BILL ANALYSIS Ó
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UNFINISHED BUSINESS
Bill No: SB 249
Author: Leno (D)
Amended: 9/3/13
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 4/24/13
AYES: Hernandez, Anderson, Beall, De León, DeSaulnier, Monning,
Nielsen, Pavley, Wolk
SENATE JUDICIARY COMMITTEE : 7-0, 4/30/13
AYES: Evans, Walters, Anderson, Corbett, Jackson, Leno, Monning
SENATE APPROPRIATIONS COMMITTEE : 7-0, 5/23/13
AYES: De León, Walters, Gaines, Hill, Lara, Padilla, Steinberg
SENATE FLOOR : 39-0, 5/28/13
AYES: Anderson, Beall, Berryhill, Block, Calderon, Cannella,
Corbett, Correa, De León, DeSaulnier, Emmerson, Evans, Fuller,
Gaines, Galgiani, Hancock, Hernandez, Hill, Hueso, Huff,
Jackson, Knight, Lara, Leno, Lieu, Liu, Monning, Nielsen,
Padilla, Pavley, Price, Roth, Steinberg, Torres, Walters,
Wolk, Wright, Wyland, Yee
NO VOTE RECORDED: Vacancy
ASSEMBLY FLOOR : 77-0, 9/9/13 - See last page for vote
SUBJECT : Public health: health records: confidentiality
SOURCE : AIDS Legal Referral Panel
Conference of California Bar Associations
L.A. Gay & Lesbian Center
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San Francisco AIDS Foundation
DIGEST : This bill 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.
Assembly Amendments clarify that both the local health officer
(LHO) and DPH are authorized to access reports of HIV infection
that are electronically submitted by laboratories, instead of
requiring laboratories, upon request by DPH, to report cases of
HIV infection by name directly, and make other, technical
changes.
ANALYSIS :
Existing law:
1. Requires DPH to administer a program to provide information,
establish testing sites, and award contracts for AIDS early
intervention projects for the provision of appropriate
medical treatment to prevent or delay the progression of
disease that results from HIV infection, to coordinate
related services, and to provide information and education to
prevent the spread of the infection to others.
2. Establishes, under the federal Health Insurance Portability
and Accountability Act of 1996 (HIPAA), requirements relating
to the provision of health insurance, and the protection of
privacy of individually identifiable health information.
3. Prohibits, under the state Confidentiality of Medical
Information Act, providers of health care, health care
service plans, or contractors, as defined, from sharing
medical information without the patient's written
authorization, subject to certain exceptions, including
disclosure to a probate court investigator, as specified.
4. Requires health care providers and laboratories to report
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cases of HIV infection to the LHO using patient names, as
specified. Requires LHOs to report unduplicated HIV cases by
name to DPH.
5. Requires health records relating to HIV or AIDS containing
personally identifying information, that were developed or
acquired by state or local public health agencies or an agent
of such an agency, to be confidential and not be disclosed,
except as provided by law for public health purposes or in
accordance with a written authorization by the person who is
the subject of the record or by his/her guardian or
conservator.
6. Permits disclosures for the purpose of facilitating
appropriate HIV/AIDS medical care and treatment, including:
A. The state public health agency HIV surveillance staff,
AIDS Drug Assistance Program (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/her HIV care, for the purpose of proactively
offering and coordinating care and treatment services to
him/her.
B. ADAP staff and DPH care services staff may further
disclose the information directly to the HIV-positive
person who is the subject of the record or the health care
provider who provides his or her HIV care, for the purpose
of proactively offering and coordinating care and
treatment services to him/her.
7. Prohibits the use of public health records related to persons
with HIV/AIDS to determine the insurability of any person.
Prohibits the use of the results of an HIV test for
determination of insurability, except for life and disability
insurance under certain conditions.
8. Establishes the ACA, which imposes various requirements, some
of which take effect on January 1, 2014, on states, carriers,
employers, and individuals regarding health care coverage.
Requires every individual to be covered under minimum
essential coverage, as specified, and requires every health
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insurance issuer offering coverage in the individual or small
group markets to ensure coverage includes specified essential
health benefits.
9. Establishes Covered California to facilitate the purchase of
qualified health plans by qualified individuals and small
employers by January 1, 2014.
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 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
Covered California, or any 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;
B. Covered California;
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C. Medi-Cal managed care plans;
D. Health plans participating in the Bridge Program;
E. Health plans offered through California; or
F. County health departments delivering HIV or AIDS health
care services.
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 LHO 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.
Background
According to a September 2012 Kaiser Family Foundation report
about expanded coverage for people with HIV/AIDS, under the ACA
there are multiple public and private sources of insurance
coverage and care for people with HIV in the United States.
Medicaid (Medi-Cal in California), the nation's principal
safety-net health insurance program for low-income Americans, is
estimated to cover the largest share of people with HIV. Fewer
are covered by Medicare (the federal health insurance program
for people age 65 and older and adults with permanent
disabilities), or have private insurance. A significant share
is uninsured, relying primarily on the RWA, the nation's single
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largest federal grant program designed specifically for people
with HIV who are uninsured or underinsured, and operating as the
"payer of last resort."
The RWA funds health care and support services for people who
have HIV/AIDS and who have no health insurance or are
underinsured. According to a 2009 Office of Inspector General
report to California, it is the largest source of federal
funding specifically for people with HIV/AIDS, and provides
assistance to more than 500,000 individuals each year. The RWA
includes a number of programs to meet the needs of different
communities and populations affected by HIV/AIDS.
In California, DPH/OA administers RWA Part B program funds given
to states and territories for HIV care, treatment and adherence
support services. According to DPH, under that program,
approximately 30,000 HIV Care Program/Minority AIDS Initiative;
40,500 AIDS Drug Assistance Program; and 900 Health Insurance
Premium Payment Program/Pre-Existing Condition Insurance Plan
clients were served in fiscal year 2011-12. In 2012, DPH/OA
received over $163.4 million RWA Part B funds.
Prior legislation
AB 714 (Atkins, 2011-12) would have required notices of health
care eligibility be sent to individuals who are enrolled in, or
who cease to be enrolled in, publicly funded state health care
programs. AB 714 was held on the Senate Appropriations
Committee suspense file.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Likely administrative costs in the hundreds of thousands to
develop agreements with other state agencies and health plans
by DPH (special fund).
Unknown potential information technology costs by DPH
(federal funds). DPH indicates that it may need to make
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changes to its information technology systems to share
information with other entities. At this time, DPH does not
know whether such changes are necessary or what they would
cost.
Potential increase in Medi-Cal costs in the low millions
(federal funds).
Unknown potential savings to programs administered by DPH
because this bill helps ensure that other sources of health
care coverage pay for services (federal funds).
SUPPORT : (Verified 5/23/13) (Unable to reverify at time of
writing)
AIDS Legal Referral Panel (co-source)
Conference of California Bar Associations (co-source)
L.A. Gay & Lesbian Center (co-source)
San Francisco AIDS Foundation (co-source)
AIDS Project Los Angeles
American Federation of State, County, and Municipal Employees,
AFL-CIO
California Communities United Institute
California Primary Care Association
Disability Rights California
National Association of Social Workers
Project Inform
Transgender Law Center
ARGUMENTS IN SUPPORT : The Conference of California Bar
Associations, AIDS Legal Referral Panel and the L.A. Gay &
Lesbian Center write that the prohibition on any sharing of HIV
information, except in extremely limited circumstances is not
only duplicative of the protections provided under other law,
but it is also an impediment to individuals enrolled in the-
funded services, who RWA must transition to new health coverage
systems under recent changes to the health care laws. The
California Primary Care Association states that existing law
impedes the RWA patients' access to care and providers' efforts
to coordinate care. The Community Clinic Association of Los
Angeles County writes that HIV-confidentiality law is inadequate
as it was drafted at a time when the only method for determining
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HIV status was a blood test, and that this bill extends the
protections that now apply to blood tests to all types of HIV
tests, including those which may be developed in the future.
ASSEMBLY FLOOR : 77-0, 9/9/13
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley,
Dahle, Daly, Dickinson, Donnelly, Fong, Fox, Frazier, Beth
Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gorell, Gray,
Grove, Hagman, Hall, Harkey, Roger Hernández, Holden, Jones,
Jones-Sawyer, Levine, Linder, Logue, Lowenthal, Maienschein,
Mansoor, Medina, Melendez, Mitchell, Morrell, Mullin,
Muratsuchi, Nazarian, Nestande, Olsen, Pan, Patterson, Perea,
V. Manuel Pérez, Quirk, Quirk-Silva, Rendon, Salas, Skinner,
Stone, Ting, Wagner, Waldron, Weber, Wieckowski, Wilk,
Williams, Yamada, John A. Pérez
NO VOTE RECORDED: Eggman, Vacancy, Vacancy
JL:d 9/9/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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