BILL ANALYSIS Ó
SB 249
Page 1
SENATE THIRD READING
SB 249 (Leno)
As Amended September 3, 2013
Majority vote
SENATE VOTE :39-0
HEALTH 18-0 APPROPRIATIONS 17-0
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|Ayes:|Pan, Logue, Ammiano, |Ayes:|Gatto, Harkey, Bigelow, |
| |Atkins, Bonilla, Bonta, | |Bocanegra, Bradford, Ian |
| |Chesbro, | |Calderon, Campos, |
| |Roger Hernández, | |Donnelly, Eggman, Gomez, |
| |Gonzalez, Maienschein, | |Hall, Holden, Linder, |
| |Mansoor, Mitchell, | |Pan, Quirk, Wagner, Weber |
| |Nazarian, Nestande, | | |
| |V. Manuel Pérez, Wagner, | | |
| |Wieckowski, Wilk | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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SUMMARY : Authorizes the sharing of health records involving the
diagnosis, care, and treatment of human immunodeficiency virus
(HIV) or acquired immunodeficiency syndrome (AIDS) related to a
beneficiary enrolled in federal Ryan White Act (RWA) funded
programs who may be eligible for health care under the federal
Patient Protection and Affordable Care Act (ACA) between the
Department of Public Health (DPH) and qualified entities, as
specified. Specifically, this bill :
1) Authorizes DPH and qualified entities, as defined, to
share with each other health records involving the
diagnosis, care, and treatment of HIV or AIDS related to a
beneficiary enrolled in RWA funded programs who may be
eligible for services under the ACA.
2) Authorizes qualified entities who are covered entities
under the Health Insurance Portability and Accountability
Act (HIPAA), as specified, to share records only for the
purpose of enrolling the beneficiary in Medi-Cal, the
Bridge Programs, Medicaid expansion programs, and any
insurance plan certified by the California Health Benefit
Exchange (Exchange), now called Covered California, or any
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other program under the ACA, as specified, and for the
purpose of continuing access to these programs and plans
without disruption.
3) Requires the information provided by DPH to be limited
only to the information necessary for the provisions in 1)
and 2) above, and excludes HIV or AIDS surveillance data.
Prohibits the further disclosure by any qualified entity,
except to any of the following, as necessary:
a) The person who is the subject of the record or to his or
her guardian or conservator;
b) The provider of health care for the person with HIV or
AIDS to whom the information pertains; or,
c) The Office of AIDS (OA) within DPH.
4) Defines qualified entity to mean the following:
a) Department of Health Care Services (DHCS);
b) The Exchange;
c) Medi-Cal managed care plans;
d) Health plans participating in the Bridge Program;
e) Health plans offered through the Exchange; or,
f) County health departments delivering HIV or AIDS health
care services.
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5) Prohibits the disclosure, discovery, or compelling the
production of the shared information in any civil,
criminal, administrative, or other proceeding.
6) Provides that 1) through 5) above are to be implemented
only to the extent permitted pursuant to federal law and
all employees and contractors of a qualified entity who
have access to confidential HIV-related medical records
under this bill are subject to, and all information that is
shared is to be protected under HIPAA, the Confidentiality
of Medical Information Act, and the Insurance Information
and Privacy Protection Act.
7)Authorizes the local health officer and DPH to access reports
of HIV infection that are electronically submitted by
laboratories, as specified.
8)Extends privacy protections that currently apply to HIV blood
tests to all types of HIV tests.
9)Makes other technical, clarifying, and conforming changes.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Potential costs in the low hundreds of thousands of dollars
(special fund/General Fund (GF)) to DPH to develop
administrative data sharing agreements and potentially modify
information technology systems pursuant to this bill. DHCS,
Covered California, and county health departments also may
incur unknown but likely minor costs for this purpose.
2)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 RWA
programs operated by DPH 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:
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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 RWA programs operated by
DPH 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.
COMMENTS : 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 RWA 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 HIV information causes serious problems for
both patients trying to access health care and providers who are
trying to coordinate care. At the same time, current HIV
confidentiality law is inadequate because it does not protect
the confidentiality of all types of HIV tests that are now
available. To illustrate the need for this bill, the author and
the sponsors point out that in 2011, data sharing was essential
to a successful transition of AIDS Drug Assistance Program
(ADAP) clients to the Low Income Health Programs (LIHPs) and
trailer bill language was created to facilitate the sharing of
data between DPH/OA and LIHPs. Prior to this trailer bill
language, DPH/OA was not able to share this data. This bill
addresses these problems by allowing the sharing of information
in limited circumstances.
In order to protect the privacy of individuals who are the
subject of HIV testing, current law prohibits the disclosure of
an HIV test to any third party in a manner that identifies or
provides identifying characteristics of the person to whom the
test results apply, unless pursuant to a written authorization.
The law prohibits the negligent, willful, or malicious
disclosure of such tests and prescribes penalties for such
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violations. Current law authorizes the disclosure of HIV tests
without written authorization to the subject of the test or
his/her legal representative, as specified; the test subject's
provider of health care (including an agent or employee), or to
an emergency response employee, as specified.
Public health records relating to HIV or AIDS which contain
personally identifying information that were developed or
acquired by a state or local health agency are confidential and
cannot be disclosed except for public health purposes or
pursuant to a written authorization by the person who is the
subject of the record. However, personally identifying
information may be disclosed when the confidential information
is necessary to carry out the duties of the agency or researcher
in the investigation, control, or surveillance of the disease.
Additionally, for purposes of facilitating appropriate HIV/AIDS
medical care and treatment, the following disclosures are
authorized:
1)State public health agency HIV surveillance staff, ADAP staff,
and care services staff may further disclose the information
to local public health agency staff, who may further disclose
the information to the HIV-positive person who is the subject
of the record, or the health care provider who provides his or
her HIV care; and,
2)ADAP staff and DPH care services staff may disclose the
information directly to the HIV-positive person who is the
subject or the record of the health care provider who provides
his or her HIV care.
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097
FN: 0002169