Requires health care service plans and health insurers to provide insurance coverage for human immunodeficiency virus (HIV) testing on or after January 1, 2010

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.