move toward HIP AA' s looser privacy standards would not sufficiently

protect people seeking and receiving substance use disorder treatment.

If patient records can be easily accessed in order to criminally

investigate or prosecute or patient, or deny them insurance or a job, or
N.JA1'f)I)

NEWJEMliY 

ASSOCIATION FOii. 'tHI! 

TII.EATHENT Of 

OPIOID DEPENDENCE

808 Market Sire.et 

Camden, NJ 08102 . 

Phone (856) llS-OSOS 

Mobile ('73) 76?-S828 •,, 

!"ax (856) 225-0317 · 

05/25/2014 09:47 8552250317 LINDA VOORHIS PAGE 02 

be used against them in a divorce or child custody proceeding, many 

patients will be afraid to enter treatment in the first place. 

• LAC continues to believe that patients in alcohol and drug programs 

should retain the power to decide when and to whom their records are 

disclosed, even for treatment and payment purposes, given the 

continued prevalence of discrimination in our society. Uris includes 

disclosures to the general health care system, HIBs, health homes, 

ACOs, and CCOs. The best way for patients to retainthat power is by 

requiring patientconsent for most disclosures, together with a strong 

prohibition on redisclosure.

• It is both necessary and technologically possible to integrate addiction 

and other health care and effectively exchange addiction treatment data 

while maintaining the core protections of 42 C.F.R. Part 2. We urge the 

continued development of technical solutions for consent management .

• Since HIP AA requires compliance with state and federal laws that 

mandate greater privacy protections, electronic health record systems 

(EHRs) must be designed so as to comply withthe many state statutes 

that require heightened protections for information related to mental 

health, HIV I AIDS, reproductive health, domestic violence and other 

types ofsensitive health information, as well as with 42 C.F.R. Part 2. lt 

is important to keep in mind, therefore, that EHRs would be required to 

accommodate enhanced protections for the medical records of some 

illnesses in order to beHIP AA-compliant even if 42 C.F .R. Part 2 did 

not exist. 

We also support the comments submitted by Lhe Legal Action Center. 

2 

Thank you for your consideration.

Sincerely,

Linda Voorhis,

President
8562250317 LINDA VOORHIS 	 PAGE 01

~6/25/2014 09:49 

URBAN TREATMENT ASSOCIATES, INC. 

808 Market Street 

Camden, NJ 08102 

Telephone (856) 225..0505 

Fax (856) 225-0317 

June 25, 2014 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: 	 Confidentiality ofAlcohol & DJ:"u,g Ahuse Patient Records Regulations, 42 C.F.R. 

Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

Urban Tr~atment Associates, Inc. (UTA) is a private, non·profit opioid treatment agency 

licensed in the State ofNew Jersey. We provide OTP services to individuals residing in 

Camden, New Jersey and its environs. Our mission is to provide comprehensive, professional 

care that recognizes the dignity ofall persons struggling against opiate dependence. 

We believe that succe~ful change is achieved through the use ofmedical, behavioral, 

pharmacological, and socially-focused treatment in an integrated setting. We further believe that 

abstinence from illicit substance use is the safest choice, but acknowledge that even the person 

not ready to stop using can be significantly helped. 

While UTA suppo1ts updating the mechanics ofthe federal alcohol and drug confidentiality 

regulations to facilitate more effective integration ofclife and needed communication in the 

electronic age, 42 C.F,R. Part l's core privacy protections MUST be maintained. 

With regard to the modifications to 42 C.F.R. Part2 proposed in SAMHSA's May 12, 2014 

Notice ofPublic List.eo.ing Session (79 Fed. Reg. 26929), UTA supports the follow.in.g principles: 

• 	 Addiction treatment should be integrated with mental and physical health care, and 

commumcation among health care providers should be encouraged. We support 

maximizing inclusion ofsubstance use disorder (SUD) records in electronic health record 
PAGE 02 05/25/2014 09:49 8552250317 LINDA VOORHIS 

(EHR) systems and health information exchanges (IDEs) while maintaining 42 C.F .R. 

Part 2' s core privacy protections. 

• TM42 C.F.R. Patt 2's heightened privacy protections are as critical today as they were when

they were enacted more than 40 years ago, and a move toward H1P AA's looser privacy

standards would not sufficiently protect people seeking and receiving substance use 

disorder treatment If patient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny them insurance or a job, or be used against 

them in a divorce or child custody proceeding, many patients will be afraid to enter 

treatment in the first place. 

• TMLAC continues to believe that patients in alcohol and drug programs should retain the 

power to decide when and to whom their .records are disclosed, even for treatment and

payment purposes, given the continued prevalence of discrimination in our society. This 

includes disclosures to the general health care system, HIEs, health homes, ACOs, and 

CCOs. The best way for patients to ret.ain that power is by requiring patient consent for 

most disclosures, together with a strong prohibition on redisclosure. 

• TMIt is both necessary and technologically possible to integrate addiction and other health

care and effectively exchange addiction treatment data while .maintaining the core

protections of 42 C.F .R. Part 2. We urge the continued development of technical 

solutions for consent management. 

• TMSince HIP AA requires compliance with state and federal laws that mandate greater

privacy protections, electronic health record systems (EHR.s) must be designed so as to

comply with the many state statutes that require heightened protections for 

infonnation related to mental health, HIV IAIDS, reproductive health domestic 

violence and other types of sensitive health information, as well as with 42 C.f .R.. 

Part 2. It is important to keep in mind, therefore, that EHR.s would be required to 

accommodate enhanced protections for the medical records of some illnesses in order 

to be HIP AA-compliant even if 42 C.F .R. Part 2 did not exist. 

We also :support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Sincerely, 

Linda Voorhis, Executive Director / Program Administrator 
16/25120 10:17 	 P.901/002 .14 

Middletown Medical, LLC. 


600 Route35 


Red Bank, NJ 07701 


Telephone (732) 706-1300 


Fax (732) 706-1313 


June 25, 2014 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: 	 Confidentiality of Alcohol & Drug Abuse Patlent Records Reeulations, 42 C.F.R. 

Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

Middletown Medical, LLC is a private opioid treatment agency licensed in the State ofNew 

Jersey. We provide OTP services to individuals residing in Monmouth, Middlesex and Ocean 

counties ofNew Jersey. Our mission is to provide comprehensive, professional care that 

recognizes the dignity of all persons struggling against opiate dependence. 

We believe that successful change is achieved through the use ofmedical, behavioral, 

pharmacological, and motivational treatment in an integrated setting. We further believe that 

abstinence from illicit substance use is the safest choice, but acknowledge that even the person 

not ready to stop using can be significantly helped. 

While we support updating the mechanics ofthe federal alcohol and drug confidentiality 

regulations to facilitate more effective integration of care and needed communication in the 

electronic age, 42 C.F.R. Part 2's core privacy protections MUST be maintained. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA's May 12, 2014 

Notice ofPublic Listening Session (79 Fed. Reg. 26929), Middletown Medical, LLC supports 

the following principles: 

• 	 Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. We support 

maximizing inclusion ofsubstance use disorder (SUD) records in electronic health record 

(EHR) systems and health information exchanges (HIEs) while maintaining 42 C.F.R. 

Part 2's core privacy protections. 
06/25/2.014 10:18 P.002/002 

•	‘ 42 C.F .R. Part 2 's heightened privacy protections are as critical today as they were when 

they were enacted more than 40 years ago, and a move toward HIPAA's looser privacy 

standards would not sufficiently protect people seeking and receiving substance use 

disorder treatment. If patient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny them insurance or a job, or be used against 

them in a divorce or child custody proceeding, many patients will be afraid to enter 

treatment in the first place. 

•	‘ The Legal Action Center continues to believe that patients in alcohol and drug programs 

should retain the power to decide when and to whom their records are disclosed, even for 

treatment and payment purposes, given the continued prevalence of discrimination in our 

society. This includes disclosures to the general health care system, JilEs, health homes, 

ACOs, and CCOs. The best way for patients to retain that power is by requiring patient 

consent for most disclosures, together with a strong prohibition on redisclosure. 

•	‘ It is both necessary and technologically possible to integrate addiction and other health 

care and effectively exchange addiction treatment data while maintaining the core 

protections of 42 C.F.R. Part 2. We urge the continued development of technical 

solutions for consent management. 

•	‘ Since HIPAA requires compliance with state and federal laws that mandate greater 

privacy protections, electronic health record systems (EHRs) must be designed so as to 

comply with the many state statutes that require heightened protections for information 

related to mental health, HIV/AIDS, reproductive health, domestic violence and other 

types of sensitive health infonnation, as well as with 42 C.F .R. Part 2. It is important to 

keep in mind, therefore, that EHRs would be required to accommodate enhanced 

protections for the medical records of some illnesses in order to be HIP AA-compliant 

even if 42 C.F .R. Part 2 did not exist. 

We also support the comments submitted by the Legal Action 

Center. 

Thank you for your consideration. 

Sincerely, 

Erin McCabe, LCSW, LCADC 

Executive Director 

2 
Morris County Aftercare 

1574 Sussex Turnpike 

Randolph NJ, 07869 

973-927-6641 . 

(FAX} 973-927-8644 

Fax 

To: SAMHSA 

Morris County 

Aftercare Center 

From: Loma Tangara, MPH, Executive Director 

Fax: 240-276-2900 P2ges: 3 (including cover) 

Phone: Date: 6/25/14 

Re: CC: 

DUrgent O ForRevlew D Please Comment D Please Reply O Please Recycle 

This notice accompanies a disclosure of information concerning a client in alcohol/drug abuse 

treatment made to you with the consent of such client This Information has been disclosed to you 

from records protected by Federal confidentiality rules (42 CFR Part 2). The Federal rules prohibit you 

from making any further disclosure of this information unless further disclosure is expressly pennitted 

by the written consent of the person to whom it pertains oras otherwise permitted by CRF 42 Part 2. A 

general authorization for the release of medical or other information is NOT sufficient for this purpose. 

The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or 

drug abuse patient. 
~{l~~fl~{if~ 

1574 Sussex Turnpike• Randolph, New Jersey 07869 • Tel. #(973) 927-6641 • Fax #(973) 927-6644 

June 25, 2014 

U.S. Substance Abuse and Mental Health Services Administration 


I <:;hoke Cherry Road 


Room S-1011 


Rockville, MD 20857 


RE: 	 Confidentiality of Alcohol & l>mg Abuse Patient Records Regulations, 42 C.FA 


Part.2. 79· Fed. Reg. 26929; Docket No. 2014-10913. 


To Who~ It May Concern: 

Re.source Center for the Chemically Dependent, Inc., DBA Morris County After Care Center, 

Inc., located. at 1574 Sussex Turnpike, Randolph, NJ 07869, is a 30-year old, private, non-profit 

outpatj,ent opioid treatment agency licensed in the State ofNew Jersey. Medical doctors, including 

a p~ychiatrist, nurses, and licensed clinicians, provide comprehensive treatment services to all 

persons .who are struggling with opiate dependence. Primary health care and co-occurring services, 

· are also provi<l:ed on site. The agency serves clients from North Jersey, Pennsylvania, and·New York 

in compliance with the rules and regulations ofthe New JefSey Division ofMental Health and 

Addiction Services. 

We believe that successful change is achieved through the use ofmedical; behavioral, 

phannacological, and socially-focused treatment in an integrat.ed setting. We further believe that 

abstinence fro:m illicit substance use is the safest choice. but acknowledge that even the person 

not ready to stop using can be significantly helped. 

While UTA supports updating the mechanics ofthe federal alcohol and drug confidentiality 


regulations to facilitate more effective integration ofcare and needed communication in the 


electronic age~ 42 C.F.R. Part l's core privacy protections MUST be maintained. 


With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA's May 12, 2014 

Notice of Public Listening Session (79 Fed. Reg. 26929), UTA supports the following principles:. 

· • 	 A,.ddiction treatment should be integrated with mental and physical health care, and 

~mmmucation among health care providers should be encouraged. We support 

maximizing 'inclusion ofsubstance use disorder (SUD) records in electronic health record 

(EHR) systems and health information exchanges (HIEs) while maintaining 42 C.F.R. 

Part 2 • s core privacy protections. 

1 
• 42 C.F.R Part 2's heightened privacy protections are as critical today as they were when

they were enacted more than 40 years ago, and a move toward IBP AA' s looser privacy

standards would not sufficiently protect people seeking and receiving substance use

disorder treatment. If patient records can be easily accessed in order to criminally

investigate or prosecute a patient, or deny them insurance or a job, or be used against

them in a divorce or child custody proceeding, many patients will be afraid to enter

treatment in the fust place.

• LAC continues to belie-ve that patients in alcohol and drug programs should retain the

powerto decide when and to whom their records are disclosed even for treatment and

payment purposesJ given the continued prevalence of discrimination in our society. This

includes disclosures to the general health care system, HIEs, health homes, ACOs, and

CCOs. The best way for patients to retain that power is by requiring patient consent for

most disclosures, together with a strong prohibition on re-disclosure.

• It is both necessary and technologically possible to integrate addiction and other health

care and effectively share addiction treatment data while maintaining the core protections

of 42 C.F .R. Part 2. We urge the continued development of technical solutions for consent

management.

• Since lilP AA requires compliance with state and federal laws tlurt mandate greater

privacy protections, electronic health record systems (EHRs) must be designed so as to

comply with the many state statutes that require heightened protections for information

related to mental health, HIV I AIDS, reproductive health, domestic violence and other

types of sensitive health information, as well as with 42 C.F .R Part 2. It is important to

keep in mind, therefore, that EHRs would be required to accommodate enhanced

protections for the medical records of some illnesses in order to be HIP AA-compliant

even if 42 C.F.R Part 2 did not exist.

We also support the comments submitted by the Legal Action Center. 

Thank you for your kind consideration. 

Sincerely, 

Lorna R. Tangara, MPH

Executive Director

2 
Since 1974 KAAP 

Kansas Association ofAddiction Professionals 

* Kansas Association of Addiction Professionals 

700 SW Jackson, Suite 1101 

Topeka, KS66603

785-235-2400 

June 23, 2014 

U.S. Substance Abuse and Mental Health Services Administration 


1 Choke Cherry Road 


Room 5-1011 


Rockville, MD 20857 


RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. Part 2. 79 Fed·. 

Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern 

My name is Dulcinea Rakestraw, and I am the Chair of the Kansas Association of Addiction 

Professionals (KAAP). KAAP is the only trade organization representing substance use disorder 

treatment and prevention professionals across the state of Kansas. 

While KAAP supports updating the mechanics of the federal alcohol and drug confidentiality 

regulations to facilitate more effective integration of care and needed communication In the electronic 

age, 42 C.F.R. Part 2's core privacy protections MUST be maintained. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA's May 12, 2014 Notice of 

Public Listening Session (79 Fed. Reg. 26929), PFH supports the following principles: 

• Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. (I/We] support maximizing 

inclusion of substance use disorder (SUD) records in electronic health record (EHR} systems and health 

information exchanges (HIEs} while maintaining 42 C.F.R. Part 2's core privacy protections; 

• 42 C.F.R. Part 2's heightened privacy protections are as critical today as they were when they 

were enacted more than 40 years ago, and a move toward HIPAA's looser privacy standards would not 

sufficiently protect people seeking and receiving substance use disorder' treatment. If patient records 

can be easily accessed in order to criminally investigate or prosecute or patient, or deny them 

insurance or a job, or be used against them in a divorce or child custody proceeding, many patients will 

be afraid to enter treatment in the first place. 

• LAC continues to bell eve that patients in alcohol and drug programs should retain the power to 

decide when and to whom their records are disclosed, even for treatment and payment purposes, 

given the continued prevalence of discrimination in our society. This includes disclosures to the 

general health care system, HIEs, health homes, ACOs, and CCOs. The best way for patients to retain 
Since 1974 * KAAP· 

Kansas Association of Addiction Professionals 

700 SW Jackson, Suite 1101 

Topeka, KS 66603 

785-235-2400

that power is by requiring patient consent for most disclosures, together with a strong prohibition on 

redisclosure. 

• It is both necessary and technologically possible to integrate addiction and other health care

and effectively exchange addiction treatment data while maintaining the core protections of 42 C.F.R.

Part 2. [I/We] urge the continued development of technical solutions for consent management.

• Since HIPAA requires compliance with state and federal laws that mandate greater privacy 

protections, electronic health record systems {EHRs) must be designed so as to comply with the many 

state statutes that require heightened protections for Information related to mental health, HIV/AIDS, 

reproductive health, domestic violence and other types of sensitive health information, as well as with 

42 C.F.R. Part 2. It is important to keep in mind, therefore, that EHRs would be .required to 

accommodate enhanced protections for the medical records of some illnesses in order to be 

HIPAA­compliant even if 42 C.F.R .. Part 2 did not exist.

We also ·support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Dulcinea Rakestraw 

Chair 
Arny Amadeo, MA, LCADC 

Director 

OFFICERS 

Courtney McShane 

President 

Catherine Santangelo 

Treasurer 

Jordan Savage 

Secretary 

BOARD OF DIRECTORS 

Paul Aiello 

Andrew J. Burch 

Earl Crowell 

Jack Elsmore 

Steve Way 

Konslanlino Zicopoulos 

FAX iZ!DOl/001 

Inter County Council on Drug and Alcohol Abuse, Inc. 

Outpatient Counseling Medication Assisted Therapy 

480 Kearny Avenue 482 Kearny Avenue 

Kearny, NJ 07032 Kearny, NJ 07032 

(201) 998-7422 (201) 997-4000

Fax (201) 998-1136 Fax (201) 998-1136 

LEGAL ACTION CENTER TEMPLATE FOR SAMHSA COMMENTS 

[SUBMITIED VIA FACSIMILE] 

6/23/14 

Inter-County Council on Drug and Alcohol Abuse 

480-482 Kearny Ave.
Ý

Kearny, NJ 07032

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records 

Regulations, 42 C.F.R. Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

While I support updating the mechanics of the federal alcohol and drug 

confidentiality regulations to facilitate more effective integration of care and 

needed communication in the electronic age, 42 C.F.R. Part 2's core privacy 

protections MUST be maintained. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in 

SAMHSA's May 12, 2014 Notice of Public Listening Session (79 Fed. Reg. 26929), 

I support the following principles: 

•Addiction treatment should be integrated with mental and physical health

care, and communication among health care providers should be encouraged.

support maximizing inclusion of substance use disorder (SUD) records in

electronic health record (EHR) systems and health information exchanges (HIEs)

while maintaining 42 C.F.R. Part 2's core privacy protections.

•42 C.F.R. Part 2's heightened privacy protections are as critical today as they

were when they were enacted more than 40 years ago, and a move toward
ff 23/2014 MON 16, 05 FAX id]OOl/001

HIPAA's looser privacy standards would not sufficiently protect people seeking 

and receiving substance use disorder treatment. If patient records can be easily 

accessed in order to criminally investigate or prosecute or patient, or deny them 

insurance or a job, or be used against them in a divon;;e or child custody 

proceeding, many patients will be afraid to enter treatment in the first place. 

•LAC continues to believe that patients in alcohol and drug programs should retain the power to decide

when and to whom their records are disclosed, even for treatment and payment purposes, given the

continued prevalence of discrimination in our society. This includes disclosures to the general health

care system, HI Es, health homes, ACOs, and CCOs. The best way for patients to retain that power is by

requiring patient consent for most disclosures, together with a strong prohibition on re-disclosure.

•It is both necessary and technologically possible to integrate addiction and other health care and

effectively exchange addiction treatment data while maintaining the core protections of 42 C.F.R. Part 2.

[I/We] urge the continued development of technical solutions for consent management.

•Since HIPAA requires compliance with state and federal laws that mandate greater privacy protections,

electronic health record systems (EHRs) must be designed so as to comply with the many state statutes

that require heightened protections for information related to mental health, HIV/AIDS, reproductive

health, domestic violence and other types of sensitive health information, as well as with 42 C.F.R. Part

2. It is important to keep in mind, therefore, that EHRs would be required to accommodate enhanced

protections for the medical records of some illnesses in order to be HIPAA-compliant even if 42 C.F.R.

Part 2 did not exist.

I also support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Sincerely,
�

Amy Amadeo, MA, LCADC 

ICCDAA Executive Director 
830 S. Hillside, Wichita, KS 67211 

Phone 316-613-2222 Fax 316-613-2220 

June 23, 2014 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. 

· Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913.

To Whom · It May Concern: 

My name is Dulcinea Rakestraw, and I am the Vice President of Treatment Services for

Preferred Family Healthcare, Inc (PFH). We are a behavioral healthcare agency that

serves around 10,000 consumers annually.

While PFH supports updating the mechanics of the federal alcohol and drug

confidentiality regulations to facilitate more effective integration of care and needed

conununication in the electronic age, 42 C.F.R Part 2's core privacy protections MUST

be maintained.

With regard to the modifications to 42 C.F.R. Part 2 proposed in SA.MHSA's May 12,

2014 Notice of Public Listening Session (79 Fed. Reg. 26929), PFH supports the

following principles:

• Addiction treatment should be integrated with mental and physical health care,

and communication among health care providers should be encouraged. [I/We] support

maximizing indusion of substance use disorder (SUD) records in electronic health record 

(EHR) systems and health information exchanges (HIEs) while maintaining 42 C.F.R. · Part 2's core privacy protections. 

• 42 C.F.R. Part 2's heightened privacy protections are as critical today as they

were when they were enacted more than 40 years ago, and a move toward HIP AA' s

looser privacy standards would not sufficiently protect: people seeking and receiving

substance use disorder treatment. If patient records can be easily accessed in order to

criminally investigate or prosecute or patient, or deny them insurance or a job, or be used

against them in a divorce or child custody proceeding, many patients will be afraid to

enter treatment in the first place.

"suyyorting .J{ea(tfiy LifestyCes" 

Preferred

Family Healthcare
• LAC continues to believe that patients in alcohol and drug programs should retain 

the power to decide when and to whom their records are disclosed, even for treatment and 

payment purposes, given the continued prevalence of discrimination in our society. This 

includes disclosures to the general health care system, IDEs, health homes, ACOs, and 

CCOs. The best way for patients to retain that poweris by requiring patient consent for 

most disclosures, together with a strong prohibition on redisclosure. 

• It is both necessary and technologically possible to integrate addiction and other 

health care and effectively exchange addiction treatment data while maintaining the core 

protections of 42 C.F.R. Part 2. [I/We] urge the continued development of technical 

solutions for consent management. 

• Since HIP AA requires compliance with state and federal laws that mandate 

greater pdvacy protections, electronic health record systems (EHRs) must be designed so 

as to comply with the many state statutes that require heightened protections for 

information related to mental health, IDV IAIDS, reproductive health, domestic violence 

and other types of sensitive health information, as well as with 42 C.F.R. Part 2. It is 

·	Eimportant to keep in mind, therefore, that EHRs would be required to accommodate 

enhanced protections for the medical records of some illnesses in order to be HIP AAcompliant even if 42 C.F.R. Part 2 did not exist. 

We also support the comments submitted by the Legal Action Center. 

Thank you for· your consideration. 

Sincerely,
E

Dulcinea Rakestraw
E

Vice President, Treatment Services
E

"Suyporting .Jfea{tliy Lifesty(es" 
ECO PROGRAM 

808 Downtowner Loop West 

Mobile, AL. 36609 

Phone: (251) 341-9504 

Fax: (251 )''341-9509 

SEND TO: FROM: 

.ATTN: DATE:

RECleJENTS FAX: TOTAL PAGES: 

Comments: 

Confldentlallty Notice 

This Information has been dlsclosed to,you from records protected by Federal Confldentlallty Statue 

(42 CFR Part 2). The federal rules prohibit you from making any furthar disclosures Is expressly 

permlttad by the written consent of the pereon to whom It pertains, or as otherwise permitted by,42 

CFR Part 2. A General Authorizatlon·for the i:elease of medical or other lnro""atlon Is not sufficient 

for this purpose. The federal rules restrict any ui,e of this lnfo""atlon to crlmlnally Investigate or 

prosecute any alcohol or drug abuse patient. 

SAMHSA ECD Program Inc.

6/26/14
June 25, 2014 

ECD Program, Inc 

808 Downtowne1· Loop W 

Mobile, Al 36609 1

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. 

Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

ECD Program, Inc. is an opiate replacement treatment facility with 230 clients. 

While ECD Program, lnc. supports updating the mechanics of the federal alcohol and drug 

confide11tia1ity regulations to facilitate more effective integratio11 of care and needed 

communication in the electronic age, 42 C.F.R. Part l's core privacy protections MUST be 

maintained. 

Although. 42 CFR, Part 2 seems very intense and sometimes awkward and complicated, it has 

been helpful in keeping very important records out of the wrong hands. This organization has 

had estranged friends and family attempt to obtain records to use against client's an.d fortunately 

42 CFR, Part 2 was in place and the friends and family were not able to obtain amm.unition 

agai11st a client. In thi.s setting, of'ten argume11ts occur amo11gst clients or custody battles occur. 

These are the most common incidents when documents are attempted to be obtailled with a 

subpoena or invalid release. 
With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA's May 12, 2014 

Notice of Public Listening Session (79 Fed. Reg. 26929)., ECD Program, Ille. supports the 

following principles: 

• Addiction treatment should be integrated with mental and physical. health care, and 

communication among health care providers should be encouraged. We support 

maximizing inclusion of substance use disorder (SUD) records 1n electwnic health record 

(EHR) systems and health infonnation exchanges (HIEs) while maintaining 42 C.F.R. 

Part 2's core privacy protections.

• 42 C.F.R. Part 2's heightened privacy protections are as c1itical today as they were when 

they were enacted more than 40 years ago, and a move toward HIP AA' s looser privacy 

standards would not sufficiently protect people seeking and receiving substance use 

diso1·der treatment. If patient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny them insurance or a job, or be used against 

them in a divorce or chil,d custody proceeding, many patients will be afraid to enter 

treatment in the first place.

• LAC continues to believe that patients in alcohol and dtug programs should retain the 

power to decide when and to whom their records are disclosed, even for treatment and 

payment purposes, given the continued prevalence ofdiscrimination in our society. This 

includes discJosures to the general health care system, HIEs, health homes, ACOs, and 

CCOs. The best way for patients to retain that power is by requiting patient conse11t for 

most disclosures, together with a strong prohibition on redisclosure.

• It is both necessary and technologically possible to integrate addiction and other health 

care and effectively exchange addiction treatment data while maintaining the core 

protections of 42 C.F.R. Part 2. urge the continued development of technical solution.s 

for consellt management.

• Since HIP AA requires compliance with state a11d federal laws that mandate g1·eater 

privacy p1·otectio11s, electronic health record systems (EHRs) must be designed so as to 

comply with the many state statutes that require heightened protections for information 

related to mental health, HIV/AIDS, reproductive health, domestic violence an.d other 

types of sensitive health information, as well as with 42 C.F .R. Part 2. It is important to 

keep in mind, therefore, that EHRs would be required to accommodate enhanced 

protections for the medical records of some illnesses in. order to be IDP AA-compliant 

even if 42 C.F.R. Part 2 did not exist. 

We also support the comments submitted by the Legal Action Center. 
Th.ank you for your consideration. 

Sincerely, 

Susan. Case, LPC 

Executive Director 

ECD Program, Inc. 
NORTH CHARLESINC.

Mental Health & 

Addiction The North 

Charles Institute 

for the Addictions 

06/25/2014 13:08 FAX 1410002/0004 

June 24, 2014 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 Rockville, MD 20857 

RE: ConfidentiaJty of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R.

Part 2. 79 Fed. Re . 26929· Docket No. 2014 10913. 

To Whom It May Concern: 

North Charles institute for the Addictions, an Opioid Treatment Program under North Charles 

Mental Health, Research and Training Foundation, Inc. has been providing opioid treatment 

services to individual in the greater Cambridge/Somerville and Boston area for over forty years. 

While North Charles, Inc. supports updating the mechanics of the federal alcohol and drug 

confidentiality regulations to facilitate more effective integration of care and needed 

communication in the electronic age, 42 C.F.R. Part 2's core privacy protections MUST be

maintained. 

We have had extensive experience with the burden that stigma and discrimination place on our 

patients every day seeking emergency and general medical care services, obtaining and 

maintaining employment, accessing housing, child custody, and safety and protection during the 

criminal arrest and prosecution to name a few. Despite the scientific evidence demonstrating the 

effectiveness of methadone treatment, addicted patients remain misunderstood. We have patients 

who are denied housing, have lost child custody battles and visitation rights. Many have been 

denied timely emergency care, adequate pain management for chronic debilitating illness, liver 

transplantation, and jobs and promotions for which they are well qualified because of their 

addictive disorders. We had attorneys request details of a patient's history and current treatment 

that unnecessarily expose them to sanctions bY the courts. 42 CFR Part Two allowed for providing 

information that is deemed necessary withoUt compromising patient privacy and stability. Many 

are on the judgment that the protections afforded to patients under HIPAA are sufficient. That is 

no the case. HIPAA protections are not equally strong. We believe that there will be tragic 

consequences if 42 CFR Part Two is not reserved and patients will be deterred from entering 

addictions treatment or destabilized in treatment that helps them maintain a sober lifestyle. 

260 Beacon Street" So rville, MA 02143 • (617) 661-5700 • =AX: (617) 868-4840 • TTY: (617) 661-5700 

In affiliation with the arvard Medical School Department c • Psychiatry at The Cambridge Hospital 

l 
06/25/2014 13:08 FAX 0003/0004 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA's May 12, 2014 

Notice of Public Listening Session (79 Fed. Reg. 26929, North Charles supports the following 

principles: 

• Addiction treatment should be integrated with mental and physical health care, and

communication among health care providers should be encouraged. We support 

maximizing inclusion of substance use disorder SUD) records in electronic health 

record (EHR) systems and health information exchanges (HIEs) while maintaining 42 

C.F.R. Part 2's core privacy protections.

• 2's heightened privacy protections are as critical today as they were 

when they w e enacted more than 40 years ago, and a move toward HiPAA's looser 

privacy standards would not sufficiently protect people seeking and receiving substance 

use disorder treatment. If patient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny their insurance or a job, or be used against 

them in a divorce or child custody proceeding, or any patients will be afraid to enter 

treatment in the first place. 

• North Charles continues to believe that patients in alcohol and drug programs should

retain the power to decide when and to whom their records are disclosed, even for 

treatment and payment purposes, given the continued prevalence of discrimination in 

our society. This includes disclosures to the genera I health care system, HI Es, health 

homes, ACOs, and CCOs. The best way for patients to retain that power is by requiring 

patient consent for most disclosures, together with a strong prohibition on redisclosure. 

• It is both necessary and technologically possible to integrate addiction and other health

care and effectively exchange addiction treatment data while maintaining the core 

protections of42 C.F.R. Part 2. We urge the continued development of technical 

solutions for consent management. 

• Since HIPAA requires compliance with state and federal laws that mandate greater

privacy protections, electronic health record systems (EHRs) must be designed so as to 

comply with the many state statutes that require heightened protections for information 

related to mental health, HIV/AIDS, reproductive health, domestic violence and other 

types of sensitive health information, as well as with 42 C.F.R. Part 2. It is important to 

keep in mind, therefore, that EHRs would be required to accommodate enhanced 

protections for the medical records of some illnesses in order to be HIPAA-compliant 

even if 42 C F.R. Part 2 did not exist. 

2 
06/25/2014 13:08 FAX 0004/0004 

We have reviewed and support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Sincerely,

Janice F. Kauffman R.N., M.P.H., C.A.S., L.A.D.C.1 

Vice President, Addi tion Treatment Services 

North Charles Mental Health research and Training Fo1 1dation, Inc. (aka North Charles, Inc.) 

Assistant Professor of Psychiatry 

Harvard Medical School 

3 
 

08:48: 56 p.m. 06-25-2014 1 I1 

• P!?t:l.:t::NTiOl'J m ELWC,HION t.1 CVA.LU)Tf(.lN • 'lf.C:.lJVl;.Rl 

June 25, 2014 

Substance Abuse and Mental Health Services Administration 

I Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

Re: Docket# 2014-10913 

Dear SAMHSA: 

I am writing on behalf of the patients of our non-profit addiction prevention and treatment organization. Located in 

the Chicago metro area, PEER Services Is dedicated to strengthening Individuals, families and local communities by 

delivering high quality addiction prevention and treatment services. We have followed with Interest, and to be honest 

a great deal of trepidation, the recent discussions on potentially reducing the privacy provisions contained In 42 CFR 

Part 2. We strongly urge you to maintain all current privacy protections contained in this key federal law which is a 

cornerstone in the delivery of substance abuse treatment to Individuals who are struggllng with substance use 

disorders. 

Al SAMHSA you are well aware of the many ways in which individuals whose lives are Impacted by addiction have 

experienced discrimination in a wide range of arenas including employment, healthcare, Insurance, the child welfare 

system, the criminal justice system and housing. The Legal Action Center has tracked many of these cases over 

recent decades. 

Many Individuals fear that their privacy will be breached if they seek addiction treatment. This Impacts not only that 

Individual, but also their family and extended community. Our agency has been providing community-based 

substance abuse treatment services for nearly forty years. Protecting the privacy of our patients has been a top 

priority of ours since our Inception. Please do not take any action that will dilute that protection. We are in the midst 

of a heroin and other opioid epidemic not only in Illinois but across the country. As advocates strive to Increase 

access to treatment, changes to the privacy laws could completely undermine the treatment community's efforts to 

make treatment accessible to those most in need. Patients need to feel safe entering treatment. Loosening or 

removing privacy protections could prove disastrous! 

While we are excited about the many benefits of implementing electronic health records systems in healthcare 

settings throughout our country, it Is essential that these systems be deigned to maintain the granularity of specific 

data such as addiction treatment information, HIV status and other private health information that individuals may 

fear will be broadly disseminated without adequate consideration of the potential consequences to the individual to 

whom the private information belongs. As part of the discussion of 42 CFR Part 2, some Individuals have suggested 

that the protections it provides are also included under HIPAA. The protections are NOT equal. HIPAA allows for the 

re-disclosure of private Information without patient consent. This very distinction is perhaps the most compelling 

reason to keep 42 CFR Part 2 intact. We are very concerned about the unintended consequences of such redlsclosure on the lives of current patients and as a factor that may discourage new patients from entering treatment. 

Please exercise great caution in responding lo pressures to erode the privacy protections which have been at the 

cornerstone of the pubHcally funded addiction treatment system for the past 40 years. 

Sincerely, 

Gretchen Igllorl, LCSW

Program Coordinator 

www.peerservices.org 906 Davis Street, Evanston, IL 60201 3633 West Lake Avenue,# 305, Glenview, IL 60026 

(847)492-1778 (847) 657-7337 Buildi11g l1ibranr healthy drug fr

ee comnwniUes (847) 492-0320 Fax (847) 657-7331 Fax 
 

 

 

 

 

 

236 Massachusetts Ave. NE STE 505 

Washington, DC 20002 

202.546.4600 

Becky D. Vaughn 

Chief Executive Officer 

COMMENTS OF THE STATE ASSOCIATIONS OF ADDICTION SERVICES (SAAS)
 

IN RESPONSE TO
 

U.S. DEPT. OF HEALTH & HUMAN SERVICES,
 

SUBSTANCE ABUSE & MENTAL HEALTH SERVICES ADMINISTRATION, 

NOTICE OF PUBLIC LISTENING SESSION, 

79 FED. REG. 26929 (MAY 12, 2014)
 

DOCKET NO. FR DOC. 2014-10913
 

(SUBMITTED JUNE 25, 2014)
 

I. Introduction to SAAS Comments

SAAS was founded in 1987 as a 501(c)(3) nonprofit organization with a mission of ensuring 

quality addiction services nationwide. The membership consists of state associations of 

addiction prevention, treatment, and recovery support providers. These associations represent 

programs of all sizes and treatment and prevention approaches. SAAS is the only national 

organization of state alcohol and drug addiction treatment and prevention provider associations. 

Through our member associations, SAAS has a direct link to thousands of programs that are the 

core of the publicly-supported addiction services system. SAAS serves as an information broker 

and advocate, linking state associations with national developments such as evidence-based 

practices and providing input to federal organizations on the needs of community-based services 

providers and their clients. We support providers with training and technical assistance. 

SAAS service provider members believe that behavioral health care should be integrated with 

physical health care, and that communication between health care providers should be 

encouraged. At the same time, SAAS believes that 42 C.F.R. Part 2’s heightened privacy 

protections are as critical today as they were when they were enacted more than 40 years ago, 

and that a move toward the looser privacy standards of the Health Insurance Portability and 

Accountability Act (HIPAA) would not sufficiently protect people seeking and receiving 

substance use disorder (SUD) treatment. SAAS providers, through first-hand experice recognize 

that patients seeking and receiving SUD treatment should retain the right to control how their 

records are disclosed, even for health and payment purposes, given the continued prevalence of 

prejudice and discrimination in our society. SAAS believes that it is both necessary and 

technologically possible to integrate SUD and other health care and to effectively exchange SUD 

treatment data while maintaining the core protections of 42 C.F.R. Part 2. 

As you consider these and other comments from stakeholders, we urge you to give the greatest 

weight to the comments made by patients and consumers, as it is their rights and access to their 

sensitive health information that will affected by any changes to 42 C.F.R. Part 2. 
 

 

 

 

 

 

 

 

 

SAAS partners with the Legal Action Center (LAC) on many policy issues--particularly SUD 

confidentiality. SAAS recognizes them as the experts in the field and appreciates and credits 

LAC for their help and support in putting these comments together. Please find our 

recommendations concerning the critical issues SAMHSA poses as follows: 

• SAAS supports maximizing inclusion of SUD records in electronic health record (EHR)

systems and health information exchanges (HIEs) while maintaining privacy protections

that are as essential today as they were when enacted in the 1970s. People with SUDs

still face loss of employment, housing, and child custody; insurance and health care

discrimination; criminal arrest, prosecution and incarceration; and a host of other

negative consequences. 42 C.F.R Part 2’s privacy protections greatly minimize the

possibility that a patient’s own treatment records could be used against them in all those

situations. In order to encourage people with SUDs to seek treatment, 42 C.F.R. Part 2’s

more stringent privacy protections must be maintained rather than accede to HIPAA

standards, which many have criticized for their insufficient protection of patient privacy,

and which would allow many more disclosures that would lead to those harmful

consequences for patients.

• SAAS supports the goals set out in the request for comments and many of the specific

suggestions for adjusting how the regulations currently operate. SAAS believes that the

current regulations, together with existing plus additional guidance from SAMHSA, can

accomplish many (if not all) of the intended goals of integrating substance use disorder

and other health care and improving communication between them more effectively.

• Since HIPAA requires compliance with state and federal laws that mandate greater

privacy protections, EHRs must be designed so as to comply with the many state statutes

that require heightened protections for information related to mental health, HIV/AIDS,

reproductive health, domestic violence and other types of sensitive health information, as

well as with 42 C.F.R. Part 2. In addition, EHRs must also be designed to comply with

the HITECH Act, which provides that individuals have a right to restrict the disclosure of

health information in electronic or any other form when they pay out of pocket for

services provided.1 It is important to keep in mind, therefore, that EHRs would be

required to accommodate enhanced protections for the medical records of some illnesses

in order to be HIPAA and HITECH-compliant even if 42 C.F.R. Part 2 did not exist.

II. Why the HIPAA Standard is Insufficient to Protect Patient Privacy

Before we answer the specific questions posed by SAMHSA in its May 12, 2014 Notice of 

Public Listening Session (“Notice”), we would like to address the suggestion by some 

stakeholders that a potential solution to the challenges posed by 42 C.F.R. Part 2 (hereinafter 

referred to as “Part 2”) to initiatives such as new models of integrated care and electronic health 

information exchange is to do away with Part 2’s heightened privacy protections in favor of a 

HIPAA standard. 

1 45 C.F.R. § 164.522(a)(1)(vi). 

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Acceding to a HIPAA standard for SUD patient information would eviscerate the core 

protections of Part 2 – in particular the requirements for patient consent, the prohibition on 

redisclosure, and the heightened standards for disclosure to law enforcement and judicial and 

administrative bodies – and would likely lead to dire consequences for Part 2 patients and their 

families. While Part 2 requires patient consent for most disclosures, thus allowing patients to 

control the flow of information that holds the potential to do them great harm in the wrong 

hands, HIPAA does not require consent for disclosures made for the purposes of treatment, 

payment, and health care operations (TPO). HIPAA’s definition of TPO is so broad as to allow 

virtually unfettered access to patient’s health information by those in the health care system; such 

an exception would be a death knell for Part 2’s patient consent requirement and prohibition on 

redisclosure. Furthermore, where Part 2 requires a special court order for disclosures to law 

enforcement and to judicial or administrative bodies (such as divorce and child custody 

proceedings)2

 with heightened review standards, HIPAA permits such disclosures in whatever 

manner is required by state law, meaning as soon as a health care provider receives a subpoena, 

judicial or administrative order, or even a discovery request. Given the disastrous consequences 

patients often face when their SUD histories are disclosed to law enforcement or judicial or 

administrative bodies, adopting this standard for SUD patient records would do great harm to 

patients and their families. 

While allowing all SUD patient information to flow to all parts of the health care system without 

restriction may seem benign or even desirable at first blush, we believe it is likely that such a 

change would backfire, resulting in disclosures that damage the lives of patients and their 

families more often than improve their care. Allowing virtually unfettered disclosure of SUD 

patient records without consent to the full range of individuals and organizations involved in 

health care (including payment and operations) and law enforcement, and allowing those entities 

to redisclose those records without restriction, as HIPAA does, would result in many people not 

obtaining the care they need for fear of being arrested and prosecuted, losing custody of their 

children, and suffering employment, insurance and other discrimination. 

In its 40 years serving SUD treatment providers and SUD patients, SAAS has seen these 

consequences first-hand time and again. Although we hope to see the day when prejudice and 

discrimination are no longer the reality for people with SUDs, that day has unfortunately not yet 

arrived. In just the past several months SAAS has received numerous requests for assistance 

from people facing SUD-based prejudice and discrimination. For example, we have heard from: 

• a young father in recovery who was being denied visitation with his children because he

was in methadone treatment, despite the fact that he was not using any illegal substances;

• a mother in recovery who had her 2-month-old infant removed from her custody after the

hospital where she gave birth reported her for having legally prescribed methadone in her

system;

• a young mother who was being threatened with eviction from a shelter because she was

taking prescribed methadone for her opioid addiction (another young mother had already

2 For example, under 42 C.F.R. Part 2, a court ordinarily may not even order disclosure of treatment records for the 

purpose of prosecuting a patient. See 42 C.F.R. §§ 2.61-2.65. 

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been evicted from the same facility for the same reason, and had become homeless; 

neither woman was using illegal substances); and 

• a young man whose employer refused to allow him to return to work after he successfully

completed treatment for alcoholism, saying that he was a safety threat even though his

physician had cleared him to return to work with no restrictions.

In addition, since January 1, 2012, SAAS has received 93 requests for assistance from SUD 

treatment programs whose patient records were being sought by law enforcement or a court 

without obtaining appropriate court orders as required by Part 2. This represents requests from 

only the 10 states to which we provide hotline assistance. 

SAAS is not alone in recognizing the importance of patient privacy protections. When the U.S. 

Department of Health and Human Services (HHS) issued the HIPAA Privacy Rule in 2000, it 

stated, “While privacy is one of the key values on which our society is built, it is more than an 

end in itself. It is also necessary for the effective delivery of health care, both to individuals and 

to populations.”3 HHS also said that, “Unless public fears are allayed, we will be unable to 

obtain the full benefits of electronic technologies.”4

Yet the issuance of the HIPAA Privacy Rule has done little to allay fears of sharing health 

information through electronic health systems, and in fact those concerns are growing. A 2010 

study in the Journal of the American Medical Informatics Association5 found that of the 

outpatient mental health clinicians surveyed: 

• 83% disagreed with including their own psychiatric records among routinely accessed

EHR systems;

• 80% said that if they were a patient, they would not want health care providers to have

the ability to routinely access their mental health records; and

• 63% said they are less willing to record highly confidential information in EHRs

compared with paper records.

According to a report issued by the American National Standards Institute in 2012, an online poll 

of 2,000 adults revealed that 97% of the public believe that health care providers and insurers 

should not be able to share their health information without their consent. 6 A 2013 study found 

that that about two-thirds of U.S. adults were concerned about a breach in the security of their 

protected health information (PHI) during transfer between health care professionals by fax or 

electronically, and concerns over the safety of PHI was associated with higher likelihood of 

withholding medical information from a health care professional. 7

3 65 Fed. Reg. 82462, 82467 (Dec. 28, 2000). 4 65 Fed. Reg. 82462, 82466 (Dec. 28, 2000). 5 See Ronald M. Salomon et al., “Openness of patients' reporting with use of electronic records: psychiatric

clinicians' views,” J. of Am. Med. Informatics Ass’n (2010);17:54-60, doi:10.1197/jamia.M3341, available at 

http://jamia.bmj.com/content/17/1/54.full. 6 Am. Nat’l Standards Inst. et al., The Financial Impact of Breached Protected Health Information (Mar. 2012), p. 

23.
 7 I. Agaku, et al., Concern About Security and Privacy, and Perceived Control Over Collection and Use of Health 

Information Are Related to Withholding Health Information from Healthcare Providers, J. of Am. Med. Informatics
 

Ass’n (Aug. 2013).
 

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The fears that these professionals and adults have regarding electronic health information privacy 

breaches are unfortunately well founded. According to HHS, more than 1,000 medical record 

breaches involving 500 or more people have been reported to HHS since federal reporting 

requirements took effect nearly five years ago.

8 In total, large health data breaches reported by 

health care providers and their business associates have affected the medical records of about one 

in ten U.S. residents, or 31.7 million people.9

The very real risks to and breaches of individuals’ privacy resulting from adoption of the HIPAA 

standard and the development of interoperable EHR systems have led many to call for the 

adoption of broader protections for all health information, giving it protections like those 

afforded by Part 2. The reports and recommendations issued by the National Committee on Vital 

Health Statistics in its consensus-driven Recommendations on Privacy and Confidentiality, 2006­

2008 advocate for this type of change, as do numerous other stakeholders.10

HHS seemed to recognize the risks that could come when health care payers are given access to 

health information when, in the final rule implementing the HITECH Act (which amended 

HIPAA in 2009), it provided that individuals have the right to restrict the disclosure of health 

information in electronic or any other form when they pay out of pocket for services provided. 

This right should not be limited to people who have the financial means to pay for health care out 

of pocket, but should be afforded to all individual, regardless of the means of payment. 

Below are the SAAS comments on the specific questions posed by SAMHSA in its May 12, 

2014 Notice. 

III. SAAS Comments

a. Applicability of 42 C.F.R. Part 2

SAAS agrees with SAMHSA that the current definition of which providers fall under Part 2 has 

been the source of some confusion. It makes no sense for the application of Part 2 to depend on 

whether entities “hold themselves out” as proving substance abuse services, rather than on what 

substance abuse treatment services they are providing. Thus we welcome a new definition of the 

applicability of Part 2 that clarifies which providers and what information is covered by Part 2. 

Such clarification would help HIEs, HIT vendors, etc. to understand what information is covered 

by Part 2 and requires heightened protection. 

8 Joseph Conn, “Major medical records breaches pass 1,000 milestone as enforcement ramps up,” Modern 

Healthcare (June 13, 2014), available at 

http://www.modernhealthcare.com/article/20140613/BLOG/306139996/major-medical-records-breaches-pass1000-milestone-as-enforcement#src=serp.
 9 “One in 10 U.S. Residents Affected by Large Health Data Breaches,” iHealthBeat (June 16, 2014), available at

http://www.ihealthbeat.org/articles/2014/6/16/one-in-10-us-residents-affected-by-large-health-data-breaches. 10 U.S. Dep’t of Health & Human Svcs, Nat’l Comm. on Vital & Health Statistics, Privacy Report:

Recommendations on Privacy & Confidentiality, 2006-2008 (May 2009), available at
 

http://www.ncvhs.hhs.gov/privacyreport0608.pdf.
 

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The definition suggested by SAMHSA, that Part 2 would apply to any federally assisted health 

care provider that provides a patient with “specialty substance abuse treatment services,” 

removes the “holds itself out” language and is a step in the right direction. However, this 

proposed definition raises new questions. What is the difference between a “specialty substance 

abuse treatment service” and a “non-specialty substance abuse treatment service”? Is the 

provision of buprenorphine a “specialty substance abuse service”? It would certainly seem so, 

and in fact we cannot see how the provision of buprenorphine could be considered otherwise. If 

that is the case, then would all physicians who prescribe buprenorphine be covered by Part 2? 

The definition suggested by SAMHSA also states that “providers would not be covered [by Part 

2] if they provided only substance abuse screening, brief intervention, or other similar pretreatment substance abuse services.” This makes clear that providers who only provide SBIRT

services “would not be covered by Part 2.” However, in order to for this provision not to run

afoul of Part 2’s authorizing statute, which explicitly extends confidentiality protections to SUD

prevention,11 “screening, brief intervention, or other similar pre-treatment substance abuse

services” would have to be differentiated from other types of prevention services. We think an

attempt at such differentiation would be difficult to impossible, and would create a large amount

of confusion. It is important to maintain the statute’s protection of SUD prevention records, as

prevention programs around the country depend on these protections to reassure their program

participants that information shared will be held in confidence.

b. Consent Requirements

Before we address SAMHSA’s specific suggestion for possible changes to Part 2’s consent 

requirement, we note that we are very gratified that SAMHSA continues to support and 

appreciate the importance of obtaining patient consent for the release of patient information. 

Based on our nearly 40 years of experience advising SUD programs and their patients, SAAS 

continues to believe that patients in SUD programs should retain the power to decide when and 

to whom their records are disclosed, including disclosures to the general health care system, 

HIEs, health homes, ACOs, and CCOs, and that the best way for patients to retain that power, 

and to ensure that care is, in fact, patient centered, is by requiring patient consent for most 

disclosures, together with a strong prohibition on redisclosure. 

Like SAMHSA, we also believe that there are ways to resolve some concerns that have been 

raised about Part 2’s consent requirements in order to facilitate “the flow of information within 

the health care context while ensuring the patient is fully informed and the necessary protections 

are in pSAASe.” In addition, we agree with SAMHSA’s assessment that “technical solutions for 

managing consent collection are possible” – in fact, such solutions are already under 

development. As such, we urge the continued development of technical solutions for consent 

management as well as the development of organizational policies and procedures that provide 

patients with meaningful consent options. 

11 See 42 U.S.C. § 290dd-2(a) (“Records of the identity, diagnosis, prognosis, or treatment of any patient which are 

maintained in connection with the performance of any program or activity related to substance abuse education, 

prevention, training, treatment, rehabilitation, or research, which is conducted, regulated, or directly or indirectly 

assisted by any department or agency of the United states shall, except as provided in subsection (e) of this section, 

be confidential....” (emphasis added)). 

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Comments on First and Second Suggested Consent Changes: 

SAMHSA’s first suggested change is, “Allow the consent to include a more general description 

of the individual, organization, or health care entity to which disclosure is to be made.” Its 

second suggested change is, “Require the patient be provided with a list of providers or 

organizations that may access their information and be notified regularly of changes to the list.” 

With respect to the first suggested change, we believe that there is a simple way to address 

concerns raised by some stakeholders that Part 2’s current “to whom” provision is too narrow. 

Part 2 currently requires that a consent form must list the “name or title of the individual or the 

name of the organization to which disclosure is to be made.”12 We believe that “title of the 

individual” to whom disclosure is to be made could be interpreted as allowing “treating 

provider” to be listed as the title of the individual to whom disclosure is to be made. 

In addition, patients could consent to the disclosure of their alcohol and drug information to their 

future treating providers, in addition to their current treating providers. With respect to the 

second suggested change, in order for consent to disclosure to future providers (such as providers 

that join an HIE or ACO after the date consent is signed) to be informed and meaningful, we 

suggest that a consent that permits disclosure to future providers should be accompanied by: 

• a limitation on disclosures only to future providers to with a treating relationship with the

patient;

• effective notification of the patient when any new provider is added to an entity to which

they have provided such consent;

• an easy opt-out mechanism that is always available but is also reiterated each time

patients are notified that a provider has been added.

We believe implementation of this interpretation of the “to whom” requirement could be 

accomplished by a change to the regulations or by sub-regulatory guidance. 

We believe our recommendation permitting patients to consent to the disclosure of their alcohol 

and drug information to their treating providers, including future treating providers, 

appropriately balances the concerns of HIEs, ACOs, and other health care entities with the need 

to provide patients with meaningful consent options. Permitting disclosure to treating providers 

and future treating providers maintains the core protections of 42 C.F.R. Part 2 – the prohibition 

on disclosing, and redisclosing, patients’ SUD records without their consent – while at the same 

time making it easier for patients who choose to consent to such disclosures to participate in 

integrated care models and HIT, including HIEs. Such an interpretation is consistent with both 

Part 2 and statutory language. 

A potential additional benefit of this change is that fewer health care providers will need to 

access patient information by “breaking the glass” (accessing a patient’s SUD information 

without consent in a medical emergency, as permitted by Part 2), since most providers treating a 

12 42 C.F.R. § 2.31. 

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patient in a medical emergency will be covered by a treating provider (including future treating 

providers) consent. Currently, when Part 2-protected records are accessed without consent in a 

medical emergency, they lose the protections of Part 2. An expanded consent interpretation that 

allows providers to access SUD records in a medical emergency by consent, rather than by 

“breaking the glass,” will ensure that more alcohol/drug records remain protected by Part 2. 

To the extent that SAMHSA is considering allowing an HIE or ACO together with all of its 

affiliated/member providers to be listed as an “organization” in the consent form’s “to whom” 

field, we strongly urge against such a change. Allowing an HIE, ACO, or other new health care 

model to call itself an “organization” would have broad implications, namely the proliferation of 

disclosures of SUD records without meaningful patient consent. Depending on the size of the 

HIE or ACO, potentially vast networks of health care providers (and other personnel) would 

have access to patients’ alcohol and drug records after the patient signs a single consent form. In 

the ACO context, member providers and personnel would be free to redisclose the SUD records 

amongst themselves without patient consent; in the HIE context, any provider affiliated with the 

HIE would be able to redisclose SUD records with any other affiliated provider without patient 

consent. This is particularly worrisome given widespread SAASk of knowledge of Part 2’s 

protections – and the reasons for those protections – among non-Part 2 providers, and the risks 

associated with freely flowing electronic health information, including breaches. 

Another possible consequence of defining or reinterpreting the meaning of “organization” in the 

context of Part 2 consent is that the expanded meaning of “organization” may apply elsewhere in 

the regulations, such as in reference to Qualified Service Organizations (QSOs). If, for example, 

an HIE along with all of its affiliated providers could be considered a QSO, then patients’ SUD 

records could be disclosed without consent by a Part 2-covered program to the HIE as well as all 

of its affiliated providers, as long as a QSO Agreement (QSOA) was in pSAASe. Because Part 2 

contains no requirement that patients be notified of a Part 2 program’s QSOAs, patients would 

not even be aware that these consent-less disclosures were occurring. The implications of this 

type of re-interpretation of QSOs and QSOAs would be a virtual gutting of Part 2’s consentbased patient protections. 

Comments on Third and Fourth Suggested Consent Changes: 

With regard to SAMHSA’s proposals regarding changes to the “by whom” consent 

requirements, we are not familiar with a current challenge that such a change would address, and 

would have concerns that such changes may only serve to make the consent process more 

onerous. We believe that the current language regarding the description of the programs or 

people permitted to make disclosures is sufficiently clear. 

Comments on Fifth Suggested Consent Change: 

We are unclear about what is meant by “explicitly describe the substance abuse treatment 

information that may be disclosed,” and what concern this suggestion is meant to address. The 

current regulations require written patient consent to describe the amount and type of 

information to be disclosed, and the purpose of the disclosure.13 In addition, current regulations 

13 42 C.F.R. § 2.31. 

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require that “any disclosure made under these regulations must be limited to that information 

which is necessary to carry out the purpose of the disclosure.”14 We believe the current 

regulations provide sufficient specificity with regard to what information will be disclosed and 

for what purpose. 

c. Redisclosure

SAMHSA is considering revising the redisclosure provision (42 C.F.R. § 2.32) “to clarify that 

the prohibition on redisclosure only applies to information that would identify an individual as a 

substance abuser, and allows other health-related information shared by the Part 2 program to be 

redisclosed, if legally permissible.” SAMHSA gives as the reason for such a revision that “most 

EHRs do not support data segmentation,” and that such a revision will “allow HIT systems to 

more easily identify information that is subject to the prohibition on redisclosure enabling them 

to utilize other technological approaches to manage redisclosure.” We support further 

clarification that Part 2’s Prohibition on Redisclosure does not apply to information that does not 

identify an individual as having an SUD or being in SUD treatment, including how that relates to 

and can facilitate communications between substance use treatment providers and HIT systems. 

The possible revision SAMHSA is suggesting would restate exactly what the current regulations 

allow. The current prohibition on redisclosure states that information cannot be redisclosed 

unless it is permitted by written consent “or as otherwise permitted by 42 CFR Part 2 [emphasis 

added].”15 Part 2’s restrictions on disclosure only apply to information that “would identify a 

patient as an alcohol or drug abuser....”16 Thus, currently under Part 2, information that does not 

identify a patient as a “substance abuser” is not protected and can be redisclosed. Therefore, no 

revision to Part 2’s redisclosure provision is necessary. SAMHSA can clarify any confusion 

about the applicability of Part 2’s redisclosure provision through the issuance of sub-regulatory 

guidance. 

Moreover, adoption of SAMHSA’s proposed revision would not ease the technological challenge 

of data implementation. Data segmentation would still be necessary to ensure proper 

implementation and adherence to the prohibition against redisclosing information that would 

identify an individual as a substance abuser. Thus we do not see any reason why Part 2’s 

prohibition on redisclosure should be revised. 

d. Medical Emergency

We do not see the need to change Part 2’s definition of medical emergency, and worry that 

broadening that definition to encompass situations that are not emergencies would create an 

impermissible end-run around Part 2’s requirement to obtain consent from the patient. At the 

same time, we strongly support further guidance making clear that health care providers can 

14 42 C.F.R. § 2.13(a). 15 42 C.F.R. §2.32. 16 42 C.F.R. §2.12(a)(i) 

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“break the glass” and disclose information in situations where a patient is not able to give 

consent and information in a patient’s medical records is needed to treat a medical emergency, 

including medications s/he is taking that could dangerously cross-react with a medication that 

might be prescribed to treat the emergency. 

SAAS does not believe there should be a changes to Part 2’s current medical emergency 

exception that states that information may be disclosed without consent “for the purpose of 

treating a condition which poses an immediate threat to the health of any individual and which 

requires immediate medical intervention,” and opposes any revision that would allow providers 

to use the medical emergency provision to prevent emergencies. 

As SAMHSA noted, the statute only allows disclosure, without a patient’s written consent, “to 

medical personnel to the extent necessary to meet a bona fide medical emergency.”17 A 

speculative concern that an emergency might happen in the future does not and should constitute 

a bona fide medical emergency that allows for an unconsented-to disclosure. Invoking the 

medical emergency exception and accessing a patient’s protected SUD records without consent 

should be allowable only when: (1) there is an actual emergency in which a patient’s prior 

consent cannot be obtained by the provider treating the emergency – because the individual is 

actually unconscious or incapacitated/unable to give consent; and (2) there is need for immediate 

action requiring immediate access to the person’s records. 

The current rule already gives providers the discretion they need to interpret it appropriately in 

fact-specific situations. We do not believe that there should be any attempt to try to write into 

regulatory language specific scenarios (such as the example SAMHSA offers of changing the 

existing standard in order to “prevent emergencies or to share information when a patient is 

unable to provide informed consent due to their level of intoxication”), because attempting to 

anticipate and spell out all of the potential scenarios that might conceivably arise would be an 

exercise in futility, and would rob those faced with such a list of the crucially important 

discretion the current standard must continue to afford them. 

e. Qualified Service Organization (QSO)

In its May 12 Notice, SAMHSA states that it has “heard concerns from payers and health 

management organizations related to disclosing information that is subject to 42 C.F.R. Part 2 to 

health care entities (ACOs/CCOs) for the purpose of care coordination and population health 

management; helping them to identify patients with chronic conditions in need of more intensive 

outreach” (emphasis added). SAMHSA proposes expanding the definition of a QSO to allow for 

Qualified Service Organization Agreements (QSOAs) for the purposes of care coordination and 

population health management. 

SAMHSA has always taken the position that a QSOA is a two-way agreement between two 

parties – one a Part 2 program and the other a Qualified Service Organization (QSO) that is 

providing a service to that Part 2 program. We strongly support that position and urge 

SAMHSA not to open up the QSOA exception so as to allow Part 2 information to flow between 

multiple entities. To do so would be a complete evisceration of Part 2’s consent requirements. 

17 42 U.S.C. § 290dd-2 (b)(2)(A) 

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To the extent that, for the purpose of care coordination and population health management, there 

might be one entity that is gathering data from difference data sources, a QSOA would be an 

acceptable tool for a Part 2 program to disclose protected information to that information 

gathering entity. If, however, Part 2 information would need to flow to all entities involved in 

care coordination and population health management, then a QSOA should not be allowed for 

such a purpose, and SAMHSA should remain staunch in its position that patient consent would 

be needed. Indeed it is quite simple for a consent to be drafted that allows communication 

among multiple parties. 

Should SAMHSA also be proposing that a QSOA can be used for payment purposes, Part 2 

currently requires that a consent be used for such a purpose, and we strongly agree that consent 

should remain the only option for disclosing information for payment purposes. This 

interpretation is the only one that is consistent with Part 2’s authorizing statute. 

Finally, we are not sure if, when SAMHSA proposed that “One potential solution includes ... to 

allow a ... QSOA to be executed between an entity that stores Part 2 information, such as a payer 

or an ACO that is not itself a Part 2 program, and a service provider,” SAMHSA meant the term 

“service provider” to refer to a program covered by Part 2, or to another type of entity. We 

strongly believe that a QSOA should remain an agreement only between a Part 2 program and an 

entity that provides a service to that program. 

In sum, to the extent that SAMHSA may be suggesting any significant broadening of the rules 

surrounding QSOAs, we believe this would not only run afoul of Part 2’s authorizing statute, but 

it would also create an end-run around Part 2’s core protections – namely the requirement that 

patient consent be obtained before making a disclosure of SUD information, and the prohibition 

on redisclosure. Allowing QSOs to disclose Part 2 information to one another would eviscerate 

Part 2’s consent and redisclosure protections and damage patient trust. 

f. Research

If SAMHSA is suggesting that third party payers, HIEs, etc., should be able to disclose Part 2 

information already in their possession to researchers, we support the underlying rationale for 

this suggested change, i.e., that researchers should have the ability to get access to information 

for research purposes. However, we are concerned that the protections contained in Part 2’s 

research exception (found at 42 C.F.R. §2.52) will not be enforceable if entities other than Part 2 

treatment providers have the authority to release Part 2 information in their possession to 

researchers. How will HIEs, third party payers, etc., be able to determine that a researcher will 

maintain the Part 2 information in accordance with the security requirements set out in 

§2.52(a)(2)? How will they be able to assess whether the potential benefits of the research

outweighs any risks to confidentiality as required by §2.52(a)(3)? Who at these organizations

will be the equivalent of a “program director” and have the authority to make these decisions?

Will they know enough about §2.52 to inform the researchers about the limitation about how the

Part 2 information can be redisclosed under §2.52(b)?

11 
 

 

 

 

 

 

 

 

 

In sum, we would support qualified researchers gaining access to Part 2 information for scientific 

research purposes, from sources other than Part 2 programs, if there is a way to ensure that all of 

Part 2’s research protections in §2.52 will be complied with. 

g. Addressing Potential Issues With Electronic Prescribing and Prescription Drug

Monitoring Programs (PDMPs)

SAAS understands, and finds both justifiable and necessary in light of the current regulation, 

SAMHSA’s current interpretation requiring Part 2 programs to obtain patients’ proper written 

consent before disclosing patients’ electronic prescription information to a pharmacy, requiring 

the pharmacy to obtain proper patient consent before disclosing the Part 2-protected information 

to a PDMP, and requiring the PDMP to obtain proper patient consent before re-disclosing Part 2­

protected information to others. As stated earlier in these comments, it is critical that SUD 

patients retain control over who has access to their records in light of ongoing prejudice and 

discrimination, and the potential unintended consequences of permitting widespread disclosure 

of those records. 

According to the National Alliance for Model State Drug Laws, as of December 2013, 18 states 

allow law enforcement to access their PDMPs with a search warrant, subpoena, court order, or 

other judicial process. Furthermore, 13 states allow law enforcement to be registered users of 

their PDMPs.18 Law enforcement attempts to access SUD patient records, and the deterrent 

impact of law enforcement access against people seeking SUD treatment, was a primary reason 

for creating Part 2’s protections in the first pSAASe. Any change to Part 2 that would allow law 

enforcement to access patients’ SUD information without their consent would directly 

contravene the most basic purposes of Part 2, and would violate Part 2’s authorizing statute.19

Furthermore, discrimination by non-Part 2 health care providers and insurers continue to cause 

real concern among SUD patients. Any change to Part 2 that would allow patients’ SUD 

information to flow without their consent to pharmacies, PDMPs, and all those with access to 

PDMPs would not only violate Part 2’s authorizing statute but could also cause damage to 

patients, including discrimination by health care providers, insurers, and others. We support 

SAMHSA’s continued interpretation of Part 2 as requiring patient consent for disclosure of their 

SUD prescription information to pharmacies, PDMPs, and those with access to PDMPs, and for 

redisclosure by any of those entities. 

18 Nat’l Alliance of Model State Drug Laws, Law Enforcement Access to State PMP Data (2013), available at 

http://www.namsdl.org/library/C4AA9EA3-65BE-F4BB-AAFBAB1F5736F070/. 19 42 C.F.R. Part 2’s authorizing statute states: “Except as authorized by a [Part 2] court order ... no [Part 2] record 

... may be used to initiate or substantiate any criminal charges against a patient or to conduct any investigation of a 

patient.” 42 U.S.C. § 290dd-2(c). 

12 
 

 

 

 

IV. Conclusion

The health care environment is changing rapidly, moving toward more integrated care and the 

electronic exchange of health information. It is important for behavioral health to be included in 

integrated care and HIE in order to provide the best care for the millions of individuals in the 

U.S. who suffer from substance use disorders, and also to reduce costs associated with those 

disorders. At the same time, the privacy protections afforded to SUD information by Part 2 

remain as critical today as they were when enacted in the 1970s. People with substance use 

disorders still face loss of employment, housing, and child custody; insurance discrimination; 

criminal arrest, prosecution, and incarceration; and a host of other negative consequences. In 

order to encourage people with substance use disorders to seek treatment, we strongly urge that 

Part 2’s privacy protections be maintained. We also urge that, where possible, the issues 

identified by SAMHSA as causing confusion be addressed through additional and revised subregulatory guidance by SAMHSA, without the need for regulatory change. 

SAAS also encourages the continued development of technology, along with corresponding 

policies and procedures, that will enable patients with SUD records – and other types of sensitive 

health records – to maintain control and choice regarding disclosures of their health information. 

We believe granular control in health information technology (HIT) is possible and imminent. 

We also hope that incentives for the adoption of HIT will be extended to behavioral health 

providers, and that SAMHSA and other departments of HHS will continue to pilot cutting-edge 

behavioral health HIT initiatives. Finally, we agree with stakeholders who stressed at the June 

11, 2014 Listening Session the importance of educating health care providers, Part 2 programs, 

and Part 2 patients about consent, Part 2, and substance use disorders generally. 

13 
 

•	 Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. We support maximizing 

inclusion of substance use disorder (SUD) records in electronic health record (EHR) systems 

and health information exchanges (HIEs) while maintaining 42 C.F.R. Part 2’s core privacy 

protections. 

CODAC BEHAVIORAL HEALTHCAR E
 

June 23, 2014 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. Part 2. 

79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

CODAC, Inc. (dba CODAC Behavioral Healthcare) is a not-for-profit organization that has been 

providing substance abuse/disorder treatment services in Rhode Island since 1971. 

For most of those years the information obtained, developed, and maintained for every patient has been 

protected by 42 C.F.R. Part 2 and its core privacy protections. 

A significant number of those served by CODAC are engaged in Medication Assisted Treatment 

(MAT) and receive methadone to treat and sustain their recovery. There remains little doubt, that 

stigma and discrimination continues to be a part of this population’s day-day life. This is evident in 

housing, employment, criminal justice, social services, and health care. In spite of continuous efforts 

by providers to educate other members of the “care community”, our patients are often denied housing, 

employment, and custody of their children if they remain in treatment. Likewise, physicians and other 

healthcare providers refuse to either initiate or continue treatment. 

It is our concern that any “weakening” of the core privacy protections will expose our patients to new 

levels of discrimination. 

While CODAC supports updating the mechanics of the federal alcohol and drug confidentiality 

regulations to facilitate more effective integration of care and needed communication in the electronic 

age, we believe that 42 C.F.R. Part 2’s core privacy protections MUST be maintained. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 2014 Notice of 

Public Listening Session (79 Fed. Reg. 26929), CODAC supports the following principles: 
 

 

CODAC BEHAVIORAL HEALTHCAR E
 

•	 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were when they 

were enacted more than 40 years ago, and a move toward HIPAA’s looser privacy standards 

would not sufficiently protect people seeking and receiving substance use disorder treatment. If 

patient records can be easily accessed in order to criminally investigate or prosecute or patient, 

or deny them insurance or a job, or be used against them in a divorce or child custody 

proceeding, many patients will be afraid to enter treatment in the first place. 

•	 We continue to believe that patients in alcohol and drug programs should retain the power to 

decide when and to whom their records are disclosed, even for treatment and payment purposes, 

given the continued prevalence of discrimination in our society. This includes disclosures to the 

general health care system, HIEs, health homes, ACOs, and CCOs. The best way for patients to 

retain that power is by requiring patient consent for most disclosures, together with a strong 

prohibition on redisclosure. 

•	 It is both necessary and technologically possible to integrate addiction and other health care and 

effectively exchange addiction treatment data while maintaining the core protections of 42 

C.F.R. Part 2. We urge the continued development of technical solutions for consent 

management. 

•	 Since HIPAA requires compliance with state and federal laws that mandate greater privacy 

protections, electronic health record systems (EHRs) must be designed so as to comply with the 

many state statutes that require heightened protections for information related to mental health, 

HIV/AIDS, reproductive health, domestic violence and other types of sensitive health 

information, as well as with 42 C.F.R. Part 2. It is important to keep in mind, therefore, that 

EHRs would be required to accommodate enhanced protections for the medical records of some 

illnesses in order to be HIPAA-compliant even if 42 C.F.R. Part 2 did not exist. 

CODAC also support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Michael Rizzi 

President/CEO 
 

 

 

June 23, 2014 

Discovery House 

66 Pavilion Ave. 

Providence, RI 02905 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. 

Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

Discovery House is a national network of Medication Assisted Treatment Programs maintaining 

18 separate locations in 4 States. We have been providing services for over 25 years. 

While Discovery House supports updating the mechanics of the federal alcohol and drug 

confidentiality regulations to facilitate more effective integration of care and needed 

communication in the electronic age, 42 C.F.R. Part 2’s core privacy protections MUST be 

maintained. 

Our organization has experienced first hand the stigma our patients face when we have attempted 

to open new facilities or even move an existing facility. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 2014 

Notice of Public Listening Session (79 Fed. Reg. 26929), Discovery House supports the 

following principles: 

•	 Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. We support 

1 
 

 

 

 

maximizing inclusion of substance use disorder (SUD) records in electronic health record 

(EHR) systems and health information exchanges (HIEs) while maintaining 42 C.F.R. 

Part 2’s core privacy protections. 

•	 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were when 

they were enacted more than 40 years ago, and a move toward HIPAA’s looser privacy 

standards would not sufficiently protect people seeking and receiving substance use 

disorder treatment. If patient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny them insurance or a job, or be used against 

them in a divorce or child custody proceeding, many patients will be afraid to enter 

treatment in the first place. 

•	 LAC continues to believe that patients in alcohol and drug programs should retain the 

power to decide when and to whom their records are disclosed, even for treatment and 

payment purposes, given the continued prevalence of discrimination in our society. This 

includes disclosures to the general health care system, HIEs, health homes, ACOs, and 

CCOs. The best way for patients to retain that power is by requiring patient consent for 

most disclosures, together with a strong prohibition on redisclosure. 

•	 It is both necessary and technologically possible to integrate addiction and other health 

care and effectively exchange addiction treatment data while maintaining the core 

protections of 42 C.F.R. Part 2. We urge the continued development of technical 

solutions for consent management. 

•	 Since HIPAA requires compliance with state and federal laws that mandate greater 

privacy protections, electronic health record systems (EHRs) must be designed so as to 

comply with the many state statutes that require heightened protections for information 

related to mental health, HIV/AIDS, reproductive health, domestic violence and other 

types of sensitive health information, as well as with 42 C.F.R. Part 2. It is important to 

keep in mind, therefore, that EHRs would be required to accommodate enhanced 

protections for the medical records of some illnesses in order to be HIPAA-compliant 

even if 42 C.F.R. Part 2 did not exist. 

2 
 

 

We also support the comments submitted by the Legal Action Center and the American
 

Association for the Treatment of Opioid Dependence.
 

Thank you for your consideration.
 

Sincerely,
 

Richard Froncillo 

Patient Ombudsman 

3 
TRIX 

LOCATIONS: 

• inland Empire 

• Los Angeles 

• San Fernando Valley 

• West Los Angeles 

Administrative Office 

1850 Sawtelle Blvd., Suite 470, West Los Angeles, CA 90025 

Tel: (310) 478-6006 Fax: (310) 478-6117 

www.matrixinstitute.org 

June 23, 2014 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: 	 Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. 

Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

The Matrix Institute on Addictions has been delivering treatment services for substance use 

disorders for the past 30 years to thousands ofpatients. 

While Matrix Institute supports updating the mechanics ofthe federal alcohol and drug 

confidentiality regulations to facilitate more effective integration of care and needed 

communication in the electronic age, 42 C.F.R. Part 2's core privacy protections MUST be 

maintained. 

I personally have had dozens of experiences over the years in which the current protections kept 

patient records and treatment information from being acquired by individuals who were not 

acting in the best interests of the patient. When there is a valid reason for providing information, 

patient's have the discretion to exercise a release of information and waive protection for a 

specific purpose. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA's May 12, 2014 

Notice ofPublic Listening Session (79 Fed. Reg. 26929), Matrix Institute supports the following 

principles: 

• 	 Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. We support 

maximizing inclusion of substance use disorder (SUD) records in electronic health record 

(EHR) systems and health information exchanges (HIEs) while maintaining 42 C.F.R. 

Part 2's core privacy protections. 
• ` 42 C.F.R. Part 2's heightened privacy protections are as critical today as they were when 

they were enacted more than 40 years ago, and a move toward HIPAA's looser privacy 

standards would not sufficiently protect people seeking and receiving substance use 

disorder treatment. If patient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny them insurance or a job, or be used against 

them in a divorce or child custody proceeding, many patients will be afraid to enter 

treatment in the first place. 

• ` We continues to believe that patients in alcohol and drug programs should retain the 

power to decide when and to whom their records are disclosed, even for treatment and 

payment purposes, given the continued prevalence of discrimination in our society. This 

includes disclosures to the general health care system, HIEs, health homes, ACOs, and 

CCOs. The best way for patients to retain that power is by requiring patient consent for 

most disclosures, together with a strong prohibition on redisclosure. 

• ` It is both necessary and technologically possible to integrate addiction and other health 

care and effectively exchange addiction treatment data while maintaining the core 

protections of 42 C.F.R. Part 2. We urge the continued development of technical 

solutions for consent management. 

• ` Since HIP AA requires compliance with state and federal laws that mandate greater 

privacy protections, electronic health record systems (EHRs) must be designed so as to 

comply with the many state statutes that require heightened protections for information 

related to mental health, HIV/AIDS, reproductive health, domestic violence and other 

types of sensitive health information, as well as with 42 C.F.R. Part 2. It is important to 

keep in mind, therefore, that EHRs would be required to accommodate enhanced 

protections for the medical records of some illnesses in order to be HIP AA-compliant 

even if 42 C.F.R. Part 2 did not exist. 

We also support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Sincerely, 

Michael McCann, M.A. 

Associate Director 

2 
 

 

 

 

 

 

 

New Hampshire Alcohol & Drug Abuse Counselors Association
 

New Hampshire Training Institute on Addictive Disorders
 

130 Pembroke Road, Suite 100 

Concord, NH 03301 

www.nhadaca.org 

(603) 225-7060 phone 

(603) 225-7062 fax 

nhtiad@myfairpoint.net 

June 23, 2014 

NH Alcohol & Drug Abuse Counselors Association 

130 Pembroke Road, Suite 100 

Concord, NH 03301 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. 

Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

The NH Alcohol & Drug Abuse Counselors Association (NHADACA) is a non-profit 

membership organization of approximately 220 members. Since 1986, NHADACA has worked 

to advance the addiction profession in New Hampshire. We accomplish our mission through 

education and advocacy. By providing relevant, quality training on substance abuse treatment, 

intervention and prevention NHADACA has improved the skills of working addiction 

professionals and those preparing to enter the profession. NHADACA is an affiliate of 

NAADAC, the National Association of Addiction Professionals, a national leader in setting 

standards for the treatment and prevention of addictive disorders and for the training and 

qualifications of professionals. 

While NHADACA supports updating the mechanics of the federal alcohol and drug 

confidentiality regulations to facilitate more effective integration of care and needed 

communication in the electronic age, 42 C.F.R. Part 2’s core privacy protections MUST be 

maintained. 

We provide ethics and confidentiality trainings for persons working within the substance abuse 

professions as well as other professions that have involvement with alcohol and drug-impacted 

or addicted persons. The frustration that some people experience when they cannot get the 

information they want immediately or without a release of information is minor in comparison to 

the security and protection the regulations afford alcohol and drug abuse patients. It is vital to 

keep these legal regulations in or to best assure clients that their privacy concerns are respected. 

1 
 

 

 

 

 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 2014 

Notice of Public Listening Session (79 Fed. Reg. 26929), the NH Alcohol & Drug Abuse 

Counselors Association supports the following principles: 

•	 Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. We support 

maximizing inclusion of substance use disorder (SUD) records in electronic health record 

(EHR) systems and health information exchanges (HIEs) while maintaining 42 C.F.R. 

Part 2’s core privacy protections. 

•	 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were when 

they were enacted more than 40 years ago, and a move toward HIPAA’s looser privacy 

standards would not sufficiently protect people seeking and receiving substance use 

disorder treatment. If patient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny them insurance or a job, or be used against 

them in a divorce or child custody proceeding, many patients will be afraid to enter 

treatment in the first place. 

•	 We agree with the Legal Action Center in the belief that patients in alcohol and drug 

programs should retain the power to decide when and to whom their records are 

disclosed, even for treatment and payment purposes, given the continued prevalence of 

discrimination in our society. This includes disclosures to the general health care system, 

HIEs, health homes, ACOs, and CCOs. The best way for patients to retain that power is 

by requiring patient consent for most disclosures, together with a strong prohibition on 

redisclosure. 

•	 It is both necessary and technologically possible to integrate addiction and other health 

care and effectively exchange addiction treatment data while maintaining the core 

protections of 42 C.F.R. Part 2. We urge the continued development of technical 

solutions for consent management. 

•	 Since HIPAA requires compliance with state and federal laws that mandate greater 

privacy protections, electronic health record systems (EHRs) must be designed so as to 

comply with the many state statutes that require heightened protections for information 

related to mental health, HIV/AIDS, reproductive health, domestic violence and other 

types of sensitive health information, as well as with 42 C.F.R. Part 2. It is important to 

keep in mind, therefore, that EHRs would be required to accommodate enhanced 

protections for the medical records of some illnesses in order to be HIPAA-compliant 

even if 42 C.F.R. Part 2 did not exist. 

Thank you for your consideration. 

Sincerely, 

Dianne Pepin, MEd., MLADC Peter DalPra, LADC, LCS 

Executive Director President 

2 
 

• Addiction treatment should be integrated with mental and physical health care, and

communication among health care providers should be encouraged. We support maximizing

inclusion of substance use disorder (SUD) records in electronic health record (EHR) systems and

health information exchanges (HIEs) while maintaining 42 C.F.R. Part 2’s core privacy protections.

June 22, 2014 

(Via Email) 

Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. Part 2. 79 

Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

Aegis Treatment Centers, LLC (Aegis) operates 25 Narcotic Treatment Programs in the state of 

California and treats approximately 6,000 patients per day, primarily using Methadone replacement 

therapy together with counseling and other services. 

While Aegis supports updating the mechanics of the federal alcohol and drug confidentiality 

regulations to facilitate more effective integration of care and needed communication in the electronic 

age, Aegis believes that 42 C.F.R. Part 2’s core privacy protections MUST be maintained. 

Over the 15 years that Aegis has operated, we have treated tens of thousands of unduplicated 

patients and have a current census of over 6,000 patients. Over the years, we have been made 

aware of hundreds and perhaps more than a thousand of instances where prejudice, NIMBY, 

ignorance and stigma have adversely impacted patients under our care. These instances involve 

uninformed social workers, parole and probation officers, judges, family and specialty physicians, 

county officials, state legislators, etc. Many of these examples resulted in threats of stopping 

treatment, losing children to the foster care system, being directed to “get off that stuff or else ...” and 

some in difficulty in maintaining employment, family relationships and social friendships. We have 

found that the confidentiality protections in 42 C.F.R. Part 2 are critically important to our patients and 

we are encouraging you to protect and maintain them. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 2014 Notice of 

Public Listening Session (79 Fed. Reg. 26929), Aegis supports the following principles: 

 

• 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were when they

were enacted more than 40 years ago, and a move toward HIPAA’s looser privacy standards would

not sufficiently protect people seeking and receiving substance use disorder treatment. If patient

records can be easily accessed in order to criminally investigate or prosecute or patient, or deny them

insurance or a job, or be used against them in a divorce or child custody proceeding, many patients

will be afraid to enter treatment in the first place.

 7246 Remmet Ave. • Canoga Park, California 91303 • Phone (818) 206-0360 • Fax (818) 206-0381 
 

 

 

 

 

 

 

• Aegis continues to believe that patients in alcohol and drug programs should retain the power

to decide when and to whom their records are disclosed, even for treatment and payment purposes,

given the continued prevalence of discrimination in our society. This includes disclosures to the

general health care system, HIEs, health homes, ACOs, and CCOs. The best way for patients to

retain that power is by requiring patient consent for most disclosures, together with a strong

prohibition on re-disclosure.

• It is both necessary and technologically possible to integrate addiction and other health care

and effectively exchange addiction treatment data while maintaining the core protections of 42 C.F.R.

Part 2. We urge the continued development of technical solutions for consent management.

• Since HIPAA together with provisions in the Health Information Technology for Economic and

Clinical Health Act (HITECH Act), and in California the Confidentiality of Medical Information Act

(CMIA), and others require compliance with state and federal laws that mandate greater privacy

protections, electronic health record systems (EHRs) must be designed so as to comply with the

many state statutes that require heightened protections for information related to mental health,

HIV/AIDS, reproductive health, domestic violence and other types of sensitive health information, as

well as with 42 C.F.R. Part 2. It is important to keep in mind, therefore, that EHRs would be required

to accommodate enhanced protections for the medical records of some illnesses in order to be

HIPAA-compliant even if 42 C.F.R. Part 2 did not exist.

We also support the comments submitted by the Legal Action Center and the American Association 

for the Treatment of Opioid Dependence. 

Thank you for your consideration. 

Sincerely yours, 

Stephen J. Maulhardt, 

Executive Vice President 

CC: Legal Action Center (LAC) 

American Association for the Treatment of Opioid Dependence (AATOD) 

 7246 Remmet Ave. • Canoga Park, California 91303 • Phone (818) 206-0360 • Fax (818) 206-0381 
 

 

 

 

 

 

 

1 The comments were prepared by a working group of the Health Law Section’s Substance Use Disorders Task Force. 

The contributors to these comments from the working group are Beth Ann Middlebrook, Myer Cohen, Lou Presenza, 

Richard Roisman, and Robert Fiebach. The final comments were approved by the Section’s Council on June 17, 2014. 

Although members of the Section who participated in the preparation and review of these comments have clients that the 

initiative affects, no such member has been engaged by a client to participate in the drafting or submission of these 

comments. 

American Bar Association

June 23, 2014 

Sylvia Mathews Burwell, Secretary 

U.S. Department of Health & Human Services 

200 Independence Ave SW 

Washington, D.C. 20201 

RE: 42 C.F.R. Part 2’s Confidentiality Protections 

Dear Secretary Burwell: 

This letter is submitted by the Health Law Section of the American Bar 

Association to provide comments to the Department of Health and Human 

Services Substance Abuse and Mental Health Services Administration in 

response to a call for comments on the federal regulations governing 

Confidentiality of 

Alcohol and Drug Patient Records (42 C.F.R. Part 2). 

The views expressed herein are presented on behalf of the Section1. No 

government attorneys or government professionals participated in the drafting or 

submission of these comments. These comments have not been approved by the 

House of Delegates or the Board of Governors of the American Bar Association 

and, accordingly, should not be construed as representing the position of the 

American Bar Association. The views expressed in these comments should not 

be construed as representing the policy or views of any government employee 

who is a member of the Section, its Council, or the Task Force on Substance Use 

Disorders. 

The American Bar Association is the largest voluntary professional association in

the world. The Section, with nearly 10,000 attorney members, is the voice of the 

organized health care bar within the ABA. Its members represent clients in all 

aspects of the health care industry, including physicians, institutional providers, 

teaching and research organizations, managed care organizations and other thirdparty payors, governmental health care programs and regulatory bodies, 

 pharmaceutical companies and 

 device  manufacturers.  

 
 

 

While the ABA Health Law Section supports updating the mechanics of the federal 

alcohol and drug confidentiality regulations to facilitate more effective integration of care 

and needed communication in the electronic age, 42 C.F.R. Part 2’s core privacy 

protections must be maintained. These recommendations to SAMHSA on the future of 42 

C.F.R. Part 2 are based on the following principles:

 Addiction treatment should be integrated with mental and physical health care,

and communication among health care providers should be encouraged.

 At the same time, 42 C.F.R. Part 2’s heightened privacy protections are as critical

today as they were when they were enacted more than 40 years ago, and a move

toward HIPAA’s looser privacy standards would not sufficiently protect

individuals seeking and receiving substance use disorder treatment. If patient

records can be easily accessed in order to criminally investigate or prosecute a

patient, or deny them insurance or employment, or be used against them in a

divorce or child custody proceeding, many individuals will be afraid to enter

treatment in the first place.

 Patients participating in alcohol and drug programs should retain the right to

decide when and to whom their records are disclosed, even for treatment and

payment purposes, given the unfortunate though continued prevalence of

discrimination in our society. This includes disclosures to the general health care

system, health information exchanges, health homes, accountable care

organizations and coordinated care organizations. The best way for patients to

retain that right is by continuing to require patient consent for most disclosures,

together with a strong prohibition on redisclosure.

 It is both necessary and technologically possible to integrate addiction and other

health care services and effectively exchange addiction treatment data while

maintaining the core protections of 42 C.F.R. Part 2.

Recommendations: 

 The ABA Health Law Section supports maximizing inclusion of substance use

disorder (SUD) records in electronic health record (EHR) systems and health

information exchanges (HIEs) while maintaining privacy protections that are as

essential today as they were when 42 C.F.R. Part 2 was enacted in the 1970s.

Individuals with the disease of addiction still face loss of employment, housing,

and child custody; insurance and health care discrimination; criminal arrest,

prosecution and incarceration; and a host of other negative consequences. 42

C.F.R Part 2’s privacy protections greatly minimize the possibilities that a

patient’s own treatment records could be used against them in these situations. In
 

order to encourage people with SUDs to access treatment services, 42 C.F.R. Part 

2’s more stringent privacy protections must be maintained rather than accede to 

HIPAA standards which would allow far more disclosures, and redisclosures, that 

could lead to harmful consequences for patients. 

 The ABA Health Law Section supports the goals set out in SAMHSA’s request

for comments and believes that the current regulations, together with additional

guidance from SAMHSA, can accomplish many (if not all) of the intended goals

of integrating SUD and other health care and improving communication between

them more effectively.

 HIPAA requires compliance with state and federal laws that mandate greater

privacy protections. Thus, electronic health record systems (EHRs) must be

designed to comply with the many state statutes that require heightened

protections for information related to mental health, HIV/AIDS, reproductive

health, domestic violence and other types of sensitive health information, as well

as with 42 C.F.R. Part 2. It therefore is important to bear in mind that EHRs

would be required to comply with enhanced protections for the medical records of

certain illnesses in order to be HIPAA compliant, even if 42 C.F.R. Part 2 did not

exist.

 The ABA Health Law Section urges the continued development of technical

solutions for patient consent management.

The ABA appreciates this opportunity to comment to HHS and SAMHSA on potential 

changes to 42 C.F.R. Part 2 regulations. 

Sincerely, 

Michael E. Clark, Chair-Elect 

ABA Health Law Section 
 

 

 

 

 

 

 

 

 

From: Amy Kelly [mailto:amyxkelly@gmail.com]
 

Sent: Tuesday, June 24, 2014 11:53 AM
 

To: Privacy Regulations (SAMHSA)
 

Subject: Comments regarding proposed changes to 42 CFR Part 2
 

June 24, 2014 

Amy Kelly, LICSW, MLADC 

195 McGregor Street; Suite 110 

Manchester, NH 03102 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. 

Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913.

 To Whom It May Concern: 

I have worked as a licensed social worker and substance abuse counselor for (19) years. One of 

the reasons that people feel comfortable talking openly about their issues with substance abuse is 

the protection offered by 42 CFR Part 2. I agree that collaboration is imperative in treatment, but 

clients need the right to limit their information as deemed appropriate to protect them from those 

who do not understand the disease of addiction. In a perfect world, everyone would accept this 

fact and show compassion for those struggling with the disease. Unfortunately, as a nation, we 

are not there yet and need to maintain the current confidentiality regulations so individuals feel 

comfortable getting the help they need. 

While I support updating the mechanics of the federal alcohol and drug confidentiality 

regulations to facilitate more effective integration of care and needed communication in the 

electronic age, 42 C.F.R. Part 2’s core privacy protections MUST be maintained.

 With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 2014 

Notice of Public Listening Session (79 Fed. Reg. 26929), I supports the following principles: 

•	 Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. I support 

maximizing inclusion of substance use disorder (SUD) records in electronic health 

record (EHR) systems and health information exchanges (HIEs) while maintaining 42 

C.F.R. Part 2’s core privacy protections. 

•	 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were when 

they were enacted more than 40 years ago, and a move toward HIPAA’s looser privacy 
 

 

 

 

 

 

 

 

standards would not sufficiently protect people seeking and receiving substance use 

disorder treatment. If patient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny them insurance or a job, or be used against 

them in a divorce or child custody proceeding, many patients will be afraid to enter 

treatment in the first place. 

•	 LAC continues to believe that patients in alcohol and drug programs should retain the 

power to decide when and to whom their records are disclosed, even for treatment and 

payment purposes, given the continued prevalence of discrimination in our society. This 

includes disclosures to the general health care system, HIEs, health homes, ACOs, and 

CCOs. The best way for patients to retain that power is by requiring patient consent for 

most disclosures, together with a strong prohibition on redisclosure. 

•	 It is both necessary and technologically possible to integrate addiction and other health 

care and effectively exchange addiction treatment data while maintaining the core 

protections of 42 C.F.R. Part 2. I urge the continued development of technical solutions 

for consent management. 

•	 Since HIPAA requires compliance with state and federal laws that mandate greater 

privacy protections, electronic health record systems (EHRs) must be designed so as to 

comply with the many state statutes that require heightened protections for information 

related to mental health, HIV/AIDS, reproductive health, domestic violence and other 

types of sensitive health information, as well as with 42 C.F.R. Part 2. It is important to 

keep in mind, therefore, that EHRs would be required to accommodate enhanced 

protections for the medical records of some illnesses in order to be HIPAA-compliant 

even if 42 C.F.R. Part 2 did not exist. 

I also support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Sincerely, 

Amy Kelly, LICSW, MLADC 

Consultant to NH DCYF 
June 24, 2014 

SUBMITTED VIA EMAIL 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Al

cohol & Drug Abuse Patient Records Regulations, 42 C.F.R. 

Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

As a person in Jong-term recovery with over 26 years of experience in the field of addiction and 

recovery I am concerned about the proposed changes to the Confidentiality ofA/cohol & Drug 

Abuse Patient Record'i Regulations. 

While I support updating the mechanics of the federal alcohol and drug confidentiality 

regulations to facilitate more effective integration of care and needed communication in the 

electronic age, 42 C.F.R. Part 2's core privacy protections MUST be maintained. 

With regard to the modifications to 42 C.F.R. Part 2 prnposed in SAMHSA 's May 12, 2014 

Notice of Public Listening Session (79 Fed. Reg. 26929)Ė I support the following principles: 

• Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. I support 

maximizing inclusion of substance use disorder (SUD) records in electronic health record 

(EHR) systems and health information exchanges (HIEs) while maintaining 42 C.F.R. 

Part 2's core privacy protections. 
• A42 C.F.R. Part 2,s heightened privacy protections are as critical today as they were when 

they were enac.ted more than 40 years ago1 and a move toward HIPAA's looser privacy 

standards would not sufficiently protect people seeking and receiving substance use 

disorder treatment. If patient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny them insurance or a job, or be used against 

them in a divorce or child custody proceeding, many patients will be afraid to enter 

treatment in the first place. 

• ALAC continues to believe that patients in alcohol and drug programs should retain the 

power to decide when and to whom their records are disclosed. even for treatment and 

payment purposes, given the continued prevalence of discrimination in our society. This 

includes disclosures to the general health care system, HIEs, health homes, ACOs. and 

CCOs. The best way for patients to retain that power is by requiring patient consent for 

most disclosures, together with a strong prohibition on redisclosure. 

• AIt is both necessary and technologically possible to integrate addiction and other health 

care and effectively exchange addiction treatment data while maintaining the core 

protections of 42 C.F.R. Part 2. I urge the continued development of technical solutions 

for consent management. 

• ASince HIPAA requires compliance with state and federal laws that mandatl· greater 

privacy protections, electronic health record systems (EHRs) must be designed so as to 

comply with the many state statutes that require heightened protections for information 

related to mental health, HIV/ AIDS, reproductive health, domestic violence and other 

types of sensitive health infonnation, as well as with 42 C.F .R. Part 2. It is important to 

keep in mind, therefore, that EHRs would be required to accommodate enhanced 

protections for the medical records of some illnesses in order to be HIP AA-compliant 

even if 42 C.F .R. Part 2 did not exist. 

l also support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

2 
 MEATOD The Maine Association for the Treatment of Opioid Dependence 

 

 

 

 

 

State chapter of the American Association for the Treatment of Opioid Dependence 

State Delegate 

to AATOD 

Jennifer Minthorn, MA 

LADC CCS 

President of MEATOD 

Assistant Vice President of 

Merrimack River Medical 

Services 

jennifer.minthorn@csachelp.com 

207-590-3263 

Members 

CAP Quality Care

1 Delta Drive 

Westbrook, ME 04092 

207-856-7227 

Discovery House 

74 Dowd Road 

Bangor, ME 04401

207-947-6800 

Discovery House

13 Beech Street 

Calais, ME 04619 

207-454-1300 

Discovery House

400 Western Ave 

S. Portland, ME 04106 

207-774-7111 

Discovery House

21 Airport Road

Waterville, ME 04901

207-872-7272 

Merrimack River 

Medical Services 

18 Mollison Way

Lewiston, ME 04240 

207-312-6860 

Merrimack River 

Medical Services 

2300 Congress Street

Portland, ME 04102

207-221-2292 

Penobscot Metro 

659 Hogan Road

Bangor, ME 04401

207-973-0400 

Spectrum Health Systems

69 Eagle Drive

Sanford, ME 04073

207-324-2007 

June 24, 2014 

The Maine Association for the Treatment of Opioid Dependence (MEATOD) 

2300 Congress Street 

Portland, Maine 04102 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 

C.F.R. Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

As the President of the Maine Association for the Treatment of Opioid Dependence 

(MEATOD) and the State’s delegate to the American Association for the Treatment of 

Opioid Dependence (AATOD), I would like to submit comments on behalf of the 

opioid treatment providers in Maine. 

While MEATOD supports updating the mechanics of the federal alcohol and drug 

confidentiality regulations to facilitate more effective integration of care and needed 

communication in the electronic age, 42 C.F.R. Part 2’s core privacy protections 

MUST be maintained. 

The patients in our programs continue to experience discrimination and stigma from 

employers, the medical community, and the criminal justice system due to their 

participation in a modality of treatment that is not seen as a legitimate form of 

treatment even though there is 50 years of research demonstrating the effectiveness of 

methadone maintenance treatment in treating opioid addiction. Without these 

protections, there will be greater chances for these patients to endure negative life 

changing experiences. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 

2014 Notice of Public Listening Session (79 Fed. Reg. 26929), MEATOD supports the 

following principles: 
 MEATOD The Maine Association for the Treatment of Opioid Dependence 

 

 

 

State chapter of the American Association for the Treatment of Opioid Dependence 

•	 Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. We support maximizing 

inclusion of substance use disorder (SUD) records in electronic health record (EHR) systems 

and health information exchanges (HIEs) while maintaining 42 C.F.R. Part 2’s core privacy 

protections. 

•	 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were when they 

were enacted more than 40 years ago, and a move toward HIPAA’s lesser privacy standards 

would not sufficiently protect people seeking and receiving substance use disorder treatment. 

If patient records can be easily accessed in order to criminally investigate or prosecute a 

patient, or deny them insurance or a job, or be used against them in a divorce or child custody 

proceeding, many patients will be afraid to enter treatment in the first place. 

•	 LAC continues to believe that patients in alcohol and drug programs should retain the power 

to decide when and to whom their records are disclosed, even for treatment and payment 

purposes, given the continued prevalence of discrimination in our society. This includes 

disclosures to the general health care system, HIEs, health homes, ACOs, and CCOs. The 

best way for patients to retain that power is by requiring patient consent for most disclosures, 

together with a strong prohibition on redisclosure. 

•	 It is both necessary and technologically possible to integrate addiction and other health care 

and effectively exchange addiction treatment data while maintaining the core protections of 

42 C.F.R. Part 2. We urge the continued development of technical solutions for consent 

management. 

•	 Since HIPAA requires compliance with state and federal laws that mandate greater privacy 

protections, electronic health record systems (EHRs) must be designed so as to comply with 

the many state statutes that require heightened protections for information related to mental 

health, HIV/AIDS, reproductive health, domestic violence and other types of sensitive health 

information, as well as with 42 C.F.R. Part 2. It is important to keep in mind, therefore, that 

EHRs would be required to accommodate enhanced protections for the medical records of 

some illnesses in order to be HIPAA-compliant even if 42 C.F.R. Part 2 did not exist. 

We also support the comments submitted by the American Association for the Treatment of 

Opioid Dependence and the Legal Action Center. 

Thank you for your consideration. 

Sincerely, 

Jennifer Minthorn, MA, LADC, CCS 

MEATOD President, AATOD State Delegate, and AATOD Board Secretary 
SUBMITTED VIA EMAIL 

June 23, 2014 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. 

Part 2. 79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

Evergreen Treatment Services specializes in medication assisted treatment for adults with opioid 

dependence. We operate three clinics in the Puget Sound area in western Washington and serve 

over 1500 patients. We employ more than 140 people who work with our population as medical 

providers, counselors, nurses and support staff. 

While Evergreen Treatment Services supports updating the mechanics of the federal alcohol and 

drug confidentiality regulations to facilitate more effective integration of care and needed 

communication in the electronic age, 42 C.F.R. Part 2’s core privacy protections MUST be 

maintained. 

For our treatment population, the stigma and misunderstanding about our patients is nothing less 

than profound. Our patients frequently report interactions with the medical community that 

shames them regarding their treatment with us, that implores them to discontinue their 

medication under the false idea that this will propel the patient toward ‘true’ recovery, that 

hesitates to appropriately treat them with short acting opioids when an acute pain problem arises, 

and that the patient reports treats them differently than other patients they can clearly see 

receiving similar care in the same office. This is not an insignificant problem; our patients often 

neglect receiving primary care precisely because of these issues. Their health suffers as a direct 

result of this. Should our patient records become more widely available to the medical 

community, my entire staff and I have grave concerns about the consequences of this on our 

patients. 42 CFR Part 2 represents an absolutely critical component of assisting our patients 

towards our mutual goals of recover. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 2014 

Notice of Public Listening Session (79 Fed. Reg. 26929), Evergreen Treatment Services supports 

the following principles: 
•	 Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. We support 

maximizing inclusion of substance use disorder (SUD) records in electronic health record 

(EHR) systems and health information exchanges (HIEs) while maintaining 42 C.F.R. 

Part 2’s core privacy protections. 

 

 

 

•	 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were when 

they were enacted more than 40 years ago, and a move toward HIPAA’s looser privacy 

standards would not sufficiently protect people seeking and receiving substance use 

disorder treatment. If patient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny them insurance or a job, or be used against 

them in a divorce or child custody proceeding, many patients will be afraid to enter 

treatment in the first place. 

•	 LAC continues to believe that patients in alcohol and drug programs should retain the 

power to decide when and to whom their records are disclosed, even for treatment and 

payment purposes, given the continued prevalence of discrimination in our society. This 

includes disclosures to the general health care system, HIEs, health homes, ACOs, and 

CCOs. The best way for patients to retain that power is by requiring patient consent for 

most disclosures, together with a strong prohibition on redisclosure. 

•	 It is both necessary and technologically possible to integrate addiction and other health 

care and effectively exchange addiction treatment data while maintaining the core 

protections of 42 C.F.R. Part 2. We urge the continued development of technical 

solutions for consent management. 

•	 Since HIPAA requires compliance with state and federal laws that mandate greater 

privacy protections, electronic health record systems (EHRs) must be designed so as to 

comply with the many state statutes that require heightened protections for information 

related to mental health, HIV/AIDS, reproductive health, domestic violence and other 

types of sensitive health information, as well as with 42 C.F.R. Part 2. It is important to 

keep in mind, therefore, that EHRs would be required to accommodate enhanced 

protections for the medical records of some illnesses in order to be HIPAA-compliant 

even if 42 C.F.R. Part 2 did not exist. 
We also support the comments submitted by the Legal Action Center in this matter. 

Thank you for your consideration. 

Sincerely, 

Molly Carney, Ph.D., M.B.A. 

Executive Director 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From: Lindsey Downing [mailto:ldowning@adsyes.org] 

Sent: Tuesday, June 24, 2014 2:23 PM
 

To: Privacy Regulations (SAMHSA)
 

Subject: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. Part 2. 79 Fed.
 

Reg. 26929; Docket No. 2014-10913.
 

June 24, 2014 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. Part 2. 79 Fed. 

Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

Alcohol and Drug Services (ADS) is a private non-profit organization in North Carolina. Our Mission is to 

promote health and wellness through providing high quality substance abuse prevention and treatment 

services that transform lives. 

While ADS supports updating the mechanics of the federal alcohol and drug confidentiality regulations 

to facilitate more effective integration of care and needed communication in the electronic age, 42 

C.F.R. Part 2’s core privacy protections MUST be maintained. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 2014 Notice of 

Public Listening Session (79 Fed. Reg. 26929), ADS supports the following principles: 

•	 Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. We support maximizing 

inclusion of substance use disorder (SUD) records in electronic health record (EHR) systems and 

health information exchanges (HIEs) while maintaining 42 C.F.R. Part 2’s core privacy 

protections. 

•	 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were when they 

were enacted more than 40 years ago, and a move toward HIPAA’s looser privacy standards 

would not sufficiently protect people seeking and receiving substance use disorder treatment. If 

patient records can be easily accessed in order to criminally investigate or prosecute or patient, 

or deny them insurance or a job, or be used against them in a divorce or child custody 

proceeding, many patients will be afraid to enter treatment in the first place. 

•	 LAC continues to believe that patients in alcohol and drug programs should retain the power to 

decide when and to whom their records are disclosed, even for treatment and payment 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

purposes, given the continued prevalence of discrimination in our society. This includes 

disclosures to the general health care system, HIEs, health homes, ACOs, and CCOs. The best 

way for patients to retain that power is by requiring patient consent for most disclosures, 

together with a strong prohibition on redisclosure. 

•	 It is both necessary and technologically possible to integrate addiction and other health care and 

effectively exchange addiction treatment data while maintaining the core protections of 42 

C.F.R. Part 2. We urge the continued development of technical solutions for consent 

management. 

•	 Since HIPAA requires compliance with state and federal laws that mandate greater privacy 

protections, electronic health record systems (EHRs) must be designed so as to comply with the 

many state statutes that require heightened protections for information related to mental 

health, HIV/AIDS, reproductive health, domestic violence and other types of sensitive health 

information, as well as with 42 C.F.R. Part 2. It is important to keep in mind, therefore, that 

EHRs would be required to accommodate enhanced protections for the medical records of some 

illnesses in order to be HIPAA-compliant even if 42 C.F.R. Part 2 did not exist. 

We also support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Sincerely, 

Lindsey Downing 

Director of Quality & Compliance 

Alcohol & Drug Services 

301 E. Washington St. Suite 101 

Greensboro, NC 27401 

Office: (336) 333-6860 Ext. 265 

Mobile: (336) 601-9452 

Fax: (336) 275-1187 

www.adsyes.org 

CONFIDENTIALITY NOTICE: This message and any attachments included are from Alcohol & Drug Services and are for 

sole use by the intended recipient(s). The information contained herein may include confidential or privileged information. 

Unauthorized review, forwarding, printing, copying, distributing, or using such information is strictly prohibited and may be 

unlawful. If you received this message in error, or have reason to believe you are not authorized to receive it, please contact 

the sender by reply email and destroy all copies of the original message. 
 

 

 

 

CONFIDENTIALITY NOTICE: This e-mail and any files transmitted with it are confidential 

and intended solely for the use of the individual or entity to which they are addressed. 

Unauthorized review, forwarding, printing, copying, distributing, or using such information is 

strictly prohibited and may be unlawful. If you received this message in error please contact the 

sender by reply e-mail and destroy all copies of the original message. Please note that any views 

or opinions presented in this e-mail are solely those of the author and do not necessarily 

represent those of ADS. Check this e-mail and any attachments for the presence of viruses as 

ADS accepts no liability for any damage caused by any virus transmitted by this e-mail. Thank 

you! Alcohol & Drug Services (ADS), www.adsyes.org 
 

 

 

 

June 23, 2014 

Mr. Jeffrey Reed, CRS 

2028 Ridge Road 

Sunbury, PA 17801 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cherry Road 

Room 5-1011 

Rockville, MD 20857 

RE: Confidentiality of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. Part 2. 

79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

As a person in recovery, I support updating the mechanics of the federal alcohol and drug 

confidentiality regulations to facilitate more effective integration of care and needed 

communication in the electronic age, 42 C.F.R. Part 2’s core privacy protections MUST be 

maintained. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA’s May 12, 2014 

Notice of Public Listening Session (79 Fed. Reg. 26929), [PERSON/ORGANIZATION] 

supports the following principles: 

• Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. [I/We] support maximizing 

inclusion of substance use disorder (SUD) records in electronic health record (EHR) systems and 

health information exchanges (HIEs) while maintaining 42 C.F.R. Part 2’s core privacy 

protections. 

• 42 C.F.R. Part 2’s heightened privacy protections are as critical today as they were when 

they were enacted more than 40 years ago, and a move toward HIPAA’s looser privacy standards 

would not sufficiently protect people seeking and receiving substance use disorder treatment. If 

patient records can be easily accessed in order to criminally investigate or prosecute or patient, or 

deny them insurance or a job, or be used against them in a divorce or child custody proceeding, 

many patients will be afraid to enter treatment in the first place. 
• LAC continues to believe that patients in alcohol and drug programs should retain the 

power to decide when and to whom their records are disclosed, even for treatment and payment 

purposes, given the continued prevalence of discrimination in our society. This includes 

disclosures to the general health care system, HIEs, health homes, ACOs, and CCOs. The best 

way for patients to retain that power is by requiring patient consent for most disclosures, together 

with a strong prohibition on redisclosure. 

• It is both necessary and technologically possible to integrate addiction and other health 

care and effectively exchange addiction treatment data while maintaining the core protections of 

42 C.F.R. Part 2. [I/We] urge the continued development of technical solutions for consent 

management. 

• Since HIPAA requires compliance with state and federal laws that mandate greater 

privacy protections, electronic health record systems (EHRs) must be designed so as to comply 

with the many state statutes that require heightened protections for information related to mental 

health, HIV/AIDS, reproductive health, domestic violence and other types of sensitive health 

information, as well as with 42 C.F.R. Part 2. It is important to keep in mind, therefore, that 

EHRs would be required to accommodate enhanced protections for the medical records of some 

illnesses in order to be HIPAA-compliant even if 42 C.F.R. Part 2 did not exist. 

I also support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Sincerely, 

Jeffrey William Reed 

Certified Recovery Specialist 
BAY AREA ADDICTION RESEARCH AND TREATMENT, INC. 

Administrative Office 

1111 Market Street, Fourth Floor 

San Francisco, CA 94103 

Telephone (415) 552-7914 www.baartprograms.com Fax (415) 552-3455 

June 23, 2014 

Bay Area Addiction Research and Treatment, Inc. 

1111 Market St. 

San Francisco, CA 94103 

U.S. Substance Abuse and Mental Health Services Administration 

1 Choke Cheny Road 

Roorn5-1011 

Rockville, MD 20857 

RE: Confidentialitv of Alcohol & Drug Abuse Patient Records Regulations, 42 C.F.R. Part 

2.	ß79 Fed. Reg. 26929; Docket No. 2014-10913. 

To Whom It May Concern: 

BAART Programs began providing drug treatment services to several hundred heroin addicts in 

San Francisco in 1977. Today, BAART Programs is a multi-service organization providing drug 

treatment and rehabilitation for patients across the country. We offer treatment for addiction to 

prescription medications such as oxycontin, hydrocodone and other opioids. Through a number of 

clinically proven methods, including methadone and buprenorphine (Suboxone) treatment, we have 

used evidence-based methods to bring the most effective results possible to our patient population. 

In combining medical treatment with the behavioral services, BAART offers the most successful 

option for many of our patients. 

While BAART supports updating the mechanics of the federal alcohol and drug confidentiality 

regulations to facilitate more effective integration of care and needed communication in the 

electronic age, 42 C.F.R. Part 2's core privacy protections MUST be maintained. 

With regard to the modifications to 42 C.F.R. Part 2 proposed in SAMHSA's May 12, 2014 Notice 

of Public Listening Session (79 Fed. Reg. 26929), BAART supports the following principles: 

•	ß Addiction treatment should be integrated with mental and physical health care, and 

communication among health care providers should be encouraged. We support 

maximizing inclusion of substance use disorder (SUD) records in electronic health record 

(EHR) systems and health information exchanges (HIEs) while maintaining 42 C.F.R. Part 

2' s core privacy protections. 

Outpatient SJibstance Abuse Treatment Services 
•	Ã 42 C.F.R. Part 2's heightened privacy protections are as critical today as they were when 

they were enacted more than 40 years ago, and a move toward HIPAA's looser privacy 

standards would not sufficiently protect people seeking and receiving substance use 

disorder treatment. If patient records can be easily accessed in order to criminally 

investigate or prosecute or patient, or deny them insurance or a job, or be used against them 

in a divorce or child custody proceeding, many patients will be afraid to enter treatment in 

the first place. 

•	Ã BAART continues to believe that patients in alcohol and drug programs should retain the 

power to decide when and to whom their records are disclosed, even for treatment and 

payment purposes, given the continued prevalence of discrimination in our society. This 

includes disclosures to the general health care system, HIEs, health homes, ACOs, and 

CCOs. The best way for patients to retain that power is by requiring patient consent for 

most disclosures, together with a strong prohibition on redisclosure. 

•	Ã It is both necessary and technologically possible to integrate addiction and other health care 

and effectively exchange addiction treatment data while maintaining the core protections of 

42 C.F.R. Part 2. We urge the continued development of technical solutions for consent 

management. 

•	Ã Since HIP AA requires compliance with state and federal laws that mandate greater privacy 

protections, electronic health record systems (EHRs) must be designed so as to comply 

with the many state statutes that require heightened protections for information related to 

mental health, HIV/AIDS, reproductive health, domestic violence and other types of 

sensitive health information, as well as with 42 C.F.R. Part 2. It is important to keep in 

mind, therefore, that EHRs would be required to accommodate enhanced protections for the 

medical records of some illnesses in order to be HIP AA-compliant even if 42 C.F.R. Part 2 

did not exist. 

We also support the comments submitted by the Legal Action Center. 

Thank you for your consideration. 

Sincerely, 

Jason Kletter, Ph.D

President

Outpatient SJibstance Abuse Treatment Services