Navigating TEFCA and 42 CFR Part 2: What Behavioral Health Providers Need to Know

The Trusted Exchange Framework and Common Agreement (TEFCA) is poised to transform health information exchange by creating a nationwide, interoperable network. For behavioral health providers, this presents new opportunities to improve care coordination and patient access—but also raises critical questions about how sensitive data, particularly information protected by 42 CFR Part 2, fits into this framework.

What Is TEFCA?

TEFCA, established under the 21st Century Cures Act, creates a standardized “network of networks” for the exchange of electronic health information (EHI). Through Qualified Health Information Networks (QHINs) and common privacy and security requirements, TEFCA aims to simplify and secure data exchange for treatment, public health, payment, and individual access.

The Special Considerations for Behavioral Health

Behavioral health providers stand to benefit from TEFCA’s streamlined interoperability:

• Faster access to patient records across systems

• Enhanced care coordination for mental health and substance use patients

• Better patient access to their own behavioral health records

However, behavioral health data often comes with heightened privacy concerns. Substance Use Disorder (SUD) treatment records are protected under 42 CFR Part 2, a federal regulation that imposes stricter consent and disclosure requirements than HIPAA.

Can Part 2-Protected Data Be Shared Under TEFCA?

Yes—but only with the proper patient consent or in circumstances allowed by Part 2 regulations. TEFCA does not override 42 CFR Part 2. Any participant in the TEFCA network must comply with all applicable privacy laws, including Part 2, meaning that:

• Part 2 data cannot be exchanged through TEFCA for treatment or other purposes without explicit patient consent.

• Behavioral health organizations or HIEs must implement consent management solutions that comply with Part 2 requirements.

• QHINs and health IT vendors must support data segmentation and tagging, ensuring sensitive information is only disclosed according to the patient’s wishes.

The Technical and Policy Landscape

While TEFCA lays the groundwork for national exchange, the technical capabilities to fully support Part 2 compliance—such as data segmentation for privacy (DS4P) and granular consent management—are still maturing. Many networks and EHR systems are working to implement these features, and federal agencies are continuing to refine the rules.

Recent updates to 42 CFR Part 2, finalized in 2024, aim to harmonize it more closely with HIPAA. These changes may simplify some aspects of consent and redisclosure, but TEFCA participants will still need to meet strict standards when handling behavioral health data.

What Should Behavioral Health Providers Do Now?

✔ Assess your readiness: Understand what data your organization shares and whether your systems support TEFCA participation and Part 2 compliance.

✔ Engage your technology partners: Ask your EHR, HIE, or other vendors about their TEFCA and consent management capabilities.

✔ Update your consent processes: Ensure that your intake and care processes obtain appropriate consent for data sharing through TEFCA.

✔ Stay informed: TEFCA’s technical standards and policy framework will continue to evolve. Watch for updates from the Office of the National Coordinator for Health IT (ONC) and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Looking Ahead

TEFCA holds tremendous promise for behavioral health, making data exchange more seamless and secure. But achieving that vision responsibly requires careful attention to privacy protections like 42 CFR Part 2. By combining modern interoperability frameworks with patient-centered consent practices, behavioral health providers can play a vital role in building a connected, compassionate healthcare system.