News & Commentary

Anthem Participates in Substance Abuse and Mental Health Services Administration (SAMHSA) Listening Session

January 31, 2018

In order to effectively deliver high-quality health care, it is important that there is a strong system of trust, transparency, and confidential information sharing between payers, providers, and consumers. This teamwork is critical in the treatment of those with substance abuse disorders, where an “all hands on deck” approach is required. On Wednesday, January 31, Eric Bailly, a Clinical Business Solutions Director with Anthem and a licensed alcohol and drug counselor, gave testimony before the Substance Abuse and Mental Health Services Administration (SAMHSA) on this very issue. He emphasized the importance of care coordination in a modernized and increasingly integrated health care delivery system, and called on SAMHSA to amend their 42 CFR Part 2 Final Rule to ensure it aligns with HIPAA to facilitate confidential health information sharing for purposes of treating individuals with substance use disorders. Read his full testimony below:

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Thank you for the opportunity to speak with you today. My name is Eric Bailly. I am a Clinical Business Solutions Director with Anthem, and am a licensed alcohol and drug counselor.   Anthem and its affiliated plans are proud to serve more than 40 million Americans across our commercial, Medicare and Medicaid plans, and for several years we have expanded our capacity to support prevention, treatment, and recovery from substance use disorders.  Anthem shares SAMHSA’s commitment to quality care and services and the protection of each individual’s personal health information. We commend SAMHSA’s efforts to update these regulations to reflect rapidly-changing health care delivery systems.  However, we believe the changes to 42 CFR Part 2 fall short.  Anthem requests that SAMHSA adopt further amendments to the regulation to achieve alignment with HIPAA.

At Anthem, we recognize that our role in the healthcare delivery system is part of a comprehensive team, and we collaborate closely with health care providers, addiction experts and individuals in long term recovery in an effort to strengthen the network and services for those we serve.

As health care systems evolve to focus on integration and care coordination, it is imperative that policies support the ability of payers, providers, and beneficiaries to access the information necessary to deliver meaningful and clinically appropriate care in a person-centered and timely manner. By not aligning with HIPAA, as well as excluding case management and care coordination as activities encompassed under “health care operations”, the Final Rule serves as a barrier to the delivery of quality health care.

Modern approaches to the treatment of substance use disorders require an “all hands on deck” approach. If those involved in overseeing a patient’s care plan and prescribing history are not able to transparently exchange information, the patient can be exposed to significant risk of negative drug interactions, overdose, or death.

For example, in the context of an electronic medical record, the information sharing restrictions in 42 CFR Part 2 set up a scenario in which an incomplete picture could be presented to an attending clinician. Without pertinent substance use disorder information at their fingertips, clinicians are inhibited from making more complete clinical decisions regarding choice of medications and whether or not a particular patient may need an additional layer of support to address an underlying substance use disorder. Additionally, enforcing two separate sets of privacy rules and regulations for those treated for substance use disorders versus a physical health condition not only conflicts with the intent of mental health parity, but results in confusion, grey areas, and administrative disruptions that can be a disincentive to providing holistic care.

We believe SAMHSA has the authority to amend its regulations to align with HIPAA, and we are heartened that the Agency has taken initiative to continue discussions in furtherance of that goal. Should the Agency continue to believe they lack the authority to make the changes necessary to achieve alignment with HIPAA, we encourage SAMHSA leadership to support existing legislative efforts, such as the Overdose Prevention and Patient Safety Act and Protecting Jessica Grubb’s Legacy Act.

Once again, Anthem appreciates the opportunity to comment today.  The significance of the necessity to align 42 CFR Part 2 with HIPAA is evidenced in the list of groups who have come together as part of the Partnership to Amend 42 CFR Part 2, many of whom are here today.  The diverse coalition includes substance use disorder consumer advocate groups, provider associations, and payers, among others. We all share the ultimate goal of providing the highest quality health care, consistently focused on recovery and resiliency.  It is imperative we make every effort to eliminate barriers to treatment and recovery for people experiencing substance used disorders.

Thank you.

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