e-mail Print Share

ADA asks agency to exempt dentists from proposed rule regarding confidentiality

April 12, 2016

By Jennifer Garvin

Rockville, Md. — The ADA filed comments April 11 in response to the Substance Abuse and Mental Health Services Administration's proposed rule to expand federal regulations regarding the confidentiality of patient records associated with substance abuse.

The agency is proposing a number of changes to the federal Confidentiality of Alcohol and Drug Abuse Patient Records regulations, including expanding the regulations to cover certain health care practices that provide substance abuse disorder diagnosis, treatment or referral. Currently these regulations apply to certain federally assisted substance use disorder programs, but not to general medical practices. The Association is concerned that expanding the regulations could affect dentists who provide screening, brief intervention and referral services, and is asking the Substance Abuse and Mental Health Services Administration to exempt dentists from the proposed rule.

"More and more dentists are providing screening, brief intervention and referral services to help patients with substance use disorders find appropriate treatment," wrote ADA President Carol Gomez Summerhays and Executive Director Kathleen T. O'Loughlin. "[The agency] has long encouraged dentists to offer screening, brief intervention and referral services, which dentists provide voluntarily and without compensation."

While the ADA supports the agency's goal —"to ensure patients with substance use disorders have the ability to participate in, and benefit from, new integrated health care models without fear of putting themselves at risk"— the Association is concerned that the proposed rule could cause confusion, and that it overlaps with compliance measures already required by the Health Insurance Portability and Accountability Act.

"This is particularly true for dental practices, many of which are solo and small group practices," wrote Drs. Summerhays and O'Loughlin. "It may be impossible for such practices to determine with certainty whether the proposed rule applies to them, and if so, which patient information needs to be protected, and what the proposed rule requires them to do."

The ADA also shared additional concerns about the proposed rule, including:

  • By permitting patients to request the names of specific health care workers to whom substance abuse information was disclosed, the rule could put those workers at risk.
  • By requiring an entity to restrict staff access to data about substance abuse disorders, the proposed rule overlaps HIPAA's "minimum necessary" requirement, but does not provide the flexibility that HIPAA allows to develop and implement reasonable and appropriate safeguards.
  • The proposed rule could discourage practitioners from participating in research because, for example, the provider may not be able to determine whether the researcher is a HIPAA-covered entity.
"The ADA urges the Substance Abuse and Mental Health Services Administration not to adopt the proposed rule, or, if the proposed rule is adopted, to exempt dental practices," wrote Drs. Summerhays and O'Loughlin.