BILL NUMBER:A303

TITLE OF BILL:

An act to amend the insurance law and the social services law, in
relation to requiring health care service plans and health insurers to
provide insurance coverage for human immunodeficiency virus (HIV) test-
ing

PURPOSE OR GENERAL IDEA OF BILL:

This bill would amend the Insurance Law to require insurers to cover the
cost of HIV testing, regardless of the patient's primary diagnosis, in
order to increase HIV screening and make it part of routine medical
care.

SUMMARY OF SPECIFIC PROVISIONS:

Section one of the bill amends Insurance Law section 3216, subsection
(i), by adding a new paragraph 26. The new paragraph requires coverage
of HIV testing in every policy that provides hospital, surgical or
medical care coverage or provides reimbursement for laboratory tests or
reimbursement for diagnostic x-ray services.  Coverage of HIV testing is
required regardless of whether the testing is related to a primary diag-
nosis.

              

Sections two and three of the bill make similar changes to Insurance Law
sections 3221 and 4303 respectively. Section four of the bill makes a
conforming change to Social Services Law section 369-ee.  Section five
of the bill is the effective date.

JUSTIFICATION:

The approximately 30,000 or more New Yorkers who do not know that they
are HIV infected do not receive appropriate medical treatment, nor do
they receive counseling, based on early diagnosis of HIV, that would
encourage them to adopt behaviors to prevent further HIV transmission.
One reason for delayed or nonexistent diagnosis is that HIV testing is
not a routine part of medical care. Routine HIV testing is a key to
controlling the spread of HIV infection, and the CDC has recommended
that HIV screening become part of routine medical care for all persons
aged 13-64. One barrier to routine screening is the lack of coverage for
HIV screening by some health insurance carriers. This bill promotes the
inclusion of HIV testing into regular medical care by assuring health
care providers that testing will be covered by the patient's insurance,
regardless of the diagnosis that is the primary reason for the medical
care.

It can be estimated that somewhere between 28,000 and 37,000 New Yorkers
do not know that they have HIV, based on the following data.  The
Centers for Disease Control and Prevention (CDC) has estimated that one

in four people living with HIV in the United States is unaware of being
infected. See the CDC's Morbidity and Mortality Weekly Report (MMWR),
June 27, 2003; see also MMWR August 8, 2008, citing the same 1 in 4
statistic in a discussion of HIV testing. Put another way, the total
number of known diagnosed cases is probably only about 75% of all cases
- diagnosed and undiagnosed. The most recent New York State Health
Department's Annual Surveillance Report for cases diagnosed through
December 2006 (published May 2008) reports 112,308 living HIV and AIDS
cases (Table 2A). The 28,000 at the low end of the estimate of undiag-
nosed cases is 25% of known (diagnosed) cases at the end of 2006.  The
37,000 at the high end of the estimated range represents 25% of the
total, if indeed the approximately 112,000 known cases as of December
2006 was only 75% of the actual total number of cases, both diagnosed
and undiagnosed. Even the low estimate is a significant number of undi-
agnosed cases, and it is critical to increase routine testing so that
people who are currently unaware that they are infected with HIV can
receive treatment and counseling that will help reduce the rate of HIV
transmission.

PRIOR LEGISLATIVE HISTORY:

New bill.

FISCAL IMPLICATIONS:

No new costs to the state. HIV testing and counseling is already a
covered benefit in Medicaid managed care, Family Health Plus and Medi-
caid fee-for-service.

EFFECTIVE DATE:

This act shall take effect immediately.