Reworking SUD Privacy Rules Top Priority for Policy Group of Behavioral Health Payers

At times, the relationship between payers and behavioral health providers can feel adversarial. However, to ensure the best care for patients, it should be collaborative.

Payers and providers tackled how to make that vision a reality, among other issues, earlier this month in Washington D.C. at the Payer’s Behavioral Health Management and Policy Summit, hosted by World Congress, a global provider of health care conferences, and the Association for Behavioral Health and Wellness (ABHW). 

ABHW is a national advocacy and educational group for payers managing behavioral health insurance benefits. Members include organizations such as Kaiser Permanente, Cigna, Anthem, AmeriHealth Caritas and other national and regional health plans, who cover a combined more than 200 million people nationwide.


Despite the friction that often exists between payers and providers, there’s one thing both parties tend to agree upon: Federal policies need to change to improve behavioral health care nationwide.

Behavioral Health Business connected with ABHW President and CEO Pamela Greenberg at last week’s event to discuss how her organization is working to make that happen.

Aligning the privacy rules surrounding substance use disorder (SUD) records with the Health Insurance Portability and Accountability Act (HIPAA), addressing the behavioral health care worker shortage, and improving access to telehealth are among ABHW’s biggest priorities for the year ahead, Greenberg told HHCN.


You can read BHB’s conversation with Greenberg below, edited for length and clarity.

BHB: For those providers and payers who couldn’t attend the event, what are the most important takeaways?

Greenberg: One of the main takeaways is that there’s a lot of growth, positive change and excitement in the industry right now.

Payers are innovating and trying to incorporate telebehavioral health, value-based payment and digital technologies. We are seeing new and stronger partnerships and creative ways to provide increased access and quality care to patients.

Whoever thought we’d be providing health care over the phone, via an app, or using the computer? Behavioral health is moving in that direction, not exclusively, but certainly for some things.

What are the biggest opportunities you see in the space right now from a policy perspective?

Over the past few years, we’ve seen an increase in attention to behavioral health issues everywhere — whether it’s on Capitol Hill, at the kitchen table, or in the employee breakroom.

A lot of this attention has come as a result of unfortunate situations, like soldiers returning home with PTSD, the opioid crisis, an increase in the number of teenagers dying by suicide and people with mental illness being incorrectly accused of gun violence.

I’d rather behavioral health not be getting attention because of these issues. I’d like to be getting attention because people realize these are diseases that like other diseases. Fortunately, the field has been able to use these unfortunate situations as a reason to talk about the importance of addressing behavioral health issues.

Because of that, we have a real opportunity from a policy perspective to talk about and hopefully move legislation that could increase quality and access to mental health and addiction services.

What are some of the biggest challenges from a policy perspective?

Despite the increase in attention on behavioral health issues, we still have an uphill battle educating people about mental health and addiction and trying to get rid of the stigma.

You may wonder why I am talking about education and stigma when you asked about challenges from a policy perspective, but without members of Congress and their constituents understanding the facts and the impact of mental health and SUDs, moving legislation becomes a challenge.

In order for elected officials to support and advocate for legislation on a topic they have to understand that issue, hear from their constituents about the impact of the policy and feel passionately about its importance. None of these things will happen if stigma persists and people remain concerned about talking about mental illness and addiction.

I think we are still a stepchild to physical health care, and that’s a challenge that we have to deal with, whether it’s in terms of trying to pass legislation on Capitol Hill or trying to get medical students interested in the behavioral health field.

By necessity, certain parts of the behavioral health industry seem to have grown up faster than the regulations governing it. That’s especially true when it comes to opioid use disorder (OUD) treatment, where we’re now seeing a large increase in regulation. Do you think those changes are generally positive or problematic?

It is critical that there is some oversight of the providers and facilities providing OUD treatment to ensure that quality, evidence-based care is being provided. This oversight can be done via certification, licensure, and/or state or federal regulation.

We do need to be careful that regulations don’t become overly prescriptive and create requirements that are impossible to meet or result in a lot of unnecessary administrative burden. But we do need guidelines and standards so that we meet at least at a minimum, basic standards of care.

Your organization has a number of policy objectives. What are you most focused on right now?

Right now, we’re most focused on an issue related to the privacy of substance use disorder (SUD) records.

SUD records are treated differently than all other medical and mental health records. There’s HIPAA for medical and mental health, and then there’s 42 CFR Part 2 for SUD.

With Part 2, there’s a requirement that patients sign a consent before their information can be disclosed, even to other providers treating them. On the flip side in medical and mental health, there’s no consent needed. That information is shared, not broadly, but for narrow purposes of treatment, payment and healthcare operations (TPO) information.

We are trying to align Part 2 with HIPAA for the purposes of TPO so the information can flow, and treatment can be better coordinated. ABHW supports enhanced patient protections in Part 2 so that information cannot be inappropriately shared.

This law will help to ensure that providers have appropriate access an individual’s SUD information, so hopefully, they would not prescribe a person with SUD opioids to treat pain. But if providers don’t know the person has an addiction, they will treat their pain, most likely, with opioids.

The workforce shortage is another priority of ABHW. Can you talk a little bit about what you’re doing on that front?

One of the big policy proposals that we support is increasing the availability of telehealth. In particular, we support broader Medicare coverage of telehealth services. There’s been some success recently in increasing access to telehealth for SUD services, and we hope to do the same for mental health.

Medicaid is generally pretty good about paying for telehealth, but in Medicare, there are still some barriers in that people must go to an originating site to receive telehealth services, and they have to be located in a rural area. We’re trying to get rid of these requirements.

The drive to get to a provider in Los Angeles could take just as long as the drive in the middle of the country.

Furthermore, one reason for telehealth is that you don’t necessarily have to leave your home for health care services. You might not be able to drive to a provider because there aren’t any available in your area or because you may not physically or mentally be able to get to your appointment.

By connecting patients with providers in other locations, telehealth helps with provider shortages and access issues.

Needless to say, there’s a lot happening on the policy front for behavioral health. If you had to make some bold predictions, what do you think we’re going to see in the year ahead?

Predictions are always difficult and because next year is a presidential election year, it is even harder to predict what will happen with behavioral health policy.

There’s Congressional interest in trying to do more to address the opioid crisis, and it’s possible that legislation could pass to help increase access to care for opioid use disorders (OUD).

For example, one of the things that ABHW supports is getting rid of the required waiver for prescribers to prescribe buprenorphine, a drug used in medication-assisted treatment (MAT) for OUD. If providers didn’t have to get this waiver, that may increase access to treatment by getting more providers interested in being buprenorphine prescribers.

This kind of legislative change doesn’t appear to be too controversial or have a big cost associated with it, which increases its likelihood of being included in an opioid package that Congress might develop.

We’re also hopeful that legislation to align Part 2 with HIPAA will pass this year or next year. There’s a lot of support in Congress for alignment, and again, it’s not something that has a big price tag.

Is there anything else we haven’t touched on that you’d like to add?

We are supporters of the Mental Health Parity Addiction and Equity Act (MHPAEA), and ABHW was a leader of the coalition that worked to get parity passed 10 years ago. Our members have teams of people whose responsibility it is to understand and implement state and federal regulations in this area.

However, ABHW is concerned that the continued attention around expansion and implementation of MHPAEA has been at the exclusion of other important behavioral health issues related to access and quality.

MHPAEA needs to be implemented, no question, but MHPAEA is not, and never was intended to be, the solution to all of the problems we face in the behavioral health arena. Implementation of parity and excessive reporting requirements are not going to increase access and quality the way it needs to be increased for addiction and mental health. Parity wasn’t intended to do those things.

We need to work collaboratively to address some of these other important issues like the workforce shortage, the opioid and broader substance use disorder crisis, and how we provide and measure quality care.

We should be discussing and addressing these issues now, so that we’re not having the same discussion in 20 years.

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