STATE HEALTH INFORMATION GUIDANCE

State Health Information Guidance What is the SHIG? State Health Information Guidance Guiding State Health Information Guidance for California Authoritative Authoritative but non-binding guidance from the State of California Clarifying Clarification of state and federal law for non-state entities Explanatory When, where and why mental health and substance use disorder information can be exchanged What is the Known Path to Yes? It’s a phrase that came up during our stakeholder interviews, and captures the essence of the SHIG – it’s a way of clearly showing how a provider can get from the kneejerk reaction of denying information sharing, to confidently and comfortably saying yes to information sharing. Generalized Widely-applicable document in plain language for a general audience Assistive The Known Path to YES 2/10

Why Is the SHIG Needed? CONFUSION DEFAULT TO NEGATIVE RISK AVOIDANCE Confusion about the law is a major barrier to sharing patient information DEFAULT TO NEGATIVE Providers often default to not sharing information even when it is legal to share RISK AVOIDANCE The primary reasons are uncertainty, risk avoidance and liability concerns GETTING TO YES The SHIG helps highlight the known path to legally and securely sharing patient information 3/10

How Was the SHIG Created? A Collaborative Product Solicitation Stakeholders solicited about existing obstacles Research User stories generated by Advisory Group reflect cross-industry insights and experience Clarification Clarification built around scenario-based illustrations along with general guidance Advisement Advisory group formed from more than 20 organizations Consultation Patient and privacy advocacy organizations consulted 4/10

Reducing Complexity Clarification Generalization Summarization Ease of Comprehension Clarification The SHIG clarifies relevant law. 01 01 Generalization The SHIG provides general principles and guidance. 02 03 02 Summarization The SHIG summarizes applicable legal citations. 03 5/10

Increasing Clarity Clear Examples Clarifying what can and cannot be shared Creating a common understanding Offering an authoritative interpretation and guidance Illustrating simple scenarios and applying rules practically Reducing uncertainty and ambiguity Presenting relevant law and regulation in plain language 6/10

Primary Regulation Sources And Conflict Resolution 42 C.F.R. Part 2 (Substance Use Disorder) 45 C.F.R. Parts 160-164 (HIPAA) Federal CA Civil Code § 56 (CMIA) CA WIC LPS § 5328 (LPS) CA HSC § 11845, § 123100, § 123125 State Authoritative but non-binding guidance Final Guidance C.F.R. – Code of Federal Regulations CMIA – California Medical Information Act WIC – Welfare and Institutions Code LPS – Lanterman-Petris-Short Act HSC – Health and Safety Code In case of conflict the SHIG errs on the side of the more restrictive law or regulation Conflict Resolution 7/10

How It Works Authoritative Scenario-Based Guidance SIMPLE, STRAIGHT-FORWARD, & ILLUSTRATED 22 SCENARIOS RELEVANT TO A WIDE RANGE OF PROVIDER SECTORS PLAIN LANGUAGE FOR A LAY AUDIENCE ALL GUIDANCE TIED TO RELEVANT STATUTES, REGULATIONS AND LAWS 8/10

Scenario Example Description Behavioral Health to Physical Health To provide effective treatment and coordinated care, a physical health provider needs patient health information from a behavioral health provider, such as substance use disorder (SUD) treatment information or mental health information. Description Behavioral Health to Physical Health Type of PHI Primary Law that Applies Substance Use Disorder 42 C.F.R. Part 2 Mental Health Lanterman-Petris-Short Act (LPS) General Health Confidentiality of Medical Information Act (CMIA) and Health Insurance Portability and Accountability Act (HIPAA) What patient health information can a behavioral health provider share with a physical health provider to provide treatment to the patient? Protected health information (PHI) can be shared for treatment and diagnosis purposes unless prohibited by law. In general, PHI includes mental health, SUD and general medical information. The extent to which sharing of patient diagnosis and medication information is permitted depends on whether the provider is regulated by 42 C.F.R. Part 2 (SUD) and therefore subject to stronger restrictions. The mental health provider may share Lanterman-Petris-Short (LPS) regulated patient information with any healthcare provider (any discipline) “who has medical or psychological responsibility for the patient.” The SUD provider (e.g., providers subject to 42 C.F.R Part 2 regulations) may only share within the SUD facility/treatment program or with a qualified service organization (QSO) providing services to the SUD facility or program. [CA Welf. & Inst. § 5328 (a); CA Civ. Code § 56.10(c)(2); Health & Saf. § 11845.5(c); 42 C.F.R. § 2.51(a); 45 C.F.R. 164.506.] Important Scenario Guidance Assumptions There is no patient or patient representative authorization There is no medical emergency There is no court order If a physical health provider is not a treatment/prevention program professional in the same SUD treatment facility, patient information can be shared without an authorization only if the patient’s condition poses an immediate threat to the health of the individual and require immediate medical attention (See In Case of an Emergency). [42 C.F.R. § 2.51(a).] A SUD provider (e.g., providers subject to 42 C.F.R Part 2 regulations) may disclose patient demographics, diagnosis, prognosis and treatment information to treatment/prevention program professionals in the same facility/treatment program. A SUD provider may also disclose patient to QSOs that provide services to the SUD treatment program. When a SUD provider is not subject to 42 C.F.R Part 2 regulations, the health information that may be shared is limited to what is relevant and necessary for the intended purposes of the disclosure. [CA Health & Saf. § 11845.5(c)(1); 42 C.F.R. § 2.12(c)(4); 45 C.F.R. § 164.502(b); CA Civ. Code § 56.10.] A mental health provider may disclose LPS regulated mental health information with physical health providers as long as the provider has responsibility for the patient’s medical or psychiatric care. The information may include prescribed psychotropic medications, diagnosis and treatment information, and programs/services utilized (discharge plans for the primary care provider). [CA Welf. & Inst. § 5328 (a) and (c); CA Civ. Code § 56.10(c)(1); 45 C.F.R. §§164.501.] [42 C.F.R. § 2.12(c); 45 C.F.R. §164.501; 45 C.F.R. § 164.502(b); CA Civ. Code § 56.10; CA Health & Saf. § 11845.5(c)(1); CA Welf. & Inst. § 5328 (a); CA Welf. & Inst. § 5328 (c).] Citations & Related Guidance 9/10

A Great Beginning The SHIG is a first step. Ongoing dialogue will continue to improve appropriate sharing of health information. Possible future additions include HIV/AIDs, foster children, minors, criminal justice, and more. 10/10