PRNewswire - December 24, 2002

LOS ANGELES, Dec. 24 /PRNewswire/ -- Groundbreaking legislation ordering California HMOs to provide "standing referrals" to AIDS specialists for patients infected with HIV will finally take effect in mid-January 2003. The bill, AB 2168, was originally signed into law in September 2000 by Governor Davis, but was delayed in implementation as the state and California physicians and medical groups worked together to craft a definition of what constitutes an HIV/AIDS specialist. The law, authored by former Assemblyman Martin Gallegos, (D, Los Angeles) gives patients a legal right to obtain care from physicians who have "demonstrated expertise" in treating AIDS.

"This is an important milestone for all Californians living with HIV/AIDS who are covered by managed care plans," said Gallegos, the author of the bill.

"Successful implementation of these regulations governing AB 2168 should markedly improve access to -- and the quality of -- care for people living with HIV/AIDS. This bill and these regulations will help save lives."

Such expertise often means the difference between life and death, according to AIDS advocates. "HMO patients come to us frequently having suffered from sub-standard care at the hands of HMOs," said Michael Weinstein, President of AIDS Healthcare Foundation, which sponsored the initial legislation. "You simply cannot provide life-saving AIDS treatment without up-to-the-minute medical education. AB 2168 and these new regulations will save lives by ensuring access to knowledgeable HIV/AIDS providers and we are grateful to former Assembly Member Gallegos for carrying this bill and seeing it through to fruition. We now look forward to helping educate Californians about their rights under the new regulations, and to working with health plans to ensure they provide the care called for by law."

Last week, the Office of Administrative Law (OAL) approved the proposed HIV/AIDS Specialist regulation. It has since been filed with the Secretary of State's Office and will be effective on January 16, 2003.

National statistics show advanced anti-HIV treatments improve health and save lives by slowing HIV's devastation. The AIDS death rate has plummeted as a result.

But studies have also shown that long-term success for patients correlates with physician expertise in administering HIV treatments.

Under AB 2168, state health code was amended to include HIV and AIDS among conditions requiring "standing referral" by HMOs to specialists. But because AIDS had yet to receive specialty designation by medical authorities, prior HMO legislation assuring access to specialists for cancer and other conditions did not include AIDS, and the state and community stakeholders worked together to define such HIV/AIDS specialists over the past year.

"We urge all people with HIV in HMOs to demand competent care by specialists," added Weinstein. "In California, HMOs who neglect their AIDS patients may now face legal sanction."

The regulation governing standing referrals to HIV/AIDS specialists is as follows:

1300.67.60 Standing Referral To HIV/AIDS Specialist

(a) The definitions and requirements of this section are applicable only to standing referrals made pursuant to Section 1374.16 of the Act. Nothing in this section requires an enrollee to transfer to a different primary care provider or limits referral authorizations that are not subject to Section 1374.16 of the Act.

(b) For the purposes of this section "AIDS" means Acquired Immunodeficiency Syndrome.

(c) For the purposes of this section "category 1 continuing medical education" means:

(1) For physicians, continuing medical education courses recognized as qualifying for category 1 credit by the Medical Board of California;

(2) For nurse practitioners, continuing education contact hours recognized by the California Board of Registered Nursing;

(3) For physician assistants, continuing education units approved by the American Association of Physician Assistants or those described in either subsection (c)(1) or (c)(2), above.

(d) For the purposes of this section "HIV" means the Human Immunodeficiency Virus.

(e) For the purposes of this section an "HIV/AIDS specialist" means a physician who holds a valid, unrevoked and unsuspended certificate to practice medicine in the state of California who meets any one of the following four criteria:

(1) Is credentialed as an "HIV Specialist" by the American Academy of HIV Medicine; or

(2) Is board certified, or has earned a Certificate of Added Qualification, in the field of HIV medicine granted by a member board of the American Board of Medical Specialties, should a member board of that organization establish board certification, or a Certificate of Added Qualification, in the field of HIV medicine; or

(3) Is board certified in the field of infectious diseases by a member board of the American Board of Medical Specialties and meets the following qualifications: (A) In the immediately preceding 12 months has clinically managed medical care to a minimum of 25 patients who are infected with HIV; and (B) In the immediately preceding 12 months has successfully completed a minimum of 15 hours of category 1 continuing medical education in the prevention of HIV infection, combined with diagnosis, treatment, or both, of HIV-infected patients, including a minimum of 5 hours related to antiretroviral therapy per year; or

(4) Meets the following qualifications: (A) In the immediately preceding 24 months has clinically managed medical care to a minimum of 20 patients who are infected with HIV; and (B) Has completed any of the following:

1. In the immediately preceding 12 months has obtained board certification or recertification in the field of infectious diseases from a member board of the American Board of Medical Specialties; or In the immediately preceding 12 months has successfully completed a minimum of 30 hours of category 1 continuing medical education in the prevention of HIV infection, combined with diagnosis, treatment, or both, of HIV-infected patients; or

2. In the immediately preceding 12 months has successfully completed a minimum of 15 hours of category 1 continuing medical education in the prevention of HIV infection, combined with diagnosis, treatment, or both, of HIV-infected patients and has successfully completed the HIV Medicine Competency Maintenance Examination administered by the American Academy of HIV Medicine.

(f) When authorizing a standing referral to a specialist pursuant to Section 1374.16(a) of the Act for the purpose of the diagnosis or treatment of a condition requiring care by a physician with a specialized knowledge of HIV medicine, a health care service plan must refer the enrollee to an HIV/AIDS specialist. When authorizing a standing referral to a specialist for the purposes of having that specialist coordinate the enrollee's health care pursuant to Section 1374.16(b) of the Act for an enrollee who is infected with HIV, a health care service plan must refer the enrollee to an HIV/AIDS specialist. The HIV/AIDS specialist may utilize the services of a nurse practitioner or physician assistant if:

(1) The nurse practitioner or physician assistant is under the supervision of an HIV/AIDS specialist; and

(2) The nurse practitioner or physician assistant meets the qualifications specified in subsection (e)(4); and

(3) The nurse practitioner or physician assistant and that provider's supervising HIV/AIDS specialist have the capacity to see an additional patient.

(g) Subsection (f) does not require a health care service plan to refer an enrollee to any provider who is not employed by or under contract with the health care service plan to provide health care services to its enrollees, unless there is no HIV/AIDS specialist, or appropriately qualified nurse practitioner or physician assistant under the supervision of an HIV/AIDS specialist, within the plan's network appropriate to provide care to the enrollee, as determined by the primary care physician in consultation with the plan medical director.

(h) The Department will hold an annual public hearing to review the implementation of this section and to consider the need to revise this section.

(i) This section will be effective on January 16, 2003.

NOTE: Authority cited: Section 1344, Health and Safety Code. Reference: Sections 1344 and 1374.16, Health and Safety Code.

AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the United States. AHF serves thousands of patients in California, New York and Florida regardless of their insurance status or ability to pay. In addition, AHF currently operates two free AIDS treatment clinics in Africa: the Ithembalabantu (Zulu for "people's hope") Clinic in KwaZulu Natal, Durban, South Africa & the Uganda Cares Healthcare Center in Masaka, Uganda. http://www.aidshealth.org .

SOURCE AIDS Healthcare Foundation

Web Site: http://www.aidshealth.org

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