MHA Statement on Revisions to 42 CFR Pt II

Mental Health America (MHA) applauds the Substance Abuse and Mental Health Services Administration (SAMHSA) for updating and considering further revisions to the patient confidentiality rule 42 CFR Pt II in its January 3, 2018 final rule.

MHA appreciates SAMHSA’s thoughtful consideration of how to break down the barriers that 42 CFR Pt II posed to the integration of mental health and substance use treatment with the rest of health care. By requiring a separate and more restrictive authorization than the Health Insurance Portability and Accountability Act (HIPAA) in order to share substance use treatment records (and often mental health is lumped in as well), 42 CFR Pt II inadvertently impeded the efforts toward comprehensive, whole-person health care and reinforced historical discrimination against behavioral health. The new rule promulgated today revises 42 CFR Pt II to tackle some of the challenges to bringing mental health and substance use into the mainstream of health care payment and delivery system reform efforts, while further extending protections against disclosure of substance use treatment records to employers and law enforcement.

MHA appreciates SAMHSA’s statement that it “plans to explore additional alignment with HIPAA, and may consider additional rulemaking for 42 CFR part 2.” Fully conforming 42 CFR Pt. 2 to HIPAA is imperative to realize the goal of full integration of health and behavioral health care, because you can't treat a whole person with half a record. MHA looks forward to working with the agency to address remaining barriers to integration, as well as to working with Congress to address statutory limitations where SAMHSA does not have the authority.

MHA also hopes that other stakeholders will take the opportunity afforded by the changing rule to meaningfully improve care for individuals with mental health and substance use conditions. Clinicians should take this opportunity to integrate effective mental health and substance use screening and treatment into their practices, while health care payers should focus their next population health and quality improvement efforts on behavioral health.

While the road to fully integrated services for mental health and substance use is still long, removing barriers is a critical first step.