​The federal regulations governing the Confidentiality of Substance Use Disorder Patient Records (42 CFR Part 2 (“Part 2")) requires additional confidentiality protections for disclosure of certain patient substance use disorder records for payment and health care operations.

Impact to In-Network Providers

This memo is to formally notify Part 2 Providers that they must obtain consent from patients receiving substance use disorder services, naming the Payer, and specifying that Patient's information can be used and disclosed for Payer's health care operations purposes, including an expiration date.

The above is a condition of payment and must be completed prior to submitting any claim for payment to AmeriHealth HMO, Inc. (“Payer").

It is the expectation that, to be in compliance with applicable law under Provider's participation agreement, the Patient consent language will be similar to the following:

“Patient (or patient's authorized representative) shall authorize Provider to use and disclose all of patient's substance use disorder records, including, but not limited to claims/encounter information, clinical notes and discharge summaries to patient's insurance company, AmeriHealth HMO, Inc. (“Insurance Company") for purposes of Insurance Company's payment and Insurance Company's healthcare operations activities. This consent form shall remain in effect for as long as the patient is receiving treatment at Provider or until ______ Provider terminates participation with Insurance Company."

Impact to Out-of-Network Providers

OON Providers should be required to obtain patient consent containing the above-referenced language as a condition to payment of claims.​