ETE POLICY TRACKER

The purpose of the ETE Dashboard Policy Tracker is to share progress on policy efforts that address ETE goals in New York State. This interactive timeline is organized by the recommendations included in 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 November 2019

Blueprint Recommendation Timeline
ETE Aim 1
Identify persons with HIV who remain undiagnosed and link them to health care

ETE Blueprint Recommendations 1-4

2014
2015
2016
2017
2018
2019
2020
Make routine HIV testing truly routine
BP1
Blueprint Recommendation 1
New York State has a law that mandates primary care providers as well as hospitals and emergency departments to offer HIV testing to all persons between the ages of 13 and 64, with certain exceptions. This law was modified in 2014 to remove the requirement for written consent except in correctional settings. Compliance is substantially below optimal levels, leading to missed opportunities where persons with undiagnosed infection are in systems of care without their HIV being identified. Electronic hard stop prompts to remind providers to offer testing should be used, and provider education is needed. HIV testing should be an expected part of all comprehensive annual primary care visits. In sum, to identify persons who remain undiagnosed, facilities and practitioners must follow the law, and New York State must enforce it. Additional settings for routine testing should be permitted, such as dental offices, pharmacies and mental health facilities, and additional changes to the law should be considered for New York to adopt a true opt-out testing model.
NYS Legislation Enacted 2014
Streamlines HIV testing consent
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NYS Legislation Enacted 2016
Streamlines HIV testing, removes upper age limit
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New York State Legislation Enacted 2014

Policy

Streamlines HIV Testing Consent

Summary

The 2014-2015 New York State Enacted Budget included Article VII legislation to amend New York State Public Health Law to simplify consent requirements for HIV-related testing consistent with Centers for Disease Control and Prevention (CDC) guidelines.

Background & Importance to ETE

If not identified and treated early, HIV infection can progress and escalate 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.

References & Policy Details
  • Chapter 60 of the Laws of 2014, Part A

New York State Legislation Enacted 2016

Policy

Streamlines HIV testing by verbally advising that a test may be performed. Removes upper age limit from the requirement to offer an HIV test

Summary

Chapter 502 of the Laws of 2016 amends New York State Public Health Law (PHL) 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. New York State Department of Health adopted regulations effective May 17, 2017 to further clarify the intent of this legislation.

Background & Importance to ETE

HIV testing must be made available to more New Yorkers. Half of all people living with diagnosed HIV infection in New York 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 years on the requirement of offering an HIV test, mandating that an HIV test be offered to all individuals over the age of 13 years. There is no public health basis to justify limiting the offer of an HIV to individuals 64 years and younger, and individuals 65 years and older are 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. Early diagnosis and access to treatment remain essential, and this legislation furthers that goal.

References & Policy Details

Expand targeted testing
BP2
Blueprint Recommendation 2
Routine testing is not sufficient, since persons at highest risk with repeated potential exposures need more frequent testing opportunities than would be afforded through primary care or hospital settings. Sites must be identified and supported that are most likely to serve populations such as MSM, transgender men and women, new immigrants, persons in neighborhoods with high seroprevalence rates, persons who inject or use drugs, sex workers, migrant and seasonal farm workers, homeless persons, and those with a history of incarceration, substance use or mental health issues. Since behavior, among other factors, affects risk, not all persons in these groups are at high risk. Therefore, programs need to determine strategies to engage those within the population most likely to be at risk of infection, keeping in mind that persons of color continue to be most heavily affected. Incentives, community based settings and mobile units, peer outreach models, and availability of free home test kits, as appropriate, are all strategies for consideration.
NYS Legislation Enacted 2016
Authorizes RNs to screen individuals at increased risk for STIs
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New York State Legislation Enacted 2016

Policy

Authorizes Registered Nurses to Screen Individuals at Increased Risk for Syphilis, Gonorrhea, and Chlamydia Pursuant to a Non-Patient Specific Order

Summary

Chapter 502 of the Laws of 2016 amends New York State Education Law to allow registered nurses (RNs) to screen individuals at increased risk for syphilis, gonorrhea, and chlamydia pursuant to a non-patient specific order by a physician or nurse practitioner. An RN who is responsible for implementing a non-patient specific order and protocol may assign licensed practical nurses (LPNs) to help (i.e., administer the ordered test or treatment, recordkeeping), provided that the RN performs required nursing assessments of potential recipients for eligibility for (and contraindications to) the ordered test, screening or treatment. The RN must provide on-site direction to the licensed practical nurse (LPN), except in emergency situations. A ratio of no more than three LPNs to one RN should be maintained. From New York State Education Department Office of the Professions (http://www.op.nysed.gov/prof/nurse/nonpatient-specific-orders-and-protocols.htm).

Background & Importance to ETE

The Ending the Epidemic Blueprint recommends expanded STI screening and education along with the expansion of pre-exposure prophylaxis (PrEP) services. STI rates are increasing in New York State. To address this problem, STI screening and sexual health care must become a routine health care service. This legislation amends 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 STIs will increase the number of people being diagnosed and treated and will reduce the overall risk of HIV infection.

References & Policy Details
  • Chapter 502 of the Laws of 2016

Address acute HIV infection
BP3
Blueprint Recommendation 3
Detecting acute HIV infection must play a critical role in the effort to end the epidemic, since acutely-infected persons are HIV’s most highly-efficient transmitters when having unprotected sex or sharing drug injection equipment. Strategic efforts must include making clients and providers aware of signs and symptoms of acute HIV infection which often mimic acute Mononucleosis in young and old alike, ensuring facilities offer nPEP and the availability other prevention services (such as PrEP) and have the capacity to screen for acute infection, using the state-of-the-art and standard-of-care 4th generation testing, and allowing for higher reimbursements for providers using the most sensitive tests.
NYS Clinical Guidelines Updated 2015
Updates the NYS guidelines for diagnosing and managing acute HIV infection
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New York State Clinical Guidelines Updated 2015

Policy

Updates the New York State guidelines for diagnosing and managing acute HIV infection

Summary

The New York State Department of Health Medical Care Criteria Committee updated the Diagnosis and Management of Acute Infection guidelines in the summer of 2015. The guidelines are intended to increase the identification and assessment of acute HIV infection, and support initiating antiretroviral therapy (ART) for those individuals. The updated guidelines also revise the recommended testing methods to be used to diagnose infection. The guidelines are being widely disseminated using a variety of program contacts and media.

Background & Importance to ETE

Under development.

References & Policy Details
  • New York State DOH - Medical Care Criteria Committee, September 2015

Improve referral and engagement
BP4
Blueprint Recommendation 4
All testing settings must be centers for referral and engagement for both positive and negative persons. State law requires that persons testing HIV-positive have an appointment made for follow-up HIV care. However, a more aggressive approach is needed. A significant number of persons who test positive are, in fact, already in the surveillance system and out of care. This is an important opportunity to identify what caused the person to fall out of care and to address the medical, housing, supportive services, behavioral health – including substance abuse – and other needs involved. In an effort to keep HIV-negative persons negative, HIV testing settings should assist in this effort by expanding their service options. Some examples of services to be offered include enrollment in insurance programs, referrals to behavioral health, substance use, and housing programs, and access to PrEP and nPEP. The use of STD clinics, drug treatment programs, and community health centers as one-stop-shops is recommended. Additionally, New York State’s existing Special Needs Plans should be expanded to provide prevention services such as PrEP and nPEP to eligible high-risk individuals.
NYS Legislation Enacted 2014
Expands HIV data sharing to improve HIV health outcomes
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New York State Legislation Enacted 2014

Policy

Expands HIV Data Sharing to Improve HIV Health Outcomes

Summary

The New York State Enacted Budget (FY 2014-15) included Article VII legislation to amend New York State Public Health Law to allow for expanded data sharing among health care providers and local and state health departments to improve patient linkage and retention in care.

Background & 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 help improve HIV treatment and health outcomes across the state.

References & Policy Details
  • 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

2014
2015
2016
2017
2018
2019
2020
Continuously act to monitor and improve rates of viral suppression
BP5
Blueprint Recommendation 5
Viral suppression of persons with diagnosed HIV infection is the cornerstone of the plan to end AIDS as an epidemic. Those who achieve and maintain viral suppression are unlikely to have their own health deteriorate due to HIV or to transmit the virus to others. Having reportable quality measures and monitoring of performance related to viral suppression by HIV providers, facilities and managed care plans would assist in improvement of treatment outcomes across the state. 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 is recommended. Timely provider reporting through surveillance, eHIVQUAL and other mechanisms is critical in maintaining an accurate picture of performance against the NYSDOH/AI Standards of Care. Also recommended is the use of electronic medical record prompts in all settings to identify nonsuppressed persons in need of re-engagement or other assistance, advanced electronic systems to allow patients access to their self-portals for the purpose of individual appointment tracking, reviewing of laboratory results and receiving appointment reminders. Identifying additional actions related to pharmacy practice that will improve ongoing access to medication is recommended as well, as is the identification of additional actions related to pharmacy practice that will improve ongoing access to medication and introduction and monitoring of trauma-informed approaches across the HIV service continuum are also recommended.
NYS Legislation Enacted 2014
Enhances HIV data sharing to improve HIV health outcomes
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New York State Legislation Enacted 2014

Policy

Enhances HIV Data Sharing to Improve HIV Health Outcomes

Summary

The 2014-2015 New York State Enacted Budget 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 & 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.

References & Policy Details
  • Chapter 60 of the Laws of 2014, Part A

Incentivize performance
BP6
Blueprint Recommendation 6
Both providers and patients have numerous competing priorities. The use of incentives for viral load suppression performance helps to keep attention on achieving this key goal. For providers, including Medicaid managed care plans and health homes, incentivization could be built into the reimbursement structure. For patients, incentives such as gift cards or non-cash rewards could be provided for adherence milestones, keeping appointments, achieving or sustaining an undetectable viral load. New computer-based and social-media technologies may present opportunities for monitoring and encouraging adherence in ways that were not previously possible. Empowering patients and providers with joint access to electronic medical records (EMRs), pharmacy, and laboratory data is also recommended.
NYC Program Implemented 2016
Scales up The Undetectables, an ART support model
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New York City Program Implemented 2016

Policy

Scales up The Undetectables, an antiretroviral therapy support model combining a social marketing campaign with a toolkit of evidence-based adherence supports for clients, including a financial incentive for achieving viral load suppression

Summary

In 2016, the New York City Health Department contracted with seven agencies in New York City to scale up The Undetectables over a three-year period as an initiative to advance the New York State Ending the Epidemic Blueprint goal of retaining persons with HIV in effective care. The New York City Health Department and Housing Works provide ongoing technical assistance and training to ensure program fidelity.

Background & Importance to ETE

The ETE 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 Health Department o) contracted with seven agencies in NYC to scale up The Undetectables over a three-year period as an initiative to advance the New York State Ending the Epidemic Blueprint goal of retaining persons with HIV in effective care. The New York City Health Department and Housing Works provide ongoing technical assistance and training to ensure program fidelity, and the program currently serves clients with HIV. 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.

References & Policy Details

Use client-level data to identify and assist patients lost to care or not virally suppressed
BP7
Blueprint Recommendation 7
There are many reasons why 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. The ability to match data and link systems to improve health outcomes is of critical importance to prevent inefficiencies such as using outreach workers to find someone no longer in their area or who have chosen to use a different provider. Other persons may be seeing a provider but, for some reason, not able to reach or maintain viral suppression. Patient access to their electronic medical records, pharmacy, and laboratory data, can empower patients and improve continuity of care and adherence. Properly cross-checked data can be used successfully to initiate appropriate provider or public health interventions to identify those persons truly lost to care or not virally suppressed and take steps to improve their health outcomes. Expansion of data sharing with managed care plans and additional community-based partners, and clinics, including migrant health centers, would increase the overall capacity to conduct linkage and retention activities. Managed care plans, health homes and other care providers need to develop additional programs to prevent lost to care situations and optimize viral load suppression. Providing joint access to both patients and providers can assist in improving rates of adherence and viral load suppression. In response to presenting barriers that may influence a patient’s retention and adherence, quality indicators should be expanded to include stigma and discrimination. Stigma measures will provide a baseline for providers and health plans to use to improve a patient’s health care experience.
NYS Legislation Enacted 2014
Enhances HIV data sharing to improve HIV health outcomes
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NYS Policy Adopted 2016
Allows social service programs to participate in RHIOs
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NYS Regulations Adopted 2017
Expands HIV data sharing between health departments and Care Coordinators
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New York State Legislation Enacted 2014

Policy

Enhances HIV Data Sharing to Improve HIV Health Outcomes

Summary

The 2014-2015 New York State Enacted Budget included Article VII legislation to amend New York State Public Health Law 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 & Importance to ETE

The New York State 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 a patient’s data may be present in multiple, non-connected data systems – such as hospital and clinic electronic medical records, insurance billing, pharmacy utilization, and surveillance – the patient may appear lost in one system but remain visible in another. 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 who is no longer in the area or who has chosen to use a different provider. Properly cross-checked data will allow for appropriate provider or public health interventions to identify those persons truly lost to care or not virally suppressed and improve their health outcomes.

References & Policy Details
  • Chapter 60 of the Laws of 2014, Part A

New York State Policy Adopted 2016

Policy

Allows Social Service Programs to Participate in 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 in New York State such as the New York City Department of Social Services/Human Resources Administration's HIV/AIDS Services Administration (HASA) program (based on patient consent), to participate in RHIOs in order to facilitate exchange of information on a patient’s housing status and other social determinants of health with a patient's health and care coordination team.

Background & 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, and Health Home care coordinators. Participating providers that obtain patient consent engage in bidirectional exchange of health data to facilitate 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 the 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.

References & Policy Details

New York State Regulations Adopted 2017

Policy

Expands HIV Data Sharing to Allow Health Departments to Share HIV-Related Information with Care Coordinators to Improve HIV Health Outcomes

Summary

The New York State Department of Health finalized amendments to the New York State Public Health Law to expand HIV data sharing to allow local and state health departments to share HIV-related information with health care providers, including entities engaged in care coordination, for purposes of patient linkage and retention in care.

Background & Importance to ETE

The New York State Ending the Epidemic Blueprint supports changing state law to expand HIV data sharing to allow local and state health departments to share a patient’s HIV-related information with that patient’s medical providers and care coordination systems to improve linkage and retention 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 statewide public health. This amendment enables providers to improve HIV care outreach by using patient-level data to more efficiently identify patients who are out of care.

References & Policy Details

Enhance and streamline services to support the non-medical needs of all persons with HIV
BP8
Blueprint Recommendation 8
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. LGBT and other infected youth warrant special attention since their developmental stage, separation from family, and experienced trauma each can provide major complications. A minor who has been determined by a provider experienced in adolescent health to be competent to consent for care should be able to receive HIV treatment without parental consent. To achieve end of AIDS goals, it will be essential to ensure adequate, stable levels of support to people living with HIV in housing, transportation, employment, nutrition, substance abuse treatment, mental health services, and/or child care. Furthermore, HIV providers must have the knowledge and capacity necessary to link clients to such supportive services. Properly trained persons with AIDS should be employed as peer guides who can help others navigate support systems. These peer guides can also offer personal understanding and encouragement to overcome stigma and discrimination that may undermine treatment adherence.
NYS Legislation Enacted 2014
Caps rent for all HASA clients at 30% of monthly income
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NYS Executive Action 2016
Expands eligibility for New York City HASA Services
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NYS Legislation Enacted 2018
Expands "Rest of State" HIV Enhanced Shelter Allowance
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New York State Legislation Enacted 2014

Policy

Caps Rent for All HASA Clients at 30% of Monthly Income

Summary

Due to public assistance budgeting practice prior to 2014, New York City Department of Social Services/Human Resources Administration HIV/AIDS Services Administration (HASA) program clients on fixed incomes receiving 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 earned and unearned monthly income, including disability income, towards their rent. This 30% rent cap will ensure more HASA clients have access to stable, permanent housing, thus reducing emergency housing placements and avoidable Medicaid expenses such as emergency department visits and hospitalizations.

Background & 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 improving access to critical enablers of effective HIV treatment, including a safe, stable, and appropriate place to live (Getting to Zero (GTZ) Recommendation 1 and Blueprint Recommendation 16, Ensure access to stable housing).

References & Policy Details

New York State Executive Action 2016

Policy

Expands Eligibility for New York City HASA Services

Summary

Per the Policy Statement, any New York City resident with diagnosed HIV meeting income and other public assistance requirements is eligible for housing assistance and other services through the New York City Department of Social Services/Human Resources Administrations’ HIV/AIDS Services Administration (HASA) program. New York State Department of Health AIDS Institute guidance 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.

Per a New York State Office of Temporary and Disability Assistance determination, New York City residents with diagnosed HIV are eligible for Emergency Shelter Allowance, which includes a monthly transportation and nutrition allowance, and a 30% monthly income contribution cap towards rental costs for public assistance recipients.

Background & 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 a patient is receiving appropriate medical care, a person with HIV needs a host of non-medical resources. Those 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 New York State Ending the Epidemic Blueprint makes clear that ensuring adequate, stable levels of support with regard to housing, transportation, and nutrition, as well as substance abuse treatment, mental health services, and/or child care, is essential for people with HIV. In New York City, the HIV/AIDS Services Administration (HASA) program provides lifesaving social services including rental, 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 income-eligible New York City residents diagnosed with HIV. Thousands of HIV-positive New York City residents will now have access to lifesaving benefits and services through HASA.

References & Policy Details

New York State Legislation Enacted 2018

Policy

Expands "Rest of State" HIV Enhanced Shelter Allowance

Summary

The 2018-2019 New York State Enacted Budget allows local departments of social services across the state 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 New York State Department of Budget and New York State Office of Temporary Disability Assistance 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 New York State Department of Budget finding that Medicaid savings on hospital emergency department and inpatient care would cover the difference between the $480 localities are required by regulation to support and meaningful rents in line with local fair market rates. These savings would be deducted from the managed care reimbursement rate for persons housed in districts across New York State, not including New York City.

Background & 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 a patient is receiving appropriate medical care, a person with HIV needs a host of non-medical resources. Those 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 New York State Ending the Epidemic Blueprint makes clear that ensuring adequate, stable levels of support with regard to housing, transportation, and nutrition, as well as substance abuse treatment, mental health services, and/or child care, is essential for people with HIV.

The New York State Ending the Epidemic 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 New York City residents diagnosed with HIV and who are New York City public assistance recipients. Upstate and on Long Island, however, an estimated 3,700 low-income households with one or more members with HIV remain homeless or unstably housed because regulations enacted in the 1980s governing the New York State HIV Enhanced Shelter Allowance program set maximum rent at $480/month—too low to secure decent housing anywhere in the State. The New York State 2018-2019 Enacted Budget includes provisions that allow statewide expansion of meaningful HIV rental assistance and the 30% rent cap affordable housing protection, and a mechanism for the New York State Department of Budget and New York State Office of Temporary and Disability Assistance to mandate expansion by allocating Medicaid savings to cover 100% of incremental costs to local districts.

References & Policy Details

Provide enhanced services for patients within correctional and other institutions and specific programming for patients returning home from corrections or other institutional settings
BP9
Blueprint Recommendation 9
HIV-infected persons within correctional facilities or other institutional settings, such as a mental health facility or drug treatment program present specific challenges in encouraging them to get tested and stay engaged in care while in these institutions and when they return to their communities in linkage and retention in care and viral load suppression. Significant work needs to be done, especially around stigma and the lack of confidentiality, so that infected institutionalized persons are willing to be identified and treated as early in their stay as possible. In order to facilitate their engagement in care, it is necessary to enhance HIV education and other support services in these settings, including the augmentation of the existing state and local correctional facility-based initiatives and expanded use of HIV peer educators in correctional facilities. HIV care within state and local correctional facilities should be improved and more closely monitored by enhancing the NYSDOH’s statutory role in oversight of HIV services for incarcerated persons. Such efforts will make optimal health outcomes more likely in the facility and improve the likelihood for acceptance of post-release referrals. Release itself may trigger a return to behaviors antithetical to optimal HIV medical outcomes and may increase chances for possible transmission to others in the community. A true continuum of care needs to be established that includes in-facility treatment, discharge planning, a firm linkage to community-based care, enrollment in Medicaid, stable housing, employment opportunities and whatever other supports are necessary.
NYS Legislation Enacted 2015
Eliminates written consent for HIV testing in correctional facilities
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New York State Legislation Enacted 2015

Policy

Eliminates the Requirement of Written Consent for HIV Testing in Correctional Facilities

Summary

The 2015-2016 New York State Enacted Budget included Article VII legislation to authorize the elimination of the requirement of written consent for HIV testing in New York State correctional facilities.

Background & 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.

References & Policy Details
  • Chapter 57 of the Laws of 2015, Part I

Maximize opportunities through the Delivery System Reform Incentive Payment (DSRIP) process to support programs to achieve goals related to linkage, retention, and viral suppression
BP10
Blueprint Recommendation 10
DSRIP provides a unique opportunity to engage and leverage the health care system statewide in support of efforts to maximize viral suppression among HIV-infected persons. 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. Having each Performing Provider System in the state adopt a Domain 4 HIV/AIDS project would benefit both DSRIP and the state’s efforts to end the HIV epidemic. Additionally, NYS Special Needs Plans (SNPs) should be added in the first quarter of 2015 to the State’s Marketplace and their scope expanded to include comprehensive HIV prevention services such as PrEP and nPEP to ensure full access to HIV SNPs for HIV-positive new Medicaid recipients and to those requesting transfers from mainstream plans.
NYS Legislation Enacted 2016
Authorizes continued operation of HIV Special Needs Plans (SNPs)
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NYS Policy Enacted 2016
Makes HIV SNPs available on the NY State of Health Marketplace
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NYS Policy Enacted 2017
Expands HIV SNP to transgender persons regardless of HIV status
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New York State Legislation Enacted 2016

Policy

Authorizes Continued Operation of HIV Special Needs Plans (SNPs)

Summary

The 2016-2017 New York State Enacted Budget included Article VII legislation to authorize the continued operation of HIV Special Needs Plans (SNPs) serving persons with mental illness or HIV through 2020.

Background & Importance to ETE

The New York State 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 and retention in care, and viral suppression. The overall goal of DSRIP is to decrease unnecessary hospitalizations by 25%. Clearly, preventing people with HIV 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 not only the services that other Medicaid health plans cover, but also special services for people with HIV/AIDS, including an HIV specialist primary care provider, HIV care coordination services, treatment adherence services, and other specialty services. This legislation authorizes the continued operation of SNPs which benefit both DSRIP and New York State’s efforts to end the epidemic.

References & Policy Details
  • Chapter 59 of the Laws of 2016, Part D

New York State Policy Enacted 2016

Policy

Makes HIV Special Needs Plans (SNPs) Available on the New York State of Health Marketplace

Summary

As of January 15, 2016, New York State allows eligible health care consumers to select and enroll in an HIV Special Needs Health Plan (SNP) through the New York State of Health marketplace, for the first time since the marketplace was established in 2012.

Background & Importance to ETE

The New York State 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 and retention in care, and viral suppression. The overall goal of DSRIP is to decrease unnecessary hospitalizations by 25%. Clearly, preventing people with HIV 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 with HIV, including an HIV specialist primary care provider, HIV care coordination services, treatment adherence services, and other specialty services. Since January 15, 2016, eligible New Yorkers have been able to enroll in SNPs through the New York State of Health marketplace, enabling easy enrollment for new members as well as efficient resumption of membership for current members upon recertification or following membership interruption. Access to SNPs through the marketplace for new and current members benefits both DSRIP and New York State’s efforts to end the epidemic.

References & Policy Details

New York State Policy Enacted 2017

Policy

Expands HIV Special Needs Plan (SNP) Eligibility to Include Transgender Persons on Medicaid, regardless of HIV Status

Summary

Effective November 1, 2017, New York State Department of Health expanded the scope of persons eligible to enroll in HIV Special Needs Plans (SNPs) to include transgender Medicaid beneficiaries, including those who are HIV negative. The New York State Department of Health AIDS Institute and New York State Department of Health 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 & 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 include transgender New Yorkers, the care coordination and integrated social support services SNPs are designed to provide are accessible to more transgender New Yorkers, many of whom often experience significant barriers to care. This policy change supports the New York State Ending the Epidemic 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.

References & Policy Details

ETE Aim 3
Provide access to PrEP for persons who engage in high-risk behaviors to keep them HIV-negative

ETE Blueprint Recommendations 11-14

2014
2015
2016
2017
2018
2019
2020
Undertake a statewide education campaign on PrEP and nPEP
BP11
Blueprint Recommendation 11
For persons at high risk of acquiring HIV who have trouble adhering to other prevention strategies, PrEP and nPEP could mean the difference between staying negative and living the rest of their lives with HIV. Clinical guidelines on how to use PrEP outside of clinical trial settings have only been available since early 2014. Considerable education must be done with providers and consumers, most especially those who should be prescribing PrEP and nPEP and those who should be taking it. In some areas there may be almost no information at all available, while in others the issue may be that old or otherwise inaccurate information is circulating in the community. Each segment of the campaign must be specifically designed for medium, content and format to meet the needs of the target audience. Special care needs to be taken with ensuring that populations at risk such as gay men of color/men of color who have sex with men are reached in an appropriate way since it is with these men that PrEP and nPEP are most likely to have an impact on reducing new HIV infections. Schools, prisons, substance use programs, and mental health facilities would also be good places to, at a minimum, provide education about PrEP and nPEP.
Include a variety of statewide programs for distribution and increased access to PrEP and nPEP
BP12
Blueprint Recommendation 12
Medical practices, facilities or other programs with prescribers that serve large numbers of gay men, sero-discordant couples, persons who inject drugs, sexually active young people, including minors, farm workers, sex workers and new immigrants should all consider what role they could play in getting high-risk persons on PrEP or nPEP and optimizing adherence. STD clinics and others providing reproductive health services, including youth-serving clinics, seem to be natural places to engage populations since almost all infections in New York are sexually transmitted. Persons at substantial risk for HIV will go to such a clinic out of necessity if they have another STD that needs treatment, and MSM who do not identify as gay may find such clinics a place to have a PrEP and nPEP discussion without the stigma that they may feel going to a venue more specifically identified with gay men. Minors determined by a provider experienced in adolescent health to have capacity to give informed consent for care should be able to receive PrEP or nPEP without parental consent. State and local HIV/STD partner services field staff are also important resource points for linking persons at highest risk to PrEP and nPEP.
NYS Legislation Enacted 2016
Authorizes pharmacists to dispense up to 7 days of PEP
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New York State Legislation Enacted 2016

Policy

Authorizes Pharmacists to Dispense up to Seven Days of PEP Pursuant to a Non-Patient Specific Order

Summary

Chapter 502 of the Laws of 2016 amends New York State Education Law to authorize a licensed pharmacist to dispense up to seven days of post-exposure prophylaxis (PEP) for the purpose of preventing HIV infection pursuant to a non-patient specific order by a licensed physician or certified nurse practitioner.

Background & Importance to ETE

The New York State Ending the Epidemic Blueprint recommends including a variety of statewide programs for distribution and increased access to post-exposure prophylaxis (PEP). PEP is an emergency medication for people who are HIV-negative and may have been exposed to HIV. 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 department 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.

References & Policy Details

Create a coordinated statewide mechanism for persons to access PrEP and nPEP and prevention focused care
BP13
Blueprint Recommendation 13
Although PrEP is a fairly straight forward 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. Non-occupational post-exposure prophylaxis (nPEP) is also an important prevention tool that should have expanded access and utilization. Repeated use of nPEP is a strong indicator that PrEP may be more appropriate. The state should create a PrEP and nPEP assistance program for persons to gain easy access with out-of-pocket costs minimized through state support or coordination of benefits with other payers.
NYS Initiative Implemented 2015
Establishes a statewide PrEP Assistance Program (PrEP-AP)
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New York State Initiative Implemented 2015

Policy

Establishes a statewide Pre-Exposure Prophylaxis Assistance Program (PrEP-AP)

Summary

In 2015, the New York State Department of Health established 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 to eligible individuals for necessary primary care services from providers serving HIV-negative, individuals at increased risk of HIV.

Background & Importance to ETE

The New York State Ending the Epidemic Blueprint recommends that the state create a Pre-exposure Prophylaxis (PrEP) Assistance Program for individuals 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 straightforward regimen of one pill per day, there are numerous complicating factors that may present barriers to access and adherence. PrEP is covered by public and private insurance; however, there may be co-pays for the medication, associated ongoing HIV, STI, or kidney function testing, or other prevention-related services that would make it less affordable. Individuals 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’s PrEP Assistance Program (PrEP-AP) provides reimbursement to eligible individuals for necessary primary care services from providers serving HIV-negative individuals at increased risk of HIV. 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.

References & Policy Details

Develop mechanisms to determine PrEP and nPEP usage and adherence statewide
BP14
Blueprint Recommendation 14
Since PrEP and nPEP has been identified as one of the three major initiatives in the plan to end HIV as an epidemic in New York, it would make sense to develop as comprehensive a system as possible to determine how many persons are on the medication and how adherent they are. Though PrEP currently is only approved at this point as a once-a-day dose of Truvada®, tracking use requires separating out persons who may be using it for treatment of HIV infection or for post-exposure prophylaxis. As new drugs become approved for PrEP and nPEP, the difficulties may increase depending on other uses for those medications. The state has good direct access to information of how Truvada® is being used by persons on Medicaid, but not so for other payers. The manufacturer of Truvada® only provides estimates of PrEP and nPEP utilization based on sales at a sample of pharmacies nationally. The possibility of creating a registry for the purposes of monitoring usage and adherence among New Yorkers is one avenue that should be explored.
ETE Aim 4
Recommendations in support of decreasing new infections and disease progression

ETE Blueprint Recommendations 15-30

2014
2015
2016
2017
2018
2019
2020
Increase momentum in promoting the health of people who use drugs
BP15
Blueprint Recommendation 15
Tremendous success has already been seen in reducing new HIV infections among persons who inject drugs. Steps should be taken to ensure that these gains are maintained and that programs are equipped 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. Policy and legislative changes must be advanced to promote expanded statewide access to clean syringes for injection drug users, increased access to drug treatment (especially expansion of methadone and buprenorphine capacity), and improved health systems to protect drug users from related adverse outcomes such as overdose and contracting viral hepatitis.
NYS Legislation Enacted 2015
Clarifies provisions related to Expanded Syringe Access Program
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NYS Executive Action 2016
Expands access to Naloxone at independent pharmacies outside New York City
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NYS Initiative Implemented 2017
Establishes a state Naloxone Co-Payment Assistance Program (N-CAP)
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New York State Legislation Enacted 2015

Policy

Clarifies Provisions of Law Related to New York State Department of Health’s Expanded Syringe Access Program and Medical Provider-Based Syringe Access Programs

Summary

The 2015-2016 New York State Enacted Budget included Article VII legislation to amend New York State Penal Law to explicitly decriminalize syringe possession or possession of a residual amount of a controlled substance for individuals participating in New York State Department of Health’s Expanded Syringe Access Program (ESAP) or a medical provider-based syringe access program.

Background & Importance to ETE

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

References & Policy Details
  • Chapter 57 of the Laws of 2015, Part I

New York State Executive Action 2016

Policy

Expands Access to Naloxone at Independent Pharmacies Outside New York City

Summary

On March 2, 2016, Governor Andrew Cuomo announced that Harm Reduction Coalition, the New York State Department of Health’s Center for Excellence in serving the needs of substance users, will issue standing medical orders to the more than 750 independent pharmacies statewide outside New York City, as well as chain pharmacies without a designated prescriber, allowing their pharmacists to dispense naloxone without a prescription. As a state-registered overdose prevention program, Harm Reduction Coalition is authorized to issue these standing orders. Many smaller counties across the state have no chain pharmacies and rely exclusively on independent pharmacies.

Background & Importance to ETE

New York State has seen tremendous success in reducing new HIV infections among persons who inject drugs. The New York State Ending the Epidemic Blueprint recommends taking steps to maintain these gains and to equip programs to address the needs of new and/or younger injectors, many of whom are unaware of the devastating epidemic of prior decades. Harm reduction approaches have been most successful in meeting the needs of this population, offering an array of services that range from syringe access and overdose prevention 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 that Harm Reduction Coalition issue will help prevent overdoses and promote drug users’ health.

References & Policy Details

New York State Initiative Implemented 2017

Policy

Establishes a State Naloxone Co-Payment Assistance Program (N-CAP)

Summary

In 2017, Governor Andrew Cuomo announced a first-in-the-nation program to provide no- or lower-cost naloxone at pharmacies across New York State. Beginning August 9, 2017, under New York State Department of Health’s Naloxone Co-Payment Assistance Program (N-CAP), 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 intervention. Uninsured individuals and individuals without prescription coverage will still be able to receive naloxone at no cost through the state network of registered opioid overdose prevention programs.

Background & Importance to ETE

New York State has seen tremendous success in reducing new HIV infections among persons who inject drugs. The New York State Ending the Epidemic Blueprint recommends taking steps to maintain these gains and to equip programs to address the needs of new and/or younger injectors, many of whom are unaware of the devastating epidemic of prior decades. Harm reduction approaches have been most successful in meeting the needs of this population, offering an array of services from syringe access and overdose prevention to drug treatment and relapse prevention. By expanding access to the Naloxone at pharmacies for New Yorkers who have prescription coverage through their health insurance plans, the New York State Department of Health’s Naloxone Co-payment Assistance Program (N-CAP) will help prevent overdoses and promote drug users’ health.

References & Policy Details

Ensure access to stable housing
BP16
Blueprint Recommendation 16
The greatest unmet need of people at risk or living with HIV in New York State is housing. Research findings show that a lack of stable housing is a formidable barrier to HIV care and treatment effectiveness at each point in the HIV care continuum – PWH who lack stable housing: are more likely to delay HIV testing and entry into care; are more likely to experience discontinuous care; are less likely to be on ART; and are less likely achieve sustained viral suppression. Studies show that housing assistance is an evidence-based HIV health intervention that is among the stronger predictors of improved HIV health and viral suppression. Expanded eligibility and new resources are necessary for the expansion of supportive housing opportunities for PWH. Statewide protections such as limiting the percentage of income that can be required for rent in publicly funded housing programs should be instituted.
NYS Legislation Enacted 2014
Caps rent for all HASA clients at 30% of income
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NYS Executive Action 2016
New York City "HASA for All"
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NYS Legislation Enacted 2018
Expands HIV enhanced shelter allowance benefit outside New York City
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New York State Legislation Enacted 2014

Policy

Caps 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 & 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). 

References & Policy Details

New York State Executive Action 2016

Policy

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 & 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.  

References & Policy Details

New York State Legislation Enacted 2018

Policy

Expands HIV enhanced shelter allowance benefit outside New York City

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 & 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.  

References & Policy Details

Reducing new HIV incidence among homeless youth through stable housing and supportive services
BP17
Blueprint Recommendation 17
Given the significant rise of HIV rates among young adults, especially among MSM of color and transgender populations, it is imperative that NYS address the structural drivers of HIV incidence including, but not limited to poverty, homelessness and housing instability, stigma, health disparities and lack of access to biomedical HIV prevention that put certain youth at extremely high risk for HIV infection and numerous other negative medical and behavioral health outcomes. Without comprehensive programs that address these and other factors, homeless and unstably housed youth and youth aging out of foster care are at high risk. Since the needs of these populations cut across many state and local government entities, it is recommended that a formalized interagency approach be adopted. More flexibility in the range of ages served by housing programs is called for to ensure those young persons at either end of the range are not arbitrarily shut out of programs that could keep them uninfected. A statewide needs assessment may be an important first step so actions taken are informed by a systematic examination of current circumstances.
NYS Legislation Enacted 2017
Raises the age to access Runaway and Homeless Youth Housing and Services
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New York State Legislation Enacted 2017

Policy

Raises the Maximum Age for Runaway and Homeless Youth Housing and Services from 21 Years to 24

Summary

The 2017-2018 New York State Enacted Budget included Article VII legislation to expand the New York State Runaway and Homeless Youth Act to include individuals ages 24 years and younger who need services and are without a place of shelter where supervision and care are available, an increase from the previous maximum age of 21 years. The enacted budget also allows municipalities to significantly extend the length of stay in runaway and homeless youth crisis and transitional beds.

Background & Importance to ETE

Homeless and unstably housed youth are at increased risk for HIV infection due to an array of risk behaviors, including survival sex (trading sex for basic needs), having multiple sexual partners, low frequency of condom use, and injection drug use.

References & Policy Details
  • Chapter 56 of the Laws of 2017, Part M

Health, housing, and human rights for LGBT communities
BP18
Blueprint Recommendation 18
Promoting the health, safety and dignity of LGBT communities is a vital part of ending the HIV epidemic in New York State. Culturally competent service models that address individual, group and community-level barriers to LGBT identified individuals engaging and linking to care must be addressed. Utilization of peer led programming may better engage people in activities that support employment, life skills training, and mentorship. Considering the major impact HIV has had on populations such as gay men and transgender persons, special attention needs to be given to developing infrastructure to allow these communities to play a direct role in identifying and addressing their own needs.
NYS Regulations Adopted 2016
Prohibits the provision of and reimbursement for conversion therapy
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NYC Initiative Implemented  2017
Establishes an LGBTQ Health Care Bill of Rights for New York City
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New York State Regulations Adopted 2016

Policy

Prohibits the Provision of and Reimbursement for Conversion Therapy Related to Sexual Orientation or Gender Identity or Expression

Summary

On February 6, 2016, Governor Cuomo announced multi-agency regulations intended to prohibit conversion therapy – practices by mental health providers that seek to change an individual's sexual orientation or gender identity or expression. The New York State Department of Financial Services issued regulations barring insurers from providing coverage for conversion therapy for minors and prohibited coverage for conversion therapy under the New York State Medicaid program. The New York State Office of Mental Health issued regulations prohibiting facilities within its jurisdiction from providing conversion therapy treatment to minors. In 2019, Governor Cuomo signed a bill to make it law, Chapter 7 of the Laws of 2019.

Background & Importance to ETE

The New York State Ending the Epidemic Blueprint recommends promoting culturally competent service models that address individual, group, and community-level barriers to care for LGBTQ individuals. In 2009, the American Psychological Association convened a Task Force on Appropriate Therapeutic Responses to Sexual Orientation that concluded that sexual orientation change efforts can pose critical health risks to LGBTQ people ranging from confusion and depression, to substance abuse and suicide. By prohibiting the provision of and reimbursement for conversion therapy, these state regulations promote the health, safety, and dignity of LGBTQ New Yorkers, a critical component to our efforts to end the HIV epidemic in New York State.

References & Policy Details

New York City Initiative Implemented 2017

Policy

Establishes an LGBTQ Health Care Bill of Rights for New York City

Summary

The New York City Health Department developed the LGBTQ Health Care Bill of Rights, which details the health care protections available to LGBQ and transgender, gender non-conforming, and non-binary (TGNCNB) patients in New York City. Released in June 2017, the LGBTQ Health Care Bill of Rights informs New Yorkers of their legal rights in health care settings, empowers New Yorkers to get the health care they deserve, and reminds New Yorkers that health care providers and staff cannot legally provide LGBTQ people with a lower quality of care because of their sexual orientation, gender identity, or gender expression. It also directs people who identify as LGBTQ to report health care discrimination to 311 and/or the New York City Commission on Human Rights. The LGBTQ Health Care Bill of Rights is distributed to clinics, health centers, and hospitals across New York City, and at Pride and other community outreach events.

Background & Importance to ETE

The New York State Ending the Epidemic Blueprint recommends promoting culturally -competent service models that address individual, group, and community-level barriers to LGBTQ-identified individuals accessing health care and support services. Transgender people in particularly are at increased risk of HIV infection due to stigma, discrimination, and lack of appropriate services. New York City’s LGBTQ Health Care Bill of Rights promotes the safety and dignity of LGBTQ communities by asserting their rights when seeking health care in New York City.

References & Policy Details

Institute an integrated comprehensive approach to transgender health care and human rights
BP19
Blueprint Recommendation 19
Due to stigma, discrimination, and related circumstances, transgender persons have extremely high rates of HIV infection. Promoting the health, safety, dignity and human rights of transgender communities will be a vital part of ending the epidemic in New York State. Removing the barriers for transgender New Yorkers to access health care, and ensuring the prompt implementation of the new regulations around access to transition services, must be a priority. Governor Cuomo has already taken steps to protect the rights of all LGBT persons in the state workforce. Having the same level of protection for sexual orientation and gender expression across the state would decrease stigma and discrimination that lead to poor health outcomes, including HIV infection.
NYS Regulatory Guidance Issued 2014
Extends health insurance to include Gender Dysphoria
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NYS Regulations Adopted 2016
Prohibits discrimination on the basis of gender identity
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NYC Executive Action 2016
Right to use NYC-operated restrooms consistent with gender identity
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NYC Data Collection Protocol Change Implemented 2016
Uses a 2-step question to improve CHS data for gender identity
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NYS Administrative Action 2017
Expands HIV SNP coverage to transgender person regardless of HIV status
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NYS Regulatory Guidance Issued 2017
Prohibits denial of health services based on gender identity
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New York State Regulatory Guidance Issued 2014

Policy

Extends Health Insurance Coverage to Include the Treatment of Gender Dysphoria

Summary

In 2014, New York State Department of Financial Services issued an Insurance Circular Letter to provide guidance to issuers regarding health insurance coverage for the treatment of gender dysphoria. The letter prohibited issuers from denying medically necessary treatment otherwise covered by a health insurance policy or contract solely on the basis that the treatment is for gender dysphoria, and required issuers to provide an insured individuals with the full range of utilization review appeal rights as described in Article 49 of New York State Insurance Law and New York State Public Health Law for any gender dysphoria treatment that is denied based on medical necessity. Effective March 11, 2015, the New York State Medicaid program covers medical hormone therapy and gender alignment surgery for individuals with a diagnosis of gender dysphoria (ICD-9 code 302.85), as well as hormone therapy 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 & Importance to ETE

The New York State Ending the Epidemic Blueprint recommends prioritizing the removal of barriers for transgender New Yorkers to access health care, and the prompt implementation of the new regulations around access to transition services. 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 New Yorkers, a vital part of ending the HIV epidemic in New York State.

References & Policy Details

New York State Regulations Adopted 2016

Policy

Prohibits Discrimination on the Basis of Gender Identity

Summary

On January 20, 2016, Governor Cuomo announced that the New York State Division of Human Rights adopted new regulations prohibiting discrimination and harassment against transgender people. The regulations affirm that transgender individuals are protected under the State’s Human Rights Law.

Background & Importance to ETE

The New York State Ending the Epidemic Blueprint recommends taking steps to protect the rights of all New Yorkers, regardless of sexual orientation and gender identity and expression, including in the workforce. By prohibiting discrimination and harassment people may experience based on their gender identity and expression, these regulations promote the health, safety, dignity, and human rights of transgender communities, a vital part of ending the epidemic in New York State.

References & Policy Details

New York City Executive Action 2016

Policy

Requires that City employees and members of the public be allowed to use the City-owned or -operated restroom or other single-sex facility that most closely aligns with their gender identity or expression

Summary

On March 7, 2016, Mayor Bill de Blasio issued an Executive Order that requires City agencies to ensure that City employees and members of the public using City-owned or -operated facilities can use restrooms and other single-sex facilities consistent with their gender identity or expression without having to show identification, medical documentation, or other proof of gender. The Executive Order also requires City agencies to post the Single-Sex Facility Policy in conspicuous locations; provide supervisory and frontline staff City-approved training on transgender diversity and inclusion; update their Equal Employment Opportunity (EEO) plans to incorporate this training requirement; and report compliance efforts.

Background & Importance to ETE

The New York State Ending the Epidemic Blueprint recommends taking steps to protect the rights of all New Yorkers, regardless of sexual orientation and gender identity and expression, including in the workforce. By prohibiting discrimination and harassment people may experience based on their gender identity and expression, these regulations promote the health, safety, dignity, and human rights of transgender communities, a vital part of ending the epidemic in New York State.

References & Policy Details

New York City Data Collection Protocol Change Implemented 2016

Policy

Incorporates Two-Step Question on Sex Assigned at Birth and Gender Identity into New York City’s Community Health Survey

Summary

In 2016, the New York City Health Department approved the inclusion of a two-step question on sex assigned at birth and current gender identity in the 2017 Community Health Survey, the agency 's annual telephone health survey of adults in New York City. The question follows the 2015 addition of a question that allowed Community Health Survey respondents to assert a transgender or gender nonconforming identity that was used in conjunction with a question, “Are you male or female?” With the new, two-step question, data aggregated over multiple years will allow New York City Health Department to better document, monitor, and address the health inequities faced by transgender and gender nonconforming New Yorkers.

Background & Importance to ETE

The New York State Ending the Epidemic Blueprint recommends taking steps to protect the rights of all New Yorkers, regardless of sexual orientation and gender identity and expression. Data collected through the New York City Health Department’s Community Health Survey helps track the health of New Yorkers, influence health program decisions, and increase the understanding of the relationship between health behavior and health status. The Community Health Survey’s new two-step question on sex assigned at birth and current 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.

References & Policy Details

New York State Administrative Action 2017

Policy

Expands HIV SNP eligibility 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 & 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. 

References & Policy Details

New York State Regulatory Guidance Issued 2017

Policy

Prohibits Denial of Claims for a Service because the Claimant is Not of the Gender to Whom the Service is Typically Provided Without First Determining Whether the Service was Appropriately Provided

Summary

In August 2017, the New York State Department of Financial Services issued an Insurance Circular Letter to provide guidance to issuers regarding health insurance coverage for health services typically or exclusively provided to claimants of a certain gender. The letter prohibits issuers from denying 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 & Importance to ETE

The New York State Ending the Epidemic Blueprint recommends taking steps to protect the rights of all New Yorkers, regardless of sexual orientation and gender identity and expression. This state regulatory guidance helps ensure 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.

References & Policy Details

Expanded Medicaid coverage for sexual and drug-related health services to targeted populations
BP20
Blueprint Recommendation 20
To end the epidemic, targeted prevention and care efforts must be made for NYS residents that are at high risk for HIV who are uninsured, underinsured or privately insured and want to keep their sexual health services confidential. The provision of a benefit that is similar to the current NYS Family Planning Benefits Program (FPBP) would cover sexual health services, such as PrEP and nPEP, STI screening and treatment, HIV management, Hepatitis C testing and treatment, family planning services, and transgender transition services.
NYS Initiative Implemented 2017
Establishes Naloxone Co-payment Assistance Program (N-CAP)
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New York State Initiative Implemented 2017

Policy

Establishes 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 (N-CAP). 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 & Importance to ETE

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.  

References & Policy Details

Establish mechanisms for an HIV peer workforce
BP21
Blueprint Recommendation 21
Employment is an important facilitator of long-term adherence and viral suppression. Many PWH have already re-entered the workforce or never left it. Others have a strong desire to work, but few opportunities are available to them. Development of a certified peer workforce that can provide Medicaid-reimbursable linkage, reengagement, treatment adherence, and retention in care services offers a high impact, cost-effective and sustainable model for delivering peer education and health navigation 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. Integration of a peer-delivered model in the health care system requires the development a set of services that are optimally delivered by peers and a standardized training program that leads to a certification or designation accepted by service provider agencies and payers, and pays a living wage.
Peer Worker Certification 2015
Implements NYSDOH AIDS Institute Peer Worker Certification Program
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Peer Worker Certification 2015

Policy

Implements New York State Department of Health AIDS Institute Peer Worker Certification Program

Summary

In 2015, the New York State Department of Health AIDS Institute established its Peer Worker Certification Program. Peer services can play a key role in meeting the state’s goals of improving linkage and retention in HIV care, improving rates of viral suppression, and preventing new infections. The potential for Medicaid reimbursement of peer-delivered interventions makes peer worker certification a critical step in ensuring access to this revenue stream for the support of peer services.

Background & Importance to ETE

Employment is an important facilitator of long-term adherence and viral suppression. However, some people with HIV have few available work opportunities. The New York State 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 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 New York State Department of Health AIDS Institute’s 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.

References & Policy Details

Access to care for residents of rural, suburban and other areas of the state
BP22
Blueprint Recommendation 22
Identified, long-term structural barriers to accessing care require specific accommodations to promote increased access, adherence and viral suppression among residents of rural, suburban and other communities across New York State. New York is a large state impacted by varied levels of care access and varied formal care structures. As a result of this varied access, the effective use of telehealth, telemedicine, digital and electronic care coordination models should be instituted among care and support service providers. Transportation should be reimbursed (via stipend, gas card, Metrocard) and made accessible in a reasonable manner to consumers. Physician incentives should be applied to encourage physicians to practice in rural and other isolated communities of the state, and should include the removal of existing barriers for the reimbursement of telemedicine services. Culturally sensitive modalities of care should be required when considering the needs of key, high risk populations including MSM, MSM of color, transgender people, women of color, and injection drug users. These identified high-risk communities often report barriers to accessing care within their local community due to stigma and discrimination further provoked by a lack of anonymity.
Promote comprehensive sexual health education
BP23
Blueprint Recommendation 23
New York State youth continue to have high rates of STIs which have serious health consequences including infertility and increased susceptibility to HIV infection. These rates are evidence that current school and family based efforts and approaches are not adequate. Since HIV transmission in New York is now almost exclusively sexually transmitted, New York State schools should be encouraged to provide comprehensive sexual health education. Such education deals not just with providing information on disease but tools for living healthily across the lifespan. This is similar to youth nutrition programs not only addressing the dangers of obesity but providing guidance on good food choices and exercise. Sexual health education, including LGBT sexual health, provides students with the knowledge, skills, and support they need to make healthy decisions, develop positive beliefs, and respect the important role sexuality plays throughout a person’s life. At the secondary level, sexuality education includes the knowledge and skills to delay sexual activity and prevent and protect against sexually transmitted infections including HIV, unintended pregnancies, including the effective use condoms, contraceptives, nPEP, and PrEP. Education at all levels must be inclusive and respectful of the role gender identity and sexual orientation play in sexual health.
Remove disincentives related to possession of condoms
BP24
Blueprint Recommendation 24
Current law permits a person’s possession of condoms to be offered as evidence of prostitution-related criminal and civil offenses. At times condoms are confiscated as contraband, and the fact that a person is carrying condoms can be used as a basis for suspicion, arrest, or prosecution. The persons targeted are often sex workers (or assumed to be sex workers) who are at the highest risk for infection. As a result, individuals are discouraged from carrying and using condoms, undermining state efforts to limit the spread of HIV and other STIs. Permitting this practice to continue to criminalize and stigmatize condom possession is in direct opposition to promotion of condom use as a prevention tool essential to public health. Reform is necessary to minimize the practice of confiscating and using condoms as evidence except in those cases where it is clearly necessary.
NYS Legislation Enacted 2015
Prohibits condoms as evidence in prostitution certain cases
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New York State Legislation Enacted 2015

Policy

Prohibits the use of condom possession as evidence in prostitution or loitering for the purpose of engaging in a prostitution offense cases

Summary

The 2015-2016 New York State Executive Budget included Article VII legislation to amend the New York State Criminal Procedure Law to prohibit the use of evidence that a person was in possession of one or more condoms as evidence in any trial, hearing, or other proceeding in a prosecution for N.Y. Pen. Law § 230.00 (“Prostitution”) or § 240.37 (“Loitering for the purpose of engaging in a prostitution offense”) for the purpose of establishing probable cause for an arrest or for proving the commission of the crime.

Background & Importance to ETE

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 efforts to limit the spread of HIV and other sexually transmitted infection. These laws are most often enforced against people involved in the sex trades, many of whom are at increased risk of HIV infection. Criminalizing and stigmatizing condom possession counteracts efforts to promote condom use as a fundamental HIV prevention strategy. By limiting the admissibility of condoms as evidence in criminal proceedings, this legislation supports the New York Ending the Epidemic Blueprint recommendation to remove disincentives related to the possession of condoms.

References & Policy Details
  • Chapter 57 of the Laws of 2015, Part I

Undetectable=Untransmittable Consensus Sign On and Anti-Stigma Media Campaigns
BP25
Blueprint Recommendation 25
New York State and City have a history of developing successful HIV-related public education campaigns. One model, the “HIV Stops with Me” campaign, is a statewide information effort targeting communities of high HIV prevalence to address stigma, discrimination and the prevention benefits of HIV treatment. A campaign that targets both HIV-infected and HIV uninfected individuals should promote prevention interventions and serve to improve treatment adherence for people living with HIV. Lowering the threshold for consent and access to treatment and ARV-P (antiretroviral prophylaxis) for adolescents at risk for HIV acquisition should be explored. Stigma has greatly impacted the ability of many members of affected communities to remain in care. A well-designed informational campaign targeting MSM of color, especially young black MSM, recent immigrants (Latin American, Haitian, Caribbean and African immigrants in particular), transgender persons and women, may result in a significant increase in persons who access PrEP and nPEP, HIV testing, are linked to care, are retained in care and are adherent to ART. The campaign should also target health care providers to increase their cultural competency and reduce the stigma that patients experience while in care. It should also increase the awareness and expanded use of new prevention options by health care providers
NYC Initiative Implemented 2016
NYC Health Department Endorses Undetectable = Untransmittable
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NYS Policy Implemented 2017
NYS Endorses Undetectable = Untransmittable
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New York City Initiative Implemented 2016

Policy

New York City Health Department Endorses Undetectable = Untransmittable (U = U)

Summary

In August 2016, New York City became the first jurisdiction in the United States to join the ""Undetectable = Untransmittable"" (“U = U”) campaign. The New York City Department of Health and Mental Hygiene signed the Prevention Access Campaign’s 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 November 2017, the New York State Department of Health became the first state health department to sign onto the Campaign and the Commissioner of Health sent out two Dear Colleague letters addressing the topic.

The Health Department issued U = U information for providers and the public on its website, developed U = U trainings, and convened community listening sessions on the importance of U = U.

The New York State Department of Health launched its U=U health marketing campaign in December 2018, addressing stigma by using the expertise of those who have experienced it and providing honest viewpoints to inform others. In June 2019, the New York City Department of Health and Mental Hygiene launched “Made Equal,” a sexual health marketing campaign promoting U = U and encouraging New Yorkers to start and continue treatment if they are living with HIV. The campaign is designed to reduce HIV-related stigma, celebrate healthy sexuality and sexual pleasure, and redefine what it means to live with HIV.

Background & Importance to ETE

The New York State Ending the Epidemic Blueprint recommends media campaigns that promote both HIV prevention and the importance of treatment for people with HIV. Campaigns should target not only HIV-positive and HIV-negative people, but also their health care providers to improve providers’ cultural competency and reduce the stigma that patients may experience while in care. New York City Health Department joining the groundbreaking U = U movement 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 helps dismantle stigma reduction in health care and other settings.

References & Policy Details

New York State Policy Implemented 2017

Policy

New York State Endorses 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 letter to clinicians and stakeholders summarizing the scientific findings that have 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 & Importance to ETE

In August 2016, New York City became the first jurisdiction in the United States to join the "Undetectable = Untransmittable" (“U = U”) campaign. The New York City Department of Health and Mental Hygiene signed the Prevention Access Campaign’s 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 November 2017, the New York State Department of Health became the first state health department to sign onto the Campaign and the Commissioner of Health sent out two Dear Colleague letters addressing the topic.

The New York State Department of health launched its U=U health marketing campaign in December 2018, addressing stigma by using the expertise of those who have experienced it and providing honest viewpoints to inform others. In June 2019, the New York City Department of Health and Mental Hygiene launched “Made Equal,” a sexual health marketing campaign promoting U = U and encouraging New Yorkers to start and continue treatment if they are living with HIV. The campaign is designed to reduce HIV-related stigma, celebrate healthy sexuality and sexual pleasure, and redefine what it means to live with HIV.

References & Policy Details

Provide Hepatitis C (HCV) testing to persons with HIV and remove restrictions to HCV treatment access based on financial considerations for individuals co-infected with HIV and HCV
BP26
Blueprint Recommendation 26
Hepatitis C virus (HCV) is a common cause of death from liver disease among the HIV-infected population. Approximately 15% to 30% of people in the U.S. with HIV are estimated to be co-infected with HCV. Data reported from the AIDS Clinical Trial Group (ACTG) A5001 cohort demonstrate that HIV/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 reduction and treatment of HCV transmission is a key priority for ensuring one devastating epidemic is not ended while another, which impacts many of the same populations, continues. HCV detection and treatment directly relates to individual health outcomes and overall quality of care. Targeted efforts may potentially eliminate HCV-related morbidity and mortality among co-infected persons by providing HCV testing to all persons living with HIV and restrictions to access based on financial considerations should be addressed and by removing restrictions to HCV treatment access based on financial considerations for individuals coinfected with HCV HIV/HCV.
NYS Clinical Guidelines Updated 2016
Removes some criteria for HCV treatments in Medicaid FFS
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NYS Executive Action 2016
Expands NYS ADAP to cover HCV treatment
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NYS Policy Implemented 2018
Establishes state-level Hepatitis C Elimination Strategy
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New York State Clinical Guidelines Updated 2016

Policy

Removes Disease Prognosis and Severity Restrictions for Hepatitis C Treatments in Medicaid Fee-for-Service

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-preferred hepatitis C DAAs were covered.

Background & Importance to ETE

Under development.

References & Policy Details

New York State Executive Action 2016

Policy

Expands New York State AIDS Drug Assistance Program (ADAP) formulary to include coverage of hepatitis C direct acting antivirals

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 & Importance to ETE

Under development.

References & Policy Details

New York State Policy Implemented 2018

Policy

Establishes state-level Hepatitis C Elimination Strategy, Supported by $5M Initial Investment

Summary

In 2018, the Governor announced a new state-level Hepatitis Elimination Strategy, including funding for hepatitis C prevention, testing, and treatment programs, such as education, patient navigation, and hepatitis C prevention programs in primary care and other settings. The proposal to create a hepatitis C elimination plan has strong community and medical provider support, as evidenced by the nearly 150 hospitals, community health centers, and local departments of health that endorsed the New York State Hepatitis C Elimination Consensus Statement in 2017. The Consensus Statement called on Governor Cuomo, the state legislature, and industry partners to make a joint commitment to hepatitis C elimination, including establishing a formal task force to develop a statewide elimination plan.

Background & Importance to ETE

Hepatitis C-related deaths have exceeded HIV-related deaths in the state outside of New York City since 2007, and with injection drug use as the most common risk factor, the opioid epidemic has fueled a rise in new infections. Hepatitis C detection and treatment directly relates to individual health outcomes and overall quality of care for people with HIV. One in five persons with HIV is co-infected with hepatitis C, and studies show that 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 hepatitis C-related end-stage liver disease as a leading cause of in-hospital mortality among HIV-infected patients. The New York State Ending the Epidemic Blueprint recommends prioritizing hepatitis C prevention and treatment as a critical component of ending the HIV epidemic.

With new drugs that provide easy-to-take and extremely effective curative treatments, the elimination of hepatitis C is within reach. The Governor’s announcement makes New York the first state in the nation to commit to hepatitis C elimination. The state’s progress towards ending the HIV epidemic makes it uniquely positioned to work with community members, providers, and health departments to develop and implement a plan to eliminate hepatitis C statewide.

References & Policy Details

Implement the Compassionate Care Act in a way most likely to improve HIV viral suppression
BP27
Blueprint Recommendation 27
In June 2014, the New York State legislature passed a medical marijuana bill that makes medical cannabis available to patients with a number of serious illnesses, including HIV. The program gives broad discretion to the Commissioner of Health in implementing the program, which should be operational by January of 2016. Given the potential role that cannabis can play in adherence, eligible individuals living with HIV/AIDS should have access to this medication.
Equitable funding where resources follow the statistics of the epidemic
BP28
Blueprint Recommendation 28
Since the early days of the HIV epidemic, certain populations have been much more heavily impacted than others. In the early 1990s, most diagnoses were related to injection drug use, while currently most new infections are among MSMs, with specific concerns about young MSM of color. Additionally, diagnoses also varied from region to region, with some communities experiencing much higher HIV incidence than others. There is a need to work with agencies and providers who target these populations, and representatives of these communities to more effectively design and implement strategies for prevention, engagement, care and treatment. Resources should be dedicated to mobilizing community members to create new indigenous groups and networks to promote health and wellness goals and broader health care access.
Expand and enhance the use of data to track and report progress
BP29
Blueprint Recommendation 29
Voluminous amounts of HIV related data are routinely collected across New York State and reported through a variety of systems; however, there are many missed opportunities to improve our capacity to understand the epidemic in New York, improve patient outcomes, and prevent new infections. Consistent outcome monitoring and innovative use of data must be also be used to measure the state’s success in achieving end of the epidemic goals. The creation of a web-based, public facing ‘Ending the Epidemic Dashboard' is recommended to broadly disseminate information to stakeholders on the Initiative’s progress. This would include reflecting trends and county-level maps of key metrics related to the initiative, and should be updated quarterly. An important step taken in 2014 was a change in state law that allows sharing of surveillance data with medical providers to improve linkage and retention of HIV-infected persons in care. The state should build on existing technologies, and adopt new ones as appropriate to collect, integrate and disseminate priority data that include prevention, quality of care, and social determinants indicators. Key HIV quality metrics need to be adopted in systems which have an impact on provider and plan reimbursement to ensure improved performance is incentivized. To advance this effort a statewide consortia made up of academia, service providers, and other organizations should be considered to design, assess, and evaluate large data sets and to conduct or commission qualitative and quantitative research crucial to measuring the Blueprint success. Analytic capacity should be increased at state and local health departments to allow for enhanced, timely reporting and appropriate use of data for public health action.
NYS Regulations Adopted 2017
Expands HIV data sharing to improve HIV health outcomes
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New York State Regulations Adopted 2017

Policy

Expands HIV Data Sharing to Allow Health Departments to Share HIV-Related Information with Care Coordinators to Improve HIV Health Outcomes

Summary

The New York State Department of Health finalized amendments to the New York State Sanitary Code to expand HIV data sharing to allow local and state health departments to share HIV-related information with health care providers, including entities engaged in care coordination, for purposes of patient linkage and retention in care.

Background & Importance to ETE

The New York State Ending the Epidemic Blueprint supports changing state law to expand HIV data sharing to allow local and state health departments to share a patient’s HIV-related information with that patient’s medical providers and care coordination systems to improve linkage and retention 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 statewide public health. This amendment enables providers to improve HIV care outreach by using patient-level data to more efficiently identify patients who are out of care.  

References & Policy Details

Increase access to opportunities for employment and vocational services
BP30
Blueprint Recommendation 30
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. Expanding access to certified benefits advisors equipped to address client needs is urged, including initial economic security, housing and health care program eligibility, individualized benefits enrollment and work incentives counseling and advisement. Likewise, current HIV service providers need to develop programs to better address economic stability, vocational development and full community inclusion of people with HIV, including identification of employment related information, resources and service needs, encouraging employment interests and supporting well-informed employment decision-making. These efforts should include building current HIV service capacity to address identified employment needs/interests of consumers through direct service provision, developing an HIV services system implementing trauma-informed care focused on vocational self-determination, continuing/improving economic, housing and health care stability, securing living wage employment, increasing adult literacy, and completing other adult and higher education to strengthen individuals’ position in the labor market. In addition, development of HIV employment programs is urged, including targeted services for transgender individuals (especially transgender women of color) without regard to HIV status; people with HIV returning to the community from or with a history of incarceration; homeless youth (especially black and Hispanic/Latino MSM and transgender women) without regard to HIV status; and HIV peer workforce education, credentialing and employment.
NYS Initiative Implemented 2015
Implements NYSDOH AIDS Institute Peer Worker Certification Program
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New York State Initiative Implemented 2015

Policy

Implements New York State Department of Health AIDS Institute Peer Worker Certification Program

Summary

In 2015, the New York State Department of Health AIDS Institute established its Peer Worker Certification Program. Peer services can play a key role in meeting the state’s goals of improving linkage and retention in HIV care, improving rates of viral suppression, and preventing new infections. The potential for Medicaid reimbursement of peer-delivered interventions makes peer worker certification a critical step in ensuring access to this revenue stream for the support of peer services.

Background & Importance to ETE

Employment is an important facilitator of long-term adherence and viral suppression. However, some people with HIV have few available work opportunities. The New York State 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 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 New York State Department of Health AIDS Institute’s 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.

References & Policy Details

Getting to Zero Recommendation Timeline
GTZ
ETE Blueprint Getting to Zero Recommendations

2014
2015
2016
2017
2018
2019
2020
Single point of entry within all Local Social Service Districts across NYS to essential benefits and services for low-income persons with HIV/AIDS
GTZ1
Getting to Zero Recommendation 1
Ensure expedited access for all low-income persons with HIV in New York State to essential benefits and social services, including safe, appropriate and affordable housing, food and transportation assistance. The greatest unmet needs of people living with HIV in New York State are housing, food and transportation. Research findings demonstrate that lack of stable housing is a formidable barrier to HIV care and treatment effectiveness at each point in the HIV care continuum and that housing assistance is an evidence-based health care intervention for homeless and unstably housed people with HIV that is linked to improved HIV health outcomes, including viral suppression. Adequate nutrition is also crucial for the management of HIV, and lack of transportation can prevent people with HIV from attending health care and social service appointments, especially in rural communities. Expanding access to essential housing, food and transportation assistance for all HIV-positive New Yorkers and establishing a clear point of entry to these public benefits for people with HIV in each local social services district in the state will address the social drivers of the epidemic (and related health disparities) by ensuring that each income-eligible person with HIV is linked to critical enablers of effective HIV treatment.
Decriminalize condoms
GTZ2
Getting to Zero Recommendation 2
Reform is necessary to end the practice of confiscating and using condoms as evidence. Current law permits a person’s possession of condoms to be offered as evidence of prostitution and trafficking-related offenses. Condoms may be confiscated as contraband, and the fact that a person is carrying condoms can be used as a basis for suspicion, arrest or prosecution for both types of offenses. As a result, individuals most in need, low-income women and LGBT people, are discouraged and deterred from carrying and using condoms. The Criminal Procedure and Civil Practice Law and Rules should be amended to prohibit evidentiary use of condoms as probable cause for arrest, or in legal proceedings related to prostitution and trafficking offenses. A comprehensive statutory ban would also support outreach workers who work in these impacted communities from being criminally charged with promoting prostitution. Most people who carry condoms are not sex workers, but ensuring that everyone is able to carry and use condoms – particularly if they engage in sex work – reduces harm to individual health and harm to the general public.
Enact reforms to improve drug user health
GTZ3
Getting to Zero Recommendation 3
The Task Force proposes a number of recommendations that promote drug user health and elevates a public health approach to drug policy, particularly as it impacts HIV incidence, prevalence and care in New York State. The recommendations include policy and legislative changes to: decriminalize syringe possession; support expanded access to clean syringes for injection drug users through Peer Delivered Syringe Exchange (PDSE) in uncovered areas of the state, and to young injectors through drug treatment, medical care and mental health counseling; increase access to drug treatment such as methadone and buprenorphine within local and state correctional facilities; remove the advertising ban on the Expanded Syringe Access Program (ESAP) and the limit of syringes per transaction distributed through ESAP; and improve health systems to protect drug users from related conditions such as contracting viral hepatitis and overdose. Increase access to Opioid Overdose Prevention through the expansion of opioid overdose prevention training and availability of naloxone to all incarcerated individuals prior to release (permitted under current law); provision of liability coverage for individuals who prescribe naloxone; and the creation of safe injection facilities (legislative change - - Penal Code exemption). Collectively, the proposals shift New York’s criminal justice approach to drug use to a public health approach, in an effort to reduce harm and end AIDS.
Passage of the Gender Expression Non-Discrimination Act (GENDA)
GTZ4
Getting to Zero Recommendation 4
All New Yorkers, including transgender New Yorkers, deserve to be treated fairly. The existing NYS Executive Order to protect transgender people in state work places is not far reaching enough to ensure broad protections from stigma and discrimination. While some counties and municipalities have a transgender civil rights ordinance, they are inconsistent in their language and create inconsistent transgender civil rights coverage. Passage of the statewide transgender civil rights law, GENDA, would standardize protections and unify transgender civil rights protections in New York State. Currently, neither federal nor state law specifically ban discrimination based on gender identity. This lack of statewide protection impacts transgender persons as it relates to employment, housing, credit and public accommodations.
NYS Legislation Enacted 2019
Enacts the Gender Expression Non-Discrimination Act (GENDA)
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New York State Legislation Enacted 2019

Policy

Enacts Gender Expression Non-Discrimination Act (GENDA)

Summary

The Gender Expression Non-Discrimination Act (GENDA) prohibits discrimination on the basis of gender identity or expression in the areas of employment, public accommodations, and housing, among other areas, and adds offenses regarding gender identity or expression in the list of those subject to treatment as hate crimes.

Background & Importance to ETE

The New York State Ending the Epidemic Blueprint supports the passage of statewide transgender civil rights law to reaffirm, standardize and unify transgender civil rights protections in New York State (GTZ 4 and BP 19, Institute an integrated comprehensive approach to transgender health care and human rights).

References & Policy Details

Passage of the Healthy Teens Act
GTZ5
Getting to Zero Recommendation 5
The Healthy Teens Act amends the Public Health Law by requiring all local school districts develop age-appropriate and medically-accurate sex education curricula. The bill awards funding for school districts, boards of cooperative education services and community-based organizations to provide comprehensive sex education programs for young people. New York State youth must be supported in making healthy, positive choices about sexual health in order to avoid negative outcomes such as HIV/STD infections and unintended pregnancy. To make positive and healthy decisions youth must have access to evidence based education, LGBT sexual health information, as well as knowledge of prevention interventions such as PrEP, nPEP and effective condom use. Youth must be equipped to live sexually-healthy lives. Sexual health is a state of well-being that involves physical, emotional, mental, social, and spiritual dimensions. Sexual health is an intrinsic element of human health and is based on a positive, equitable, and respectful approach to sexuality, relationships, and reproduction. It includes: the ability to understand the benefits, risks, and responsibilities of sexual behavior; the prevention and care of disease and other adverse outcomes; and the possibility of fulfilling sexual relationships. Sexual health is impacted by socioeconomic and cultural contexts—including policies, practices, and services—that support healthy outcomes for individuals, families, and their communities. To promote positive sexual health among youth the passage of the Healthy Teens Act is necessary.
Expanded Medicaid coverage to targeted populations
GTZ6
Getting to Zero Recommendation 6
To respond to the care needs of all individuals, the state should provide presumptive Medicaid coverage as a Medicaid waiver program to uninsured/underinsured NYS residents who are at high HIV risk, including transgender persons, and persons newly diagnosed with HIV, on the basis of their identification as New York State residents. The benefit would be similar to the existing NYS Family Planning Benefits Program (FPBP), maintaining the FPBP’s 223% federal poverty level (FPL) income guideline and three-month retroactivity to focus on those not already enrolled in care; cover sexual health services, such as PrEP, nPEP, STI screening and treatment, HIV management, hepatitis C testing and treatment, family planning services, and transgender transition services.
Guarantee minors the right to consent to HIV and STI treatment, diagnosis, prevention, and prophylaxis, including sexual health-related immunization.
GTZ7
Getting to Zero Recommendation 7
Competent minors, who are already able to consent to both STI and HIV testing without parental consent, also should be guaranteed the right to consent to HIV treatment and ARV prophylaxis. A process or policy must be in place that allows for young adults and youth, including transgender youth, to gain access to HIV and STI treatment, as well as prevention services, such as PrEP and nPEP and immunization for HPV, without parental consent so that confidentiality is preserved. Protections must be in place to ensure that insurance information, such as “explanation of benefits” (EOB) documents, are sent to the patient (i.e. young adult or minor) rather than to the policy holder (i.e. the parents) if that young person is using parental insurance to support HIV treatment or prevention services, such as ARV-P services.
NYS Regulations Adopted 2017
Allows minors to consent to HIV prevention and treatment
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New York State Regulations Adopted 2017

Policy

Allows Minors to Consent to HIV Prophylaxis and Treatment without Parental/Guardian Involvement

Summary

In April 2017, the New York State Department of Health adopted regulations to add HIV to the list of Group B sexually transmitted diseases. This had the effect of requiring local health department clinics to provide HIV diagnosis and treatment, including prevention services (e.g., PEP, PrEP), either directly or by referral, and allowing providers (in and outside local health departments’ clinic settings) to administer these services to minors without parental/guardian consent or notification. The amendments also prohibited the release of medical and billing records containing information regarding these services to a minor’s parent/guardian without the minor’s consent.

Background & Importance to ETE

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/guardian involvement, to also consent to HIV treatment and PrEP.

References & Policy Details