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DC
Confidentiality Coalition Update
by Danille Drake, PhD
Co-chairs of the Coalition of Clinician Representatives met with the DC
Insurance Commissioner on July 30 to affirm an understanding about a
viable interpretation of the first part of the DC Law that protects
patient/client confidentiality. The next step in this round will be the
Commissioner's presentation of this interpretation, to the insurance
company representatives involved in these discussions.
The DC Law has become increasingly important locally, as well as nationally, particularly since the HIPAA privacy law was enacted. The DC law is divided into two parts. The first part indicates the limits of information that may be disclosed in a routine claims review. The second part of the law indicates an independent review process that can be used if the insurance company believes it needs a more comprehensive assessment than would be possible in a routine claims review. If the insurance companies agree with our interpretation, we can then move forward to work toward an understanding of the second part of the law, the definition of Independent Review.
Those of you who have been following this matter over the past two-plus years may recall that our conversations with insurance industry representatives have surrounded disagreement over interpretation of the first part of the DC law regarding client/patient information allowed:
- Administrative Information (Name, address, etc.)
- Diagnostic Information (the five DSM Axes)
- Status of Patient or Client (voluntary or involuntary)
- Reason for Beginning or Continuing Treatment
- Prognosis (limited to estimated duration of treatment)
The Coalition of Clinicians has differed from insurance company representatives over one main point: The definition of item #4, Reason for Beginning or Continuing Treatment. Insurers would like this heading to include information about medication, discharge criteria, and progress. After much deliberation, the Coalition has accepted the inclusion of medication and discharge criteria, defined as Purpose or Overall Goal of Treatment, which has been an additional category that insurance representatives want included in a routine claims review. We believe though, that the inclusion of progress as part of the definition of Reason for Beginning or Continuing Treatment could open the door to increasingly intrusive reviews by the insurance companies.
We are hopeful that the Commissioner's presentation to the insurance companies will be accepted. We can then move the discussion forward to the most important part of the law pertaining to Independent Review.
Responses to this matter may be emailed to danilledrake@aol.com.
For GSCSW Legislative
Information contact:
GWSCSW
5028 Wisconsin Avenue NW, Suite 404
Washington DC 20016
Phone 202 537 0007
Fax 202 364-0435
Email GWSCSW@gmail.com
Website http://www.gwscsw.org