BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  SB 249
                                                                  Page  1

          Date of Hearing:   August 14, 2013

                        ASSEMBLY COMMITTEE ON APPROPRIATIONS
                                  Mike Gatto, Chair

                     SB 249 (Leno) - As Amended:  June 27, 2013 

          Policy Committee:                             HealthVote:18-0
                       Judiciary                        Vote: 10-0

          Urgency:     No                   State Mandated Local Program:  
          No     Reimbursable:              No

           SUMMARY  

          This bill revises rules related to sharing and disclosure of  
          information on a person's HIV status. Specifically, key  
          provisions of this bill:

          1)Require laboratories, upon request by the California  
            Department of Public Health (CDPH), to report cases of HIV  
            infection by name directly to CDPH.

          2)Authorize local public health staff to disclose information  
            related to a person's HIV status to that person or their  
            health care provider for the purpose of proactively offering  
            and coordinating care and treatment services to that person.

          3)Authorize CDPH and qualified entities (such as the Department  
            of Health Care Services (DHCS) and Medi-Cal managed care  
            plans) to share with each other health records of  
            beneficiaries enrolled in federal Ryan White Act funded  
            programs who may be eligible for other health care programs.

          4)Require employees and contractors, as defined, of a qualified  
            entity who have legal access to confidential HIV-related  
            medical records to sign confidentiality agreements pursuant to  
            provisions of existing law. 

           FISCAL EFFECT  

          1)Potential costs in the low hundreds of thousands of dollars  
            (special fund/GF) to CDPH to develop administrative data  
            sharing agreements and potentially modify information  
            technology systems pursuant to this bill.  DHCS, Covered  








                                                                  SB 249
                                                                  Page  2

            California, and county health departments also may incur  
            unknown but likely minor costs for this purpose.   

          2)Potential costs of up to $200,000 GF annually for CDPH to  
            track confidentiality agreements.

          3)This bill will facilitate data-sharing that may lead more  
            individuals to enroll in Medi-Cal and health care coverage  
            through Covered California, leaving fewer individuals in Ryan  
            White Care Act programs operated by CDPH and local programs.   
            It is impossible to attribute an exact fiscal effect to the  
            bill specifically, since individuals may transition to  
            different coverage options regardless of this bill.  However,  
            to the extent the information-sharing allowed by this bill  
            results in more individuals transitioning sooner than would  
            otherwise be the case, the following effects are expected:

             a)   Potential increases in Medi-Cal costs related to  
               additional Medi-Cal enrollees (100% federal funds  
               initially, then ramping down to 90% federal/10% GF by  
               2020).
             b)   Potential increases in Covered California costs related  
               to additional enrollees (federal/special funds).
             c)   Unknown potential savings to Ryan White Care Act  
               programs operated by CDPH and local health care programs  
               (federal and local funds), assuming this bill helps more  
               individuals gain coverage for which they are eligible  
               through Medi-Cal or Covered California. 

            This bill also may reduce the total cost burden of HIV/AIDS  
            care statewide by facilitating care coordination that prevents  
            deterioration of a person's medical condition. Well-controlled  
            HIV/AIDS infection is less costly to treat.

           COMMENTS  

           1)Rationale  . According to the author, the prohibition on  
            disclosure of HIV information has become not only somewhat  
            redundant because of laws that protect the confidentiality of  
            all medical information, but is also an impediment to  
            individuals enrolled in the federal Ryan White Care Act  
            (RWCA)-funded services.  As a result of federal and state  
            health care reform, those individuals must transition to new  
            health coverage systems.  Current restrictions on the sharing  
            of information causes serious problems for both patients  








                                                                  SB 249
                                                                  Page  3

            trying to access health care and providers who are trying to  
            coordinate care.  This bill addresses these problems by  
            allowing the sharing of information in limited circumstances.

           2)Background  . In the the early years of the epidemic, policies  
            surrounding HIV/AIDS emphasized the autonomy and privacy  
            rights of people with or at risk for infection. This has led  
            to HIV/AIDS being treated differently than other diseases and  
            conditions in regard to many testing, consent, and reporting  
            requirements.  In some cases, special treatment around HIV  
            data has led to barriers in identification, communication and  
            provision of care coordination.  

            Numerous programs and services are available for individuals  
            with HIV/AIDS, including:
             a)   Federally funded Ryan White Care Act programs, including  
               the AIDS Drug Assistance Program (ADAP), housing,  
               outpatient care, and other services.  RWCA programs are  
               meant to fill in gaps in other services and are generally  
               the funder of last resort.  RWCA programs are administered  
               by the CDPH and local jurisdictions that are funded  
               directly.   
             b)   Low-Income Health Programs, which are  
               county/federal-funded transitional programs for individuals  
               who will qualify for the expansion of Medi-Cal in 2014.  
             c)   Medi-Cal, which will provide comprehensive health care  
               services for legally residing individuals under 138% of  
               poverty effective January 1, 2014, as well as continue  
               providing some special services through the AIDS Medi-Cal  
               Waiver program.
             d)   Covered California, which will begin providing coverage  
               for any legally residing individual who applies for  
               coverage in 2014, with the help of federal subsidies for  
               qualifying individuals.   
             e)   Local county-administered indigent health programs.

            Given new opportunities and individual responsibility for  
            coverage in 2014, an individual may transition from one of  
            these programs to another, with attendant differences in plans  
            medical providers.  This bill will facilitate communication  
            between these and other entities involved in providing care. 

           Analysis Prepared by  :    Lisa Murawski / APPR. / (916) 319-2081 










                                                                  SB 249
                                                                  Page  4