Health Center Funding Cliff Update

Confidentiality and Medical Records: Do Special Protections Apply?


Since the 1970s, the Federal Government has required that the medical records of patients who receive treatment for substance use disorder (SUD) be given extra protections to ensure confidentiality.  These federal rules - commonly known as 42 CFR Part 2 - have recently been revised, and are more extensive than the standard protections required under HIPAA.   Given the Health Resources and Services Administration's (HRSA)  recent announcement of the  availability of funds to expand access to substance use disorder (SUD) and mental health services, health centers are reportedly concerned about complying with the revised confidentiality rules that impact medical records for SUD treatment.

First, health centers should note that the 42 CFR Part 2 rules do not apply to all SUD records; rather, whether they apply depends on the characteristics of the health care provider who provided the SUD services.  In general terms, only records generated by providers who are publicly identified as offering SUD treatment services are subject to 42 CFR Part 2.  According to  the final rule issued in January 2017, health center providers generally are not subject to these requirements, as they are viewed as providing "general medical care."

However, there are two important exceptions:  health center providers (and the SUD treatment records they generate) are  subject to 42 CFR rules if the provider meets either of the following criteria:

  • They "work in an identified unit within [the health center]  that holds itself out as providing, and provides, substance use disorder diagnosis, treatment or referral for treatment"


  • "the primary function of the provider is substance use disorder diagnosis, treatment or referral for treatment and they are identified as providers of such services."

In other words, if a health center provider is publicly identifiable as a provider of SUD services, either by the unit they work in or individually, then the medical records they generate are subject to the 42 CFR protections.  This means these providers are required to obtain patient consent before sharing information about SUD diagnosis and treatment.  Click  here for more information on which health center providers are subject to 42 CFR Part 2.

The 42 CFR requirements can complicate efforts to coordinate care for patients who are dealing with SUD.  To help address those problems, the recent revisions made some simplifications to the consent process; for example, patients can now consent to sharing with their records with all providers within a specified group, as opposed to having to name each provider individually.  In addition, some states and providers are adopting innovative approaches to support ensuring care coordination while maintaining appropriate confidentiality.  For example, see this  case study of how a community has implemented a standard consent form.  More information on coordinating care for patients with SUD while adhering to 42 CFR protections is available from the  HRSA/ SAMSHA Center for Integrated Health Solutions.

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement number U30CS16089, Technical Assistance to Community and Migrant Health Centers and Homeless for $6,375,000.00. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 

Fact Sheet Highlights the Cost Savings Health Centers Generate for Medicaid

  May 18, 2018  | 

We've always known that health centers and Medicaid are ideal partners in the effort to cut health care costs.  A host of independent studies, both statewide and national, have confirmed those findings over the course of many years.  Now a new NACHC fact sheet based on 2016 federal data showcases those findings and takes a closer look at the costs of caring for a large Medicaid population.

Health centers provide care to one in every 6 Medicaid beneficiaries, but Medicaid payments to health centers make up only just under two percent of total Medicaid spending.   Meanwhile, health centers are providing affordable access to preventive care for a large portion of the Medicaid population, reducing costly visits to hospital emergency rooms.   In fact, health centers save the Medicaid program $6 billion annually.  And a previous landmark study [ see press release] found that in 13 states,  health centers save, on average, $2,371 (or 24 percent) per Medicaid patient when compared to other providers.  In communities fortunate enough to have a health center, there are lower rates of hospital utilization among Medicaid beneficiaries who are health center patients because having a usual source of care ensures they don't delay getting care until they are very sick.

Caring for Medicaid patients does have its challenges, though. Nearly half of health center patients (49 percent) rely on Medicaid, but the amount of Medicaid revenue collected in 2016 only covered 80 percent of the cost associated with caring for that population, which puts health centers in a tight financial squeeze.  Adequate Medicaid reimbursement is a key issue for health centers, as is a strong and robust Medicaid program.


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