BILL ANALYSIS Ó
SB 249
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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
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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
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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
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