Updated requirements on confidentiality and claim submission for substance use disorder treatment – 42 CFR Part 2

The Substance Abuse and Mental Health Services Administration (SAMHSA) has updated its regulations concerning the confidentiality of health records for individuals receiving treatment for substance use disorders through federally assisted programs known as Part 2 Programs.

These regulations, outlined in 42 CFR Part 2 (Confidentiality of Substance Use Disorder Patient Records), govern how patient-identifiable information may be used, disclosed and redisclosed. In addition, these rules are distinct and separate from the Health Insurance and Portability Act of 1996 (HIPAA) and applicable state privacy laws.

Consent requirements for claim submission

Part 2 Programs must obtain explicit patient consent before submitting substance use disorder treatment claims to Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and/or its delegates. The consent must:

• Clearly state that the disclosure is for Treatment, Payment and Health Care Operations (TPO)
• Authorize Blue Cross NC to use and redisclose the Part 2 records for TPO purposes.

Updated Note segment (NTE) language requirement for substance use claims

In October 2021, Blue Cross NC began validating the 837 Note segment (NTE) on substance use claims protected by 42 CFR Part 2. As part of ongoing regulatory updates, the required language for this note is changing.

New required language effective February 1, 2026:

• 42 CFR Part 2 prohibits unauthorized use/disclosure of these records – TPO on file.

Claims that do not include this exact statement may trigger the 837-error message P-040.

Current accepted language (as of today):

• 42 CFR Part 2 prohibits unauthorized disclosures of these records.

Starting November 1, 2025:

• Providers may use either the current or new revised language.

Starting February 1, 2026:

• Only the new required language will be accepted.