From: Laurie McBride Date: Mon, 4 Aug 1997 20:23:23 August 1, 1997 (97-5) LEGISLATIVE UPDATE: HIV/Health Care Policy Contacts: Eric Astacaan, Legislative Advocate Ellen McCormick, Legislative Advocate Laurie McBride, Executive Director Sam Catalano, Legislative Assistant LIFE: California's Lesbian, Gay, Bisexual, Transgender and HIV/AIDS Lobby 1997 PRIORITIES: 1997-98 CALIFORNIA STATE BUDGET 1997 AIDS Budget The Budget Sub-Committees of Health for both the California State Assembly and State Senate met and made their recommendations. Sub-Committee recommendations form the basis of the legislature's budget package. If the proposals are the same for individual line items from both the Assembly and Senate sides, then the proposals are pretty much set in stone. If they are different, they end up as discussion points in a joint Assembly/Senate budget "conference" committee: the discrepancy must be resolved there. AIDS Drug Assistance Program (ADAP) BACKGROUND: The Governor's Budget proposed a $47,288,000 increase to ADAP. This increase came from $11,659,000 General Fund, $18,600,000 in Title II federal funds, $4,129,000 in drug rebates, and the mandated use of $12,900,000 of local EMA funds. SUB-COMMITTEE RECOMMENDATIONS: Both State Assembly and Senate Sub-Committees agreed that EMAs should not be required to shift funds to ADAP. The $12.9 would now come from General Funds. In fact, the Governor's May Revise budget (updated after budget hearings) now calls for the same: the $12.9 for ADAP coming from State General Funds. At LIFE's February meeting, the House voted to oppose the mandatory requirement that EMAs shift funds to ADAP. Thus LIFE is strongly in support of the current budget proposal. Support (HOD 2/97) Viral Load Testing for ADAP Clients BACKGROUND: The Governor's Budget proposed $3.8 million from the General Fund to initiate viral load testing for ADAP clients. SUB-COMMITTEE RECOMMENDATIONS: Both recommended keeping the $3.8 for this purpose. Centralization of ADAP (Pharmaceutical Benefit Management [PBM] Contract) BACKGROUND: ADAP pharmacy services are currently administered through a decentralized system. DHS has accepted a bid from a PBM to reduce program costs without reducing availability of drugs or capping the number of prescriptions filled. Other benefits will include better data collection, better prices on drugs, and drug rebates to the state. SUB-COMMITTEE RECOMMENDATIONS: Conference item. The Senate Sub-Committee agreed that centralization was a good idea; the Assembly Sub-Committee called for centralization with a "carve-out" for Los Angeles. Curently: While the full budget accord has not been reached as of this date (07/30/97), agreement has been reached favoring statewide centralization with no carve out for Los Angeles. The company chosen to administer the statewide ADAP program has proposed a provider network far exceeding the existing network, and has put in place strong consumer protections. Support Centralization with No Carve-Out (HOD 6/97) Anonymous Testing Services BACKGROUND: The Governor's Budget proposed eliminating $1.6 million General Fund previously used for anonymous HIV testing services in family planning clinics. SUB-COMMITTEE RECOMMENDATIONS: Both recommended keeping the $1.6 for this purpose. AB 889 (Gallegos) Oppose Unless Amended Expanding and speeding up the addition of newly approved drugs to the ADAP formulary. Current law requires that all HIV therapies are included on the Medi-Cal formulary, and all newly approved drugs are added automatically. Thus Medi-Cal recipients have access to the full range of therapies for the treatment of HIV. Under the AIDS Drug Assistance Program (ADAP), however, the drug formulary of existing drugs is limited, and the addition of newly approved drugs is not automatic. Adding new therapies to the ADAP formulary is a prolonged process, involving review by a medical advisory committee and cost neutrality studies by the Department of Health Services and Department of Finance. AB 889 would expand the existing ADAP formulary by requiring the program to give any drug available to any eligible person with certain provisions. Opponents feel that enactment of this bill could actually damage, even bankrupt ADAP since, unlike Medi-Cal, ADAP has limited funds. Once funds run out, there is no mandate in place that would require the state or federal government to continue the program. Even a temporary interruption in the accessibility of ADAP drugs would endanger thousands of Californians. Until the funding mechanism is worked out, LIFE's House of Delegates continues to oppose. STATUS: Pending Senate Appropriations AB 967 (Migden) Support ADAP Funding: Legislation would provide that for the purposes of the Administration of ADAP, the Director of Health Services may request, but not require, a county to shift local or federal funds to administer the program. STATUS: Vetoed by Governor 1997 PRIORITIES: DISABILITY DETERMINATIONS/INSURANCE AB 1052 (Villaraigosa) Support Currently, new AIDS drugs are automatically added to the Medi-Cal formulary. This bill would provide for the automatic addition of any new AIDS vaccines and/or "anti-viral agents" used prophylactically. This bill expands existing law from drugs used to "treat" AIDS and opportunistic infections to include vaccines and prophylactic uses of anti-viral agents. STATUS: 05/21 Pending Senate Appropriations AB 1099 (Migden) Support Making it possible for Medi-Cal recipients living with AIDS to go back to work. Right now, Medi-Cal recipients who go back to work must pay a "share of cost" of any Medi-Cal benefits. Some people living with AIDS want to return to work, but find this "share of cost" a barrier to doing so. For example, an individual earning $2,000 a month would pay roughly $1000 in share of cost, leaving precious little for living and other expenses. AB 1099 would exempt up to $2500/month in earnings from counting toward the share of cost requirement. This exemption would hold until the individual is eligible for and receives full medical insurance coverage. STATUS: Pending Senate Appropriations AB 1137 (Ducheny) Watch Similar to AB 1052 by Villaraigosa. This bill is still in Assembly Health Committee. SB 495 (Rosenthal) Support Would increase weekly benefit cap to $490 from $336 for disability periods beginning 01/01/98. STATUS: Pending Assembly Floor SB 964 (Knight) Oppose Would take away safeguards for employees by making it easier for employers to opt out of State Disability Insurance program through a Voluntary Plan for coverage of disability benefits. STATUS: Stalled in Senate Industrial Relations SB 1035 (Polanco) Support Sets up a pilot project to allow DHS to study the cost-effectiveness of early intervention for patients who otherwise qualify for Medi-Cal but who are not yet disabled. The bill is designed to study the expense of treatment at certain stages of infection and illness, such as is it more or less expensive to let people get sick before offering treatment? This bill intends to set up a study and come up with some determinations. Sponsored by AIDS Healthcare Foundation. SB 1035 failed its first vote on the Senate floor; it needed 2/3 vote to pass. The 6/4 amendment made it a majority vote bill. It passed upon reconsideration. STATUS: Pending Assembly Appropriations 1997 PRIORITIES: ACCESS TO HEALTHCARE & SERVICES/ MANAGED CARE AB 7 (Brown) Support Requires every healthcare service plan contract, nonprofit hospital service plan contract, and certain disability insurance policies issued after 1/1/98 to include coverage for a minimum of 48 hours of inpatient care for a woman undergoing a mastectomy. STATUS: Pending Senate Floor AB 12 (Figueroa) Support Requires every health care service plan contract and every individual or group policy of disability insurance issued after 1/1/98 that provides mastectomy coverage to cover a physician ordered follow-up visit within 48 hours of discharge and to cover all complications from a mastectomy. STATUS: Pending Senate Appropriations AB 38 (Figueroa) Support Requires every healthcare service plan contract, nonprofit hospital service plan contract, and certain disability insurance policies issued after 1/1/98 that provide maternity coverage, from restricting benefits for inpatient hospital care to a time period less than 48 hours following a normal vaginal delivery and less than 96 hours for a caesarean section. STATUS: Pending Senate Floor AB 269 (Ortiz) Support Prohibits a health facility or physician and surgeon from permitting a patient to depart the facility or physician's office unless a physician or other appropriately licensed health professional has determined that the patient can be safely cared for in the home or other community setting. LIFE's concern that this could interfere with a patient's ability to leave "Against Medical Advice" has been addressed in the current amendments. The bill is strictly intended to protect patients from being released without the some assurances that proper care is available. STATUS: Pending Senate Insurance - Taken off Calendar AB 341 (Sweeney) Support Requires a health care service plan and certain disability insurers to authorize payment in a timely manner for a second opinion by an appropriately qualified health professional, if requested by an enrollee or insured. STATUS: Pending Senate Appropriations AB 434 (Gallegos) Support Requires the deletion of provisions stating that the reasons for the termination of a provider will only be disclosed if the termination occurs during the contract year. STATUS: Pending Senate Insurance AB 497 (Wildman) Support Some health care service plans, disability insurers, and contracting providers have apparently created a "screening" program for calls, that is: put the caller on hold for 10 minutes or more; hope that they don't call back. This bill would require health care plans, disability insurers, and contracting providers to answer phone calls within five minutes and imposes requirements regarding the time frame for appointments with specialists, and for responses to requests for care by patients in acute care. The committee recommended support because people with HIV and AIDS need and deserve timely responses for treatment . STATUS: Pending Senate Insurance, Hearing Set: 08/20/97 AB 536 (Gallegos) ` Support Would require a physician who denies service to health plan enrollees to be licensed in California; requires either a physical exam or a thorough review of the patient's medical records prior to a plan's decision to deny care; includes within the practice of medicine, making a decision resulting in denial of services to an enrollee; and requires various disclosures to enrollees. STATUS: Pending Senate Appropriations AB 663 (Ortiz) Support Would establish the INTENT of the legislature to create a Public Health Contingency Fund to provide counties with the resources for basic health protection services. Under this bill, would develop public health capacity standards to evaluate each counties "disease control capability". Any county that fails the evaluation would be eligible, based on demonstrated financial need, to receive state funding. There is no funding mechanism tied to this bill. STATUS: Pending Senate Appropriations AB 794 (Figueroa) Support Requires a healthcare service plan to disclose to any person or organization, upon request, the processes the plan uses to authorize or deny healthcare services by a provider pursuant to the benefits provided by the plan. STATUS: Pending Senate Appropriations AB 1100 (Thomson and Perata) Support Would require that health care service plans and disability insurers provide coverage for the diagnosis and treatment of mental illness on the same terms and conditions as coverage for other medical conditions. Proponents argue that mental illness is inappropriately treated because of lack of insurance coverage. STATUS: Pending Senate Appropriations AB 1208 (Migden) Support Would require DHS to study patient care issues on death and dying including: relevant court cases around terminally ill patients, physician assisted suicide, pain management, physician and/or health care provider abandonment, and insurance coverage. STATUS: Pending Senate Health Cmte AB 1298 (Villaraigosa) Support Prohibits a health care service plan, disability insurer or a contracting provider from impeding or impairing communication or the right of free association among enrollees or insureds, except to protect the health and safety of enrollees, insureds, and employees. Introduced because some HMOs were not allowing representatives from Health Access to talk with other patients in the waiting room or with employees. STATUS: Pending Senate Appropriations AB 1341 (Alquist) Support This bill would require any person or organization that receives state funds for health research to perform a specified percentage of its aggregate research on women's health and subsequently, with those funds, publish the results accordingly. STATUS: Pending Senate Appropriations SB 253 (Burton) Support Prohibits a health facility from discriminating or retaliating against a patient or employee of that facility because the patient or employee presents a grievance or complaint relating to the care, services or conditions of that facility. STATUS: Pending Assembly Appropriations SB 324 (Rosenthal) Support Requires the definition of the practice of medicine to include making a decision regarding the medical necessity or appropriateness of any diagnosis, treatment, operation, or prescription. STATUS: Pending Assembly Appropriations 1997 PRIORITIES: HIV PREVENTION/ EDUCATION/ HARM REDUCTION AB 600 (Kuehl) Support Family Access to Care and Treatment Program: To provide preventative health care services to low-income men and women. Preventative health care means screening, including periodic history, physicals, and appropriate laboratory tests; evaluation and counselling; including sexual health, family planning, fitness, psycho-social evaluation, cardiovascular risk, and other health factors; limited treatment including but not limited to treatment of sexual transmitted diseases, necessary immunizations, and contraceptive medical procedures and supplies. Under existing law, these services offered through the Office of Family Planning are restricted to women who can conceive. The purpose of this legislation is to open up the program to all persons who need medical treatment and related services. STATUS: Pending Senate Cmte AB 818 (Martinez) Support Existing law requires prenatal care providers to offer HIV testing to pregnant women (along with counselling and referral services). This bill would extend that requirement to include every medical care provider treating any patient from age 15 to 54 years of age. This bill would also require the State Office of AIDS to develop a voucher program for low-income individuals to get home HIV test kits. This voucher program should be implemented by January 1, 1999. LIFE's HIV/Healthcare Committee is in favor of requiring medical care providers to offer HIV testing to all patients. The committee sees a problem with the home HIV testing kits, however, citing problems of unreliability and lack of appropriate counselling. LIFE asked the author to drop the home testing provisions, which was done 5/1. STATUS: Pending Senate Health AB 881 (Runner) Oppose Would require every general acute care hospital to test every newborn; requires disclosure of results to the baby's parents or guardian. Additionally, the bill requires the hospital to report the number of tests with positive results to the Department of Health Services, without revealing the identity of the babies tested. STATUS: Pending Assembly Health Cmte, No hearing date scheduled - Two Year Bill SB 560 (Hayden) Support Regulated Chemicals Surtax: Creates a new tax to create the California Methamphetamine Reduction and Rehabilitation Fund. Potentially important to us because of the new evidence coming out that links Meth use with HIV sero-conversion. The items to be taxed are limited to cash purchases of specific chemicals used to make Methamphetamines. This legislation is crafted to avoid taxing over-the-counter products like Sudafed (commonly used in meth). It has also been crafted to avoid taxing legitimate uses of specific chemicals purchased in bulk by chemists, pharmacists, and labs. STATUS: Pending Assembly Appropriations SB 862 (Lee) Support If Amended Would establish the Interagency Commission on African American Males, to implement recommendations by the Commission on the Status of African American Males. Problems identified by the first commission included poverty, unemployment, and that "African American males represent 12 percent of the AIDS-related deaths in California". LIFE is seeking amendments to study homophobia within the African-American male community. STATUS: Pending Assembly Cmte SB 885 (Watson) Support This bill would establish the Clean Needle and Syringe Exchange Pilot Projects, and would authorize pharmacists, physicians, and certain persons authorized under the pilot projects to furnish hypodermic needles and syringes without a prescription or permit. The bill would authorize specified counties and cities to develop pilot projects upon the request of the county or city local health officer. (Same bill introduced last three years). This bill is being co-sponsored by the cities of Los Angeles, Long Beach, San Francisco and Santa Clara. STATUS: 05/19 Pending Assembly Appropriations SB 1007 (Vasconcellos) Support Comprehensive Statewide Plan for Prevention and Treatment of HIV/AIDS: To convene a Strategic Plan Task Force for the treatment of HIV/AIDS into the 21st Century. This planning mechanism will utilize community plans developed by Statewide Working Groups in both Treatment and Prevention, lending them weight in the public policy arena. Findings will also be useful in bill analysis and advocacy as legislators grapple with emerging problems. STATUS: Pending Assembly Appropriations SB 1110 (Leslie) Oppose Positive Parental Consent Bill: Originally required positive written parental consent before any public school student receives instruction on STDs, AIDS, human sexuality, family life, or any other health education instruction delivered by outside organizations or guest speakers. Further prohibitions on such discussions in general school assemblies even by school personnel without positive parental permission. Also adds emphasis on monogamy and other virtues to existing emphasis on abstinence. Changes requirement for instruction on compassion for people with AIDS to compassion for "anyone with a debilitating handicap(s) and/or terminal disease." Would prohibit teaching compassion (as in tolerance, acceptance, respect) for drug use or any "particular" sexual "lifestyle" or "practice." Substantially amended: Now requires parental notification of guest speakers. Objectionable language about "particular lifestyles" has been removed. Opposition of other groups has changed to neutral or even support. STATUS: Assembly Appropriations SB 1301 (Leslie) Oppose Close the bathhouses: Legislative attempt to close the bathhouses. Several amendments were tried, but this bill in all forms was successfully defeated in its first hearing. STATUS: Stalled in Senate Judiciary Cmte 1997 PRIORITIES: MEDICAL USE OF MARIJUANA AB 610 (Margett) Oppose Creates nearly insurmountable obstacles for the implementation of Proposition 215 by imposing enormous licensing fees and taxes on the cultivation, and separately, the distribution of marijuana for medicinal use. STATUS: Pending hearings in Assembly Health & Assembly Agriculture - Two year bill SB 535 (Vasconcellos) Support Would create a Marijuana Research Program. SB 535 authorizes the University of California to create a California Medical Marijuana Research Center to develop and implement medical marijuana studies and to solicit proposals for research projects. It also appropriates $2 million of State General Fund dollars to the Center to conduct this research. Lack of such research is often cited as a reason for denying the medicinal use of marijuana. Yet research projects at the federal and state level have been blocked for years. SB 535 would push the state to allow serious medical research to begin. STATUS: Pending Assembly Appropriations HIV, THE PRISONS AND CRIMINAL JUSTICE AB 29 (Villaraigosa) Support Compassionate Release: This bill would establish a procedure for recalling a prisoner's sentence if the prisoner is found to be terminally ill. This is a re-introduction of last year's legislation, which Governor Wilson vetoed. STATUS: Pending Senate Floor SB 705 (Rainey) Oppose Criminalizing the intentional transmission of HIV. Recent amendments limit SB 705's provisions to the intentional transmission of HIV through sexual contact without disclosure. The penalty has been reduced to a felony punishable by imprisonment for 5, 7, or 9 years. Amended out: provisions covering needle sharing, the lesser penalties of exposing someone without intent; plus intent must be proven by prosecutors; obtaining medical records requires a court hearing and disclosure is defined simply as relating HIV status. STATUS: Pending Assembly Appropriations MEDICAL INSURANCE FOR THE UNINSURED LIFE's House of Delegates voted to take a WATCH position on a number of bills designed to expand access and/or eligibility to health insurance for uninsured Californians. We strongly support the concept of universal health coverage. AB 534 (Thomson) Watch Health Care Coverage Expansion Act of 1997. Would cover more children through Medi-Cal and create a program for low-income employees and dependents to provide a basic benefit package. STATUS: Pending Senate Floor AB 1112 (Gallegos) Watch California Health Program. Would provide health coverage to uninsured Californians through Medi-Cal. STATUS: Pending Senate Floor AB 1126 (Villaraigosa) Support Would expand Medi-Cal eligibility, without share of cost, to individuals under 19 years of age with family incomes at or below 200 % of poverty. Important to us because of the number of youth with HIV and AIDS who are not accessing any medical care because of cost. Studies show a correlation between lack of access to primary care and primary infection for youth. In California there are 1.7 million youth through age 18 without insurance. Recently the San Francisco DPH released statistics which estimated that there are 4700 young people with HIV in the city (ages 13-26). Less than 10% of these youth are enrolled in HIV care. STATUS: Pending Assembly Concurrence AB 1430 (Figueroa) Watch Health Insurance Act of 1998. Would state the intent of the legislature to offer low-income people the option of receiving medical care through a basic insurance package. Would offer employers lower workers' compensation insurance rates in return for providing basic health insurance. STATUS: Pending Senate Floor SB 954 (Rosenthal) Watch Health Insurance Access for Children and Families Act of 1997. Would establish a program of publicly sponsored health insurance to be provided through commercial and non-profit providers. Specifically for working uninsured residents of California, and to be administered by MRMIP (Managed Risk Medical Insurance Board). STATUS: Pending Assembly Floor MISC INSURANCE ISSUES AB 49 (Murray) Support Workers Compensation, Death Benefits & HIV Related Disease: This bill would provide that workers' compensation death benefits shall be furnished in the case of the death of a medical health worker or public safety employee, as specified, due to HIV related disease, subject to specified conditions. Under existing law, a proceeding to collect workers' compensation benefits for the death of an asbestos worker must be commenced within one year of the date of death. This bill would provide that the same time limit applies to a proceeding to collect those benefits for the death of a medical health worker or public safety employee, as specified, from an HIV related disease. STATUS: Pending Senate Industrial Relations - Two Year Bill AB 489 (Figueroa) Support Viatical insurance bill sponsored by APLA, which would allow owners of group Life Insurance policies to make viatical settlements. STATUS: Pending Senate Floor SB 393 (Rosenthal) Support Existing law, which LIFE supported, requires health insurers and plans to offer and issue health coverage to small employers without any exclusions due to medical underwriting or other than the employers' willingness to make premium payments. Existing law defines small employers as those with 2 to 50 employees. This bill would extend those guidelines to employers with 51 to 100 employees. STATUS: Pending Assembly Appropriations SB 462 (Rosenthal) Support Existing law prohibits medical providers from charging patients for clinical lab tests if the test is not actually perform or supervised in their offices. This bill would allow physicians to charge for HIV tests, if the test kit bought by the doctors includes the cost of the lab fee. STATUS: Pending Senate Appropriations - Two Year Bill SB 1137 (Kopp) Watch Would allow life and disability agents to be licensed as viatical settlement brokers and would authorize the Insurance Commissioner to adopt conflict of interest regulations. Staff is doing research on the provisions in this bill to require additional education, if any; also checking on conflict of interest issues. STATUS: Pending Senate Concurrence SB 1262 (Johnston) Watch Existing law authorizes life and disability insurers to decline an insurance application on the basis of a positive HIV test performed at the discretion of the insurer on the applicant's blood. This bill would expand this to include any test performed by the insurer on any specimen of the applicant. Reflects the changes in testing procedures, including oral tests. STATUS: Pending Assembly Floor MEDICAL LIABILITY ISSUES AB 250 (Kuehl) Support Requires that the $250,000 limitation on non-economic losses shall NOT apply if the healthcare provider acted in any of the following ways: 1) consumed alcohol or illegal drugs that impaired his or her ability to perform professional services causing injury to the plaintiff; the healthcare provider has had three or more disciplinary actions taken against him or her; 3) committed sexual abuse or misconduct upon the plaintiff; 4) the injury resulted from gross negligence; 5) the negligence or misconduct resulted in death; 6) the injury was to a person under the age of 14 years. STATUS: Assembly Inactive File AB 1220 (Migden) Support Requires that the $250,000 limitation on non-economic losses shall NOT apply if the healthcare provider acted in any of the following ways: 1) refused or delayed evaluation, diagnosis, treatment, or made a referral to another health care provider for the provider's economic benefit; 2) failed to refer to another health care provider who possessed the requisite skill, training and expertise; 3) administered an evaluation, diagnosis, or treatment without possessing the requisite skill, training, or expertise. STATUS: Pending Assembly Judiciary Cmte - Two Year Bill MEDI-CAL AND AFDC RELATED AB 426 (Gallegos) Support Requires Medi-Cal to test enrollment information materials for cultural and linguistic appropriateness and ease of comprehension. STATUS: Pending Senate Floor SB 163 (Solis) Support Exempts eligible relative caregivers from the 2-year work participation requirements and the 5-year eligibility limitations contained in new federal laws. STATUS: Pending Assembly Desk PREVENTION-RELATED ITEMS AB 995 (Pacheco) Oppose Gassing. Irate inmates have been known to throw handfuls of fecal matter at prison guards, an activity known as "gassing." Originally this bill would have made gassing an "assault with a deadly weapon". AB 995 has been amended to make gassing "aggravated battery"; all references to HIV have been taken out; the bill does refer to tuberculosis and hepatitis. STATUS: Pending Senate Appropriations SB 274 (Watson) Support Tuberculosis control. Would authorize DHS to make grants to local health jurisdictions or joint entities to fund secured housing for recalcitrant patients to enable local health officers to implement legal orders of detention for the examination and treatment of tuberculosis. STATUS: Pending Senate Health Cmte POSSIBLE LEGISLATIVE POSITIONS SPONSOR: LIFE to participate in drafting, strategy, lobbying, and amendments to bill, in conjunction with the author's office and other sponsors (if any). Support: Support of the bill. Support Seeking Amendment: Support stands regardless of the fate of amendments. Support IF Amended: Support when amendments are accepted. Neutral Watch: No action, just watching. Oppose Unless Amended: Authors and sponsors are notified of LIFE's opposition unless LIFE's amendments are accepted. Oppose No Position ---------------------------------------------------------------------------- This message has been brought to you by LIFE: California's Lesbian, Gay, Bisexual, Transgender and HIV/AIDS Lobby. LIFE has been lobbying on behalf of California's lesbian, gay, bisexual, transgender and HIV-affected communities since 1986. LIFE is the oldest and largest institution representing these communities in California's State Capitol and is proud to celebrate over a decade of service. If you would like further information about LIFE activities, events or membership please contact our office at: LIFE: California's Lesbian, Gay, Bisexual, Transgender and HIV/AIDS Lobby 926 J Street, Suite 522 Sacramento, CA 95814 (916) 444-0424 fax (916) 444-3059