Confidentiality, Third-Party Billing, & the Health Insurance Claims Process:
Implications for Title X
24
National Family Planning
& Reproductive Health Association
1 42 U.S.C. §§ 300 et seq.
2 See, e.g., Madlyn C. Morreale, Amy J. Stinnett, and Emily C. Dowling, eds.,
Policy Compendium on Confidential Health Services for Adolescents, 2nd Ed.
(Chapel Hill, NC: Center for Adolescent Health & the Law, 2005). http://
www.cahl.org/policy-compendium-2nd-2005/.
3 Rachel B. Gold, “A New Frontier in the Era of Health Reform: Protecting
Confidentiality for Individuals Insured as Dependents,” Guttmacher Policy
Review 16, no. 4 (2013): 2. https://www.guttmacher.org/pubs/gpr/16/4/
gpr160402.pdf. According to the Kaiser Family Foundation, more women of
reproductive age (27%) than men (20%) are insured as dependents. Ibid.
4 Research findings have shown that privacy concerns influence the behavior of
adolescents and young adults with respect to whether they seek care, where
they do so, which services they accept, and how candid they are with their
health care providers. Carol A. Ford, Abigail English, and Garry Sigman,
“Confidential Health Care for Adolescents: Position Paper of the Society for
Adolescent Medicine,” Journal of Adolescent Health 35, no. 2 (2004): 160-167.
http://www.jahonline.org/article/S1054-139X%2804%2900086-2/fulltext;
Alina Salganicoff, Usha Ranji, Adara Beamesderfer, and Nisha Kuran, Women
and Health Care in the Early Years of the ACA: Key Findings from the 2013 Kaiser
Women’s Health Survey (Menlo Park, CA: Henry J. Kaiser Family Foundation,
May 2014): 28, 38-39. https://kaiserfamilyfoundation.files.wordpress.
com/2014/05/8590-women-and-health-care-in-the-early-years-of-the-
affordable-care-act.pdf. Adolescents are especially concerned about disclosures
to their parents of their use of family planning services, but young adults have
similar concerns. Diane M. Reddy, Raymond Fleming, and Carolyne Swain,
“Effect of Mandatory Parental Notification on Adolescent Girls’ Use of Sexual
Health Care Services,” JAMA 288, no. 6 (2002): 710–714; Rachel K. Jones, et
al., “Adolescents’ Reports of Parental Knowledge of Adolescents’ Use of Sexual
Health Services and eir Reactions to Mandated Parental Notification for
Prescription Contraception,” JAMA 293, no. 3 (2005): 340–348; Carol A.
Ford, et al., “Young Adults’ Attitudes, Beliefs, and Feelings About Testing for
Curable STDs Outside of Clinic Settings,” Journal of Adolescent Health 34, no.4
(2004): 266-269.
5 Victims of intimate partner violence have heightened concerns about
protecting their confidential information due to fears of serious physical
and psychological danger from spouses or domestic partners as a
result of disclosure. National Consensus Guidelines on Identifying and
Responding to Domestic Violence Victimization in Health Care Settings.
(San Francisco: Family Violence Prevention Fund, 2004). http://www.
futureswithoutviolence.org/userfiles/file/HealthCare/consensus.pdf.
6 42 C.F.R. § 59.11.
7 Jennifer J. Frost, Rachel Benson Gold, and Amelia Bucek, “Specialized
Family Planning Clinics in the United States: Why Women Choose em
and eir Role in Meeting Women’s Health Care Needs,” Women’s Health
Issues 22 (November 2012): e519-e525.
8 Office of Population Affairs, Program Requirements for Title X Funded
Family Planning Projects, (April 2014), Sec. 10. http://www.hhs.gov/opa/
pdfs/ogc-cleared-final-april.pdf.
9 Abigail English, Center for Adolescent Health & the Law, and National
Family Planning & Reproductive Health Association, Adolescent
Confidentiality Protections in Title X, June 5, 2014. http://www.
nationalfamilyplanning.org/document.doc?id=1559.
10 Health Insurance Portability and Accountability Act of 1996 (HIPAA), Pub.
L. No. 104-191, 110 Stat. 1936 (codified as amended in scattered sections of
titles 18, 26, 29, and 42 of the U.S. Code).
11 45 C.F.R. Part 160 and Part 164, Subparts A and E.
12 Patient Protection and Affordable Care Act (H.R. 3590), Pub. L. No. 111-
148, 124 Stat. 119 (signed into law March 23, 2010), and amended by the
Health Care and Education Affordability Reconciliation Act of 2010 (H.R.
4872), Pub. L. No. 111-1522 (signed into law March 30, 2010).
13 “Title X Funding History,” Office of Population Affairs, accessed April 2,
2015, http://www.hhs.gov/opa/about-opa-and-initiatives/funding-history/.
14 45 C.F.R. § 164.522(a) and (b).
15 45 C.F.R. §§ 164.502(a)(1)(ii) and 164.506.
16 Centers for Medicare and Medicaid Services, US Department of Health
and Human Services. Medicaid & CHIP: December 2014 Monthly
Applications, Eligibility Determinations and Enrollment Report. Feb. 23,
2015. http://www.medicaid.gov/medicaid-chip-program-information/
program-information/downloads/december-2014-enrollment-report.pdf.
HHS.gov/HealthCare, US Department Health and Human Services. Open
Enrollment Week 13: February 7, 2015 – February 15, 2015. http://www.
hhs.gov/healthcare/facts/blog/2015/02/open-enrollment-week-thirteen.html.
17 Abigail English and M. Jane Park, Access to Health Care for Young Adults:
e Affordable Care Act is Making a Difference (Chapel Hill, NC: Center for
Adolescent Health & the Law; and San Francisco: CA: National Adolescent
Health Information and Innovation Center, 2012). http://nahic.ucsf.edu/
download/access-to-health-care-for-young-adults-the-affordable-care-act-
of-2010-is-making-a-difference/; Benjamin D. Sommers, Office of the
Assistant Secretary for Planning and Evaluation, U.S. Dept. of Health &
Human Services, Number of Young Adults Gaining Insurance Due to the
Affordable Care Act Now Tops 3 Million, June 2012. http://aspe.hhs.gov/
aspe/gaininginsurance/rb.cfm.
18 Salganicoff et al., Women and Health Care [see note 4, above]; Lauren Slive
and Ryan Cramer, “Health Reform and the Preservation of Confidential
Health Care for Young Adults” Journal of Law, Medicine & Ethics 40, no. 2
(2012): 383-390.
19 42 U.S.C. § 300gg-13; 45 C.F.R. § 147.130.
20 An exemption to the contraceptive coverage requirement has been made
available for religious institutions, together with associated requirements
for accommodations. Coverage for Certain Preventive Services Under
the Affordable Care Act; Final Rules, 78 Fed. Reg. 39870-39899, July 2,
2013, http://www.gpo.gov/fdsys/pkg/FR-2013-07-02/pdf/2013-15866.
pdf; Centers for Medicare and Medicaid Services, Center for Consumer
Information and Oversight, US Department of Health and Human
Services, Women’s Preventive Services Coverage and Nonprofit Religious
Organizations, accessed March 29, 2015, http://www.cms.gov/CCIIO/
Resources/Fact-Sheets-and-FAQs/womens-preven-02012013.html. e
requirement and the exemption have been extensively litigated and are the
subject of numerous ongoing court cases. Kelsey Miller, A Guide to the
Lawsuits Challenging Obamacare’s Contraceptive Coverage Requirements,
Kaiser Health News, Sept. 17, 2013, http://kaiserhealthnews.org/news/
contraception-mandate-challenges/.
21 Health Resources and Services Administration, US Department of Health
and Human Services, Women’s Preventive Services Guidelines, accessed
March 29, 2015, http://www.hrsa.gov/womensguidelines/.
22 Abigail English, Rachel B. Gold, and Elizabeth Nash, Confidentiality
for Individuals Insured as Dependents: A Review of State Laws and Policies
(Washington, DC: Guttmacher Institute, and New York: Public Health
Solutions, 2012). http://www.guttmacher.org/pubs/confidentiality-review.
pdf; AMA Council on Scientific Affairs, “Confidential Health Services for
Adolescents,” JAMA 269, no. 11 (1993): 1420-1424.
23 Society for Adolescent Health and Medicine, et al., “Recommendations
for Electronic Health Record Use for Delivery of Adolescent Health Care:
Position Paper,” Journal of Adolescent Health 54, no. 4 (2014): 487-490.
http://www.adolescenthealth.org/SAHM_Main/media/Advocacy/Positions/
Apr-14-Elec-Health-Records.pdf; Committee on Adolescence, American
Academy of Pediatrics, et al., “Standards for Health Information Technology
to Ensure Adolescent Privacy,” Pediatrics 130, no. 5 (2012): 987-990. http://
pediatrics.aappublications.org/content/130/5/987.long; Arash Anoshiravani,
et al., “Special Requirements for Electronic Medical Records in Adolescent
Medicine. Journal of Adolescent Health 51, no.5 (2012): 409-414. http://
www.jahonline.org/article/S1054-139X%2812%2900335-7/pdf.
24 Slive and Cramer, “Health Reform.” [see note 18, above]
25 42 U.S.C. § 1396k; 42 C.F.R. § 433.147.
26 Rebecca Gudeman, “e Affordable Care Act and Adolescent Health:
Closing Confidentiality Loopholes so that Adolescents Can Benefit Fully
From Newly Available Health Benefits and Insurance,” Youth Law News
Endnotes