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The purpose of the ETE Dashboard Policy Tracker is to monitor and report progress on the ETE policy agenda in New York State. This interactive timeline is organized by the key recommendations from the ETE Blueprint and highlights legislative and policy changes/adoptions related to the NYS ETE Initiative. Newly introduced legislation and policies that have not been passed or adopted are not shown. If you have any questions or comments about the information presented here, please do not hesitate to contact us.
Updated 2018
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Blueprint Recommendation Timeline
ETE
Aim
1
Identify persons with HIV who remain undiagnosed and link them to health care
Show ETE Blueprint Recommendations 1-4:
ETE
Aim
1
Identify persons with HIV who remain undiagnosed and link them to health care
Hide ETE Blueprint Recommendations 1-4:
Policy Milestones Timeline
Make routine HIV testing truly routine
BP1
Simplify HIV Testing Consent
The New York State Enacted Budget (FY 2014-15 included Article VII legislation to simplify consent requirements for HIV-related testing consistent with Centers for Disease Control and Prevention (CDC) guidelines.
If not identified and treated early, HIV infection progresses and escalates to AIDS. Individuals who are infected but not on treatment are more likely to transmit the virus. Indeed, almost half of all new infections are thought to be from individuals who are unaware of their HIV status. In recognition of this fact, the first point of the Governor's three point plan is to identify persons with HIV who remain undiagnosed and to link them to care. Since 2010, New York State has required that health care providers offer HIV testing to all patients between the ages of 13 and 64 as a routine part of health care services. However, a 2015 review of hospital implementation of the requirement showed that too many New Yorkers are still not taking advantage of available testing. This bill takes steps to remove any barriers to individuals being able to voluntarily accept HIV testing by reducing administrative hurdles, and by educating individuals about their HIV status and options for accessing treatment.
2014-15 New York State Executive Budget, Health and Mental Hygiene Article VII Legislation.
Chapter 60 of the Laws of 2014, Part A.
Require Opt-out HIV Testing and Improve Routine HIV Testing for Older Adults
Chapter 502 of the Laws of 2016 amends Public Health Law (PHL) § 2781 to streamline routine HIV testing. The amendments require that, at a minimum, the individual be advised that an HIV related test is going to being performed, and that any objection by the individual be noted in the individual's medical record. The legislation also amends PHL to eliminate the existing upper age limit for purposes of offering an HIV related test. Previous statute limited the mandatory offering to individuals between thirteen and sixty-four years of age. NYSDOH adopted regulations effective May 17, 2017 to further clarify the intent of this legislation.
HIV testing must be made available to more New Yorkers. Half of all people living with diagnosed HIV infection in this State are age 50 and older, and approximately 200 cases of HIV are diagnosed each year in persons age 60 and older. This bill removes the upper age limit of 64 on the requirement of offering an HIV test, mandating that an HIV test be offered to all adults, regardless of age. There is no scientific basis justifying a 64 year age limit, and people over such age remain exposed to multiple risk factors. In addition, with the advent of new medications, persons over the age of 64 diagnosed with HIV are now able to live average life spans. However, early diagnosis and access to treatment remain essential, and this legislation furthers that goal.
Press release on Governor signing Ending the Epidemic legislation
New York State Assembly Bill A10724
New York State Assembly Bill S8129
New York Codes, Rules, and Regulations, Title 10, Part 63
Chapter 502 of the Laws of 2016. NYSDOH final rulemaking for 10 NYCRR Part 63
Expand targeted testing
BP2
Authorize Registered Nurses to Conduct STD Screenings
Chapter 502 of the Laws of 2016 amends Education Law to allow registered nurses to conduct STD screenings.
The Ending the Epidemic Blueprint recommends expanded STD screening and education along with the expansion of PrEP services. STD rates are increasing in New York State. In 2016, there were 2,472 cases of primary and secondary syphilis, 29,048 gonorrhea cases, and 109,549 chlamydia cases, all representing an increase from the previous year. To address this problem, STD screening and sexual health care must become a routine health care service. This bill amends the New York State Education Law to allow registered nurses to screen persons at increased risk for syphilis, gonorrhea and chlamydia, pursuant to a non-patient specific order. Expanding the existing nursing scope of practice to allow for registered nurses to screen persons at increased risk for these STDs will increase the number of people being diagnosed and treated, and will reduce the overall risks for HIV.
New York State Assembly Bill A10724
New York State Assembly Bill S8129
Chapter 502 of the Laws of 2016
Address acute HIV infection
BP3
Update Guidelines for Acute HIV Infection
The Diagnosis and Management of Acute Infection guidelines were updated in the summer of 2015. The guideline is intended to increase the identification and assessment of acute HIV infection, and supports initiating an tiretroviral therapy (ART) for those patients. The guideline also revises the recommended testing methods to be used to diagnose infection. The updated guideline is being widely disseminated using a variety of program contacts and media.
NYS DOH, Medical Care Criteria Committee (September 2015)
Improve referral and engagement
BP4
Enhance HIV Data Sharing to Improve HIV Health Outcomes
The New York State Enacted Budget (FY 2014-15) included Article VII legislation to allow for enhanced data sharing among health care providers and health departments to maintain patient linkages and improve continuity and retention in care. This legislation was enacted in the 2014-15 NYS Budget.
The Ending the Epidemic Blueprint recommends the use of viral load and other data collected by the New York State HIV surveillance system as a mechanism for objective validation of performance. Also recommended is the use of electronic medical record prompts in all settings to identify non-virally suppressed persons in need of re-engagement or other assistance. This legislation allows local and state health departments to share patient-specific identified information with health care providers for the purposes of patient linkage and retention in care, as approved by the health commissioner. Reportable quality measures and monitoring of performance related to viral suppression by HIV providers, facilities and managed care plans will contribute to the improvement of treatment outcomes across the state.
New York Codes, Rules, and Regulations, Title 10, Part 63
Chapter 60 of the Laws of 2014, Part A.
ETE
Aim
2
Link and retain persons diagnosed with HIV in care to maximize virus suppression so they remain healthy and prevent further transmission
Show ETE Blueprint Recommendations 5-10:
ETE
Aim
2
Link and retain persons diagnosed with HIV in care to maximize virus suppression so they remain healthy and prevent further transmission
Hide ETE Blueprint Recommendations 5-10:
Policy Milestones Timeline
Continuously act to monitor and improve rates of viral suppression
BP5
Enhance HIV Data Sharing to Improve HIV Health Outcomes
The New York State Enacted Budget (FY 2014-15) included Article VII legislation to allow for enhanced data sharing among health care providers and health departments to maintain patient linkages and improve continuity and retention in care.
The Ending the Epidemic Blueprint recommends the use of viral load and other data collected by the New York State HIV surveillance system as a mechanism for objective validation of performance. Also recommended is the use of electronic medical record prompts in all settings to identify non-virally suppressed persons in need of re-engagement or other assistance. This legislation allows local and state health departments to share patient-specific identified information with health care providers for the purposes of patient linkage and retention in care, as approved by the health commissioner. Reportable quality measures and monitoring of performance related to viral suppression by HIV providers, facilities and managed care plans will contribute to the improvement of treatment outcomes across the state.
New York Codes, Rules, and Regulations, Title 10, Part 63
Chapter 60 of the Laws of 2014, Part A.
Incentivize performance
BP6
Scale up integrated, client-centered toolkit for providers and people with HIV to address social and structural barriers to ART adherence
In 2016, the New York City Department of Health and Mental Hygiene (DOHMH) contracted with seven agencies in NYC to scale up The Undetectables over a three-year period as an initiative to advance the NY Ending the Epidemic Blueprint goal to retain persons with HIV in effective care. NYC DOHMH and Housing Works have provided coordinated technical assistance and training to ensure fidelity to the program mode.
The Ending the Epidemic Blueprint recommends incentivizing performance, including for patients by providing gift cards or non-cash rewards for reaching adherence milestones, keeping appointments, and achieving or sustaining an undetectable viral load. The Undetectables Viral Load Suppression Program, developed by Housing Works, is a client-centered approach that employs a toolkit of evidence-based adherence supports, including financial incentives for achieving or maintaining viral suppression, in the context of integrated health and care coordination services. An innovative social marketing component acknowledges treatment adherence as an heroic act to protect individual and community health. A two-year Housing Works pilot demonstrated significant improvements in durable viral suppression, and in July 2016, the New York City Department of Health and Mental Hygiene (DOHMH) contracted with seven agencies in NYC to scale up The Undetectables over a three-year period as an initiative to advance the NY Ending the Epidemic Blueprint goal to retain persons with HIV in effective care. NYC DOHMH and Housing Works have provided coordinated technical assistance and training to ensure fidelity to the program mode, and the program currently serves over 1700 PLWH. As a component of an intervention to address social and structural barriers to anti-retroviral therapy (ART) adherence, the incentives provided by The Undetectables Program promote maintaining the health of people living with HIV (PLWH), preventing new infections, and advancing health equity.
New York City Department of Health and Mental Hygiene RFP
Use client-level data to identify and assist patients lost to care or not virally suppressed
BP7
Enhance HIV Data Sharing to Improve HIV Health Outcomes
The New York State Enacted Budget (FY 2014-15) included Article VII legislation to allow for enhanced data sharing among health care providers and health departments to maintain patient linkages and improve continuity and retention in care.
The Ending the Epidemic Blueprint recommends using client-level data to identify and assist patients lost to care or not virally suppressed. There are many reasons that patients may be lost to care from the perspective of a particular provider or system. Since data about patients may be present in multiple, non-connected data systems such as hospital and clinic electronic medical records, insurance billing, pharmacy utilization, and surveillance, there are common instances of persons appearing lost in one system but remaining visible in others. Also, patients may move out of the jurisdiction, become incarcerated, or die from non-HIV- related causes. This legislation allows local and state health departments to share patient-specific identified information with health care providers for the purposes of patient linkage and retention in care, as approved by the health commissioner. The ability to match data and link systems to improve health outcomes will reduce inefficiencies such as using outreach workers to find someone no longer in the area or who has chosen to use a different provider. Properly cross-checked data will support the initiation of appropriate provider or public health interventions to identify those persons truly lost to care or not virally suppressed and improve their health outcomes.
2014-15 New York State Executive Budget, Health and Mental Hygiene Article VII Legislation.
Chapter 60 of the Laws of 2014, Part A.
Enhance and streamline services to support the non-medical needs of all persons with HIV
BP8
Provide enhanced services for patients within correctional facilities and other institutional settings
BP9
Oral Consent for HIV Testing in Correctional Facilities
The New York State Enacted Budget (FY 2015-16) included Article VII legislation to authorize the elimination of the requirement of written consent for HIV testing in New York State correctional facilities.
Chapter 57 of the Laws of 2015, Part I
Maximize Opportunities Through the DSRIP Process
BP 10
Authorize Continued Operation of SNPs
The New York State Enacted Budget (FY 2016-17) included Article VII legislation to authorize the continued operation of HIV Special Needs Plans (SNPs) serving persons with mental illness or HIV until 2020. There are currently three Special Needs Plans statewide serving approximately 14,540 recipients.
Chapter 59 of the Laws of 2016, Part D.
Make SNPs available on the NYS of Health Insurance Marketplace
As of January 15, 2016, eligible health care consumers have the ability to select and enroll in an HIV Special Needs Health Plan (SNP) through the New York State of Health (NYSoH) Marketplace, for the first time since the NYSoH was established in 2012.
ETE
Aim
3
Provide access to PrEP for high-risk persons to keep them HIV-negative
Show ETE Blueprint Recommendations 11-14:
ETE
Aim
3
Provide access to PrEP for high-risk persons to keep them HIV-negative
Hide ETE Blueprint Recommendations 11-14:
Policy Milestones Timeline
Undertake a Statewide Education Campaign on PrEP and nPEP
BP 11
Include a Variety of Statewide Programs for Distribution and Increased Access to PrEP and nPEP
BP 12
Authorize Prescription of nPEP Starter Packs
Chapter 502 of the Laws of 2016 amends Education Law to allow a licensed physician and certified nurse practitioner to prescribe and order a patient or non-patient specific order for dispensing up to a seven day starter pack of of HIV post-exposure prophylaxis (nPEP) for the purpose of preventing HIV infection following a potential HIV exposure. The legislation also allows a licensed pharmacist to execute a non-patient specific order for dispensing up to a seven day starter pack of nPEP.
Chapter 502 of the Laws of 2016.
Create a Coordinated Statewide Mechanism for Persons to Access PrEP and nPEP and Prevention-Focused Care
BP 13
Establish a Pre-Exposure Prophylaxis Assistance Program (PrEP-AP)
In 2015, the New York State Department of Health, AIDS Institute created a Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) modeled on and using the HIV Uninsured Care Programs (HUCP), primary care (ADAP Plus), operational systems and infrastructure. PrEP-AP provides reimbursement for necessary primary care services for eligible individuals being seen by providers who are experienced providing services to HIV-negative, high-risk, individuals.
https://www.health.ny.gov/diseases/aids/general/resources/adap/prep.htm
Develop Mechanisms to Determine PrEP and nPEP Usage and Adherence Statewide
BP 14
ETE
Aim
4
Recommendations in support of decreasing new infections and disease progression
Show ETE Blueprint Recommendations 15-30:
ETE
Aim
4
Support decreasing new infectious and disease progression
Hide ETE Blueprint Recommendations 15-30:
Policy Milestones Timeline
Increase Momentum in Promoting the Health of People who Use Drugs
BP 15
Clarify provisions of law related to Expanded Syringe Access Program and medical provider- based syringe access programs
The New York State Enacted Budget (FY 2015-16) included Article VII legislation to amend the Penal Law 220.45 to explicitly decriminalize syringe posesion or posession of a residual amount of a controlled substance for persons participating in the State's Expanded Syringe Access Program (ESAP) or a medical provider-based syringe access program.
Chapter 57 of the Laws of 2015, Part I.
Expanding naloxone at independent pharmacies outside NYC
On March 2, 2016, Governor Andrew Cuomo announced that the Harm Reduction Coalition, the NYS DOH’s Center for Excellence in serving the needs of substance users, will issue standing medical orders to the more than 750 independent pharmacies outside the five boroughs of New York City, as well as chain pharmacies without a designated prescriber, allowing their pharmacists to dispense naloxone without a prescription. As a DOH-registered overdose prevention program, the HRC is able to issue these standing orders. Many smaller counties in the state have no chain pharmacies and rely exclusively on independent pharmacies.
https://www.governor.ny.gov/news/governor-cuomo-announces-narcan-now-available-independent-pharmacies
http://harmreduction.org/overdose-prevention/nyspharmacies/
Naloxone Co-payment Assistance Program (N-CAP)
Governor Andrew Cuomo announced a first-in-the-nation program to provide no-cost or lower-cost naloxone at pharmacies across New York State. Beginning August 9, 2017, individuals with prescription health insurance coverage, including Medicaid and Medicare, will receive up to $40 in co-payment assistance, resulting in reduced cost or no cost for this lifesaving medicine. Uninsured individuals and individuals without prescription coverage will still be able to receive naloxone at no cost through New York's network of registered opioid overdose prevention programs.
https://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/directories.htm
Ensure Access to Stable Housing
BP 16
Expand eligibility to HASA in NYC
On June 23, 2016, Governor Andrew Cuomo announced a NYS DOH policy change that expanded eligibility to NYS Emergency Shelter Allowance to all people with an HIV diagnosis as well as the 30% income contribution cap toward rental costs for HIV-positive New York City Public Assistance recipients.
The inability to meet basic subsistence needs is a formidable barrier to consistent engagement in HIV care and treatment effectiveness at each point in the HIV care continuum. Expanding the reach of HIV specific housing and services and establishing access to these public benefits for low income people with HIV infection will address the social drivers of the epidemic (and related health disparities) by ensuring that each eligible person with HIV is linked to critical enablers of effective HIV treatment, including a safe, stable and appropriate place to live, adequate nutrition and the ability to travel to health care and supportive services (GTZ 1 and BP 16, Ensure access to stable housing).
NYS DOH Policy Statement: Defining Program Eligibility by HIV Status. June 23, 2016.
Expand essential benefits and services for all income-eligible persons with HIV statewide
NYS bill S3449 and the concurrent A315, also known as PATHS (Point of Access to Housing and Services), will amend the Social Services Law to direct the Office of Temporary and Disability Assistance (OTDA) to ensure that local departments of social services (LDSS’s) provide expedited access to essential benefits and social services – including safe, appropriate and affordable housing, food and transportation support – for all income-eligible persons with HIV in the State.
Legislation reintroduced in 2017.
The inability to meet basic subsistence needs is a formidable barrier to consistent engagement in HIV care and treatment effectiveness at each point in the HIV care continuum. Expanding the reach of HIV specific housing and services and establishing a clear point of access to these public benefits for low income people with HIV infection in LDSSs across NYS will address the social drivers of the epidemic (and related health disparities) by ensuring that each eligible person with HIV is linked to critical enablers of effective HIV treatment, including a safe, stable and appropriate place to live, adequate nutrition and the ability to travel to health care and supportive services (GTZ 1 and BP 16, Ensure access to stable housing).
S3449, A315
Reducing New HIV Incidence Among Homeless Youth Through Stable Housing & Supportive Services
BP 17
Raise the maximum age for RHY services to 24
The New York State Enacted Budget (FY 2017-2018) included Article VII legislation to expand the application of the New York State Runaway and Homeless Youth Act to include individuals age 24 and younger who need services and are without a place of shelter where supervision and care are available, an increase from the upper limit of 21. The enacted budget also allows municipalities to significantly extend the length of stay in Runaway and Homeless Youth (RHY) crisis and transitional beds.
Homeless youth are at high risk for HIV infection. Several factors place homeless youth at risk for HIV including survival sex (trading sex for basic needs), having multiple sexual partners, low frequency of condom use, and injection drug use. The early start of sexual activity and the large number of sexual partners also place some homeless youth at risk for HIV infection. In one study of New York City street youth, 21 percent of males and 24 percent of females reported having had more than 100 lifetime partners.
Chapter 56 of the Laws of 2017, Part M.
Health, Housing and Human Rights for LGBT Communities
BP 18
Prohibition on Conversion Therapy
On February 6, 2016, Governor Cuomo announced multi-agency regulations intended to probhibit conversion therapy--practices by mental health providers that seek to change an individuals's sexual orientation or gender identity or expression. The NYS Department of Financial Services issued regulations barring insurers from providing coverage for conversion therapy for minors and prohibitied coverage for conversion therapy under the NYS Medicaid program. The NYS Office of Mental Health issued regulations prohibiting facilities under its jurisdiction from providing conversion therapy treatment to minors.
https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/OMH_conversiontherapy.pdf
NYC LGBTQ Health Care Bill of Rights
On June 6, 2017, the administration of NYC Mayor Bill de Blasio announced the first-ever LGBTQ Health Care Bill of Rights.
https://www1.nyc.gov/assets/doh/downloads/pdf/ah/lgbtq-bor-wallet.pdf
Institute an Integrated Comprehensive Approach to Transgender Health Care & Human Rights
BP 19
Provide Health Insurance Coverage for the Treatment of Gender Dysphoria
NYS Department of Financial Services (DFS) issued a regulatory guidance to all NYS insurers that a policy that includes coverage for mental health conditions may not exclude coverage for the diagnosis and treatment of gender dysphoria. Effective March 11, 2015, the NYS Medicaid program will cover medically hormone therapy and gender alignment surgery for individuals with a diagnosis of gender dysphoria (ICD-9 code 302.85). Hormone therapy is covered for individuals 18 years of age and older. Gender reassignment surgery is covered for individuals who are 18 years of age or older, or 21 years of age or older if that surgery will result in sterilization.
http://www.transgenderlegal.org/media/uploads/doc_597.pdf
https://www.health.ny.gov/health_care/medicaid/program/update/2015/jun15_mu.pdf
NYS DFS, Insurance Circular Letter No. 7 (2014)
Gender Identity Human Rights Protections
On January 20, 2016, Governor Cuomo announced that the New York State Division of Human Rights adopted new regulations that prohibit discrimination and harassment against transgender people. The regulations affirm that transgender individuals are protected under the State’s Human Rights Law.
NYS DHR, 9 New York Code of Rules and Regulations (NYCRR) §466.13, Discrimination on the basis of gender identity.
Improving Access to NYC Facilities for Transgender and Gender Non-conforming Persons
On March 7, 2016, Mayor Bill de Blasio issued an Executive Order that requires city agencies to ensure that employees and members of the public using NYC facilities are allowed to use restrooms and other single-sex facilities consistent with their gender identity or expression.
Executive Order No. 16, 2016
Improve Collection of Gender Identity Information on Community Health Survey
In 2016, NYC Department of Health and Mental Hygiene approved the inclusion of a two-step question on sex assigned at birth and current gender identity in the 2017 Community Health Survey, the Department 's annual telephone health survey of NYC adults. The two-step question aligns with an emeging national standard for the accurate and inclusive collection of individuals' gender identity.
http://www1.nyc.gov/site/doh/data/data-sets/community-health-survey.page
Community Health Survey
Protect coverage for health services provided to transgender individuals
NYS Department of Financial Services (DFS) issued a regulatory guidance to all NYS insurers in order to ensure that transgender individuals are able to access covered services. The guidance specifies that an issuer should not deny a claim for a health service provided to an individual because the individual is seemingly not of the gender to whom the service is typically or exclusively provided without seeking additional information to determine whether the service was appropriately provided to the individual.
NYS DFS, Insurance Circular Letter No. 12 (2017)
Expanded Medicaid Coverage for Sexual & Drug-Related Health Services to Targeted Populations
BP 20
Naloxone Co-payment Assistance Program (N-CAP)
Governor Andrew Cuomo announced a first-in-the-nation program to provide no-cost or lower-cost naloxone at pharmacies across New York State. Beginning August 9, 2017, individuals with prescription health insurance coverage, including Medicaid and Medicare, will receive up to $40 in co-payment assistance, resulting in reduced cost or no cost for this lifesaving medicine. Uninsured individuals and individuals without prescription coverage will still be able to receive naloxone at no cost through New York's network of registered opioid overdose prevention programs.
https://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/directories.htm
Establish Mechanisms for an HIV Peer Workforce
BP 21
Peer Worker Certification Program
The NYS DOH AIDS Institute established Peer Worker Certification Program in 2015. Peer certification is highlighted in the NYS Blueprint for Ending the AIDS Epidemic and peer services can play a key role in meeting the state’s goals of increasing linkage and retention in care, rates of viral suppression, and preventing new infections. Anticipation of possible future Medicaid reimbursement for peer-delivered interventions makes moving forward with peer worker certification a critical step in ensuring access to this revenue stream for the support of peer services.
https://www.health.ny.gov/diseases/aids/ending_the_epidemic/docs/webinar_series/vocational_opps/cotroneo.pdf
https://www.hivtrainingny.org/home/peercertification
Access to Care for Residents of Rural, Suburban and Other Areas of the State
BP 22
Promote Comprehensive Sexual Health Education
BP 23
Comprehensive Sex Ed Mandate
NYS bill S3737 and the concurrent A768 would add a new section 817 to the NYS Education Law to require the Commissioners of Health, Mental Health and Education to create and establish a comprehensive, medically accurate and age-appropriate sex education curriculum to be taught in grades 1-12 in all public and charter schools.
Legislation reintroduced in 2017.
The ETE Blueprint supports educating New York State youth in making healthy, positive choices about sexual health in order to avoid negative health outcomes such as HIV and STIs and unintended pregnancy (BP 23, Promote comprehensive sexual health education). This recommendation supports an expansion of comprehensive, age-appropriate, medically accurate health and sexuality education in 1-12 schools, which in turn would increase the number of young people receiving ageappropriate information about HIV and STI prevention tools, such as condoms, and nPEP and PrEP. This recommendation will also create a foundation of support for HIV testing by providing young people with information and messages that encourage and normalize HIV testing and prevention tools such as condoms, nPEP and PrEP. Mandating a basic curriculum for sexual health education is necessary to ensure that all youth are provided with the same essential public health information. A curriculum developed under the direction of these three State agencies will be inclusive of the full range of health and mental health issues currently affecting our youth, and the use of a uniform curriculum will facilitate implementation across the State.
S3737, A768
Healthy Teens Act
NYS bills S.700-A and the concurrent A.1616-A, also known as the Healthy Teens Act, would add language to NYS Public Health Law §§1450 – 1457 to establish a grant program through the NYS Department of Health (DOH) to support provision of age-appropriate health and sexuality education in NYS 1-12 education by eligible applicants. The following organizations and institutions would be able to apply to the DOH grant program: public school districts, boards of cooperative educational services, school-based health centers and community organizations.
Legislation reintroduced in 2017.
The ETE Blueprint supports educating New York State youth in making healthy, positive choices about sexual health in order to avoid negative health outcomes such as HIV and STIs and unintended pregnancy (BP 23, Promote comprehensive sexual health education and GTZ5 Passage of the Healthy Teens Act). This recommendation supports an expansion of comprehensive, age-appropriate, medically accurate health and sexuality education in K-12 schools, which in turn would increase the number of young people receiving age- appropriate information about HIV and STI prevention tools, such as condoms, and nPEP and PrEP. This recommendation will also create a foundation of support for HIV testing by providing young people with information and messages that encourage and normalize HIV testing. Mandating comprehensive sexual health education with curriculum developed by the Departments of Health, Mental Health and Education is the optimal way to ensure that our youth are provided with the most recent, medically accurate information available as well as ensuring that all of our youth have access such information.
S1070, A2750
Remove Disincentives Related to Possession of Condoms
BP 24
Decriminalize condom posession
Governor Andrew Cuomo's 2015-16 Executive Budget included Article VII legislation to amend the Criminal Procedure Law to limit the admission of condoms in criminal proceedings for misdemeanor prostitution offenses.
2015-16 NYS Executive Budget, Health and Mental Hygiene Article VII Legislation
Treatment as Prevention Information and Anti-Stigma Media Campaign
BP 25
NYS DOH endorsement of Prevention Access Campaign Consensus Statement: Undetectable = Untransmittable (U = U)
In September 2017, NYS DOH became the first State health department to endorse the Prevention Access Campaign Consensus Statement that the risk of sexual transmission of HIV from a person living with HIV who has an undetectable viral load is negligible. Commissioner Howard A. Zucker sent a Dear Colleague to clinicians and stakeholders summarizing the scientific findings that have difiniteively demonstrated definitively demonstrated that not only does effective antiretroviral therapy and sustained viral load suppression improve the individual health of each person with HIV, it also prevents the transmission of HIV to their sexual partners.
https://www.health.ny.gov/diseases/aids/ending_the_epidemic/docs/september_physician_letter.pdf
https://www.health.ny.gov/diseases/aids/ending_the_epidemic/docs/september_stakeholder_letter.pdf
Dear Colleague Letter from Commissioner Howard A. Zucker, September 29, 2017
Provide HCV Testing for PLWH and Remove Restrictions to HCV Treatment Access Based on Financial Considerations
BP 26
HCV Routine Testing Law
Chapter 425 of the Laws of 2013 requires the offering of a hepatitis C screening test to every individual born between 1945 and 1965 receiving inpatient hospital care or primary care. The New York State Hepatitis C Testing Law is in line with recommendations issued by the CDC and the U.S. Preventive Services Task Force. This law sunsets on January 1, 2020.
https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/rapid_antibody_testing/faqs.htm
https://www.health.ny.gov/diseases/communicable/hepatitis/hepatitis_c/docs/hcv_testing_law_evaluation.pdf
Chapter 425 of the Laws of 2013.
Remove disease prognosis and severity restrictions for HCV treatments
On April 27, 2016, the New York State Drug Utilization Review (DUR) Board removed the disease prognosis and severity clinical criteria for non-preferred hepatitis C direct acting antivirals (DAAs). Prior DUR restrictions required Medicaid fee-for-service patients to have stage 3 fibrosis or cirrhosis, or a concurrent HIV-infection, before non-prefered hepatitsi C DAAs were covered.
https://www.health.ny.gov/health_care/medicaid/program/dur/meetings/2016/04/summary_durb.pdf
New York State Medicaid Drug Utilization Review (DUR) Board Meeting Summary for April 27, 2016
Amendment of the NYS AIDS Drugs Assistance Program (ADAP) formulary to cover Hepatitis hep C direct acting antivirals (DAAs).
Following successful pricing negotiations with pharmaceutical manufacturers by the National ADAP Crisis Task Force, in which New York has a leadership role, the New York State Department of Health, AIDS Drug Assistance Program (ADAP) will offer access to Hepatitis C direct acting antivirals (DAAs) for participants in the state’s AIDS Drug Assistance Program. This formulary addition was effective November 28, 2016. Prior to this only peginterferon and ribavirin were on the formulary.
https://www.health.ny.gov/diseases/aids/general/resources/adap/formulary.htm
https://www.nastad.org/sites/default/files/ADAP-Crisis-Task-Force-Fact-Sheet-November-2016.pdf
NYSDOH HIV Uninsured Care Programs, Covered Services and ADAP Formulary - June 2017
Implement the Compassionate Care Act in a Way Most Likely to Improve HIV Viral Suppression
BP 27
Equitable Funding Where Resources Follow the Statistics of the Epidemic
BP 28
Expand and Enhance the Use of Data to Track and Report Progress
BP 29
Enhance HIV Data Sharing and improve care coordination
The New York State Department of Health proposed regulations to amend 10 NYCRR Part 63 that address HIV testing, HIV case reporting, and expanded data sharing to allow case coordinators acces to HIV-related information for the purpose of linkage to and retention in care, among other maters.
https://docs.dos.ny.gov/info/register/2016/dec14/pdf/rulemaking.pdf
Chapter 461 of the Laws of 2016. This law was further clarified in 10 NYCRR Part 63, effective May 17, 2017.
Increase Access to Opportunities for Employment and Employment/Vocational Services
BP 30
Peer Worker Certification Program
The NYS DOH AIDS Institute established Peer Worker Certification Program in 2015. Peer certification is highlighted in the NYS Blueprint for Ending the AIDS Epidemic and peer services can play a key role in meeting the state’s goals of increasing linkage and retention in care, rates of viral suppression and preventing new infections. Anticipation of possible future Medicaid reimbursement for peer-delivered interventions makes moving forward with peer worker certification a critical step in ensuring access to this revenue stream for the support of peer services.
Getting to Zero Recommendation Timeline
Show ETE Blueprint Getting to Zero Recommendations
Show ETE Blueprint Getting to Zero Recommendations
Getting to Zero Recommendation 1
Single point of entry within all Local Social Service Districts across NYS to essential benefits and services for low-income persons with HIV/AIDS.
Expand essential benefits and services for all income-eligible persons with HIV statewide
NYS bill S3449 and the concurrent A315, also known as PATHS (Point of Access to Housing and Services), will amend the Social Services Law to direct the Office of Temporary and Disability Assistance (OTDA) to ensure that local departments of social services (LDSS’s) provide expedited access to essential benefits and social services – including safe, appropriate and affordable housing, food and transportation support – for all income-eligible persons with HIV in the State.
Legislation reintroduced in 2016.
The inability to meet basic subsistence needs is a formidable barrier to consistent engagement in HIV care and treatment effectiveness at each point in the HIV care continuum. Expanding the reach of HIV specific housing and services and establishing a clear point of access to these public benefits for low income people with HIV infection in LDSSs across NYS will address the social drivers of the epidemic (and related health disparities) by ensuring that each eligible person with HIV is linked to critical enablers of effective HIV treatment, including a safe, stable and appropriate place to live, adequate nutrition and the ability to travel to health care and supportive services (GTZ 1 and BP 16, Ensure access to stable housing).
S3449, A315
Getting to Zero Recommendation 2
Decriminalization of condoms.
Prohibition on the use of condoms as evidence
NYS bill S5062/A7061 would amend civil and criminal laws, rules and practices to prohibit use of the possession or presence on the premises of condoms and other sexual and reproductive health devices as evidence of any crime; and, further, repeal certain provisions of the criminal procedure law relating to condoms.
Legislation reintroduced in 2017.
As a part of the 2015-16 NYS budget, and in an attempt to curb the use of condoms as evidence for the majority of impacted New Yorkers, Governor Cuomo recommended, and the Legislature approved, language that would ban the use of condoms as evidence for two specific misdemeanor offenses: prostitution and loitering for the purposes of prostitution. The two crimes represented 90% of the arrests in which condoms had been used as evidence. This was a vital step, yet in practice condoms are still subject to confiscation and may be used as evidence of other crimes, both misdemeanor and felony. Condoms are a vital tool for New Yorkers to practice safer sex and protect themselves from HIV and other sexually transmitted infections. According to the U.S. Centers for Disease Control and Prevention (CDC), “a number of carefully conducted studies, employing rigorous methods and measures, have demonstrated that consistent condom use is highly effective in preventing HIV transmission.†Wide use of condoms should be promoted by all levels of government as a vital public health and HIV prevention method. The potential use of condoms as evidence of sex work or other crimes undermines the efforts of New York State and City public health authorities, health providers and nongovernmental organizations to promote safer sex and multilevel HIV prevention. The ETE Blueprint recommends removing disincentives related to possession of condoms (BP24 and “Getting to Zero†recommendation number 2) and clearly states that the practice of confiscating condoms and laws that permit a person’s possession of condoms to be offered as evidence continue to criminalize and stigmatize condom possession, which is in direct opposition to promotion of condom use as an HIV and STD prevention tool essential to public health.
S5062, A7061
Getting to Zero Recommendation 3
Enact reforms to improve drug user health.
Safer Consumption Services Act
NYS bill A08535, the Safer Consumption Services Act, would amend NYS public health law to provide for the establishment of supervised consumption facilities (SCFs) as a means of preventing disease transmission and drug overdose deaths and linking high-risk individuals to full spectrum health care. Such services should be integrated with existing harm reduction programs in order to provide, directly or by referral, access to drug treatment, primary healthcare, mental health services, syringe exchange, housing support, health education, and other services.
A08534
Getting to Zero Recommendation 4
Passage of the Gender Expression Non-Discrimination Act (GENDA).
Gender Expression Non- Discrimination Act (GENDA)
NYS bill S.502, also known as Gender Expression Non-Discrimination Act (GENDA), will add “gender identity or expression†to the language of the existing NYS Human Rights Law (NYS Executive Law, Article 15) that protects against discrimination in the areas of employment, health care, housing, public transportation, public accommodations, and credit.
Legislation reintroduced in 2015 and 2016.
The ETE Blueprint supports the passage of statewide transgender civil rights law to reaffirm, standardize and unify transgender civil rights protections in New York State (GTZ 4 and BP 19, Institute an integrated comprehensive approach to transgender health care and human rights).
Press link: http://gaycitynews.nyc/state-senate-committee-nixes-genda/
S502, A3358
Getting to Zero Recommendation 5
Passage of the Healthy Teens Act.
The Healthy Teens Act
NYS bills S.700-A and the concurrent A.1616-A, also known as the Healthy Teens Act, would add language to NYS Public Health Law §§1450 – 1457 to establish a grant program through the NYS Department of Health (DOH) to support provision of age-appropriate health and sexuality education in NYS 1-12 education by eligible applicants. The following organizations and institutions would be able to apply to the DOH grant program: public school districts, boards of cooperative educational services, school-based health centers and community organizations.
Legislation reintroduced in 2016.
The ETE Blueprint supports educating New York State youth in making healthy, positive choices about sexual health in order to avoid negative health outcomes such as HIV and STIs and unintended pregnancy (BP 23, Promote comprehensive sexual health education and GTZ5 Passage of the Healthy Teens Act). This recommendation supports an expansion of comprehensive, age-appropriate, medically accurate health and sexuality education in K-12 schools, which in turn would increase the number of young people receiving age- appropriate information about HIV and STI prevention tools, such as condoms, and nPEP and PrEP. This recommendation will also create a foundation of support for HIV testing by providing young people with information and messages that encourage and normalize HIV testing. Mandating comprehensive sexual health education with curriculum developed by the Departments of Health, Mental Health and Education is the optimal way to ensure that our youth are provided with the most recent, medically accurate information available as well as ensuring that all of our youth have access such information.
S1070, A2750
Getting to Zero Recommendation 6
Expanded Medicaid coverage to targeted populations.
Getting to Zero Recommendation 7
Guaranteeing minors the right to consent to HIV and STI treatment, diagnosis, prevention, and prophylaxis, including sexual health- related immunization.
Minor consent for HIV treatment and prevention
The New York State Department of Health adopted new rules effective April 12, 2017. Sections 23.1 and 23.2 of Title 10 NYCRR to add HIV to Group B of the existing list of sexually transmitted diseases (STDs) enabling minors to consent to HIV treatment and prevention without parental consent.
Data support the critical importance of access to HIV prevention and treatment for young people. According to the U.S. Centers for Disease Control and Prevention (CDC), in 2014, 22% of new HIV infections were diagnosed among youth ages 13-24 years old. Most of these newly diagnosed infections occurred among young gay and bisexual males. Young black/African American and Hispanic/Latino gay and bisexual males are especially affected. Youth with HIV are the least likely out of any age group to be linked to care. Addressing HIV in youth requires that we give youth the tools they need to reduce their risk, make healthy decisions, get treatment and care if needed, and communicate effectively with others. In New York State, more than 30% of new HIV diagnoses in 2014 were among individuals under 24 years of age. In New York City in 2015, 39% of persons newly diagnosed with HIV were under the age of 29, and persons living with HIV under the age of 24 had the lowest rate of viral load suppression of any group.
Notice of Adoption (page 4): https://docs.dos.ny.gov/info/register/2017/april12/pdf/Rule%20Making%20Activities.pdf