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NAMD Statement: NAMD Urges More Comprehensive Action on Substance Use Privacy Rules


February 8, 2016

Washington, D.C. – On behalf of the nation’s Medicaid Directors, NAMD appreciates the Substance Abuse and Mental Health Services Administration’s (SAMHSA) work to update regulations governing the privacy of substance use disorder data (42 CFR Part 2). We applaud SAMHSA’s recognition that the outdated regulations create a barrier to high-quality care for those with substance use disorders. We also appreciate the difficult task SAMHSA faced of balancing vital patient privacy protections with the need to modernize the regulations and allow those with substance use disorders to benefit from advancements in care delivery.

As the largest payer of behavioral health services in the nation, Medicaid programs are deeply involved with improving the care for beneficiaries affected by this serious and growing issue. In 2009, Medicaid was responsible for 1 out of every 5 dollars spent on substance use disorder treatment and is expected to be the single largest payer of substance use disorder services by 2020.

While NAMD shares SAMHSA’s goal in developing this proposed rule, we believe that the regulation does not remedy Medicaid Directors’ longstanding concerns with 42 CFR Part 2. State Medicaid agencies and providers are rapidly embracing approaches to deliver integrated care through models such as health homes, coordinated care entities, and accountable care organizations. These models of person-centered care, encouraged and embraced by public and private insurers alike, require that ALL of an individuals’ providers be engaged in ensuring care is seamlessly coordinated across the delivery system. This includes the vital services provided by substance use disorder treatment providers. Medicaid Directors’ experiences indicate that most aspects of the regulations at 42 CFR Part 2 are a major barrier to providing this seamless, coordinated care for those with substance use disorders covered by Medicaid.

State Medicaid Directors’ concerns with 42 CFR Part 2 can best be remedied by aligning substance use disorder privacy regulations, to the greatest extent permissible under current federal statute, with the federal requirements found under the Health Insurance Portability and Accountability Act (HIPAA). So long as substance abuse information is treated differently from other health information, individuals with substance use disorders will never have the same access, quality, and safety of care as persons with other diseases. Rather, greater alignment with HIPAA will ensure Medicaid programs and providers can increase access to substance use disorder services; integrate services; ensure patient safety; and ultimately improve the well-being of Medicaid enrollees.

As we move forward, NAMD will continue to partner with SAMHSA and other federal policymakers on this vital issue and ensure Medicaid innovations can advance person-centered care delivery for beneficiaries with substance use disorders.


The National Association of Medicaid Directors (NAMD) is a bipartisan, nonprofit, professional organization representing leaders of state Medicaid agencies across the country. NAMD members drive major innovations in health care while overseeing Medicaid, one of the nation’s most vital health care safety net programs, which covers more than 72 million Americans. NAMD serves as the voice for state Medicaid directors in national policy discussions, supports state-driven policies and practices that strengthen the efficiency and effectiveness of Medicaid and actively monitors emerging issues in Medicaid and health care policy. Learn more at and follow NAMD on Twitter @statemedicaid.

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