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Integration & Confidentiality of Protected Health Information

Summary:

Mental Health America believes that our laws and regulations should not require a separate authorization for behavioral health information to be shared. We believe that individuals have a right to control the disclosure and dissemination of their protected health information (PHI), but also believe strongly that separate authorizations create a barrier to integrating treatment and perpetuate stigma without giving the individual any more control over their information.

Discussion:

The Health Insurance Portability and Accountability Act (HIPAA) requires an individual to sign a form authorizing their health care provider to disclose their health information to others, such as other providers or family members. For substance use information, a separate federal law that dates back before HIPAA requires an individual to sign a special form (sometimes referred to as a “super authorization”) to allow disclosure of their substance use information at the same time. Federal law does not say explicitly that a separate authorization is required for mental health information, but providers often interpret the law regarding substance use to include all other behavioral health information as well, or state law may require this.

Separate authorizations complicate the coordination and integration of treatment, because you cannot treat a whole person with only half a health record. When a special authorization is required for behavioral health information, a provider receiving a record with no behavioral health information in it cannot know whether the person has no behavioral health records, whether they have declined to share them, or whether they were never even asked. This at best contributes to confusion and at worst to poor quality care.

Separate authorizations also contribute to stigma. When an individual goes in for substance use treatment and receives a special authorization form, it implies that they should be wary of disclosure and that they might be doing something that others could view negatively.

Mental Health America's Position:

In Position Statement 27, MHA opposes separate authorizations because “there is no evidence that additional formalities actually increase privacy, and such special protections compromise integration of care.”  MHA recommends repealing the separate authorization requirement for substance abuse information (42 U.S.C. § 290dd-2) and clarifying that federal law does not require a separate authorization for behavioral health information. MHA also recommends the repeal of state laws requiring separate authorization of behavioral health information. While the separate authorization requirement may have been needed in the distant past to prevent discrimination, the protections of HIPAA and the Americans with Disabilities Act have long since made this outdated.

With a single authorization, individuals will still have full control over their health information. They will still decide when and to whom to disclose their own PHI. Care integration will be promoted. Behavioral health will be further normalized, and the stigma around it – often unintentionally worsened by those seeking to protect individuals – will be reduced.

500 Montgomery Street, Suite 820
 Alexandria, VA 22314

Phone (703) 684.7722

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