Coordinated Care Consent


CalMHSA worked with law firm Manatt to create a Universal Consent that mirrored DHCS’s work on the ASCMI. As SmartCare implementation went along, counties started expressing their concerns about such a consent. CalMHSA altered this Universal Consent to be a more focused consent that addressed coordinating care between the mental health and substance use treatment providers within a county’s system of care. This new Coordinated Care Consent would focus specifically on the sharing of data within the SmartCare application only; any sharing of data with people who could not access SmartCare would require a standard Release of Information (ROI) authorization.

How it Works

In SmartCare, there is a concept called Clinical Data Access Group, or CDAG. This is a group of programs that can share clinical data freely amongst themselves. For mental health programs, HIPAA allows sharing of clinical data fairly freely so long as it is for treatment, payment, or operations (TPO). This means that a provider working at MH Program A can share clinical information for treatment reasons with a provider working at MH Program B, even if that program is at a completely different agency. For substance use treatment programs, 42 CFR is stricter. Recent changes to this regulation allow for a single authorization to be used without naming specific names, but an authorization is still required to share clinical data between Providers, meaning legal entities or agencies. If there are two substance abuse counselors (SACs) who work at SUD Program C, they can share information because they are both working with the client. However, if one SAC works for SUD Agency X and the other SAC works for SUD Agency Y, then an ROI is needed for them to share clinical information.

CDAGs allow system administrators to designate these groups based on how their county’s system of care operates. Every SmartCare user must be assigned at least one CDAG. This determines what the user can see when logged into SmartCare. The user will only be able to see documents associated with a program that is associated with their CDAG. Any other documents will be hidden from that user.

This is how SmartCare works by default. This is “the rule.” However, clients can request that their providers be able to coordinate with each other. The client can then sign a Coordinated Care Consent document in SmartCare. Once the client signs this document, the CDAG rules for this client no longer apply. Any SmartCare user will be able to see all clinical documents regardless of what program the document is associated with. This is “the exception” to “the rule.”

For CDAG rules to be overruled, there must be:

  1. a Coordinated Care Consent
  2. that indicates the client agrees to share
  3. that is signed by the client or guardian
  4. with client signature date of today or earlier

CDAG rules apply unless all 4 of the above items are present.

When creating a document in SmartCare, the author of the document must sign the document first. This creates a PDF version of the document and adds automatic co-signers to the document. Usually, this author is a staff member. Once the author (staff member) has signed the Coordinated Care Consent, the client (and their guardian, if applicable) is added as a co-signer. The CDAG rules remain in effect until the client and/or the guardian co-sign the Coordinated Care Consent. If only the author (staff member) signs the Coordinated Care Consent, then CDAG rules still apply.

As opposed to standard ROIs, there is no way to limit the date range of records that the Coordinated Care Consent applies to. When the Coordinated Care Consent is signed by the client, all records will be visible to all SmartCare users, regardless of the date of the record. Since CDAG rules are either on (the rule) or off (the exception), the client’s signature cannot be backdated. The date the client’s signature is documented in SmartCare is the date SmartCare will disable CDAG for that client.

The client can revoke their consent at any time by completing a new Coordinated Care Consent with the “I consent” field marked as “no”. Once the document is signed, the author (staff member) can document that the client provided verbal consent in the client signature popup window. The client’s approval (whether by signature or verbal approval) must be documented before the CDAG rules re-apply.

County Feedback

In August 2023, three county counsels reached out to CalMHSA on behalf of a contingent of county counsels requesting changes to this document. CalMHSA began meeting with these three representatives alongside Manatt to address their concerns. All updates to this document were taken back to the county counsels by their representatives for review and approval, and all changes were reviewed by Manatt. Updates were implemented in May 2024.

Updated 5/23/24