Bill S8227-2009

Makes provisions relating to HIV testing, including consent for such testing, required offering for such testing, confidentiality and disclosure

Relates to HIV testing, including consent for such testing, required offering for such testing, confidentiality and disclosure.

Details

Actions

  • Jul 30, 2010: SIGNED CHAP.308
  • Jul 19, 2010: DELIVERED TO GOVERNOR
  • Jun 30, 2010: returned to senate
  • Jun 30, 2010: passed assembly
  • Jun 29, 2010: ordered to third reading rules cal.461
  • Jun 29, 2010: substituted for a11487
  • Jun 25, 2010: referred to codes
  • Jun 25, 2010: DELIVERED TO ASSEMBLY
  • Jun 25, 2010: PASSED SENATE
  • Jun 25, 2010: ORDERED TO THIRD READING CAL.1252
  • Jun 17, 2010: REFERRED TO RULES

Votes

VOTE: COMMITTEE VOTE: - Rules - Jun 25, 2010
Ayes (13): Smith, Espada, Stachowski, Montgomery, Duane, Hassell-Thompson, Krueger, Parker, Serrano, Stewart-Cousins, Dilan, Klein, Valesky
Ayes W/R (4): Volker, LaValle, Hannon, Saland
Nays (4): Skelos, Johnson O, Farley, Seward
Absent (1): Padavan
Excused (1): Larkin

Memo

BILL NUMBER:S8227

TITLE OF BILL:

An act to amend the public health law, in relation to HIV testing

PURPOSE:

This bill: (1) revises the informed consent requirements associated with HIV/AIDS testing, while ensuring that adequate patient protections are maintained; (2) tailors counseling information based on HIV test results; (3) updates current testing requirements to reflect medical advances; (4) and facilitates authorization for testing in the case of certain occupational exposures to HIV infection.

SUMMARY OF PROVISIONS:

Section 1 of this bill amends Public Health Law (PHL) § 2781 to authorize HIV related testing to be part of a signed general consent to medical care, or documented oral consent when the test being ordered is a rapid HIV test. Such consent would be durable and remain in effect until it is revoked or expires. Patients will be provided an opportunity to decline HIV testing, and testing will only be done with full patient consent after the patient is provided with pre-test counseling information. In all instances, a physician will be required to provide oral notification to the patient whenever an HIV test is performed and this shall be noted on the patient's medical record. The provisions of this section regarding oral informed consent for a rapid HIV test shall not apply to tests performed in a facility operated under the correction law.

Section 1 also provides that HIV counseling messages shall be tailored based on whether the HIV test indicates infection. Counseling with respect to positive tests will remain consistent with existing law. In the case of negative results, counseling will emphasize risks associated with participating in high risk behavior and may be accomplished by oral or written reference to information previously provided. The bill also provides that in the case of a positive test for HIV infection, the person ordering the test must provide or arrange for follow-up medical care if the patient consents.

Section 1 further provides that in situations involving occupational exposures that create a significant risk of contracting or transmitting HIV infection, HIV testing will be allowed in cases where: (1) the source person is deceased, comatose or unable to provide consent, and his or her health care provider determines that mental capacity to consent is not expected to be regained in time for the exposed person to receive appropriate medical care, as determined by the exposed person's health care provider; (2) an authorized representative for the source person is not available or expected to become available in time for the exposed person to provide appropriate medical care; and (3) the exposed

person would benefit medically by knowing the Source person's HIV test results. In these limited cases, a provider shall order an anonymous HIV test of the source person and the results of the anonymous test, but not the identity of the source person would be disclosed to the exposed person's provider, solely for the purpose of making appropriate decisions regarding post-exposure medical treatment. The results of the HIV test of the source person would not be disclosed to the Source person or placed in the source person's medical record.

Section 1 also eliminates the requirement that a physician certify that informed consent has been obtained before ordering HIV related testing by a laboratory or other facility.

Section 2 of the bill adds a new PHL § 2781-a to require that an HIV related test be offered to every individual between the ages of 13 and 64 years of age (or younger or older if there is evidence of risk activity) receiving health services as an inpatient or in the emergency department of a hospital or receiving primary care services in the outpatient department of a hospital or in a freestanding diagnostic and treatment center or from a physician, physician assistant, nurse practitioner, or midwife providing primary care. The HIV related testing must be offered unless the health care provider believes: (1) the person is being treated for a life threatening emergency; (2) the individual has been previously offered or been the subject of an HIV related test (except that a test shall be offered if otherwise indicated); and (3) the patient lacks capacity to consent to such testing. Such offering shall be culturally and linguistically appropriate.

Section 3 of the bill amends PHL § 2135 to authorize the Department of Health (DOH) to use HIV testing information (in the aggregate without identifying patient information) for programs approved by the Commissioner of Health (Commissioner) for the improvement of the quality of medical care provided to individuals with HIV/AIDS. This bill also permits DOH to share this information with public health disease programs within DOH or local health departments to access co-morbidity or completeness of reporting and to direct program needs. Information will not be shared outside of DOH or the local health departments.

Section 4 of the bill amends PHL § 2780(4) to update the definition of "HIV related testing" to mean tests approved for the diagnosis of HIV, and to establish the definition of "Rapid HIV test or testing" to means any laboratory screening test or tests approved for detecting antibodies to HIV, that produce results in sixty minutes or less, and encompasses a confirmatory HIV related test if the screening test is reactive.

Section 5 of the bill amends PHL § 2130(1) to require that data obtained "upon periodic monitoring of HIV infection" be reported to the Commissioner.

Section 6 of the bill amends PHL § 2782( 1) to provide limited access to confidential HIV information to the executor or administrator of an estate when needed to fulfill the responsibilities of such a position.

Section 7 of the bill amends PHL § 2782(5)(a) to clarify instances under which disclosure need not be accompanied by a written statement regarding confidentiality and redisclosure requirements and prohibitions. In particular, the written statement would no longer have to be provided for routine disclosures to providers assisting in rendering care or for disclosures made to health insurers in the day to day course of the billing process.

Section 8 of the bill amends PHL § 2786(1) to designate the informed consent forms for HIV related testing and disclosure that must be developed by the Commissioner as "standardized model" forms and removes the requirement that providers obtain prior authorization for the use of alternative consent and release forms, provided that the forms contain information consistent with the standardized model forms.

Section 9 of the bill provides that on or before September 1, 2012, the Commissioner must evaluate the impact of the bill with respect to the number of persons who are tested for HIV infection and the number of persons who access care and treatment. Such report shall be submitted to the Governor and to the chairs of the Assembly and Senate Health Committees.

Section 10 of the bill provides that the bill will be effective on September 1, 2010, but authorizes the Commissioner to adopt regulations necessary to implement the bill prior to that date.

EXISTING LAW:

PHL § 2130 requires health care practitioners and laboratories that determine that a person is infected with HIV or AIDS to report the case to DOH.

PHL § 2135 requires that any HIV information obtained by DOH or any municipal health officer must be maintained as confidential, except as otherwise required by law.

PHL § 2780 defines a number of terms and in particular defines "HIV related test" as "any laboratory test or series of tests for any virus, antibody, antigen or etiologic agent whatsoever thought to cause or to indicate the presence of AIDS."

PHL § 2781 requires written, informed consent before any HIV related test may be ordered, and a physician or other practitioner must certify that consent was received before ordering that such test be performed. The written, informed consent consists of a statement signed by the subject of the test which explains, among other things, the purpose of the test and the applicable confidentiality protections. PHL § 2781 further requires that before execution of the written consent, the practitioner or his or her representative must provide an explanation of the nature of AIDS and HIV related illness; information about discrimination problems that could arise from disclosure of test results, and information about the transmission risks associated with HIV infection. When

test results are communicated, the patient must be provided with counseling or referrals for counseling about matters such as the emotional consequences of learning the results and the need to change behavior to prevent transmission of HIV infection. The informed consent requirements do not apply in certain circumstances, such as when a researcher does not know the test subject's identity.

PHL § 2782 prohibits persons who obtain confidential HIV related information from disclosing such information, with certain exceptions. In those circumstances when disclosure is authorized, it must be accompanied by a statement advising that further disclosure without consent is prohibited.

PHL § 2786 requires the Commissioner to develop forms for informed consent for HIV related testing and disclosure of confidential related information.

JUSTIFICATION:

Significant advances in the medical treatment of and testing for HIV/ AIDS have been made in the last two decades. In the early days of the epidemic (in the 1980s), an HIV/AIDS diagnosis was tantamount to a death sentence. Today, people with HIV/AIDS are living longer with the help of new and improved treatments and testing/monitoring. It is vital to increase HIV/AIDS testing rates so that people with HIV can seek treatment, earlier and reduce transmission to others, and so that people without HIV can learn to stay that way. This bill updates New York's laws to encourage such testing and reflect new medical technologies and advances.

Recommendations issued by the federal Centers for Disease Control and Prevention (CDC) in 2006 include a recommendation for routine HIV screening for patients between the ages of 13 and 64 in all health care settings, in addition to regular testing for high-risk groups. The bill incorporates this recommendation, with routine screening - meaning that the patient will be offered the opportunity to undergo HIV testing required for patients between 13 and 64, or for younger or older patients if there is evidence of behavior that increases the risk of infection. Expanded screening will increase the number of individuals who are tested for HIV/AIDS.

The CDC also recommends that states eliminate the requirement of a separate written informed consent for each HIV test, and instead assume that a general consent to medical treatment encompasses consent for HIV testing. This bill relaxes current written consent requirements by providing an option for a durable written general consent that would specifically include HIV testing, or a documented oral consent when the test being ordered is a rapid HIV test. The bill also makes a corresponding technical change to the law requiring that the Commissioner develop forms to be used for informed consent purposes. Specifically, the bill designates such forms as "standardized model" forms, and providers would no longer need to obtain prior authorization for the use of alternative forms that

contain information consistent with the standardized model forms. Similarly, the bill removes the requirement that physicians confirm that informed consent has been obtained before ordering HIV related testing.

Currently, the law requires post-test counseling which is the same regardless of the test's results. This legislation will require that counseling be tailored based on whether the HIV test indicates infection. Counseling will remain consistent with existing law with respect to positive tests. For negative results, counseling will emphasize risks associated with participating in high risk behavior and may be accomplished by oral or written reference to information previously provided.

The bill also requires physicians to report HIV data obtained through laboratory tests conducted in conjunction with periodic monitoring of HIV infection, which will enable DOH to monitor the spread of HIV/AIDS and to target program initiatives. This provision reflects the availability of data from HIV tests which was not available when the statute was originally enacted. The bill makes similar technical changes to various provisions of law to update references to testing in accordance with newer testing technologies. In addition, the bill protects individuals who are at risk of acquiring HIV infection due to an occupational event by permitting HIV testing if consent is not available.

Finally, the bill makes certain appropriate changes to existing confidentiality provisions, first by allowing limited access to confidential HIV information to the executor or administrator of an estate when needed by such persons to fulfill their responsibilities. Second, under current law, disclosure of HIV related information must be accompanied by a written statement regarding confidentiality and redisclosure. It is appropriate to exempt from these requirements routine disclosures of information which are made to providers for purposes of treatment and to third party payers for reimbursement purposes.

LEGISLATIVE HISTORY:

An earlier version of this bill, A.1146l/S.8722, was introduced in 2008 but did not pass. A.9195/S.6326, which addressed some of the issues raised in this bill, was introduced in 2007-08 and was passed by the Assembly in 2007.

FISCAL IMPLICATIONS:

This bill will not have a measurable fiscal impact to the State, HIV testing and counseling is already a covered benefit in Medicaid managed care, Family Health Plus and Medicaid fee-for-service. Any additional administrative demands can be accommodated within existing DOH resources.

EFFECTIVE DATE:

This bill takes effect on September 1, 2010. The Commissioner is authorized to adopt regulations prior to that date as necessary to implement the bill.


Text

STATE OF NEW YORK ________________________________________________________________________ S. 8227 A. 11487 S E N A T E - A S S E M B L Y June 17, 2010 ___________
IN SENATE -- Introduced by Sen. DUANE -- read twice and ordered printed, and when printed to be committed to the Committee on Rules IN ASSEMBLY -- Introduced by COMMITTEE ON RULES -- (at request of M. of A. Gottfried, Towns) -- read once and referred to the Committee on Health AN ACT to amend the public health law, in relation to HIV testing THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 2781 of the public health law, as added by chapter 584 of the laws of 1988, paragraph (d) of subdivision 6 as added by chapter 220 of the laws of 1996 and subdivision 7 as added by chapter 429 of the laws of 2005, is amended to read as follows: S 2781. HIV related testing. 1. Except as provided in section three thousand one hundred twenty-one of the civil practice law and rules, or unless otherwise specifically authorized or required by a state or federal law, no person shall order the performance of an HIV related test without first [receiving] HAVING RECEIVED the written OR, WHERE AUTHORIZED BY THIS SUBDIVISION, ORAL, informed consent of the subject of the test who has capacity to consent or, when the subject lacks capacity to consent, of a person authorized pursuant to law to consent to health care for such individual. [A physician or other person authorized pursu- ant to law to order the performance of an HIV related test shall certi- fy, in the order for the performance of an HIV related test, that informed consent required by this section has been received prior to ordering such test by a laboratory or other facility.] WHEN THE TEST BEING ORDERED IS A RAPID HIV TEST, SUCH INFORMED CONSENT MAY BE OBTAINED ORALLY AND SHALL BE DOCUMENTED IN THE SUBJECT OF THE TEST'S MEDICAL RECORD BY THE PERSON ORDERING THE PERFORMANCE OF THE TEST. 2. [Informed] EXCEPT WHERE SUBDIVISION ONE OF THIS SECTION PERMITS INFORMED CONSENT TO BE OBTAINED ORALLY, INFORMED consent to [an] HIV related [test] TESTING shall consist of a statement CONSENTING TO HIV RELATED TESTING signed by the subject of the test who has capacity to consent or, when the subject lacks capacity to consent, by a person
authorized pursuant to law to consent to health care for the subject [which includes at least the following: (a) an explanation of the test, including its purpose, the meaning of its results, and the benefits of early diagnosis and medical inter- vention; and (b) an explanation of the procedures to be followed, including that the test is voluntary, that consent may be withdrawn at any time, and a statement advising the subject that anonymous testing is available; and (c) an explanation of the confidentiality protections afforded confi- dential HIV related information under this article, including the circumstances under which and classes of persons to whom disclosure of such information may be required, authorized or permitted under this article or in accordance with other provisions of law or regulation] AFTER THE SUBJECT OR SUCH OTHER PERSON HAS RECEIVED THE INFORMATION DESCRIBED IN SUBDIVISION THREE OF THIS SECTION. 2-A. WHERE A WRITTEN CONSENT TO HIV RELATED TESTING IS INCLUDED IN A SIGNED GENERAL CONSENT TO MEDICAL CARE FOR THE SUBJECT OF THE TEST OR IN A SIGNED CONSENT TO ANY HEALTH CARE SERVICE FOR THE SUBJECT OF THE TEST, THE CONSENT FORM SHALL HAVE A CLEARLY MARKED PLACE ADJACENT TO THE SIGNATURE WHERE THE SUBJECT OF THE TEST, OR, WHEN THE SUBJECT LACKS CAPACITY TO CONSENT, A PERSON AUTHORIZED PURSUANT TO LAW TO CONSENT TO HEALTH CARE FOR SUCH INDIVIDUAL, SHALL BE GIVEN AN OPPORTUNITY TO SPECIFICALLY DECLINE IN WRITING HIV RELATED TESTING ON SUCH GENERAL CONSENT. 2-B. A WRITTEN OR ORAL INFORMED CONSENT FOR HIV RELATED TESTING PURSUANT TO THIS SECTION SHALL BE VALID FOR SUCH TESTING UNTIL SUCH CONSENT IS REVOKED OR EXPIRES BY ITS TERMS. EACH TIME THAT AN HIV RELATED TEST IS ORDERED PURSUANT TO INFORMED CONSENT IN ACCORDANCE WITH THIS SECTION, THE PHYSICIAN OR OTHER PERSON AUTHORIZED PURSUANT TO LAW TO ORDER THE PERFORMANCE OF THE HIV RELATED TEST, OR SUCH PERSON'S REPRESENTATIVE, SHALL ORALLY NOTIFY THE SUBJECT OF THE TEST OR, WHEN THE SUBJECT LACKS CAPACITY TO CONSENT, A PERSON AUTHORIZED PURSUANT TO LAW TO CONSENT TO HEALTH CARE FOR SUCH INDIVIDUAL, THAT AN HIV RELATED TEST WILL BE CONDUCTED AT SUCH TIME, AND SHALL NOTE THE NOTIFICATION IN THE PATIENT'S RECORD. 2-C. THE PROVISIONS OF THIS SECTION REGARDING ORAL INFORMED CONSENT FOR A RAPID HIV TEST SHALL NOT APPLY TO TESTS PERFORMED IN A FACILITY OPERATED UNDER THE CORRECTION LAW. 3. Prior to the execution of [a] written, OR OBTAINING AND DOCUMENTING ORAL, informed consent, a person ordering the performance of an HIV related test shall provide EITHER DIRECTLY OR THROUGH A REPRESENTATIVE to the subject of an HIV related test or, if the subject lacks capacity to consent, to a person authorized pursuant to law to consent to health care for the subject, an explanation [of the nature of AIDS and HIV related illness, information about discrimination problems that disclo- sure of the test result could cause and legal protections against such discrimination, and information about behavior known to pose risks for transmission and contraction of HIV infection.] THAT: (A) HIV CAUSES AIDS AND CAN BE TRANSMITTED THROUGH SEXUAL ACTIVITIES AND NEEDLE-SHARING, BY PREGNANT WOMEN TO THEIR FETUSES, AND THROUGH BREASTFEEDING INFANTS; (B) THERE IS TREATMENT FOR HIV THAT CAN HELP AN INDIVIDUAL STAY HEAL- THY; (C) INDIVIDUALS WITH HIV OR AIDS CAN ADOPT SAFE PRACTICES TO PROTECT UNINFECTED AND INFECTED PEOPLE IN THEIR LIVES FROM BECOMING INFECTED OR MULTIPLY INFECTED WITH HIV;
(D) TESTING IS VOLUNTARY AND CAN BE DONE ANONYMOUSLY AT A PUBLIC TEST- ING CENTER; (E) THE LAW PROTECTS THE CONFIDENTIALITY OF HIV RELATED TEST RESULTS; (F) THE LAW PROHIBITS DISCRIMINATION BASED ON AN INDIVIDUAL'S HIV STATUS AND SERVICES ARE AVAILABLE TO HELP WITH SUCH CONSEQUENCES; AND (G) THE LAW ALLOWS AN INDIVIDUAL'S INFORMED CONSENT FOR HIV RELATED TESTING TO BE VALID FOR SUCH TESTING UNTIL SUCH CONSENT IS REVOKED BY THE SUBJECT OF THE HIV TEST OR EXPIRES BY ITS TERMS. PROTOCOLS SHALL BE IN PLACE TO ENSURE COMPLIANCE WITH THIS SECTION. 4. A person authorized pursuant to law to order the performance of an HIV related test shall provide DIRECTLY OR THROUGH A REPRESENTATIVE to the person seeking such test an opportunity to remain anonymous and to provide written, informed consent OR AUTHORIZE DOCUMENTATION OF ORAL INFORMED CONSENT, through use of a coded system with no linking of indi- vidual identity to the test request or results. A health care provider who is not authorized by the commissioner to provide HIV related tests on an anonymous basis shall refer a person who requests an anonymous test to a test site which does provide anonymous testing. The provisions of this subdivision shall not apply to a health care provider ordering the performance of an HIV related test on an individual proposed for insurance coverage. 5. At the time of communicating the test result to the subject of the test, a person ordering the performance of an HIV related test shall, DIRECTLY OR THROUGH A REPRESENTATIVE: (A) IN THE CASE OF A TEST INDICATING EVIDENCE OF HIV INFECTION, provide the subject of the test or, if the subject lacks capacity to consent, the person authorized pursuant to law to consent to health care for the subject with counseling or referrals for counseling: [(a)] (I) for coping with the emotional consequences of learning the result; [(b)] (II) regarding the discrimination problems that disclosure of the result could cause; [(c)] (III) for behavior change to prevent transmission or contraction of HIV infection; [(d)] (IV) to inform such person of avail- able medical treatments; and [(e)] (V) regarding the [test subject's] need to notify his or her contacts; AND (B) IN THE CASE OF A TEST NOT INDICATING EVIDENCE OF HIV INFECTION, PROVIDE (IN A MANNER WHICH MAY CONSIST OF ORAL OR WRITTEN REFERENCE TO INFORMATION PREVIOUSLY PROVIDED) THE SUBJECT OF THE TEST, OR IF THE SUBJECT LACKS CAPACITY TO CONSENT, THE PERSON AUTHORIZED PURSUANT TO LAW TO CONSENT TO HEALTH CARE FOR THE SUBJECT, WITH INFORMATION CONCERNING THE RISKS OF PARTICIPATING IN HIGH RISK SEXUAL OR NEEDLE-SHARING BEHAV- IOR. 5-A. WITH THE CONSENT OF THE SUBJECT OF A TEST INDICATING EVIDENCE OF HIV INFECTION OR, IF THE SUBJECT LACKS CAPACITY TO CONSENT, WITH THE CONSENT OF THE PERSON AUTHORIZED PURSUANT TO LAW TO CONSENT TO HEALTH CARE FOR THE SUBJECT, THE PERSON WHO ORDERED THE PERFORMANCE OF THE HIV RELATED TEST, OR SUCH PERSON'S REPRESENTATIVE, SHALL PROVIDE OR ARRANGE WITH A HEALTH CARE PROVIDER FOR AN APPOINTMENT FOR FOLLOW-UP MEDICAL CARE FOR HIV FOR SUCH SUBJECT. 6. The provisions of this section shall not apply to the performance of an HIV related test: (a) by a health care provider or health facility in relation to the procuring, processing, distributing or use of a human body or a human body part, including organs, tissues, eyes, bones, arteries, blood, semen, or other body fluids, for use in medical research or therapy, or for transplantation to individuals provided, however, that where the test results are communicated to the subject, post-test counseling, as
described in subdivision five of this section, shall nonetheless be required; or (b) for the purpose of research if the testing is performed in a manner by which the identity of the test subject is not known and may not be retrieved by the researcher; or (c) on a deceased person, when such test is conducted to determine the cause of death or for epidemiological purposes[.]; OR (d) conducted pursuant to section twenty-five hundred-f of this chap- ter[.]; OR (E) IN SITUATIONS INVOLVING OCCUPATIONAL EXPOSURES WHICH CREATE A SIGNIFICANT RISK OF CONTRACTING OR TRANSMITTING HIV INFECTION, AS DEFINED IN REGULATIONS OF THE DEPARTMENT AND PURSUANT TO PROTOCOLS ADOPTED BY THE DEPARTMENT, (I) PROVIDED THAT: (A) THE PERSON WHO IS THE SOURCE OF THE OCCUPATIONAL EXPOSURE IS DECEASED, COMATOSE OR IS DETERMINED BY HIS OR HER ATTENDING HEALTH CARE PROFESSIONAL TO LACK MENTAL CAPACITY TO CONSENT TO AN HIV RELATED TEST AND IS NOT REASONABLY EXPECTED TO RECOVER IN TIME FOR THE EXPOSED PERSON TO RECEIVE APPROPRIATE MEDICAL TREATMENT, AS DETERMINED BY THE EXPOSED PERSON'S ATTENDING HEALTH CARE PROFESSIONAL WHO WOULD ORDER OR PROVIDE SUCH TREATMENT; (B) THERE IS NO PERSON AVAILABLE OR REASONABLY LIKELY TO BECOME AVAIL- ABLE WHO HAS THE LEGAL AUTHORITY TO CONSENT TO THE HIV RELATED TEST ON BEHALF OF THE SOURCE PERSON IN TIME FOR THE EXPOSED PERSON TO RECEIVE APPROPRIATE MEDICAL TREATMENT; AND (C) THE EXPOSED PERSON WILL BENEFIT MEDICALLY BY KNOWING THE SOURCE PERSON'S HIV TEST RESULTS, AS DETERMINED BY THE EXPOSED PERSON'S HEALTH CARE PROFESSIONAL AND DOCUMENTED IN THE EXPOSED PERSON'S MEDICAL RECORD; (II) IN WHICH CASE (A) A PROVIDER SHALL ORDER AN ANONYMOUS HIV TEST OF THE SOURCE PERSON; AND (B) THE RESULTS OF SUCH ANONYMOUS TEST, BUT NOT THE IDENTITY OF THE SOURCE PERSON, SHALL BE DISCLOSED ONLY TO THE ATTENDING HEALTH CARE PROFESSIONAL OF THE EXPOSED PERSON SOLELY FOR THE PURPOSE OF ASSISTING THE EXPOSED PERSON IN MAKING APPROPRIATE DECISIONS REGARDING POST-EXPO- SURE MEDICAL TREATMENT; AND (C) THE RESULTS OF THE TEST SHALL NOT BE DISCLOSED TO THE SOURCE PERSON OR PLACED IN THE SOURCE PERSON'S MEDICAL RECORD. 7. In the event that an HIV related test is ordered by a physician or certified nurse practitioner pursuant to the provisions of the education law providing for non-patient specific regimens, then for the purposes of this section the individual administering the test shall be deemed to be the individual ordering the test. S 2. The public health law is amended by adding a new section 2781-a to read as follows: S 2781-A. REQUIRED OFFERING OF HIV RELATED TESTING. 1. EVERY INDIVID- UAL BETWEEN THE AGES OF THIRTEEN AND SIXTY-FOUR YEARS (OR YOUNGER OR OLDER IF THERE IS EVIDENCE OR INDICATION OF RISK ACTIVITY) WHO RECEIVES HEALTH SERVICES AS AN INPATIENT OR IN THE EMERGENCY DEPARTMENT OF A GENERAL HOSPITAL DEFINED IN SUBDIVISION TEN OF SECTION TWENTY-EIGHT HUNDRED ONE OF THIS CHAPTER OR WHO RECEIVES PRIMARY CARE SERVICES IN AN OUTPATIENT DEPARTMENT OF SUCH HOSPITAL OR IN A DIAGNOSTIC AND TREATMENT CENTER LICENSED UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER OR FROM A PHYSICIAN, PHYSICIAN ASSISTANT, NURSE PRACTITIONER, OR MIDWIFE PROVIDING PRIMARY CARE SHALL BE OFFERED AN HIV RELATED TEST UNLESS THE HEALTH CARE PRACTITIONER PROVIDING SUCH SERVICES REASONABLY BELIEVES THAT (A) THE
INDIVIDUAL IS BEING TREATED FOR A LIFE THREATENING EMERGENCY; OR (B) THE INDIVIDUAL HAS PREVIOUSLY BEEN OFFERED OR HAS BEEN THE SUBJECT OF AN HIV RELATED TEST (EXCEPT THAT A TEST SHALL BE OFFERED IF OTHERWISE INDI- CATED); OR (C) THE INDIVIDUAL LACKS CAPACITY TO CONSENT TO AN HIV RELATED TEST. 2. AS USED IN THIS SECTION, "PRIMARY CARE" MEANS THE MEDICAL FIELDS OF FAMILY MEDICINE, GENERAL PEDIATRICS, PRIMARY CARE, INTERNAL MEDICINE, PRIMARY CARE OBSTETRICS, OR PRIMARY CARE GYNECOLOGY, WITHOUT REGARD TO BOARD CERTIFICATION. 3. THE OFFERING OF HIV RELATED TESTING UNDER THIS SECTION SHALL BE CULTURALLY AND LINGUISTICALLY APPROPRIATE IN ACCORDANCE WITH RULES AND REGULATIONS PROMULGATED BY THE COMMISSIONER. 4. THIS SECTION SHALL NOT AFFECT THE SCOPE OF PRACTICE OF ANY HEALTH CARE PRACTITIONER OR DIMINISH ANY AUTHORITY OR LEGAL OR PROFESSIONAL OBLIGATION OF ANY HEALTH CARE PRACTITIONER TO OFFER AN HIV RELATED TEST OR TO PROVIDE SERVICES OR CARE FOR THE SUBJECT OF AN HIV RELATED TEST. S 3. Section 2135 of the public health law, as added by chapter 163 of the laws of 1998, is amended to read as follows: S 2135. Confidentiality. All reports or information secured by the department, municipal health commissioner or district health officer under the provisions of this title shall be confidential except: (A) in so far as is necessary to carry out the provisions of this title; (B) WHEN USED IN THE AGGREGATE, WITHOUT PATIENT SPECIFIC IDENTIFYING INFOR- MATION, IN PROGRAMS APPROVED BY THE COMMISSIONER FOR THE IMPROVEMENT OF THE QUALITY OF MEDICAL CARE PROVIDED TO PERSONS WITH HIV/AIDS; OR (C) WHEN USED WITHIN THE STATE OR LOCAL HEALTH DEPARTMENT BY PUBLIC HEALTH DISEASE PROGRAMS TO ASSESS CO-MORBIDITY OR COMPLETENESS OF REPORTING AND TO DIRECT PROGRAM NEEDS, IN WHICH CASE PATIENT SPECIFIC IDENTIFYING INFORMATION SHALL NOT BE DISCLOSED OUTSIDE THE STATE OR LOCAL HEALTH DEPARTMENT. S 4. Subdivision 4 of section 2780 of the public health law, as added by chapter 584 of the laws of 1988, is amended and a new subdivision 4-a is added to read as follows: 4. "HIV related test OR HIV RELATED TESTING" means any laboratory test, TESTS or series of tests [for any virus, antibody, antigen or etiologic agent whatsoever thought to cause or to indicate the presence of AIDS] APPROVED FOR THE DIAGNOSIS OF HIV. 4-A. "RAPID HIV TEST OR TESTING" MEANS ANY LABORATORY SCREENING TEST OR TESTS APPROVED FOR DETECTING ANTIBODIES TO HIV, THAT PRODUCE RESULTS IN SIXTY MINUTES OR LESS, AND ENCOMPASSES A CONFIRMATORY HIV RELATED TEST IF THE SCREENING TEST IS REACTIVE. S 5. Subdivision 1 of section 2130 of the public health law, as added by chapter 163 of the laws of 1998, is amended to read as follows: 1. Every physician or other person authorized by law to order diagnos- tic tests or make a medical diagnosis, or any laboratory performing such tests shall immediately (a) upon [initial] determination that a person is infected with human immunodeficiency virus (HIV), [or] (b) upon [initial] diagnosis that a person is afflicted with the disease known as acquired immune deficiency syndrome (AIDS), [or] (c) upon [initial] diagnosis that a person is afflicted with HIV related illness, AND (D) UPON PERIODIC MONITORING OF HIV INFECTION BY ANY LABORATORY TESTS report such case OR DATA to the commissioner. S 6. Subdivision 1 of section 2782 of the public health law is amended by adding a new paragraph (q) to read as follows: (Q) AN EXECUTOR OR AN ADMINISTRATOR OF AN ESTATE SHALL HAVE ACCESS TO THE CONFIDENTIAL HIV INFORMATION OF A DECEASED PERSON AS NEEDED TO
FULFILL HIS OR HER RESPONSIBILITIES/DUTIES AS AN EXECUTOR OR ADMINISTRA- TOR. S 7. Paragraph (a) of subdivision 5 of section 2782 of the public health law, as added by chapter 584 of the laws of 1988, is amended to read as follows: (a) Whenever disclosure of confidential HIV related information is made pursuant to this article, except for disclosures made pursuant to [paragraph] PARAGRAPHS (a), (D) AND (I) of subdivision one of this section or paragraph (a) or (e) of subdivision four of this section, such disclosure shall be accompanied or followed by a statement in writ- ing which includes the following or substantially similar language: "This information has been disclosed to you from confidential records which are protected by state law. State law prohibits you from making any further disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. Any unauthorized further disclosure in violation of state law may result in a fine or jail sentence or both. A general authorization for the release of medical or other information is NOT sufficient authori- zation for further disclosure." An oral disclosure shall be accompanied or followed by such a notice within ten days. S 8. Subdivision 1 of section 2786 of the public health law, as added by chapter 584 of the laws of 1988, is amended to read as follows: 1. The commissioner shall promulgate rules and regulations concerning implementation of this article for health facilities, health care providers and other persons to whom this article is applicable. The commissioner shall also develop STANDARDIZED MODEL forms to be used for informed consent for HIV related testing and for the release of confi- dential HIV related information and materials for pre-test counseling as required by subdivision three of section twenty-seven hundred eighty-one of this article, and for post-test counseling as required by subdivision five of section twenty-seven hundred eighty-one of this article. Persons, health facilities and health care providers may use forms for informed consent for HIV related testing, and for the release of confi- dential HIV related information other than those forms developed pursu- ant to this section, provided [that the person, health facility or health care provider doing so receives prior authorization from] THEY CONTAIN INFORMATION CONSISTENT WITH THE STANDARDIZED MODEL FORMS DEVEL- OPED BY the commissioner. All forms developed or [authorized] USED pursuant to this section shall be written in a clear and coherent manner using words with common, everyday meanings. The commissioner, in consul- tation with the AIDS institute advisory council, shall promulgate regu- lations to identify those circumstances which create a significant risk of contracting or transmitting HIV infection; provided, however, that such regulations shall not be determinative of any significant risk determined pursuant to paragraph (a) of subdivision four of section twenty-seven hundred eighty-two or section twenty-seven hundred eighty- five of this article. S 9. On or before September 1, 2012 the commissioner of health shall evaluate the impact of this act with respect to the number of persons who are tested for HIV infection and the number of persons who access care and treatment. Such report shall be submitted to the governor and to the chairs of the assembly and senate committees on health. S 10. This act shall take effect September 1, 2010; provided, however, that the commissioner of health is authorized to adopt rules and regu- lations necessary to implement this act prior to such effective date.

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