Legislative Affairs - Federal Issues

On September 18, 2007, the U.S. Senate made history by passing the Mental Health Parity Act (S. 558) by unanimous consent. On March 5, 2008, the House passed a similar strong mental health parity bill (H.R. 1424) by a vote of 268-148.

We need psychologists to contact their legislators NOW and urge them to encourage House and Senate leaders to complete negotiations on a mental health parity bill that can pass in both chambers this year.

To learn more about the issues  or to contact your legislators, click here.

APA Practice Organization Action Alert

The Senate may soon consider S. 1693, the “Wired for Health Care Quality Act”, a bill designed to encourage the development of health information technology (HIT) in the health care system.  Unfortunately, this legislation lacks adequate privacy and security provisions that are necessary to protect the confidentiality of patient records.  Senator Patrick Leahy (D-VT) has just offered some helpful privacy and security protections, and these are a good start.  However, Congress should not move forward on HIT legislation without first assuring that the privacy and security of patient records is a core element of HIT development.

A vote in the Senate could occur at any time, and we need you to contact your Senators NOW to urge them to include the strongest privacy protections in HIT legislation.  The Leahy amendment is a good start, but it should go further.  At the same time, Federal Advocacy Coordinators in targeted states should continue to coordinate ongoing quality calls to the House Energy and Commerce Committee.

Targets: All members of the U.S. Senate

Action: Click here to urge your Senators to include the strongest privacy protections in HIT legislation

If you are not able to reach the Legislative Action Center from the above link, please visit http://capwiz.com/apapractice/issues/alert/?alertid=11384796&type=CO.

Grassroots feedback is also extremely important to our advocacy efforts, so we would very much appreciate it if you would e-mail (jcook@apa.org) or fax (202-336-5797) us any substantive responses you receive from your Senator.

Sample Letter for Grassroots Psychologists:

Dear ____________________:

I am writing as a psychologist and constituent to urge you to include the strongest protections for patient records privacy and security in any health information technology (HIT) legislation the Senate considers.  While well-intentioned, S. 1693, the “Wired for Health Care Quality Act” lacks these protections.  Senator Leahy’s privacy and security amendment is a good start, but it should go further.

While HIT legislation offers the potential for improvement in the cost and delivery of health care services, it comes with a major risk – health records in a national, electronic system are more susceptible to intentional or negligent disclosure on a massive scale, causing a loss of privacy and other related problems for patients.  Mental health records are particularly vulnerable to exposure and need heightened privacy and security because they often contain information that could lead to a patient’s embarrassment or stigmatization.  For my patients, even the potential loss of records’ privacy can be devastating and enough to keep them from seeking the treatment they need.

The protection of my patients’ records is critically important and must be the cornerstone of any HIT bill the Senate moves forward.  Please insist on the inclusion of the strongest privacy and security provisions.  I appreciate your consideration of my concerns and look forward to hearing from you.

Background: 

Health information technology (HIT) development involves moving the current, mainly paper-based health records system to a national electronic health records system.  This change has many advantages.  For example, it would allow for the comprehensive management of information and its secure exchange between patients, providers and other entities that use health records.  It could improve quality by preventing medical errors and reduce costs through decreased paperwork and increased administrative efficiency.  Patients would be helped as they manage chronic diseases.  Providers would have accessibility to records in a standard, electronic format for treatment decisions and for payment purposes.

There is a major risk associated with HIT development—health records in a national, electronic system are more susceptible to intentional or negligent disclosure on a massive scale, causing a loss of privacy and other related problems for patients.  This is a real concern since records in centralized electronic systems are being compromised on a daily basis.  In fact, according to the Privacy Rights Clearinghouse, more than 216,000,000 data records belonging to U.S. residents have been exposed to potential misuse as a result of security breaches since January 2005.

Mental health records need heightened privacy and security protection.  Mental health records are particularly vulnerable to disclosure, because they typically contain information that could lead to a patient’s embarrassment or stigmatization.  For these patients even the potential loss of records’ privacy can be devastating.  The patient and psychologist must maintain control over the release of these records into the health system since, as the U.S. Supreme Court recognizes in Jaffee v. Redmond, their relationship is “rooted in the imperative need for confidentiality and trust” and that the “mere possibility” of disclosure could impede the development of a confidential relationship necessary for successful treatment.

A strong federal HIT privacy and security law must also harmonize with the requirements of HIPAA.  Psychologists, like other providers, must currently comply with the privacy and security standards provided through the Health Insurance Portability and Accountability Act (HIPAA).  The relationship between the HIPAA standards and HIT privacy and security standards will have to be clearly addressed as the HIT debate moves forward to ensure the strongest protections for patients while providing the least compliance burden for health care providers.

The Leahy privacy and security amendment is a good start, but it should go further.  The amendment requires that the Department of Health and Human Services will in the future make recommendations regarding privacy and security to Congress, including recommendations regarding how HIPAA will apply to HIT systems.  It clarifies how patient records may be used for marketing purposes.  It also clarifies the right of patients to inspect their records in electronic form, provides for a notice of privacy practices and calls for standards for notifying patients when their records’ privacy has been breached.  These are important improvements to S. 1693, but not nearly enough to protect the highly sensitive information associated with mental health records.