Provides for HIV related testing to be offered routinely during medical visits

Section 2 amends PHL 2781 to remove redundant pre-test counseling provisions in subdivision 2, these standards are instead included in subdivision 3 and are consistent with current Department of Health guidelines. A new subdivision 2-a is added allowing written consent for an HIV-related test to be part of a signed general consent to medical care. The general consent must include a clearly marked place adjacent to the signature line allowing an individual to specifically decline HIV related testing in writing. An informed consent would remain valid until revoked or it expires, oral notification (documented in a patient's record) to a subject would be required for any subsequent performance of an HIV related test. Subdivision 5 is amended to streamline post-test counseling provisions. A new subdivision 5-a is added to provide for the arrangement of follow-up medical care for persons testing positive for HIV.

Section 3 adds a new section 2781-a to the Public Health Law requiring every physician, physician assistant, nurse practitioner, or midwife to offer to perform or arrange for an HIV -related test for individuals between the ages of 18 and 64 when the individual is receiving primary care services, or care in an emergency room, from the practitioner. Exceptions are made for instances where the individual is being treated for a life threatening emergency, the individual has received an HIV test in the past 12 months, or the individual lacks capacity to consent. The offering of an HIV related test would be required to be in a culturally and linguistically appropriate manner in accordance with rules and regulations from the Commissioner of Health.

Sections 4 and 5 make technical amendments to PHL 2782(8) and 2785-a(2) respectively.

Section 6 requires the Commissioner of Health to report to the Governor and the Legislature two and four years after the bill takes effect assessing the impact of required offering on the frequency of HIV testing and other outcomes.

Section 7 sets an effective date of 180 days after the bill shall have become law.

Existing law

Currently, the HIV informed consent must be separate from a general informed consent and must be written. There is no mandate for HIV testing by age group, regardless of risk, and pre- and post-counseling is required.

Justification

More than 100,000 New York City residents are living with HIV/AIDS - more cases than Los Angeles, San Francisco, Miami, and combined. Each year, more than 1,000 people in NYC first find out that they are HIV-positive when they are already sick with AIDS. They had been infected, on average, for 10 years. The key to stemming this epidemic, as recognized by the Mayor of New York City, the CDC, San Francisco, and other jurisdictions, is making voluntary HIV testing a routine part of medical care in the same manner as testing for other treatable conditions. Now that there is effective treatment, the benefits of getting tested for HIV far outweigh the risks. Reducing barriers to HIV testing and improving linkage to care of those testing HIV-positive will help people learn their status, live longer, protect themselves, and reduce spread of HIV.

A one-time, durable written consent which may be included as part of the general medical consent, with the option to opt-out at time of getting written consent and oral notification prior to testing is a much more streamlined approach. This will further support patient-autonomy because the patient can choose to decline test at the time of offer and/or can withdraw consent at any time.

The provisions in this bill are complementary in that they mandate health care practitioners offer HIV testing, while at the same time streamlining the counseling and consent process that health care practitioners often cite as an administrative burden and barrier to their offering of HIV tests.

Legislative history

2007-2008: S.6326

Fiscal implications

Minimal, as mandating testing will increase state reimbursements for tests.

Local fiscal implications

To be determined.

Effective date

180 days after it shall have become law.