Today Governor Charlie Baker signed into law important legislation that advances patient confidentiality. An Act to Protect Access to Confidential Healthcare (PATCH Act) (S. 2296) ensures that when multiple people are on the same insurance plan, confidential health care information is not shared with anyone other than the patient.
Health plans typically send a Summary of Payments (SOP) form detailing the type and cost of medical services received to the primary policyholder each time an enrollee on the plan accesses care. The SOP form is meant to explain how and when an insurance plan is being used and is not a medical bill. In some instances, the SOP form may contain information on sensitive health care services, such as care related to domestic violence or sexual assault, mental health or substance use disorders, sexual and reproductive health or HIV/AIDS, and can unintentionally compromise patient confidentiality for anyone enrolled as a dependent on another person’s health insurance policy, such as a young adult or spouse.
The Protecting Access to Confidential Health Care (PATCH) Alliance, a broad-based group of over 40 provider, advocacy, and community-based organizations concerned with maintaining confidentiality in health insurer communications with their members, organized support for the bill alongside the Massachusetts Association of Health Plans and Blue Cross Blue Shield of Massachusetts.
“Health Care For All is very grateful for the support of the House of Representatives and the Senate for this important legislation and thanks the Governor for making this law a reality,” said Amy Rosenthal, Executive Director of Health Care For All, and added: “We all deserve privacy when it comes to our medical care and this law closes a loophole that can prevent people from seeking critical services. Knowing that the information about a medical visit can be shared is a deterrent for young adults who need access to reproductive health services, individuals who need mental health substance abuse treatment or even survivors of domestic violence or sexual assault.”
The PATCH Act establishes a number of mechanisms to ensure confidentiality. These protections include sending SOP forms directly to the patient rather than to the primary policyholder; allowing patients to choose their preferred address and method for receiving SOPs; providing only general information about certain sensitive services or visits; and providing patients the option to opt-out of receiving SOPs if no payment is due. Those provisions can be particularly important to those seeking contraceptive care and other reproductive health services.
“Last year, Massachusetts guaranteed 1.4 million Bay Staters co-pay free contraception coverage through passage of the ACCESS Bill,” said Rebecca Hart Holder, Executive Director of NARAL Pro-Choice Massachusetts, representing the Massachusetts Coalition for Choice, a group that includes Planned Parenthood Advocacy Fund of Massachusetts, the ACLU of Massachusetts, and the Massachusetts Family Planning Association. Holder added: “The PATCH Act builds on that progress and ensures that all patients in need of sensitive healthcare services, including reproductive health care, can access care confidentially. With the passage of the PATCH Act, Massachusetts continues to be a beacon of reproductive freedom in a time of constant federal attacks on health care and reproductive rights.”
Additional concerns arise in the context of violence and abuse when the primary policyholder may be the coercive, controlling or abusive party. Fear that the controlling partner or family member will learn of the treatment and further exacerbate the abuse may deter many from seeking care altogether.
“Enactment of the PATCH bill marks a critical step in assuring that survivors of sexual and domestic violence can access the health care they need without compromising their confidentiality or risking their safety,” observed Maureen Gallagher, Policy Director at Jane Doe Inc.
Katia Santiago-Taylor, of Boston Area Rape Crisis Center, echoed that statement by saying, “Survivors of sexual violence may delay seeking critical medical evaluation out of fear of lack of confidentiality when accessing medical care. This law removes that roadblock and provides survivors with the comfort of knowing that they have one less issue to worry about.”
The law additionally provides confidentiality protections for those receiving other sensitive medical services.
“An Act to protect access to confidential healthcare will significantly improve patient access to HIV care, including testing and treatment,” said Carl Sciortino, Executive Director of AIDS Action Committee and added: “Currently, fear of confidentiality breaches can prevent individuals from getting tested for HIV and deter HIV positive individuals from obtaining treatment and even HIV medication. By protecting patient privacy, this law will encourage people to use their private insurance when they seek necessary health care like HIV/STI testing.”
“Healthcare privacy is a critical issue for LGBTQ youth, who face a great deal of stigma in receiving routine care and who need to know that what is confidential at the doctor’s office won’t be made public when the paperwork gets sent home. LGBTQ youth of color in particular face both heightened health disparities and significant social stigma, and the government should do all it can to protect their right to get the care they need,” stated Corey Prachniak-Rincón, Director of the Massachusetts Commission of LGBTQ Youth. “There are already so many barriers that LGBTQ youth face in getting care – fear of discrimination, lack of family support, costs and transportation – we don’t want them to also fear being “outed” because they went to see a doctor and their families received something sensitive in the mail. The Commission is pleased to see that the legislature and Governor acted to fix a loophole in the Commonwealth’s health care privacy laws.”
This new law is also welcomed by health care providers.
Dr. Kimberly Daly, of Salem State University’s Counseling and Health Services, added “On behalf of college and university students across the Commonwealth, we are thrilled by the passage of the PATCH Act. Many chronic conditions arise during the college years and students need to be able to access confidential healthcare, including mental health and reproductive services. When young adults cannot access confidential care, they often forgo or delay treatment. Especially given the rising concerns related to behavioral health and substance abuse, the need to remove any barrier to care is essential. We support this passage of this bill to ensure that all Massachusetts students will be able to receive the services they need to be successful in their academic pursuits.”
“NASW-MA supports the PATCH Act because social workers see the negative effects of this privacy loophole firsthand. Individuals will choose to not seek treatment for substance use or mental health issues for fear of their health insurance policyholder, often a spouse or a parent, finding out” said Rebekah Gewirtz, Executive Director of National Association of Social Workers-Massachusetts. “Although we have made great strides in combatting stigma related to mental health and seeking help, for many there is still incredible shame. We applaud this legislation for closing the loophole and ensuring that any individual can access mental or physical health care when they need it.”
The health insurers in Massachusetts further support this law in order to ensure confidentiality protections for their members.
“We are proud to support this important legislation to create new privacy protections for residents of the Commonwealth,” said Andrew Dreyfus, CEO and President of Blue Cross Blue Shield of Massachusetts. “As the state’s largest health insurer, protecting our members’ personal health information is critically important to us. Giving members more control over their sensitive health information is a vital component of maintaining confidentiality.”
“Thank you to everyone who worked so hard on this important legislation, especially Representative Hogan, Senator Spilka, Speaker DeLeo, Senate President Chandler, Attorney General Healy, the PATCH Alliance, and the Baker Administration,” said Lora Pellegrini, President and CEO of the Massachusetts Association of Health Plans. “The PATCH Act will give health plan members confidence in knowing that they can receive the medical treatment they need, while ensuring that their medical information remains private.”