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the Health Home optional Medicaid state plan benefit to promote coordinated care for chronic conditions, which has led to dramatic reductions in opioid use, overdoses and emergency department visits related to opioid use. COLLABORATIVE LEARNING CMS’s Transforming Clinician Practice Initiative (TCPI) is a collaborative learning initiative that facilitates information sharing and practice reform on a large scale, with over 90% of clinicians operating in small, rural, or underserved areas participating. One TCPI member—the Integrated Pain Care program at Community Care of West Virginia—achieved promising results, including: 1. Zero opioid-related deaths among the 2,628 patients over the past 2 years 2. A reduction in opioid prescriptions by 86% in 4 years.7 ADVANCED ANALYTICS CMS’s Quality Improvement Organizations provided advanced data analytic support and clinical expertise to a network of 10 hospitals and partners across Colorado to change pain management practices and improve care. Over a 6-month timeframe, CMS data showed that these hospitals achieved a 36% reduction in the use of opioids— about 35,000 fewer administrations of opioids in the emergency department—and an increase in non-opioid pain medications by 31%. INNOVATIVE MODELS CMS introduced 2 innovative opioid models focused on particularly vulnerable populations. The Integrated Care for Kids (InCK) Model focuses on integrating physical and behavioral health care, preventing opioid abuse, and improving outcomes for children affected by family opioid abuse. The Maternal Opioid Misuse (MOM) Model supports transformation in the care of pregnant women with opioid use disorder. By supporting the coordination of clinical care and the integration of other services critical for health, wellbeing, and recovery, the model has the potential to improve quality of care and reduce costs for mothers and infants. States and care delivery partners will begin implementing changes in 2020. HIPAA regulations allow health professionals to share health information with a patient’s loved ones in emergency or dangerous situations – but misunderstandings to the contrary persist and create obstacles to family support that is crucial to the proper care and treatment of people experiencing a crisis situation, such as an opioid overdose. This document explains how health care providers have broad ability to share health information with patients’ family members during certain crisis situations without violating HIPAA privacy regulations. 2 HIPAA allows health care professionals to disclose some health information without a patient’s permission under certain circumstances, including: · Sharing health information with family and close friends who are involved in care of the patient if the provider determines that doing so is in the best interests of an incapacitated or unconscious patient and the information shared is directly related to the family or friend’s involvement in the patient’s health care or payment of care. 3 For example, a provider may use professional judgment to talk to the parents of someone incapacitated by an opioid overdose about the overdose and related medical information, but generally could not share medical information unrelated to the overdose without permission. · Informing persons in a position to prevent or lessen a serious and imminent threat to a patient’s health or safety. 4 For example, a doctor whose patient has overdosed on opioids is presumed to have complied with HIPAA if the doctor informs family, friends, or caregivers of the opioid abuse after determining, based on the facts and circumstances, that the patient poses a serious and imminent threat to his or her health through continued opioid abuse upon discharge. 5 1 “HIPAA” refers to the Health Insurance Portability and Accountability Act of 1996 and, for purposes of this guidance, the HIPAA privacy and security regulations. 2 This guidance does not discuss the requirements of other federal or state laws that apply to individuals’ health information, including the federal regulations that provide more stringent protections for the confidentiality of substance use disorder patient records maintained in connection