March 2, 2026

By Laura Groshong, LICSW, Director of Policy and Practice

I've received many questions about the new Health Insurance Portability and Accountability Act (HIPAA) regulations that went into effect today. These new rules apply to all LCSWs who receive Federal funding, i.e., Medicare, Medicaid, Veteran’s Administration, etc., AND self-identify as treating patients with substance abuse disorders. The rules also apply to an LCSW receiving reports about a patient’s substance use treatment provided elsewhere. If an LCSW does not meet these criteria, they do not need to make the following changes to their Notice of Privacy Practices (NPP).

The reason for the changes to the NPP is that there was a discrepancy between the confidentiality standards for psychotherapy as defined in HIPAA rules and confidentiality standards as defined in federal law under 42 C.F.R. Part 2 (“Part 2”). The language that must be included in an LCSW’s NPP is as follows:

“Use and Disclosure of Substance Use Disorder Records Subject to 42 CFR Part 2: If applicable, your substance use disorder (“SUD”) records are protected by federal law under 42 C.F.R. Part 2 (“Part 2”). This law provides extra confidentiality protections and requires a separate patient consent for the use and disclosure of SUD counseling notes. Each disclosure made with patient consent must include a copy of the consent or a clear explanation of the scope of the consent. It must also be accompanied by a written notice containing the language in 42 CFR Part 2.32(a). Disclosure of these records requires your explicit written consent, except in limited circumstances such as: (a) Medical Emergencies: to the extent necessary to treat you, (b) Reporting Crimes on Program Premises, (c) Child Abuse Reporting: In connection with incidents of suspected child abuse or neglect to appropriate state or local authorities, and (d) Fundraising: We will provide you with an opportunity to decline to receive any fundraising communications prior to making such communications. You may revoke this consent at any time.

Prohibitions on Use and Disclosure of Part 2 Records: SUD records received from programs subject to Part 2, or testimony relaying the content of such records, shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless based on your written consent, or a court order after notice and an opportunity to be heard is provided to you or the holder of the record, as provided in Part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested SUD record is used or disclosed. If SUD records are disclosed to us or our business associates pursuant to your written consent for treatment, payment, and healthcare operations, we or our business associates may further use and disclose such health information without your written consent to the extent that the HIPAA regulations permit such uses and disclosures, consistent with the other provisions in this Notice regarding PHI.” (https://www.ecfr.gov/current/title-42/chapter-I/subchapter-A/part-2)

One other change is the creation of “SUD Counseling Notes”, a category like Psychotherapy Notes, which allows LCSWs to now have private notes about substance use disorders. This is not required, just as Psychotherapy Notes are not required, but is a new option for substance use disorders.

Please let me know if you have any questions about this new HIPAA Rule by contacting me at lwgroshong@clinicalsocialworkassociation.org.