Privacy Issues in Mental Health and Substance Abuse Treatment: Information Sharing Between Providers and Managed Care Organizations: Final Report. 3. APA Guidelines

01/17/2003

The APA adopted Minimum Necessary Guidelines for Third-Party Payers for Psychiatric Treatment in December 2001 (reproduced in Appendix G).  The guidelines “are based on the cumulative professional experience of APA members with respect to current practice and the necessity of privacy for effective psychiatric care.”  The guidelines are also based on the principle that third-party payers should not ask for more information to approve psychiatric treatment than they would in order to approve treatment for physical health.  Finally, the guidelines are founded on the current HCFA 1500 claim form and the protocol for disclosures to third-party payers as specified in the District of Columbia and state of New Jersey third-party mental-health privacy statutes (see Table IV.2).

The APA guidelines suggest restricting information sharing to a greater degree than either the Maryland or Magellan forms.  For example, there would be no sharing of information on previous treatment or on whether treatment has been coordinated with a person’s primary care provider; and there would be only a yes/no question on whether the patient is on medications, for example.  

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