If 42 CFR Part 2 was your significant other, you’d be sitting them down and having “the talk” about growing apart, how the relationship isn’t working anymore. You might even say “things have to change or this won’t work out”. You won’t say “it’s me, not you” because the reality is, we in behavioral health have changed a lot since 42 CFR Part 2 came into our life, we’ve changed for the better. Unfortunately, Part 2 hasn’t changed at all.
Back in 1975 when we started this relationship together, there was fear that knowledge of substance abuse conditions would be used against people. The strict protection of privacy that 42 CPR Part 2 provides was intended to help those with substance use disorders seek help without fear of retribution or criminal prosecution. We all agree that this was necessary and important for people who are suffering from this terrible disease to seek out and receive treatment.
The last substantive update to the rule was in 1987. Do you remember where you were in 1987, what you were doing with your life, how you made decisions, what you knew about the world then vs. now? Do you know what else happened in 1987?
- Ronald Reagan was President
- Prozac makes its debut in the United States
- Fox Broadcasting Co. made its prime-time TV debut (The Simpsons seen on TV for the first time)
- Women wore shoulder pads and men wore suspenders to work
- Popular music included Michael Jackson Bad, U2 With or Without Me, George Michael “Faith” and Bananarama was still relevant!
- Popular movies included Wall Street, Good Morning, Vietnam and Dirty Dancing
A lot has changed since 1975 and 1987; more research and information about the nature of substance use disorders, advancements in treatment (especially medications) and The Mental Health Parity and Addiction Equity Act regarding fairness of treatment. The way we approach behavioral health disorders has changed significantly in the last few decades and continues to change for the better. The focus is on whole health treatment, medical professionals are being trained on behavioral health conditions and have incorporated better assessment and screening into their regular practice. We are seeing an increase in the use of SBIRT in many settings and addiction isn’t just being seen as a mental health problem that specialty providers deal with, everyone else refers.
Of the millions of people who need treatment, still only a small percentage of them actually receive services every year; millions of people go without help.
Is a strict privacy law the best way to turn that around?
One of the key advances in healthcare treatment isn’t a new fancy machine or an advanced degree; it’s how we all communicate and coordinate with each other. The emergence of care coordination and sharing information between providers is quite possibly one of the best advances in healthcare. Definitely for behavioral healthcare. And this is where privacy, HIPAA, 42 CFR Part 2 and technology all collide. How do we make sure we’re all communicating, providing the best care possible and respecting privacy of those we serve?
We’ve seen some amazing advanced in communication, even EHR vendors from different sides of the healthcare industry working together, sharing data, figuring out ways for two EHRs in an integrated healthcare setting to share data on the same client. It’s a brave new world and looks like we’re all re-evaluating our relationship, especially HHS.gov.
Earlier this year, the Secretary of HHS announced proposed revisions to 42 CFR Part 2. This decision has not happened in a vacuum, in 2014 both HHS and SAMHSA sought feedback and conducted sessions to improve Part 2. The comment period for the proposed changes published in Feb 2016 is now closed and SAMHSA is taking all information into consideration. We don’t know what the final changes will be, but for the first time in almost 30 years, there will be significant changes to the rule.
The question isn’t “Do we need to change?”, the question is whether the proposed changes are enough. What are your thoughts about Part 2 and the proposed changes? If Part 2 changes a little with us, do we think the relationship can be saved? Do we stay together and work through it?
Those of you in the field working with those struggling with substance use issues know better than anyone: how do we improve the coordination of care?