Tag Archives: chip

New SAMHSA Rule Allows Disclosure of Patient Substance Use for Payment, Healthcare Operations

By Lisa W. Clark and Erin M. Duffy

On January 3, 2018, the Substance Abuse and Mental Health Services Administration (SAMHSA) finalized revisions to the Confidentiality of Substance Use Disorder Patient Records regulations, found in 42 CFR Part 2. The new final rule implements the changes proposed a year ago by SAMHSA in its supplemental notice of proposed rulemaking (SNPRM), which was issued alongside the first major changes to the federal regulations governing Part 2 covered data since 1987. After receiving public comment on the SNPRM, SAMHSA has finalized provisions relating to the disclosure of patient-identifying substance use information for payment and healthcare-related purposes and the disclosure of patient-identifying substance use information for the purposes of carrying out a Medicaid, Medicare or Children’s Health Insurance Program (CHIP) audit or evaluation. The new final rule also permits lawful holders to issue an abbreviated notice of the prohibition on redisclosure to accommodate electronic health record systems with standard character limitations on free text fields.

Read the full story on the Duane Morris LLP website.

CMS Will Acquire New Tools to Prevent Fraud

On December 16, 2010, at the regional health care fraud prevention summit in Boston, Massachusetts, HHS Secretary Sebelius and Attorney General Eric Holder announced that CMS will issue a solicitation for new analytic tools to prevent fraud in Medicare, Medicaid and CHIP. In its press release on the subject, HHS stated that the tools will “integrate many of the Agency’s pilot programs into the National Fraud Prevention Program and complement the work of the joint HHS and Department of Justice Health Care Fraud Prevention and Enforcement Action Team (HEAT).” The tools will be designed to prevent fraudulent payments before they occur, including through predictive modeling and identification of real-time trends by tracking billing patterns and other information.

To read the full press release, please go to: http://www.hhs.gov/news/press/2010pres/12/20101216a.html.

Health Care Reform Insurance Web Portal Requirements

This regulation outlines the requirements for state insurance websites (“Web Portals”) that must be made public by July 1, 2010 to individuals and small business in all 50 states and the District of Columbia. Currently, each web portal at minimum must contain the following information (to the extent practicable):

  • Health insurance coverage offered by health insurance issuers
  • Medicaid coverage
  • Children’s Health Insurance Program (CHIP) coverage
  • State health benefits high risk pool coverage
  • Coverage under the high risk pool
  • Coverage for small businesses and their employees (small group market)

Continue reading Health Care Reform Insurance Web Portal Requirements