NRPM: Standards for Privacy of Individually Identifiable Health Information. d. Other federally funded health programs.


There are a number of authorities under the Public Health Service Act and other legislation that contain explicit confidentiality requirements either in the enabling legislation or in the implementing regulations. Many of these are so general that there would appear to be no problem of inconsistency, in that nothing in the legislation or regulations would appear to restrict the assisted provider’s discretion to comply with the requirements proposed below. There are, however, several authorities under which either the requirements of the enabling legislation or of the program regulations would impose requirements that would differ from the rules proposed below. We have identified several as presenting potential issues in this regard. First, regulations applicable to the substance abuse block grant program funded under section 1943(b) of the Public Health Service Act require compliance with 42 CFR part 2, and thus raise the issues identified in section 2 above. Second, there are a number of federal programs which, either by statute or by regulation, restrict the disclosure of patient information to, with minor exceptions, disclosures “required by law.” See, for example, the program of projects for prevention and control of sexually transmitted diseases funded under section 318(e)(5) of the Public Health Service Act (42 CFR 51b.404); the regulations implementing the community health center program funded under section 330 of the Public Health Service Act (42 CFR 51c.110); the regulations implementing the program of grants for family planning services under title X of the Public Health Service Act (42 CFR 59.15); the regulations implementing the program of grants for black lung clinics funded under 30 U.S.C. 437(a) (42 CFR 55a.104); the regulations implementing the program of maternal and child health projects funded under section 501 of the Act (42 CFR 51a.6); the regulations implementing the program of medical examinations of coal miners (42 CFR 37.80(a)). These legal requirements would restrict the grantees or other entities under the programs involved from making many of the disclosures that proposed § 164.510 would permit. In some cases, permissive disclosures for treatment, payment or health care operations would also be limited. Since proposed § 164.510 is merely permissive, there would not be a conflict between the program requirements, as it would be possible to comply with both. However, it should be recognized that entities subject to both sets of requirements would not have the total range of discretion that the rules proposed below would suggest.