Overdose Prevention and Patient Safety Act - H.R.6082 (Preview)
SUMMARY: This bill expands the circumstances under which medical records relating to substance use disorders can be disclosed without a patient's written consent, thereby enabling medical professionals to access that information when treating them. It also specifies how other disclosures may be made, expands current prohibitions against the disclosure of such medical records without a court order or patient consent, clarifies the penalties that may be imposed, and expressly prohibits entities from discriminating against an individual on the basis of information contained in such medical records.
BACKGROUND:
The nation's opioid crisis has been building since the 1990s, when drug companies began promoting slow-release opioid pain medication they said was less likely to cause addiction. Doctors embraced the opportunity to prescribe medications that could relieve pain with less addiction risk, and started prescribing opioids for individuals who suffered from chronic pain in addition to those who needed pain relief for a brief time, such as after surgery.
Because no monitoring for abuse or addition occurred, however, a growing number of patients became addicted, while unused medication was subject to being sampled and abused by others (often for recreational use) leading them to become addicted. Addicted individuals, when unable to obtain prescribed medications, also frequently began seeking illicit opioids such as heroin and fentanyl, which are far more powerful and dangerous.
According to the Centers for Disease Control (CDC), 151 Americans die every day from an opioid overdose. The CDC says that more than 630,000 people died from drug overdoses from 1999 to 2016, with 66% of the more than 63,600 drug overdose deaths in 2016 involving an opioid (five times higher than in 1999). Estimates of the economic cost of the opioid crisis vary, with health care research organization Altarum in November 2017 estimating a $95 billion cost for 2016, and the White House's Council of Economic Advisors that month estimating a $500 billion cost in 2015 when accounting for the broader societal cost of premature deaths from overdose.
This bill is one of a series of bills being considered this week to address the nation's opioid and drug abuse crisis.
Patient Privacy & Opioid Use Disorder
Current laws and regulations protect a patient's right to privacy and make it illegal to disclose patient information except under specified, limited circumstances. The restrictions on disclosure of health records that deal with opioid use disorder and treatments for addiction, overdose and recovery are even more stringently guarded than other health records. The extra restrictions were added decades ago, in recognition that individuals experiencing opioid use disorders had been avoiding getting medical help for fear of discrimination or other negative repercussions (such as losing their job) if the records became public.
Health care providers, on the other hand, say the current restrictions on medical records dealing with opioid use disorder and associated treatments are hindering their ability to effectively treat patients, especially patients they are seeing for the first time or patients they are seeing under emergency situations. Physicians have argued that even if a patient has disclosed to them an opioid use disorder, this does not provide the necessary specific medical information about the disorder or the prior treatments the patient has undergone. For that, they say, they need access to medical records.
Disclosure of Health Records
The bill allows medical professionals to access — without the patient's written consent — an individual's medical records relating to substance use disorder when treating the individual for such disorders. That information also could be disclosed without consent to the disorder treatment facility or program where the individual is receiving treatment, for the purposes of payment and health care operations. Under the measure, such disclosures must be made in accordance with HIPAA privacy regulations.
The measure expresses the sense of Congress that any person treating a patient for substance use disorder should access an individual's prescription drug monitoring program to prevent possible further substance abuse.
Other Disclosure Authorities & Penalties
The bill also allows the unauthorized disclosure of substance abuse medical records to public health authorities, but only if the individual's identifying information is not included. And it specifically allows individuals to consent to the disclosure of their substance abuse medical records for certain criminal, civil or administrative purposes.
The measure expands current prohibitions against the disclosure of such medical records without a court order or patient consent, making it illegal to impermissibly disclose such information in association with federal, state or local law enforcement activities (including the application for a warrant) or as part of the record or decision in any proceeding before a federal agency. (Current law only prohibits disclosure of such records for any criminal prosecution or civil action before a federal or state court.)
Under the measure, penalties for prohibited disclosure would be the same as penalties applied under the Social Security Act. (Under current law, the penalties are those applied under the specific title of the U.S. code that governs crime.)
Anti-Discrimination
The bill prohibits any entity from discriminating against an individual on the basis of information contained in substance abuse medical records.
Specifically, entities may not discriminate against an individual in the provision of health care, hiring or terms of employment, the sale or rental of housing, or access to federal, state or local courts.
Any recipient of federal funds may not discriminate against an individual on the basis of such medical records when affording access to services provided through those federal funds.
Implementation
The bill requires the Health and Human Services (HHS) Department to revise existing regulations to implement the bill within a year of enactment.
Under the measure, HHS must update regulations to require covered entities to provide notice in plain language of the revised privacy practices. The notice must include a statement of the patient's rights regarding protected health information, and a brief description of how an individual can exercise these rights. It also must describe the circumstances under which an entity is either permitted or required to use or disclose protected health information without the patient's written authorization.
HHS must also develop model programs for training health care providers on permitted uses and disclosures of substance abuse medical records, as well as model programs for training patients and their families regarding their rights.
CBO Cost Estimate
The Congressional Budget Office had not released a cost estimate for the bill.
