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Disclosing sensitive patient information to payers

Compliance Monitor, July 7, 2006

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Q: Can we disclose information about a patient's alcohol/drug abuse or HIV status to a payer to get approval for admission, verify coverage, or submit a claim?

A: The privacy rule does not offer special protections for sensitive information, such as treatment for substance abuse, HIV/AIDS, or mental health conditions. However, there are other federal regulations (e.g., "Confidentiality of Alcohol and Drug Abuse Patient Records," 42 CFR Part 2) that provide additional protections for treatment of alcohol or drug abuse. HIPAA does not preempt these regulations.

42 CFR Part 2 does not apply to most healthcare providers. It applies only to federally-funded programs "that hold themselves out as providing alcohol or drug abuse diagnosis, treatment, or referral." This law does not apply, for example, to an acute care hospital that treats a patient in the ED or intensive care unit for the acute effects of a drug overdose.

To comply with 42 CFR Part 2, substance-abuse-treatment facilities may disclose information to third-party payers only with the written consent of the patient and must limit the information to the minimum necessary. Some state laws/regulations may offer additional protections for sensitive information. Review them for additional restrictions.

Editor's note: Mary Brandt, president of Bellaire, TX-based Brandt & Associates, LLC, answered this question. This is not legal advice. Consult your attorney for legal matters.

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