Q&A: Alcohol & drug abuse

Q: Can a provider disclose information related to a patient’s alcohol and drug abuse or HIV status to an insurance company to obtain approval for admission, verify coverage, or submit a claim for payment purposes?

A: The privacy rule doesn’t 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 doesn’t preempt these regulations.

42 CFR Part 2 doesn’t 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.” For example, this law doesn’t apply 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 can 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 might offer additional protections for sensitive information, and you should review them for additional restrictions.