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 October 2023ETE Aim 1
Identify persons with HIV who remain undiagnosed and link them to health care
ETE Blueprint Recommendations 1-4
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 New York State'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
- Chapter 502 of the Laws of 2016
- 10 New York Codes, Rules, and Regulations, Part 63
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 (https://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
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
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
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
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
- New York City Health Department Request for Proposals
- The Undetectables Program
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
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
- Chapter 58 of the Laws of 2014
- Press Release from VOCAL-NY on HIV/AIDS Services Administration (HASA) Rental Assistance, April 3, 2014
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 Department of Health AIDS Institute Policy Statement and New York State Office of Temporary and Disability Assistance Determination
- New York State DOH - AIDS Institute Policy Statement, June 2016
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
- Chapter 59 of the Laws of 2018
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
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
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
- Chapter 502 of the Laws of 2016
- https://legislation.nysenate.gov/pdf/bills/2015/A10724
- https://legislation.nysenate.gov/pdf/bills/2015/S8129
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
ETE Aim 4
Recommendations in support of decreasing new infections and disease progression
ETE Blueprint Recommendations 15-30
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, New York State 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, New York State announced a first-in-the-nation program to provide no- or lower-cost naloxone at pharmacies across the 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
New York State Legislation Enacted 2021
Policy
Decriminalization of the Possession and Sale of Hypodermic Needles
Summary
Chapter 433 of the Laws of 2021 amends the public health law to expand access to the possession and sale of hypodermic needles and allow pharmacies and healthcare agencies registered under the Expanded Syringe Access Program (ESAP) to remove the limit on the sale of the number of syringes you can obtain (previous law was 10 syringes). Additionally, this legislation would lift the ban on advertising at pharmacies that syringes are available to the public. Effective October 7, 2021.
Background & Importance to ETE
The Blueprint proposes several recommendations that promote drug user health and elevates a harm reduction and public health approach to drug policy, particularly as it impacts HIV incidence, prevalence and health care in New York State.
References & Policy Details
- Chapter 433 of the Laws of 2021
New York State Legislation Enacted 2021
Policy
Expansion of Access to Medication Assisted Treatment for Substance Abuse Disorders to Eligible Medicaid Recipient
Summary
This legislation allows individuals eligible in the New York State Medicaid Program to access all forms of Medication Assisted Treatment (MAT) that is most beneficial to their care and treatment. The bill adds all buprenorphine products, methadone or long-acting injectable naltrexone for detoxification or maintenance treatment of a substance use disorder. Currently, some individuals may be limited to only one type of MAT. Additionally, this legislation removes any prior authorization for these medications.
Background & Importance to ETE
The Blueprint proposes several recommendations that promote drug user health and elevates a public health approach to drug policy and drug treatment, particularly as it impacts HIV incidence, prevalence and health care in New York State.
References & Policy Details
- Chapter 720 of the Laws of 2021
- Governor’s Approval Message #91 of 2021
New York State Legislation Enacted 2021
Policy
Expansion of Access to Medication Assisted Treatment for Substance Abuse Disorders to Incarcerated Individuals
Summary
This legislation would expand access to medication used to treat substance disorders, such as methadone, buprenorphine and naltrexone and appropriate counseling for incarcerated individuals and those transitioning out of prison.
Background & Importance to ETE
The Blueprint proposes several recommendations that promote drug user health and elevates a public health approach to drug policy and drug treatment, particularly as it impacts HIV incidence, prevalence and health care in New York State.
References & Policy Details
- Chapter 432 of the Laws of 2021
- Governor’s Approval Message #22 of 2021
New York State Legislation Enacted 2022
Policy
Opioid Overdose Prevention in NYS Colleges and Universities
Summary
Chapter 580 of the Laws of 2022 amends the education law to require every campus (on-campus or off-campus housing) of the State University of New York and every campus of the City University of New York shall provide training for the administration of an opioid antagonist by every resident assistant employed by the campus and to maintain quantities of the opioid antagonist determined by the NYS Department of Health. The resident assistant may designate additional employees to administer an opioid antagonist in the event the resident assistant is not available. Effective immediately (October 28, 2022).
Background & Importance to ETE
The Blueprint proposes several recommendations that promote drug user health and elevates a harm reduction and public health approach to drug policy, particularly as it impacts HIV incidence, prevalence, and health care in New York State.
References & Policy Details
- Chapter 580 of the Laws of 2022
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
- Chapter 58 of the Laws of 2014
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
- Chapter 59 of the Laws of 2018
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
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, New York State 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, New York State 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
New York State Legislation Enacted 2021
Policy
Amends the Gender Expression Non-Discrimination Act (GENDA) of 2019
Summary
Chapter 8 of the Laws of 2019 enacted 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. In 2021, Chapter 158 of the Laws of 2021 amends GENDA to enhance protections. First, the legislation allows New Yorkers to use “X” as a non-binary sex designation on a NYS Driver’s license. Second, the legislation provides protections to reduce discrimination against non-binary or transgender New Yorkers by permitting a name change and sex designation changes to be sealed more easily. Finally, the legislation will provide New Yorkers with the ability to amend their birth certificates and use a designation of mother, father, or parent for the first time. Effective June 24, 2021.
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
- Chapter 158 of the Laws of 2021
- Governor’s Approval Message #9 of 2021
New York State Legislation Enacted 2022
Policy
Healthcare Workforce Training for Diverse Patient Populations
Summary
This law requires the Commissioner of Health, in consultation with the Commissioner of Education, to develop a training program module to the existing Home Care Curriculum and the Nurse Aide Training Program to help ensure that LGBTQAI+ individuals of all ages receive culturally competent care. This training program will focus on the certification of home health aides, personal care aides, personal care staff, and Certified Nurse Aide (CNA). Effective December 23, 2022.
Background & Importance to ETE
Culturally competent service models that address individual, group and community-level barriers to LGBT identified individuals engaging and linking to care must be addressed. Additionally, due to stigma, discrimination and related circumstances, transgender persons have 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 is a top priority.
References & Policy Details
- Chapter 737 of the Laws of 2022
- Governor’s Approval Memo #55 of 2022
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, 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
New York State Legislation Enacted 2020
Policy
Promoting the health, safety, dignity and human rights of transgender communities.
Summary
Chapter 353 of the Laws of 2020 amend the New York State Civil Rights Law to designate all single occupancy bathroom facilities in public places and in all public and private schools as gender neutral. This legislation takes effect 90 days after becoming law.
Background & Importance to ETE
The importance to ETE is to institute an integrated comprehensive approach to transgender health care and human rights, to promote health, safety, dignity and human rights of transgender communities. A person’s sexual orientation and gender identity are not justifications to exclude individuals from public spaces, including bathrooms. The legislation recognizes that a person’s sexual orientation and gender identity are not justification to exclude individuals from public spaces, including bathrooms. The legislation supports the ETE B19 recommendation to institute an integrated comprehensive approach to transgender healthcare and human rights by promoting the health, safety, dignity and human rights of transgender communities.
References & Policy Details
- Chapter 353 of the Laws of 2020
New York State Legislation Enacted 2022
Policy
Establishes the Lorena Borjas Transgender Wellness and Equity Fund
Summary
Chapter 232 of the Laws of 2022 amends the public health law and provides funding to be appropriated to the NYSDOH Department of Health AIDS Institute to support organizations that provide critical services for the transgender, gender non-conforming, non-binary and intersex community. Effective April 1, 2023.
Background & Importance to ETE
Due to stigma, discrimination and related circumstances, transgender persons have 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 is a top priority.
References & Policy Details
- Chapter 232 of the Laws of 2022
- Governor’s Approval Memo #9 of 2022
New York State Legislation Enacted 2022
Policy
Healthcare Workforce Training for Diverse Patient Populations
Summary
This law requires the Commissioner of Health, in consultation with the Commissioner of Education, to develop a training program module to the existing Home Care Curriculum and the Nurse Aide Training Program to help ensure that LGBTQAI+ individuals of all ages receive culturally competent care. This training program will focus on the certification of home health aides, personal care aides, personal care staff, and Certified Nurse Aide (CNA). Effective December 23, 2022.
Background & Importance to ETE
Culturally competent service models that address individual, group and community-level barriers to LGBT identified individuals engaging and linking to care must be addressed. Additionally, due to stigma, discrimination and related circumstances, transgender persons have 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 is a top priority.
References & Policy Details
- Chapter 737 of the Laws of 2022
- Governor’s Approval Memo #55 of 2022
New York State Initiative Implemented 2017
Policy
Establishes Naloxone Co-payment Assistance Program (N-CAP)
Summary
New York State 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
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
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
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
- New York State DOH - Dear Colleague Letter to Physicians from Commissioner Howard A. Zucker, September 29, 2017
- New York State DOH - Dear Colleague Letter to Stakeholders from Commissioner Howard A. Zucker, September 29, 2017
- Prevention Access Campaign's "U=U Consensus Statement" Endorsement, August 2016
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, New York State 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 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. 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
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
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
GTZ
ETE Blueprint Getting to Zero Recommendations
New York State Legislation Enacted 2021
Policy
Decriminalization of the Possession and Sale of Hypodermic Needles
Summary
Chapter 433 of the Laws of 2021 amends the public health law to expand access to the possession and sale of hypodermic needles and allow pharmacies and healthcare agencies registered under the Expanded Syringe Access Program (ESAP) to remove the limit on the sale of the number of syringes you can obtain (previous law was 10 syringes). Additionally, this legislation would lift the ban on advertising at pharmacies that syringes are available to the public. Effective October 7, 2021.
Background & Importance to ETE
The Blueprint proposes several recommendations that promote drug user health and elevates a harm reduction and public health approach to drug policy, particularly as it impacts HIV incidence, prevalence and health care in New York State.
References & Policy Details
- Chapter 433 of the Laws of 2021
New York State Legislation Enacted 2021
Policy
Expansion of Access to Medication Assisted Treatment for Substance Abuse Disorders to Eligible Medicaid Recipients
Summary
This legislation allows individuals eligible in the New York State Medicaid Program to access all forms of Medication Assisted Treatment (MAT) that is most beneficial to their care and treatment. The bill adds all buprenorphine products, methadone or long-acting injectable naltrexone for detoxification or maintenance treatment of a substance use disorder. Currently, some individuals may be limited to only one type of MAT. Additionally, this legislation removes any prior authorization for these medications.
Background & Importance to ETE
The Blueprint proposes several recommendations that promote drug user health and elevates a public health approach to drug policy and drug treatment, particularly as it impacts HIV incidence, prevalence and health care in New York State.
References & Policy Details
- Chapter 720 of the Laws of 2021
- Governor’s Approval Message #91 of 2021
New York State Legislation Enacted 2021
Policy
Expansion of Access to Medication Assisted Treatment for Substance Abuse Disorders to Incarcerated Individuals
Summary
This legislation would expand access to medication used to treat substance disorders, such as methadone, buprenorphine and naltrexone and appropriate counseling for incarcerated individuals and those transitioning out of prison.
Background & Importance to ETE
The Blueprint proposes several recommendations that promote drug user health and elevates a public health approach to drug policy and drug treatment, particularly as it impacts HIV incidence, prevalence and health care in New York State.
References & Policy Details
- Chapter 432 of the Laws of 2021
- Governor’s Approval Message #22 of 2021
New York State Legislation Enacted 2022
Policy
Opioid Overdose Prevention in NYS Colleges and Universities
Summary
Chapter 580 of the Laws of 2022 amends the education law to require every campus (on-campus or off-campus housing) of the State University of New York and every campus of the City University of New York shall provide training for the administration of an opioid antagonist by every resident assistant employed by the campus and to maintain quantities of the opioid antagonist determined by the NYS Department of Health. The resident assistant may designate additional employees to administer an opioid antagonist in the event the resident assistant is not available. Effective immediately (October 28, 2022).
Background & Importance to ETE
The Blueprint proposes several recommendations that promote drug user health and elevates a harm reduction and public health approach to drug policy, particularly as it impacts HIV incidence, prevalence, and health care in New York State.
References & Policy Details
- Chapter 580 of the Laws of 2022
New York State Legislation Enacted 2022
Policy
Voluntary Nightlife Opioid Antagonist Program
Summary
This legislation establishes a voluntary nightlife opioid antagonist program, including access to opioid antagonists and public reporting. New York State has a robust opioid antagonist program including the Statewide Standing Order for pharmacies to carry stocks of Naloxone and trainings and education by both the New York State Department of Health and the Office of Addiction Services and Supports. This new law allows bars, entertainment venues, clubs and restaurants that have a high-volume of business at night to participate in the program. Effective April 22, 2023.
Background & Importance to ETE
The Blueprint proposes several recommendations that promote drug user health and elevates a public health approach to drug policy and drug treatment.
References & Policy Details
- Chapter 778 of the Laws of 2022
- Governor’s Approval Message #72 of 2022
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
- Chapter 8 of the Laws of 2019
New York State Legislation Enacted 2021
Policy
Amends the Gender Expression Non-Discrimination Act (GENDA) of 2019
Summary
Chapter 8 of the Laws of 2019 enacted 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. In 2021, Chapter 158 of the Laws of 2021 amends GENDA to enhance protections. First, the legislation allows New Yorkers to use “X” as a non-binary sex designation on a NYS Driver’s license. Second, the legislation provides protections to reduce discrimination against non-binary or transgender New Yorkers by permitting a name change and sex designation changes to be sealed more easily. Finally, the legislation will provide New Yorkers with the ability to amend their birth certificates and use a designation of mother, father, or parent for the first time. Effective June 24, 2021.
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
- Chapter 158 of the Laws of 2021
- Governor’s Approval Message #9 of 2021
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.