Privacy Issues in Mental Health and Substance Abuse Treatment: Information Sharing Between Providers and Managed Care Organizations: Final Report. A. Models for Disclosure of Personal Health Information

01/17/2003

Several managed care entities have developed models for determining what types of mental health information should be included in the medical record. The American Managed Behavioral Healthcare Association (AMBHA), an association that represents nine (including the largest) managed behavioral healthcare organizations has developed a set of guidelines; it recommends that the following mental health information be included: diagnosis, mental status, psychiatric history, treatment goals and objectives, progress, medications, types and frequencies of treatment, and summary and progress notes (AMBHA, 1999). However, AMBHA states that detailed psychotherapy notes should be separated from the general medical file. Patients should be required to sign a consent for health information to be disclosed to the MCO for purposes of treatment, payment and health care operations at the time of enrollment and periodically (i.e., every 12 months) thereafter; if the patient refuses to sign, he or she can be terminated from the health plan. Patients should have the right to inspect and copy their medical record, and to request corrections and amendments as necessary.

Harvard Pilgrim Health Care (HPHC), an MCO based in Boston, Massachusetts, has developed a new set of confidentiality policies after consulting with patient advocacy groups and conducting focus groups of HPHC members. Mental health treatment information that is included in the patient's medical record is limited to the date of the mental health visit, the name of the clinician, an encrypted diagnosis code, and current mental health medications (Simmons, 1997). This information can be segregated from the general health record upon the patient's request. Harvard Pilgrim strongly recommends that providers share with patients the necessity of sharing current medication information with other providers, to prevent adverse drug interactions, but if the patient refuses to have such information included in the general medical file, the information will not be released. Furthermore, detailed psychotherapy notes are to be separated from the rest of the mental health record.

Technical guidance made available by, the Substance Abuse and Mental Health Services Administration (SAMHSA) suggests that alcohol and drug treatment centers disclose to third party payers only the results of the initial evaluation and diagnosis, a summary of the treatment plan, the patient's attendance, progress and compliance, and the discharge plan (SAMHSA, 1996a).

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