HHS’ Office for Civil Rights issued guidance Sept. 30 on how state Medicaid agencies may use substance use disorder patient records protected under 42 CFR part 2 to verify exclusions from the Medicaid community engagement requirement.
Federal law generally requires certain adults ages 19-64 who are Medicaid applicants or beneficiaries to engage in work, community service or certain other activities for 80 hours per month, or be enrolled at least half-time in education, to be eligible for Medicaid. States are required to implement the requirement no later than Jan. 1, 2027, according to CMS’ June 3 interim final rule.
Certain individuals are excluded from the requirement, including individuals who are medically frail or otherwise have special medical needs and individuals participating in certain substance use disorder treatment programs.
A state Medicaid agency may use Part 2 records to verify an exclusion when the use is consistent with a written patient consent previously obtained by a Part 2 program for all future uses and disclosures for treatment, payment and healthcare operations purposes. An agency may also obtain written patient consent to use Part 2 records to verify an exclusion.
Written consent obtained by a state Medicaid agency must include the required elements specified in 42 CFR 2.31(a), including the patient’s right to revoke consent and an expiration date or event.
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