Washington, DC – 42 CFR Part 2 is a federal regulation that provides critical protection for sensitive health information, including treatment data for substance use disorder (SUD) treatment. In an FAQ (Frequently Asked Questions) document released today, the U.S. Department of Health and Human Services Office for Civil Rights (OCR) outlined Part 2 protections as they relate to Medicaid community engagement requirements for people with SUD.
ABHW spearheaded advocacy to urge OCR to issue these clarifications, which are critical to ensuring that people with SUD who qualify for the exemption do not experience a lapse in coverage, and applauds their inclusion in the document. Specifically, the FAQ includes two significant recommendations proposed by ABHW:
- Clarify that eligibility determinations for community engagement exemptions based on SUD diagnosis or treatment are subject to Part 2 protections and require patient consent
- Explicitly clarify that a patient’s Part 2 consent for “treatment, payment, and health care operations” purposes satisfies consent requirements for the Medicaid exemption eligibility determinations
“Allowing a single, existing consent for Part 2 to be used for this purpose will protect patient privacy and safety and ensure exemptions are implemented without unnecessary barriers or delays,” says Debbie Witchey, President and CEO of ABHW.
ABHW leads the Partnership to Amend 42 CFR Part 2 (the Partnership), a coalition of nearly 50 organizations dedicated to aligning Part 2 regulations with modern standards while preserving their core privacy protections. Through this collaboration, ABHW has helped advance policies that streamline the Part 2 framework and bring it into closer alignment with HIPAA, reducing barriers to coordinated care. By supporting clearer consent pathways and minimizing unnecessary data segmentation that fragments the medical record, these updates help ensure that clinicians have appropriate access to the information they need to deliver safe, high-quality, whole-person care. When behavioral health information can be responsibly integrated, rather than walled off, providers are better positioned to coordinate and improve patient outcomes.
“These essential clarifications will help ensure that the medically frail exemptions are implemented in accordance with the requirements of the law, without unnecessary administrative barriers or disruptions in coverage for Medicaid beneficiaries who qualify for these exemptions,” Witchey says”
###
ABOUT THE ASSOCIATION FOR BEHAVIORAL HEALTH AND WELLNESS
ABHW is the leading health plan association working to improve access and quality of care for mental health and substance use disorders. ABHW’s members include national and regional health plans who care for approximately 200 million people. Together, we work to reduce stigma and advance federal policy on mental health and substance use disorder care. ABHW member companies include Aetna Behavioral Health, Elevance Health, Centene Corporation, Evernorth, a Cigna company, Health Care Service Corporation, Kaiser Permanente, Lucet, Magellan Health, Molina Healthcare, Optum, and PerformCare, a subsidiary of AmeriHealth Caritas. To learn more, visit www.abhw.org and follow us on BlueSky and LinkedIn.
