President Trump issues ACA executive order
On his first day in office President Trump signed an executive order to minimize the economic burden of the Patient Protection and Affordable Care Act (ACA). While the executive order grants appropriate cabinet secretaries and agency heads the authority to minimize the "burden" caused by the ACA, it also requires White House officials to comply with the Administrative Procedure Act.
Consequently, the White House must go through the notice and rulemaking process to change ACA policies. The executive order is very broad and it is unclear at this time exactly which ACA policies the Trump Administration plans to modify. The AMA will continue to closely monitor the situation and engage the new administration as it moves forward to modify the ACA.
New guidance issued on how HIPAA permits disclosures of PHI
The U.S. Department of Health and Human Services Office of Civil Rights (OCR) recently released a series of clarifying guidance documents on how the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule permits disclosures.
The new FAQs clarifies that physicians may disclose protected health information (PHI) to a patient's loved ones, regardless of whether they are recognized as relatives under applicable law (e.g., a patient's partner to whom he/she is not married). The FAQs make clear that the permissive disclosures are not limited by the sex or gender identity of the person. Concurrently, OCR is in the process of updating existing guidance to make clear that the terms marriage, spouse, and family member include, respectively, all lawful marriages, whether same-sex or opposite-sex, lawfully married spouses and the dependents of all lawful marriages, and clarifies certain rights of individuals under the Privacy Rule.
The OCR and the Office of the National Coordinator for Health Information Technology also released a Fact Sheet (PDF) explaining HIPAA permits disclosures of PHI to support public health activities conducted by public health agencies, as authorized by state or federal law. It provides a few examples of sharing PHI in support of public health policies.
The AMA has consistently urged policymakers to increase their education efforts to assist physicians in their understanding of how HIPAA permits clinicians to share PHI. The AMA has also created a toolkit on related aspects of HIPAA, which includes requirements around privacy and security.
Final rule permits increased access to substance abuse data
The U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) recently issued a final rule easing existing restrictions on how clinicians may share substance abuse treatment records with one another.
The new rule, 42 CFR Part 2—commonly known simply as "Part 2"—now permits clinicians to obtain a single authorization from their patients to establish which information their clinician shares with other clinicians. Formerly, clinicians needed to obtain patient authorization for each disclosure, which was burdensome for both physicians and patients.
The AMA strongly supported SAMHSA's efforts to modernize the Part 2 rules to better align them with the current health care delivery system, while simultaneously preserving important patient privacy protections. In particular, the AMA agreed with SAMHSA's goal of enabling patients with substance use disorders to benefit from new integrated health care models without exposing them to adverse consequences that could act as a deterrent to their seeking needed care.
The new rule becomes effective Feb. 17.
AMA weighs in again on VA's new full-practice authority policy
In a Jan. 13 letter (PDF), the AMA continued to register its concern with the Department of Veterans Affairs (VA) decision to allow full practice authority for most Advanced Practice Registered Nurses (APRN). The final rule (PDF) requested additional comments on the VA's decision to exclude Certified Registered Nurse Anesthetists (CRNA) and, specifically, whether advanced practice authority for CRNAs would bring further access improvements to anesthesia providers.
The AMA urged the VA to maintain the CRNA exclusion largely because the VA's own workforce data supports it. According the VA's 2015 Mission Critical Occupations Report, access to anesthesiologists is improving and the specialty is not among the top five that are difficult to recruit and retain. The AMA also supported maintaining the CRNA exclusion for patient safety reasons and so as not to undermine states' rights—45 states and the District of Columbia require CRNAs to practice with or be supervised by physicians.
