Performance Improvement 2004. Privacy Issues in Mental Health and Substance Abuse Treatment: Information Sharing Between Providers and Managed Care Organizations


Confidentiality is a key element of mental health and substance abuse treatment. In the absence of assured confidentiality, many patients with mental disorders or substance abuse problems might refuse or fail to seek treatment. As the payers of treatment, however, managed care organizations (MCOs) and insurance companies need to know the services for which payment is being requested and whether the treatment is appropriate. The dual needs for confidentiality and disclosure have created tension between providers and payers of services. This report clarifies the sources of tension between providers and payers with regard to what personal information should be shared for patients receiving mental health or substance abuse treatment. It also provides information to support a m ore consistent application of privacy-sensitive approaches to collecting personal health information in the future. It was found that MCOs collect personal information about enrollees receiving mental health and substance abuse services for many reasons. It was found that there was wide variation in the information collected by MCOs for authorizing outpatient treatment, although there are some common elements. It was also found that respondents for inpatient authorizations described them as much more intrusive.

PIC ID: 7881
Agency Sponsor: ASPE-OSP, Office of Science Policy
Federal Contact: Fanning, John, 202- 690-7100
Performer: Mathematica Policy Research, Inc., Plainsboro, NJ

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