The Honorable Kevin Brady                                       The Honorable Sander Levin
Chairman                                                                     Ranking Member
House Ways & Means Committee                             House Ways & Means Committee 
1102 Longworth House Office Building                      1102 Longworth House Office Building
Washington, D.C. 20515                                             Washington, D.C. 20515

Dear Chairman Brady and Ranking Member Levin:

On behalf of the National Association of Accountable Care Organizations (NAACOS) and our members, we applaud your recent appeal to Acting Administrator Slavitt regarding the need for increased access to data for mental and behavioral health conditions, especially for Medicare beneficiaries. As your letter stated, “…it is essential that Medicare provide more robust data for analysis by the public and policymakers about the extent and nature of mental and behavioral health conditions among the senior population.” We fully agree with you that Medicare should make data on substance abuse more widely available while respecting and protecting seniors’ privacy.

NAACOS is the largest association of Medicare ACOs representing over 3 million beneficiary lives through 180 Medicare Shared Savings Program (MSSP) ACOs, Next Generation and Pioneer ACOs. We are a member-led and member-owned non-profit organization that works on behalf of ACOs across the nation to improve the quality of Medicare delivery, population health and outcomes, and health care cost efficiency. Having the ability to address a beneficiary’s mental and behavioral issues in a more thorough manner is crucial to a healthier, better quality of life.

NAACOS recently submitted comments to the Substance Abuse and Mental Health Services Administration (SAMHSA) on their proposed rule on the “Confidentiality of Substance Use Disorder Patient Records.” (attached) Our recommendations reflect our expectation and desire to amend the current outdated regulations impeding care coordination for patients with a history of substance abuse. Updating these regulations is critical to allow these patients to benefit from highly coordinated healthcare models such as ACOs, which work to improve care with better data sharing and communication. For example, facilitating the electronic exchange of patient information across providers is a fundamental ACO activity that improves the quality of care that individual patients receive.

In general, we support SAMHSA's proposal and specifically request that in the final rule the agency:

  • Works with the Center for Medicare & Medicaid Services (CMS) to ensure that when proper criteria are met, such as through a qualified service organization agreement and/or a signed consent form, patient substance use claim information is available to ACOs through their Claim and Claim Line Feed files.
  • Recognizes that all clinicians and support staff in an ACO are focused on population health and SAMHSA should not finalize policies that arbitrarily limit information on substance abuse to certain parts of an ACO.
  • Finalizes use of a "general" designation in the consent form and allow a flexible approach for the information included on the form.
  • Finalizes their proposal to provide medical personnel with more discretion to determine when a "bona fide medical emergency exists" under the medical emergency exception.

NAACOS and our members are on the cutting edge of high-value, integrated health care. We hope to continue working with your Committee as a stakeholder and a resource as value-based payment delivery evolves.


Clif Gaus

President and CEO

Cc:          The Honorable Pat Tiberi
                The Honorable Jim McDermott