ETE Policy Tracker

[2014]

Policy Name

Simplify HIV Testing Consent

Summary

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.

Background and Importance to ETE

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.

Additional Information

2014-15 New York State Executive Budget, Health and Mental Hygiene Article VII Legislation.

Reference/Citation

Chapter 60 of the Laws of 2014, Part A.

[2016]

Policy Name

Require Opt-out HIV Testing and Improve Routine HIV Testing for Older Adults

Summary

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.

Background and Importance to ETE

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.

Additional Information

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

Reference/Citation

Chapter 502 of the Laws of 2016. NYSDOH final rulemaking for 10 NYCRR Part 63

[2016]

Policy Name

Authorize Registered Nurses to Conduct STD Screenings

Summary

Chapter 502 of the Laws of 2016 amends Education Law to allow registered nurses to conduct STD screenings.

Background and Importance to ETE

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.

Additional Information

New York State Assembly Bill A10724

New York State Assembly Bill S8129

Reference/Citation

Chapter 502 of the Laws of 2016

[2015]

Policy Name

Update to the Diagnosis and Management of Acute Infection Guidelines

Summary

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.

Background and Importance to ETE

Additional Information

Reference/Citation

NYS DOH, Medical Care Criteria Committee (September 2015)

[2014]

Policy Name

Enhance HIV Data Sharing to Improve HIV Health Outcomes

Summary

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.

Background and Importance to ETE

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.

Additional Information

New York Codes, Rules, and Regulations, Title 10, Part 63

Reference/Citation

Chapter 60 of the Laws of 2014, Part A.

[2014]

Policy Name

Enhance HIV Data Sharing to Improve HIV Health Outcomes

Summary

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.

Background and Importance to ETE

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.

Additional Information

New York Codes, Rules, and Regulations, Title 10, Part 63

Reference/Citation

Chapter 60 of the Laws of 2014, Part A.

[2016]

Policy Name

Scale up integrated, client-centered toolkit for providers and people with HIV to address social and structural barriers to ART adherence

Summary

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.

Background and Importance to ETE

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.

Additional Information

The Undetectables

Reference/Citation

New York City Department of Health and Mental Hygiene RFP

[2014]

Policy Name

Enhance HIV Data Sharing to Improve HIV Health Outcomes

Summary

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.

Background and Importance to ETE

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.

Additional Information

2014-15 New York State Executive Budget, Health and Mental Hygiene Article VII Legislation.

Reference/Citation

Amendment of Part 63 of Title 10 NYCRR

[2016]

Policy Name

Allow HIV Data Sharing with Care Coordinators to Improve HIV Health Outcomes

Summary

Regulatory action to allow local and state health departments to share HIV surveillance information with health care providers, including entities engaged in care coordination, for purposes of patient linkage and retention in care.

Background and Importance to ETE

The Ending the Epidemic Blueprint supports changing state law to allow sharing HIV surveillance data with medical providers and care coordination systems to improve linkage and retention of HIV-infected persons in care. Including care coordination systems is an important strategy for improving retention in effective HIV care since they now play a vital role in the public health infrastructure of New York State. This amendment enables providers to improve HIV care outreach by using client-level data to identify patients lost to care.

Additional Information

New York Codes, Rules, and Regulations, Title 10, Part 63, Section 63.6

Reference/Citation

Amendment of Part 63 of Title 10 NYCRR

[2016]

Policy Name

Allow Social Service Programs to Participate in Regional Health Information Organizations (RHIOs)

Summary

The State Health Information Network - New York (SHIN-NY) approved a proposal to change the policies governing New York Regional Health Information Organizations (RHIOs) to allow social service programs such as the NYC Human Resources Administration's HIV/AIDS Services Administraion (HASA) to participate in RHIOs, in order to faciiliate the consented exchange of information on housing status and other social determinants of health with a patient's health and care coordination team.

Background and Importance to ETE

New York State has invested significant resources in the development of Regional Health Information Organizations (RHIOs). Participating providers include hospitals, primary and specialist health providers snd Health Home care coordinators. Participating providers that obtain patient consent engage in bidirectional exchange of health data to facilate integrated care. Persons who must rely on public benefits and services to meet basic subsistence needs represent some of the highest utilizers of health care services, with some of the poorest health outcomes. This change will allow consented integration of care between participating social service programs and the evolving integrated health care system, with the goals of improved retention in care and better health outcomes

Additional Information

Statewide Health Information Network for New York (SHIN-NY)

Reference/Citation

SHIN-NY policy change

[2014]

Policy Name

Cap rent for all HASA clients at 30% of income

Summary

Due to public assistance budgeting practice prior to 2014, HASA clients on fixed incomes who received rental assistance were required to pay upwards of 70% of their disability income towards rent. This led to high rates of arrears and housing loss. Under the new legislation, HASA’s rental assistance program aligns with other low-income housing programs so that clients pay no more than 30% of their income towards their rent. The policy is expected to eventually pay for itself by reducing emergency housing placements and avoidable Medicaid expenses including emergency room visits and hospitalizations.

Background and Importance to ETE

The inability to meet basic subsistence needs, including stable housing, is a formidable barrier to consistent engagement in HIV care and treatment effectiveness. Reducing barriers to HIV specific housing and services 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 (GTZ 1 and BP 16, Ensure access to stable housing).

Additional Information

HIV/AIDS Services Administration (HASA) Rental Assistance Press Release.

Amendment to Chapter 5 of Title 68 of t he Rules of the City of New York

Reference/Citation

2014-15 NYS Executive Budget, Health and Mental Hygiene Article VII Legislation

[2016]

Policy Name

New York City "HASA for All"

Summary

The guidance issued by the AIDS Institute confirms that, to the extent permitted by law, the terms “clinical/symptomatic HIV illness or AIDS”, “AIDS or HIV-related illness”, and other similar terms mean laboratory-confirmed HIV diagnosis.  The Office of Temporary and Disability Assistance’s determination that those diagnosed with HIV will be eligible for Emergency Shelter Allowance extends access to a monthly transportation and nutrition allowance as well as a 30% income contribution cap toward rental costs to all persons with diagnosed HIV who are New York City Public Assistance recipients. 

Background and Importance to ETE

The U.S. Centers for Disease Control and Prevention recommend that care and treatment begin immediately upon diagnosis of HIV in order to achieve viral load suppression. To achieve and maintain viral suppression, which is the clearest indicator that appropriate medical care is being provided, a person with HIV needs a host of non-medical resources. Persons with HIV who lack jobs, housing, financial resources, adequate insurance, behavioral well-being, and/or personal support systems are less likely to achieve improved health outcomes. The Ending the Epidemic Blueprint makes clear that ensuring adequate, stable levels of support to people living with HIV in housing, transportation, and nutrition, as well as substance abuse treatment, mental health services, and/or child care is essential. In NYC, the HIV/AIDS Services Administration (HASA) provides lifesaving social services including rental subsidies and transportation and nutritional assistance.  In 2016, after many years of a "HASA for All" campaign, the criteria to receive these essential benefits were updated to include all HIV positive people who meet the income requirement. Thousands of HIV-positive New York City residents will now have access to lifesaving benefits and services through HASA.

Additional Information

NYS AIDS Institute policy statement

Announcement from Governor Cuomo

Reference/Citation

NYS AIDS Institute policy statement

[2018]

Policy Name

"Rest of State" HIV Enhanced Shelter Allowance

Summary

The 2018-19 NYS Enacted Budget allows local departments of social services the option to provide meaningful rental assistance (above the 1980’s regulatory amount of $480) and the 30% rent cap; and establishes a mechanism for the NYS Department of Budget (DOB) and the Office of Temporary Disability Assistance (OTDA) to make Medicaid savings from improved housing status available to local districts to cover the excess costs of market rate rental assistance and the 30% affordable housing protection. The expanded HIV Enhanced Shelter allowance benefit becomes mandatory upon a DOB finding that Medicaid savings on ER and inpatient care would cover the difference between the $480 localities are required by regulation to support and meaningful rents in line with local FMRs. These savings would be deducted from the managed care reimbursement rate for persons housed in districts in the rest of the State outside NYC.

Background and Importance to ETE

The U.S. Centers for Disease Control and Prevention recommend that care and treatment begin immediately upon diagnosis of HIV in order to achieve viral load suppression. To achieve and maintain viral suppression, which is the clearest indicator that appropriate medical care is being provided, a person with HIV needs a host of non-medical resources. Persons with HIV who lack jobs, housing, financial resources, adequate insurance, behavioral wellbeing, and/or personal support systems are less likely to achieve improved health outcomes. The Ending the Epidemic Blueprint makes clear that ensuring adequate, stable levels of support to people living with HIV in housing, transportation, and nutrition, as well as substance abuse treatment, mental health services, and/or child care is essential.

The Blueprint housing recommendations were fully implemented in New York City in 2016, providing access to a monthly transportation and nutrition allowance as well as a 30% income contribution cap toward rental costs to all persons with diagnosed HIV who are New York City Public Assistance recipients. Upstate and on Long Island, however, an estimated 3,700 low-income households living with HIV remain homeless or unstably housed because 1980s regulations governing the NYS HIV Enhanced Shelter Allowance (ESA) program set maximum rent at $480/month—too low to secure decent housing anywhere in the State. The 2018 Enacted Budget includes provisions that allow Statewide expansion of meaningful HIV rental assistance and the the 30% rent cap affordable housing protection, and a mechanism for the State Department of Budget and Office of Temporary and Disability Assistance (OTDA) to mandate expansion by allocating Medicaid savings to cover 100% of incremental costs to local districts.

Additional Information

Announcement from Governor Cuomo

Reference/Citation

2018-19 NYS Enacted Budget, Aid to Localities Article VII Legislation

[2015]

Policy Name

Oral Consent for HIV Testing in Correctional Facilities

Summary

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.

Background and Importance to ETE

The Ending the Epidemic Blueprint recommends expanding state and local correctional facility-based initiatives to promote HIV testing and engagement in care, including initiatives to identify and treat institutionalized persons with HIV as early in their stay as possible. This legislation simplifies consent for HIV testing in New York State correctional facilities, supporting increased rates of testing among institutionalized persons. Allowing oral consent for testing will promote early identification and treatment of institutionalized persons with HIV, making optimal health outcomes more likely in the facility.

Additional Information

2015-2016 New York State Executive Budget, Health and Mental Hygiene Article VII Legislation

Reference/Citation

Chapter 57 of the Laws of 2015, Part I

[2016]

Policy Name

Authorize Continued Operation of SNPs

Summary

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.

Background and Importance to ETE

The Ending the Epidemic Blueprint recommends utilizing opportunities in the Delivery System Reform Incentive Payment (DSRIP) process to support programs to achieve goals related to linkage, retention, and viral suppression. The overall goal of DSRIP is to decrease unnecessary hospitalizations by 25%. Clearly, preventing HIV-infected persons from progressing to AIDS and developing opportunistic infections or other conditions that would require a hospital stay is in support of DSRIP’s prime objective. HIV Special Needs Plans (SNPs) are health plans that cover all the services covered by other Medicaid health plans in addition to special services for people living with HIV/AIDS, including an HIV specialist primary care provider, HIV care coordination services, treatment adherence services, and other specialty services. SNPs should be added to the State’s healthcare marketplace to ensure full access for HIV-positive new Medicaid recipients and those requesting transfers from mainstream plans. This legislation authorizes the continued operation of SNPs, currently serving 14,540 New York residents across the state. The continued operation of SNPs benefits both DSRIP and the state’s efforts to end the epidemic.

Additional Information

2016-2017 New York State Executive Budget, Health and Mental Hygiene Article VII Legislation

Reference/Citation

Chapter 59 of the Laws of 2016, Part D.

[2016]

Policy Name

Make SNPs available on the New York State of Health Insurance Marketplace

Summary

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.

Background and Importance to ETE

The Ending the Epidemic Blueprint recommends utilizing opportunities in the Delivery System Reform Incentive Payment (DSRIP) process to support programs to achieve goals related to linkage, retention, and viral suppression. The overall goal of DSRIP is to decrease unnecessary hospitalizations by 25%. Clearly, preventing HIV-infected persons from progressing to AIDS and developing opportunistic infections or other conditions that would require a hospital stay is in support of DSRIP’s prime objective. HIV Special Needs Plans (SNPs) are health plans that cover all the services covered by other Medicaid health plans in addition to special services for people living with HIV/AIDS, including an HIV specialist primary care provider, HIV care coordination services, treatment adherence services, and other specialty services. SNPs should be added to the State’s healthcare marketplace to ensure full access for HIV-positive new Medicaid recipients and those requesting transfers from mainstream plans. Since January 15, 2016, eligible New Yorkers have been able to enroll in SNPs through the New York State of Health (NYSoH) marketplace, enabling easy enrollment for new members as well as efficient resumption of membership for current members upon recertification or following membership interruption. Access through the marketplace to SNPs for new and current members benefits both DSRIP and the state’s efforts to end the epidemic.

Additional Information

New York State Medicaid Update, February 2016 (Vol 32, No 02)

Reference/Citation

[2017]

Policy Name

HIV SNP eligibility expanded to transgender persons on Medicaid, regardless of HIV status

Summary

Effective November 1, 2017, NYS DOH expanded the scope of persons eligible to enroll in HIV Special Needs Plans (SNPs) to encompass transgender Medicaid beneficiaries, including those who are HIV negative. The AIDS Institute and Office of Health Insurance Programs (OHIP) worked with three HIV SNPs to ensure training, policies and procedures for a smooth transition for this new HIV SNP expansion population.

Background and Importance to ETE

Despite major advances in both treating and preventing HIV, transgender individuals still face an alarmingly high rate of new infections. The prevalence of HIV among transgender women is nearly 50 times higher worldwide than among the general population. For transgender women of color, this health disparity is even greater—from 2007 to 2011, 90 percent of transgender women in New York City diagnosed with HIV were black or Latina. With the expansion of SNP eligibility to transgender New Yorkers, the care coordination and integrated social support services that SNPs are designed to provide will now be accessible to more transgender individuals, who often experience significant barriers to care. This policy change supports the ETE Blueprint recommendation to institute an integrated comprehensive approach to transgender health care and human rights. It also supports the Getting to Zero (GTZ) Recommendation 6 to provide expanded Medicaid coverage to targeted populations.

Additional Information

New York State Department of Health Medical Update, October 2017 (Vol 33, No 10)

Reference/Citation

NYS DOH Medical Update, October 30 2017, Volume 33 Number 10

[2016]

Policy Name

Authorize Prescription of nPEP Starter Packs

Summary

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.

Background and Importance to ETE

The Ending the Epidemic Blueprint recommends including a variety of statewide programs for distribution and increased access to Post-Exposure Prophylaxis (PEP). PEP is an HIV prevention method that only works if used within a short period of time after exposure to the virus. Specifically, PEP should be used within 72 hours of exposure, and is recommended within 36 hours of exposure - with optimal intake being within 2 hours. Currently, most patients must go to an emergency room in order to obtain PEP. By enabling pharmacists to dispense a seven-day starter kit of PEP pursuant to a non-patient specific order, this bill provides a cost-effective way of significantly increasing access to and efficacy of HIV prevention for HIV-negative persons. Expanding access to PEP also strengthens consumer understanding and awareness, improves referral and coordination with doctors and other health professionals for follow-up to PEP, and promotes individual assessment for other HIV prevention measures.

Additional Information

New York State Assembly Bill A10724

New York State Assembly Bill S8129

Reference/Citation

Chapter 502 of the Laws of 2016.

[2015]

Policy Name

Establish a Pre-Exposure Prophylaxis Assistance Program (PrEP-AP)

Summary

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.

Background and Importance to ETE

The Ending the Epidemic Blueprint recommends that the state create a PrEP Assistance Program for persons to gain easy access to PrEP with out-of-pocket costs minimized through state support or coordination of benefits with other payers. Although PrEP is a fairly straightforward regimen of one pill per day, there are numerous complicating factors that could be barriers to access and adherence. PrEP is covered by public and private insurance; however, there could be co-pays for the medication, associated ongoing HIV, STD or kidney function testing, or other prevention-related services that would make it less affordable. Persons considering PrEP may have difficulty figuring out their coverage, or how to access the various assistance programs that are available. The New York State Department of Health, AIDS Institute’s PrEP Assistance Program (PrEP-AP) provides reimbursement for necessary primary care services for eligible individuals being seen by providers who are experienced in providing services to HIV-negative, high-risk, individuals. The program also offers a hotline to assist patients with the application process. By minimizing affordability and cost barriers, PrEP-AP supports expanding the availability and utilization of PrEP as a key HIV prevention tool.

Additional Information

New York State Department of Health Pre-Exposure Prophylaxis Assistance Program (PrEP-AP)

Reference/Citation

[2015]

Policy Name

Clarify provisions of law related to Expanded Syringe Access Program and medical provider-based syringe access programs

Summary

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.

Background and Importance to ETE

New York State has already seen tremendous success in reducing new HIV infections among persons who inject drugs. The Ending the Epidemic Blueprint recommends taking steps to maintain these gains and to equip programs to address the needs of the next generation of injectors, which is unaware of the devastating epidemic of prior decades. Harm reduction approaches have been most successful in meeting the needs of this population, offering services that range from syringe access and overdose prevention all the way to access to drug treatment and relapse prevention. By decriminalizing syringe possession and possession of residual amounts of a controlled substance for persons participating in the State’s Expanded Syringe Access Program (ESAP) or a medical-provider-based syringe access program, this legislation promotes access to clean syringes for injection drug users statewide.

Additional Information

2015-2016 New York State Executive Budget, Health and Mental Hygiene Article VII Legislation

Reference/Citation

Chapter 57 of the Laws of 2015, Part I.

[2016]

Policy Name

Expanding naloxone at independent pharmacies outside NYC

Summary

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.

Background and Importance to ETE

New York State has already seen tremendous success in reducing new HIV infections among persons who inject drugs. The Ending the Epidemic Blueprint recommends taking steps to maintain these gains and to equip programs to address the needs of the next generation of injectors, which is unaware of the devastating epidemic of prior decades. Harm reduction approaches have been most successful in meeting the needs of this population, offering services that range from syringe access and overdose prevention all the way to access to drug treatment and relapse prevention. By allowing independent and chain pharmacies without a designated provider to dispense naloxone without a prescription, the standing orders issued by the NYS DOH’s Harm Reduction Coalition support overdose prevention and harm reduction approaches to drug user health.

Additional Information

Governor's press release announcing Narcan program

Harm Reduction Coalition standing orders for pharmacies outside of New York City

Reference/Citation

[2017]

Policy Name

Naloxone Co-payment Assistance Program (N-CAP)

Summary

Governor Andrew Cuomo announced a first-in-the-nation program (N-CAP) 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.

Background and Importance to ETE

New York State has already seen tremendous success in reducing new HIV infections among persons who inject drugs. The Ending the Epidemic Blueprint recommends taking steps to maintain these gains and to equip programs to address the needs of the next generation of injectors, which is unaware of the devastating epidemic of prior decades. Harm reduction approaches have been most successful in meeting the needs of this population, offering services that range from syringe access and overdose prevention all the way to access to drug treatment and relapse prevention. By expanding access to the lifesaving medication Naloxone at pharmacies for New Yorkers who have prescription coverage through their health insurance plans, the NYS DOH AIDS Institute’s Naloxone Co-payment Assistance Program (N-CAP) supports overdose prevention and harm reduction approaches to drug user health.

Additional Information

New York State Department of Health, Naloxone Co-payment Assistance Program

Reference/Citation

[2016]

Policy Name

Expand eligibility to HASA in NYC

Summary

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.

Background and Importance to ETE

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).

Additional Information

https://www.governor.ny.gov/news/governor-cuomo-announces-all-hiv-positive-individuals-new-york-city-become-eligible-housing

Reference/Citation

NYS DOH Policy Statement: Defining Program Eligibility by HIV Status. June 23, 2016.

[2017]

Policy Name

Expand essential benefits and services for all income-eligible persons with HIV statewide

Summary

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.

Background and Importance to ETE

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).

Additional Information

Reference/Citation

S3449, A315

[2017]

Policy Name

Raise the maximum age for RHY services to 24

Summary

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.

Background and Importance to ETE

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.

Additional Information

Reference/Citation

Chapter 56 of the Laws of 2017, Part M.

[2016]

Policy Name

Prohibition on Conversion Therapy

Summary

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.

Background and Importance to ETE

Additional Information

https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/OMH_conversiontherapy.pdf

https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/ConversionTherapy_Medicaid_Update.pdf

[2017]

Policy Name

NYC LGBTQ Health Care Bill of Rights

Summary

On June 6, 2017, the administration of NYC Mayor Bill de Blasio announced the first-ever LGBTQ Health Care Bill of Rights.

Background and Importance to ETE

Additional Information

https://www1.nyc.gov/assets/doh/downloads/pdf/ah/lgbtq-bor-wallet.pdf

[2015]

Policy Name

Provide Health Insurance Coverage for the Treatment of Gender Dysphoria

Summary

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.

Background and Importance to ETE

Additional Information

http://www.transgenderlegal.org/media/uploads/doc_597.pdf

https://www.health.ny.gov/health_care/medicaid/program/update/2015/jun15_mu.pdf

Reference/Citation

NYS DFS, Insurance Circular Letter No. 7 (2014)

[2016]

Policy Name

Gender Identity Human Rights Protections

Summary

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.

Background and Importance to ETE

Additional Information

https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/466.13_NYCRR_Discrimintation_GenderIdentity.pdf

Reference/Citation

NYS DHR, 9 New York Code of Rules and Regulations (NYCRR) §466.13, Discrimination on the basis of gender identity.

[2016]

Policy Name

Improving Access to NYC Facilities for Transgender and Gender Non-conforming Persons

Summary

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.

Background and Importance to ETE

Additional Information

http://www1.nyc.gov/office-of-the-mayor/news/223-16/mayor-de-blasio-mandates-city-facilities-provide-bathroom-access-people-consistent-gender

Reference/Citation

Executive Order No. 16, 2016

[2016]

Policy Name

Improve Collection of Gender Identity Information on Community Health Survey

Summary

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.

Background and Importance to ETE

Additional Information

http://www1.nyc.gov/site/doh/data/data-sets/community-health-survey.page

Reference/Citation

Community Health Survey

[2017]

Policy Name

Protect coverage for health services provided to transgender individuals

Summary

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.

Background and Importance to ETE

Additional Information

https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/CircularLetterTransgenderCoding.pdf

Reference/Citation

NYS DFS, Insurance Circular Letter No. 12 (2017)

[2017]

Policy Name

Naloxone Co-payment Assistance Program (N-CAP)

Summary

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.

Background and Importance to ETE

Additional Information

https://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/directories.htm

Reference/Citation

[2015]

Policy Name

Peer Worker Certification Program

Summary

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.

Background and Importance to ETE

Additional Information

https://www.health.ny.gov/diseases/aids/ending_the_epidemic/docs/webinar_series/vocational_opps/cotroneo.pdf

https://www.hivtrainingny.org/home/peercertification

Reference/Citation

[2017]

Policy Name

Comprehensive Sex Ed Mandate

Summary

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.

Background and Importance to ETE

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.

Additional Information

Reference/Citation

S3737, A768

[2017]

Policy Name

Healthy Teens Act

Summary

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.

Background and Importance to ETE

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.

Additional Information

Reference/Citation

S1070, A2750

[2015]

Policy Name

Decriminalize condom posession

Summary

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.

Background and Importance to ETE

Additional Information

https://www.budget.ny.gov/pubs/archive/fy1516archive/eBudget1516/fy1516artVIIbills/HMH_ArticleVII_MS.pdf

Reference/Citation

2015-16 NYS Executive Budget, Health and Mental Hygiene Article VII Legislation

[2017]

Policy Name

NYS DOH endorsement of Prevention Access Campaign Consensus Statement: Undetectable = Untransmittable (U = U)

Summary

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.

Background and Importance to ETE

Additional Information

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

Reference/Citation

Dear Colleague Letter from Commissioner Howard A. Zucker, September 29, 2017

[2013]

Policy Name

HCV Routine Testing Law

Summary

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.

Background and Importance to ETE

Additional Information

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

Reference/Citation

Chapter 425 of the Laws of 2013.

[2016]

Policy Name

Remove disease prognosis and severity restrictions for HCV treatments

Summary

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.

Background and Importance to ETE

Additional Information

https://www.health.ny.gov/health_care/medicaid/program/dur/meetings/2016/04/summary_durb.pdf

Reference/Citation

New York State Medicaid Drug Utilization Review (DUR) Board Meeting Summary for April 27, 2016

[2016]

Policy Name

Amendment of the NYS AIDS Drugs Assistance Program (ADAP) formulary to cover Hepatitis hep C direct acting antivirals (DAAs).

Summary

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.

Background and Importance to ETE

Additional Information

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

Reference/Citation

NYSDOH HIV Uninsured Care Programs, Covered Services and ADAP Formulary - June 2017

[2017]

Policy Name

Enhance HIV Data Sharing and improve care coordination

Summary

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.

Background and Importance to ETE

Additional Information

https://docs.dos.ny.gov/info/register/2016/dec14/pdf/rulemaking.pdf

Reference/Citation

Chapter 461 of the Laws of 2016. This law was further clarified in 10 NYCRR Part 63, effective May 17, 2017.

[2015]

Policy Name

Peer Worker Certification Program

Summary

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.

Background and Importance to ETE

Additional Information

Reference/Citation