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