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SAMHSA Unveils 42 CFR Part 2 Changes

July 16, 2020

The Substance Abuse and Mental Health Services Administration this week announced the adoption of 42 CFR Part 2 revisions that it says are designed to facilitate care coordination between providers while maintaining privacy protections.

“We need an all-hands-on-deck approach to treating substance use disorders,” HHS Assistant Secretary for Mental Health and Substance Use Elinore F. McCance-Katz, MD, PhD, the head of SAMHSA, said in a news release. “We must do all we can to ensure the greatest access and availability to care for individuals living with substance use disorders. Although well-intentioned, the non-disclosure of critical, lifesaving information the previous rule permitted is itself stigmatizing.”

What is changing

HHS has published a fact sheet on what is (and isn’t) changing as a result of the Part 2 revisions. Among the highlights of what’s new:

  • Treatment records created by non-42 CFR Part 2 providers based on their own encounters with patients are not covered by Part 2 unless any SUD records previously received from a Part 2 program are incorporated into such records. The change ensures new records created by non-Part 2 providers no longer become subject to Part 2.
  • When receiving messages from patients on their personal devices, employees of Part 2 provider organizations can now satisfy device “sanitization” requirements of Part 2 by deleting the messages. Devices no longer need to be confiscated or destroyed.
  • SUD patients may now consent to the disclosure of Part 2 treatment records without naming a specific person as the recipient for the disclosure.
  • To prevent duplicative enrollments in SUD treatment and prescriptions for treatment, as well as adverse drug events related to treatment, non-OTP and non-central registry providers are now eligible to query a central registry to determine whether patients are already receiving treatment. OTPs are also permitted to enroll in state prescription drug monitoring programs and report data to the PDMP when prescribing or dispensing medications (schedules II to V).

Part 2 will continue to restrict the disclosure of SUD treatment records without patient consent, with the following exceptions as defined by the revisions announced this week: declared emergencies from natural disasters that disrupt treatment facilities and services are considered a “bona fide medical emergency,” for the purpose of scientific research, audits/program evaluations, and appropriate court orders.

Mark Dunn, director of public policy for the National Association of Addiction Treatment Providers, said in an email to BHE that NAATP supports the changes.

“We are supportive of moving mental health and substance use disorders into mainstream healthcare and supported the changes to 42 CFR2,” Dunn wrote. “We are hopeful that it will accomplish that goal while continuing to protect critical privacy rights for patients.”

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