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F I S C A L I M P A C T R E P O R T

SPONSOR Picraux

DATE TYPED 2-4-05

HB 635

SHORT TITLE Rural NM Hepatitis C Service Delivery

SB

ANALYST Collard

APPROPRIATION

Appropriation Contained Estimated Additional Impact Recurring

or Non-Rec

Fund

Affected

FY05

FY06

FY05

FY06

$2,200.0

Recurring General Fund

(Parenthesis ( ) Indicate Expenditure Decreases)

Duplicates SB 650

Relates to Appropriation in the General Appropriation Act

SOURCES OF INFORMATION

LFC Files

Responses Received From

New Mexico Corrections Department (NMCD)

Health Policy Commission (HPC)

Department of Health (DOH)

SUMMARY

Synopsis of Bill

House Bill 635 appropriates $2.2 million from the general fund to the Department of Health for

the purpose of developing a training and service delivery system for screening and treatment of

hepatitis C, using telemedicine capabilities and coordinating with NMCD and primary care clin-

ics.

Significant Issues

DOH notes hepatitis C is a viral disease of the liver spread through blood and possibly other bod-

ily fluids. In New Mexico, hepatitis C infection is 10 times more prevalent than HIV infection.

DOH notes Sanjeev Arora, MD with the University of New Mexico (UNM) Health Science Cen-

ter indicates the cost of managing hepatitis C without treatment is estimated at a lifetime cost of

$100 thousand per person. This bill would provide operational funding to enhance hepatitis C

prevention and treatment services to outlying areas of the state through the network of commu-

nity-based primary care centers and provide resources for treatment of inmates within NCMD.

House Bill 635 -- Page 2

The bill also charges DOH to use interactive telehealth to aid in the treatment of hepatitis C. Few

clinicians in New Mexico are knowledgeable about the treatment, which requires a complex

long-term intervention. Telehealth technologies allow the available experts to consult on cases

and train their peers in the latest treatment protocols.

NMCD notes $500 thousand is designated for the Corrections Department to provide screening

for all inmates who are sent by the courts to the Reception and Diagnostic Center in Los Lunas.

HPC notes the following statistics:

•

The estimated number of New Mexicans with hepatitis C is greater than 32 thousand.

Less than 5 percent have been treated.

•

Without treatment, approximately 8 thousand hepatitis C patients will develop cirrho-

sis/liver disease between 2010 and 2015 resulting in several thousand deaths.

•

In correctional facilities, 1,978 prisoners have been diagnosed and none have been

treated. The number of diagnoses is expected to reach 2,400.

•

New Mexico has the highest rate of chronic liver disease deaths in the United States.

•

Hepatitis C is curable in 45 percent to 85 percent of cases although there can be se-

vere side effects.

•

Thirty-two of 33 New Mexico counties are listed as Medically Underserved Areas.

Fourteen counties are designated as Health Professional Shortage Areas.

FISCAL IMPLICATIONS

The appropriation of $2.2 million contained in this bill is a recurring expense to the general fund.

Any unexpended or unencumbered balance remaining at the end of FY06 shall revert to the gen-

eral fund.

DOH indicates the appropriation would permit creation of a system of care for hepatitis C within

community-based primary care centers. It would support training of primary care center staff in

the prevention and outpatient treatment of hepatitis C, the costs of indigent hepatitis C patients

seen at community-based primary care centers, treatment of inmates within NMCD, and expan-

sion of the syringe exchange and harm reduction program.

Additionally, primary care center activities would be integrated with the efforts of DOH staff,

creating a continuum of care for hepatitis C-infected individuals similar to the continuum of care

already in place for HIV-infected individuals. This continuum of care will range from out-

reach/identification of patients and include similar testing, counseling, harm reduction and treat-

ment alternatives.

ADMINISTRATIVE IMPLICATIONS

NMCD indicates it has established protocols for the diagnosis and delivery of hepatitis C treat-

ment that has endured court scrutiny and is aligned with the most current medical requirements.

The proposed legislation may require more staff and/or the purchase of more equipment.

DUPLICATION, RELATIONSHIP

House Bill 635 duplicates Senate Bill 650. Additionally, there is an executive recommendation

for $2 million as a special appropriation for this purpose. NMCD currently receives $500 thou-

House Bill 635 -- Page 3

sand for hepatitis C treatment. DOH also indicates HB 635 relates to HB 536 and its duplicate,

SB 473, which creates a telehealth commission to encourage single, coordinated statewide efforts

to create a telehealth system.

OTHER SUBSTANTIVE ISSUES

HPC notes telemedicine is the use of medical information exchanged from one site to another

using electronic communications for the health and education of patients or providers and to im-

prove patient care. Telemedicine requires a high-speed Internet connection and a video camera

at each location.

According to the UNM Department of Internal Medicine, Extension for Community Healthcare

Outcomes (ECHO) Project the implementation of a telemedicine model may result in high qual-

ity of health care and lower costs. Other positive outcomes may include fewer medical errors,

prevention of unnecessary testing, prevention of death from an untreated disease, mitigation cost

of future care (liver transplants), reduction of treatment related complications, improvement of

outcomes with disease management protocols, preservation of rural physician time, a supplement

for in inadequate nursing resources, and greater connectivity for rural clinics.

HPC indicates the model should be scalable and include provider training, installation of proto-

cols and software on-site, conduct telemedicine clinics, collect data and monitor outcomes, and

assess cost effectiveness of program.

DOH notes the hepatitis C initiative is a collaboration between DOH, UNM, NMCD and the

New Mexico primary care system to develop a continuum of care, from testing and early detec-

tion through antiviral treatment for eligible persons infected with hepatitis C, including long term

chronic disease management.

Hepatitis C is the most common blood-borne viral infection in the United States and is the single

leading cause of liver transplantation in the United States. New Mexico has the highest rate of

deaths due to chronic liver disease and cirrhosis in the United States, a rate 25 percent higher

than the next highest state.

Injection drug users are the population with the highest rate of infection with the hepatitis C vi-

rus. Injection drug use with shared syringes, and other injection equipment, increases the risk of

transmission of this blood borne virus.

ALTERNATIVES

HPC recommends the UNM School of Medicine be included as a collaborative partner in the de-

velopment of this bill.

KBC/lg