Loosen HIPAA overdose notification restrictions
Recommendation
The Secretary of Health and Human Services (HHS) should use the waiver process established by Section 1135 of the Social Security Act to temporarily modify Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) requirements to augment treatment capacity and loosen Health Insurance Portability and Accountability Act (HIPAA) restrictions to allow notification to families of persons who have overdosed and been revived.[1]
Background/summary
On October 26, 2017, the Secretary of Health and Human Services (HSS) declared a nationwide opioid public health emergency (PHE). This declaration was most recently renewed on April 1, 2023.[2] Section 1135 of the Social Security Act gives the Secretary of HHS the ability to waive certain requirements under Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) during a PHE to ensure health care supplies and services are available.[3] While 1135 waivers have been used for PHEs in the past, they have not been used during the opioid PHE.[4] As a result, regulatory flexibilities that could increase support for millions of individuals with opioid use disorder (OUD) have not been put to use.[5]
Additionally, families can play a crucial role in supporting individuals receiving OUD treatment.[6] However, under the Health Insurance Portability and Accountability Act (HIPAA), families are only notified of an overdose and revival if the individual gives permission, is incapacitated in an emergency as deemed by the provider, or to prevent a serious imminent threat to themselves or others.[7] Outside of these exceptions, families are not notified, limiting their ability to provide support during treatment.[6]
citations
1. The Kennedy Forum. Recommendations of Congressman Patrick J. Kennedy to the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Last Accessed October 2017.
2. U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. Renewal of Determination That A Public Health Emergency Exists. Last Accessed on July 7, 2023.
3. U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. Quality, Safety & Oversight Group - Emergency Preparedness: 1135 Waivers. Last Accessed July 22, 2022.
4. U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. Waiver or Modification of Requirements Under Section 1135 of the Social Security Act. Last Accessed on July 7, 2023.
5. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. SAMHSA Announces National Survey on Drug Use and Health (NSDUH) Results Detailing Mental Illness and Substance Use Levels in 2021. Last Accessed January 4, 2023.
6. National Institutes of Health, National Library of Medicine. Value of family involvement in substance use disorder treatment: Aligning clinical and financing priorities. Last Accessed October 27, 2021.
7. U.S. Department of Health and Human Services. When does HIPAA allow a doctor to notify an individual’s family, friends, or caregivers that a patient has overdosed? Last Accessed December 28, 2022.