HARRISBURG, Pa. - Caught in a fragmented health care system, addicts in Pennsylvania can become frustrated in their journey toward recovery.

That's the message Gov. Ed Rendell's administration says it has been hearing from patients who wrestle with drug or alcohol abuse while suffering from mental illness or chronic diseases such as diabetes.

"We have a system where one (service) provider is not allowed to talk to another," Health Secretary Dr. Calvin Johnson said. "The system is not working in the best interest of the client."

The administration's proposed solution , a set of Health Department rule changes undergoing a lengthy review , is to provide a wider range of information to insurers, governments and other entities that pay for health care.

Current rules allow treatment providers to inform insurers whether a patient is being treated, the person's prognosis and progress, the nature of the program, and whether any relapses have occurred.

The department's proposal would broaden the available records to include the patient's treatment history, specific medical conditions, and history of substance abuse.

But some lawmakers, drug and alcohol treatment providers, and the state bar association argue loosening the regulations is tantamount to letting insurers eavesdrop on patient-counselor conversations that can delve into deeply personal topics, such as relations with family members.

"We're required by licensure to interview patients very intensely," said Deborah Beck, president of the Drug and Alcohol Service Providers Organization of Pennsylvania. "We know all about you, about your psychological history, your sexual history, none of which have anything to do with what your (treatment) payer would need to know."

Michelle Denk, executive director of the Pennsylvania Association of County Drug and Alcohol Administrators, said she sees no evidence that patients have been unable to get the help they need under the current regulations.

"From our perspective, there is enough leeway in right now that the system works," Denk said. "We have not seen any data saying that clients have not had access to treatment because insurance companies have not gotten information."

A state regulatory review panel agreed earlier this month that the opponents' concerns were legitimate and asked the department to elaborate on its rationale for the changes.

"We agree ... that an unintended consequence of the proposal could be fewer people seeking and receiving treatment for their drug and alcohol addiction problems for fear that personal and potentially embarrassing information could be released to others," the Independent Regulatory Review Commission said in written comments released Feb. 13.

Johnson said his agency is evaluating feedback from the commission and other parties and considering whether further revisions are needed as the department works on a final version of the new rules.

He noted that no information would be released to any insurer without a patient's written consent, and such files are already subject to federal rules governing confidentiality of medical records.

Johnson has an ally in Public Welfare Secretary Estelle Richman, who said Pennsylvania's current confidentiality requirements far exceed those in federal law, making them the strictest in the nation.

At the same time, she agrees that the new regulations safeguard the privacy of any information that is not essential for insurers to determine whether a treatment is medically necessary.

"They don't need to know whether you've been in and out of child welfare," Richman said. "They do need to know whether you've been struggling with addiction issues."

--AP

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