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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. Legislation and policies that have been introduced but 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 March 2019
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Blueprint Recommendation Timeline
ETE
Aim
1
Identify persons with HIV who remain undiagnosed and link them to health care
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
Make routine HIV testing truly routine
BP 1
Simplifies 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 NYS Executive Budget, Health & 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 Cuomo 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
Expand targeted testing
BP 2
Authorizes 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
BP 3
Updates the guidelines for diagnosing and managing 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 antiretroviral 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
BP 4
Enhances 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
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
Continuously act to monitor & improve rates of viral suppression
BP 5
Enhances 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
BP 6
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.
NYC DOHMH Request for Proposals
Use client-level data to identify & assist patients lost to care or not virally suppressed
BP 7
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.
Amendment of Part 63 of Title 10 NYCRR
Allow HIV Data Sharing with Care Coordinators to Improve HIV Health Outcomes
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.
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.
New York Codes, Rules, and Regulations, Title 10, Part 63, Section 63.6
Allow Social Service Programs to Participate in Regional Health Information Organizations (RHIOs)
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.
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
Enhance & streamline services to support the non-medical needs of all persons with HIV
BP 8
Cap rent for all HASA clients at 30% of income
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.
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).
HIV/AIDS Services Administration (HASA) Rental Assistance Press Release.
Amendment to Chapter 5 of Title 68 of the Rules of the City of New York
2014-15 NYS Executive Budget, Health and Mental Hygiene Article VII Legislation
New York City "HASA for All"
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.
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.
NYS AIDS Institute policy statement
Announcement from Governor Cuomo
"Rest of State" HIV Enhanced Shelter Allowance
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.
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.
Announcement from Governor Cuomo
2018-19 NYS Enacted Budget, Aid to Localities Article VII Legislation
Provide enhanced services for patients within correctional facilities & other institutional settings
BP 9
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.
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.
2015-2016 New York State Executive Budget, Health and Mental Hygiene Article VII Legislation
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.
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.
2016-2017 NYS Executive Budget, Health & Mental Hygiene Article VII Legislation
Chapter 59 of the Laws of 2016, Part D.
Make SNPs available on the New York State 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.
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.
New York State Medicaid Update, February 2016 (Vol 32, No 02)
HIV SNP eligibility expanded to transgender persons on Medicaid, regardless of HIV status
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.
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.
ETE
Aim
3
Provide access to PrEP for high-risk persons to keep them HIV-negative
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
Undertake a statewide education campaign on PrEP & nPEP
BP 11
Include a variety of statewide programs for distribution & 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.
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.
New York State Assembly Bill A10724 New York State Assembly Bill S8129
Chapter 502 of the Laws of 2016
Create a coordinated statewide mechanism for persons to access PrEP & nPEP and prevention-focused care
BP 13
Establish a Pre-Exposure Prophylaxis Assistance Program (PrEP-AP)
In 2015, the New York State Departent 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.
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.
NYS DOH Pre-Exposure Prophylaxis Assistance Program (PrEP-AP)
Develop mechanisms to determine PrEP & nPEP usage and adherence statewide
BP 14
ETE
Aim
4
Recommendations in support of decreasing new infections and disease progression
ETE Blueprint Recommendations 15-30
ETE
Aim
4
Support decreasing new infectious and disease progression
Hide ETE Blueprint Recommendations 15-30
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.
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.
2015-2016 New York State Executive Budget, Health and Mental Hygiene Article VII Legislation
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.
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.
Governor Cuomo's press release announcing Narcan program
Harm Reduction Coalition standing orders for pharmacies outside of New York City
Naloxone Co-payment Assistance Program (N-CAP)
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.
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.
Ensure access to stable housing
BP 16
Cap rent for all HASA clients at 30% of income
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.
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).
HASA Rental Assistance Press Release (Vocal NY) Notice of Adoption of Final Rule Amending Chapter 5 of Title 68
2014-15 NYS Executive Budget, Health and Mental Hygiene Article VII Legislation
New York City "HASA for All"
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.
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.
Governor Cuomo's press release about housing support eligibility expansion
"Rest of State" HIV Enhanced Shelter Allowance
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.
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.
Governor Cuomo's Press Release of Expansion of Rental Assistance Program
2018-19 NYS Enacted Budget, Aid to Localities Article VII Legislation
Reduce 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.
New York State Senate Budget Bill 2006-C (Asssembly Bill 3006-C) New York State Senate Bill A2040C
Chapter 56 of the Laws of 2017, Part M
Health, housing & 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.
The Ending the Epidemic Blueprint recommends promoting culturally-competent service models that address individual, group and community-level barriers to LGBT identified individuals engaging in and linking to care. In 2009, The American Psychological Association convened a Task Force on Appropriate Therapeutic Responses to Sexual Orientation that concluded sexual orientation change efforts can pose critical health risks to lesbian, gay, bisexual, and transgender people ranging from confusion and depression, to substance abuse and suicide. By prohibiting the provision of and reimbursement for conversion therapy, these regulations promote the health, safety and dignity of LGBT communities, a vital part of ending the HIV epidemic in New York State.
Proposed Forty-fifth Amendment to 11 NYCRR 52 New Subdivision to 14 NYCRR Section 547.8 Medicaid Update Article on Conversion Therapy
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. The bill includes the right to receive care that is mindful of a person's sexual orientation, sexual behavior, gender identity and gender expression; the right to sexual health care including HIV testing; the right to mental and behavioral health care including care following trauma; and the right to privacy and confidentiality for all residents and visitors receiving care within the five boroughs.
The Ending the Epidemic Blueprint recommends promoting culturally-competent service models that address individual, group and community-level barriers to LGBT-identified individuals engaging and linking to care. Transgender persons face especially high rates of HIV infection due to stigma, discrimination, and related circumstances. New York City’s LGBTQ bill of rights promotes the safety and dignity of LGBT communities in accessing health care, a vital part of ending the HIV epidemic in New York State.
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.
Due to stigma, discrimination, and related circumstances, transgender persons have extremely high rates of HIV infection. The Ending the Epidemic Blueprint recommends that removing the barriers for transgender New Yorkers to accessing health care and ensuring the prompt implementation of the new regulations around access to transition services be a priority. By ensuring coverage of the diagnosis and treatment of gender dysphoria—and for Medicaid patients, hormone therapy and gender reassignment surgery—these changes to regulatory guidance and policy promote the health, safety, dignity, and human rights of transgender communities, a vital part of ending the HIV epidemic in New York State.
New York State Department of Financial Services Insurance Circular Letter No. 7 (2014)
NYS DOH Medicaid Update, June 2015 (Vol. 31, No. 6)
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.
Due to stigma, discrimination, and related circumstances, transgender persons have extremely high rates of HIV infection. The Ending the Epidemic Blueprint recommends that the State take steps to protect the rights of all persons regardless of sexual orientation and gender expression across the state, including in the workforce. By prohibiting discrimination and harassment against transgender persons, these regulations promote the health, safety, dignity and human rights of transgender communities, a vital part of ending the epidemic in New York State.
NYS DHR, 9 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.
Due to stigma, discrimination, and related circumstances, transgender persons have extremely high rates of HIV infection. The Ending the Epidemic Blueprint recommends taking steps to protect the rights of all persons regardless of sexual orientation and gender expression across the state. This important New York City action promotes the safety, dignity and human rights of transgender communities, a vital part of ending the epidemic in New York State.
Mayor de Blasio Mandates City Facilities Provide Bathroom Access to People Consistent with Gender Identity Executive Order No. 16 Access to Single-Sex City Facilities Consistent with Gender Identity and Expression
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.
Due to stigma, discrimination, and related circumstances, transgender persons have extremely high rates of HIV infection. The Ending the Epidemic Blueprint recommends taking steps to protect the rights of all persons regardless of sexual orientation and gender expression across the state. The NYC Department of Health and Mental Hygiene’s (DOHMH) Community Health Survey (CHS) results are analyzed and disseminated in order to track the health of New Yorkers, influence health program decisions, and increase the understanding of the relationship between health behavior and health status. The DOHMH’s new two-step question on gender identity enables better survey data on the health of transgender New Yorkers, promoting not only the health but also the dignity and human rights of transgender communities, a vital part of ending the Epidemic in New York State.
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 References & Policy Details to determine whether the service was appropriately provided to the individual.
Due to stigma, discrimination, and related circumstances, transgender persons have extremely high rates of HIV infection. The Ending the Epidemic Blueprint recommends that removing the barriers for transgender New Yorkers to accessing health care and ensuring the prompt implementation of the new regulations around access to transition services be a priority. This change to regulatory guidance ensures that gender identity is not a barrier to transgender individuals accessing all services covered by health insurers, promoting the health, safety, dignity and human rights of transgender communities, a vital part of ending the epidemic in New York State.
New York State Department of Financial Services, Insurance Circular Letter No. 12 (2017)
HIV SNP eligibility expanded to transgender persons on Medicaid, regardless of HIV status
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.
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.
NYS DOH Medical Update, October 2017 (Vol. 33, No. 10)HIV SNPs Population Expansion
Expand 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.
The Ending the Epidemic Blueprint recommends establishing and extending targeted prevention and care efforts for NYS residents at high risk for HIV who are uninsured, underinsured or privately insured and want to keep their sexual or drug-related health services confidential. 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) facilitates low- and no-cost access to a medication that can save drug users’ lives statewide.
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.
Employment is an important facilitator of long-term adherence and viral suppression. However, some PWH have few available work opportunities. The Ending the Epidemic Blueprint recommends the development of a certified peer workforce that provides Medicaid-reimbursable linkage, re- engagement, treatment adherence, and retention in care services. Peers reflect the diversity of the people they are serving, and they are uniquely qualified by their shared experiences to assist HIV-positive consumers to navigate various health care environments across the service continuum. Peers help to ensure that a consumer-centered approach is taken in service delivery and that access to culturally and linguistically-appropriate interventions and health care services are more available. The AIDS Institute’s establishment of the Peer Worker Certification Program will support linkage to and engagement in care and viral suppression, not only for peer workers but also for the communities they serve statewide.
NYS DOH AIDS Institute< Peer Worker Certification Program presentation
NYS DOH AIDS Institute Peer Certification Information and Resources
Access to care for residents of rural, suburban and other areas of the state
BP 22
Promote comprehensive sexual health education
BP 23
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.
Laws permitting a person’s possession of condoms to be offered as evidence of prostitution-related criminal and civil offenses discourage individuals from carrying and using condoms, undermining state efforts to limit the spread of HIV and other STIs. The persons targeted are often sex workers (or assumed to be sex workers), who are at the highest risk for infection. This practice, which continues to criminalize and stigmatize condom possession, is in direct opposition to the promotion of condom use as a prevention tool essential to public health. By limiting the admissibility of condoms in criminal proceedings, this 2015 legislation supports the Ending the Epidemic Blueprint recommendation to remove disincentives related to the possession of condoms.
2015-16 NYS Executive Budget, Health and Mental Hygiene Article VII Legislation
Treatment as prevention information & anti-stigma media campaign
BP 25
NYS DOHMH endorsement of Prevention Access Campaign Consensus Statement: Undetectable = Untransmittable (U = U)
In August 2016, New York City (NYC) became the first jurisdiction in the United States to join the "Undetectable = Untransmittable" (“U = U”) campaign when the NYC Health Department signed a consensus statement affirming that people with HIV who have maintained an undetectable viral load for at least six months do not sexually transmit HIV. In a November 28, 2017 Dear Colleague letter, Dr. Demetre Daskalakis, Deputy Commissioner for the Division of Disease Control, summarized the scientific findings that support U=U and called on providers to council HIV positive and negative patients on the implications of U=U, including on the importance of ART adherence, prevention strategies such as PrEP, PEP, and condoms, and regular testing.
The Ending the Epidemic Blueprint recommends the implementation of media campaigns targeting both HIV-infected and HIV uninfected individuals that promotes prevention interventions and serves to improve treatment adherence for people living with HIV. Among other audiences, campaigns should target health care providers to increase their cultural competency and reduce the stigma that patients experience while in care. Campaigns should also increase the awareness and expanded use of new prevention options by health care providers. The NYC DOHMH's endorsement of the groundbreaking U=U message not only gives providers new tools to support people with HIV to maintain treatment adherence, improve individual health outcomes, and support people with HIV to have fulfilling sex lives without fear of transmission, but also promotes stigma reduction in health care and other settings.
NYC DOHMH Letter to Medical Providers Re: Undectable is Untransmittable (U=U)
August 2016 "U=U Consensus Statement" Endorsement
NYSDOH Statement on Viral Load Suppression and 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.
The Ending the Epidemic Blueprint recommends the implementation of a statewide media campaign targeting both HIV-infected and HIV uninfected individuals that promotes prevention interventions and serves to improve treatment adherence for people living with HIV. Among other audiences, campaigns should target health care providers to increase their cultural competency and reduce the stigma that patients experience while in care. Campaigns should also increase the awareness and expanded use of new prevention options by health care providers. The NYS DOH's endorsement of the groundbreaking U=U message not only gives providers new tools to support people with HIV to maintain treatment adherence, improve individual health outcomes, and support people with HIV to have fulfilling sex lives without fear of transmission, but also promotes stigma reduction in health care and other settings.
Provide HCV testing for PLWH & 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.
NYS DOH Hepatitis C Testing Law FAQs
NYS HCV Testing Law Evaluation Report - January 2016
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.
NYS 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 NYS DOH 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.
NYS DOH AIDS Drug Assistance Program (ADAP) Formulary, January 2, 2019
NASTAD AIDS Drug Assistance Program (ADAP) Crisis Task Force Fact Sheet, November 2016
NYS DOH HIV Uninsured Care Programs, Covered Services and ADAP Formulary - June 2017
Commitment to HCV Elimination Strategy
To increase access to Hepatitis C (HCV) medications, the Governor is proposing to increase funding for HCV prevention, testing and treatment programs, such as education, patient navigation, and HCV prevention programs in primary care and other settings. The proposal to create a Hepatitis C elimination plan has strong community and medical provider support. One hundred forty-seven hospitals, community health centers, and local departments of health endorsed the NYS Hepatitis C Elimination Consensus Statement last year, calling on Governor Cuomo, the NYS Legislature, and industry partners to make a joint commitment to hepatitis C elimination, with a formal Task Force to establish a statewide elimination plan.
HCV-related deaths have exceeded HIV-related deaths in the state outside of New York City since 2007, and with injecting drug use as the most common risk factor, the opioid epidemic has fueled a rise in new HCV cases. HCV detection and treatment directly relates to individual health outcomes and overall quality of care for persons with HIV. One in five persons with HIV is co-infected with HCV, and studies show that HCV co-infected patients visit the emergency department more frequently, are hospitalized more often, and have longer hospital stays than HIV mono-infected patients. Other studies have established HCV-related end-stage liver disease as a leading cause of in-hospital mortality among HIV-infected patients. The Ending the Epidemic Blueprint recommends that the reduction and treatment of HCV transmission be a key priority for ensuring one devastating epidemic is not ended while another, which impacts many of the same populations, continues. With new antiretroviral drugs that provide easy-to-take and extremely effective curative treatments, national and international experts have endorsed the ambitious but achievable goal of HCV elimination. The Governor’s announcement makes New York the first state in the nation to commit to hepatitis C elimination. The State’s experience with and unprecedented progress on the plan to end the HIV epidemic makes it well-poised to work with community, provider, and health department stakeholders to create and implement a plan to eliminate HCV.
Governor Cuomo's press release on enhanced rental assistance program March 16, 2018
Chapter 53 of the Laws of 2018
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 & enhance the use of data to track and report progress
BP 29
Enhance HIV Data Sharing & Improve Care Coordination
The New York State Deparment 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 matters.
New York State Register, December 14, 2016, Rule Making Activities
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 & 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.
Research findings indicate a positive relationship between employment and employment services for people with HIV, and access to care, treatment adherence, improved physical and behavioral health, and reductions in viral load and health risk behavior. The Ending the Epidemic Blueprint recommends increasing access to employment and employment/vocational services for people with HIV. The AIDS Institute’s establishment of the Peer Worker Certification Program, which provides training and supports subsequent employment opportunities for persons with HIV statewide, will promote improved health outcomes for persons with HIV seeking employment statewide.
NYS DOH AIDS Institute Peer Worker Certification Program presentation
NYS DOH AIDS Institute Peer Certification Information and Resources
Getting to Zero Recommendation Timeline
GTZ
ETE Blueprint Getting to Zero Recommendations
GTZ
Hide ETE Blueprint Getting to Zero Recommendations
Single point of entry across NYS to essential benefits and services for low-income persons with HIV/AIDS
GTZ 1
Decriminalize condoms
GTZ 2
Enact reforms to improve drug user health
GTZ 3
Passage of the Gender Expression Non-Discrimination Act (GENDA)
GTZ 4
Gender Expression Non- Discrimination Act (GENDA)
Passage of the Healthy Teens Act
Expand Medicaid coverage to targeted populations
GTZ 6
Guarantee minors the right to consent to HIV and STI treatment and prevention
GTZ 7
Expansion of minor consent for HIV treatment access 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. 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, persons living with HIV under the age of 24 had the lowest rate of viral load suppression of any group. Most of these newly diagnosed infections occurred among young gay and bisexual males, with young black/African American and Hispanic/Latino gay and bisexual males especially affected. This rule supports the Ending the Epidemic Blueprint Getting to Zero recommendation to enable competent minors, who are already able to consent to both STI and HIV testing without parental consent, to also consent to HIV treatment and ARV prophylaxis.