March 10, 2016

The Substance Abuse and Mental Health Services Administration
Department of Health and Human Services
www.regulations.gov

Attn: SAMHSA–4162–20

Thank you for the opportunity to comment on the proposed updates to 42 CFR Part 2 – Confidentiality of Alcohol and Drug Abuse Patient Records. The National Committee for Quality Assurance (NCQA) commends you and your staff for this proposal and strongly agrees with its intent to modernize privacy standards in a new era of high quality, integrated care. The rule will help patients with substance use disorders benefit from emerging care models that require enhanced health information exchange for better care coordination that these patients urgently need.

Current regulations impede care coordination and quality improvement efforts for patients with a history of substance abuse. Updates are needed so these patients can benefit from Patient-Centered Medical Homes, Accountable Care Organizations, and other alternative payment models working to improve care with better data sharing and coordination. Facilitating the electronic exchange of patient information across providers is not only a fundamental activity of these advanced models, it’s critical to actually improving the quality of care that individual patients receive.

Over the 2014 HEDIS reporting year, several behavioral health measures – such as Adherence to Antipsychotic Medications for Individuals with Schizophrenia – saw minimal to no improvement. Two measures related to Follow-Up after Hospitalization for Mental Illness even saw statistically significant five-year performance declines. The same is true for a measure related to the Initiation and Engagement of Alcohol and Other Drug Dependence Treatment. Exchange of information should never compromise patients’ right to privacy; but improvement on these measures requires greater coordination of care. That coordination is contingent upon patient-centered information sharing across providers.

We strongly support the provisions allowing patients to designate specific disclosures of information, especially the update enabling patients to identify health information exchanges and research institutions as recipients. These entities play significant roles in broader quality improvement initiatives and providing greater access to behavioral health data will facilitate much-needed advancements in this under-resourced, often overlooked aspect of care. To ensure patient preferences are adhered to throughout that information exchange, each patient should have a right to obtain a list of entities to which their information has been disclosed.

As advanced models of care continue to grow and expand under the Medicare Access and CHIP Reauthorization Act, these changes will become even more important. A patient-centered approach to information security will protect the right to privacy while facilitating higher quality, coordinated care.

Thank you again for the opportunity to provide feedback. If you have any questions about our thoughts, please contact Joe Castiglione, Public Policy Analyst, at castiglione@ncqa.org or (202) 955 1725.

Sincerely,

Margaret O’Kane,
President