Redaction of Substance Abuse Claims

Redaction of Substance Abuse Claims

Current Version Date: 
12/16/2015

CMS is committed to supporting research use of CMS data and ensuring that patient information is properly protected.  However, under the Confidentiality of Alcohol and Drug Abuse Patient Records Regulations, 42 CFR Part 2, CMS cannot disclose or allow the use of patient identifiable information from alcohol or drug abuse patient records for research purposes without patient consent.

Currently, CMS only makes alcohol or drug abuse treatment information available in limited data set files, which omit any direct identifiers, and public use files, which do not contain identifiable information about individuals who have sought or are seeking substance abuse treatment.

When researchers need access to more detailed claims information than that which is included in limited data set files or public use files, there is a risk that the data could be used to identify a patient receiving treatment for alcohol or drug abuse.  Therefore, to ensure compliance with SAMHSA regulations, after gathering requested data for a researcher, CMS redacts any substance abuse related claims from the resulting research identifiable files based on codes within the claims. CMS implemented this in November 2013 for Medicare claims and March 2014 for Medicaid claims.  

Please see the tables under Additional Resources to understand the impact on Medicare and Medicaid data. Medicaid data users are encouraged to view the spreadsheet which provides details on redaction by board eligibility group. The rates vary by child, adult, disabled and aged categories. All tables provide counts and precentages for affected claims and beneficiaries, as well as the impact on total program payment amount.

For more information on SAMHSA regulations, please visit the SAMHSA website.

Article Number: 
203
External Author(s): 
Centers for Medicare & Medicaid Services
Author(s): 
This work was performed under CMS Contract Number HHSM-500-2013-00166C

Disclaimer

The process and materials mentioned as part of this KnowledgeBase article are current, as of the publication date on the article, to the best of our knowledge. The examples provided are correct in the aggregate but may not apply to every subgroup or circumstance that a researcher may wish to study. It is up to the researcher to conduct analysis and confirm that the patterns described in this KnowledgeBase article apply to his/her particular study. If your research findings appear to contradict the advice provided, please contact ResDAC at resdac@umn.edu.