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

SPONSOR Griego

DATE TYPED 2-14-05

HB

SHORT TITLE Billy Griego HIV and AIDS Act

SB 314/aSPAC

ANALYST Collard

APPROPRIATION

Appropriation Contained Estimated Additional Impact Recurring

or Non-Rec

Fund

Affected

FY05

FY06

FY05

FY06

See Narrative

(Parenthesis ( ) Indicate Expenditure Decreases)

Duplicates HB 531

Relates to HB 530, SB 313, HJM 22 and SJM 21

SOURCES OF INFORMATION

LFC Files

Responses Received From

Department of Health (DOH)

Division of Vocational Rehabilitation (DVR)

Department of Indian Affairs (DIA)

Health Policy Commission (HPC)

SUMMARY

Synopsis of SPAC Amendment

The Senate Public Affairs Committee amendment to Senate Bill 314 amends six areas of the bill.

In the amendment, “ombudsman” is replaced by “constituent services program” and “services to

be delivered by a consumer-based organization” is replaced by “services shall be delivered in a

consumer-oriented model”. Instead of creating an independent ombudsman office of HIV and

AIDS, an independent constituent services program would be created. In addition to recording

and reviewing all complaints, the constituent services program would review all fiscal matters

and include expenditures along with activities in its annual report. DOH supports these amend-

ments.

Senate Bill 314/aSPAC -- Page 2

Significant Issues

DOH notes the amendment replaces the office of ombudsman proposed in the original bill with a

constituent services program. HIV/AIDS services reach over 1,600 clients with an estimated

28,880 visits. HIV/AIDS prevention programs have over 40 thousand interventions annually.

The independent constituent services program would record and review all complaints and re-

quests for public program services for individuals with HIV/AIDS.

Synopsis of Original Bill

Senate Bill 314 establishes certain duties by DOH pertaining to persons living with HIV and

AIDS. This includes facilitating coordination among all agencies, providing education, preven-

tion and treatment services, administering the federal Ryan White grant, and providing clinical

services, drug assistance, and insurance assistance. The bill also creates a medical advisory

committee consisting of seven members, DOH’s chief medical officer, four physicians and two

consumers, to review HIV/AIDS drug formulary and policies. Finally, the bill creates an inde-

pendent ombudsman to be part of a newly created office with the ombudsman appointed by and

serving at the pleasure of the governor. The ombudsman function would be to record and review

all complaints and requests for services. The bill requires DOH to provide an annual report on

HIV/AIDS activities to the Legislature and the governor by December 15.

Significant Issues

DIA indicates Native Americans constitute 10 percent to 11 percent of the population of New

Mexico. Current data shows Native Americans representing approximately 6 percent of the

HIV/AIDS epidemic in New Mexico. There are community based programs that currently pro-

vide HIV/AIDS and related prevention services to Native Americans. These organizations and

other providers indicate a problem providing prevention services to individuals living in large

rural areas where cultural and language barriers exist. Similarly, there are barriers to providing

services to Native Americans with HIV and AIDS living in urban areas. For both rural and ur-

ban Native American populations, intervention, prevention and treatment services would need to

be tailored to the needs of the target population within that setting.

It should be noted DOH recently contracted for an assessment of Native American case man-

agement services. The information collected from the assessment came directly from Native

American clients, Native American providers and the Indian Health Service. The assessment

would be a useful resource to use in coordinating HIV/AIDS services among agencies and in

guiding the implementation of this bill.

DOH indicates major crises facing the department and the HIV/AIDS community are the costs of

medications and assuring that HIV services and prevention programs remain available through-

out New Mexico. The number of people living with HIV/AIDS continues to grow. The cost of

drugs continues to rise. The New Mexico AIDS Drug Assistance Program (ADAP) provides life-

saving medications to poor and uninsured New Mexicans living with HIV/AIDS. The Health

Management Alliances (HMAs) service agencies provide life-saving care. The HIV Prevention

community provides support to people at risk in preventing HIV. This bill is similar to the fed-

eral Ryan White CARE Act and would mandate the preservation of HIV/AIDS programs.

Senate Bill 314/aSPAC -- Page 3

FISCAL IMPLICATIONS

While there is no direct appropriation for this bill, DOH will have to take on administrative costs.

However, DOH notes the FY06 budget includes almost $14.6 million for direct HIV services in-

cluding prevention, treatment and medications, with $9.4 million from the general fund, $3.9

million from federal funds and almost $1.3 million from program revenues.

DVR notes the bill does not provide appropriations for the operations of the committee. The

committee will expend funds for per diem, payment of services such as contracts, administrative

functions, publication and dissemination of reports and DOH will assume the financial responsi-

bility.

ADMINISTRATIVE IMPLICATIONS

The functions in the bill can be handled by the current DOH staff; however, there would be ad-

ministrative implications in setting up an “ombudsman” office external to DOH. DOH will un-

dertake this as a priority, to the extent the budget will allow.

DUPLICATION, RELATIONSHIP

Senate Bill 314 duplicates House Bill 531. Additionally, Senate Bill 314 relates to House Bill

530, and its duplicate Senate Bill 313, which establishes the governor’s HIV and AIDS commis-

sion and also relates to Senate Joint Memorial 21 and House Joint Memorial 22, which calls for

the improvement of HIV/AIDS services in the state.

OTHER SUBSTANTIVE ISSUES

DOH notes limited access to specialized HIV services throughout New Mexico has resulted in

the development of HIV “centers of excellence” permitting a standard of care to everyone who

is HIV positive living in New Mexico. In an era of improved medical treatment, the number of

people living with HIV/AIDS continues to grow. Effective antiretroviral therapy combined with

access to quality service has led to a decline in the HIV positive population that progresses to

AIDS. These medications and services can be costly.

Over the last three years, the New Mexico AIDS Drug Assistance Program (ADAP) has aver-

aged 22 new clients enrolled in the program each year. During the past six months an average of

five new clients has enrolled each month. In addition, the per-client cost of HIV-related medica-

tions has continued to rise.

DOH-contracted HIV services and ADAP are funded with federal and state monies. Given the

growth in HIV/AIDS and the increasing costs, programs across the nation, including ADAP, are

facing a serious fiscal crisis. For example, fifteen states have implemented restrictions to enroll-

ment and utilization of their ADAP programs. These include capped enrollment, reduction in

HIV medication formularies, and/or lowered financial eligibility for enrollment. In New Mexico,

the challenge is to maintain a standard HIV medications formulary as well as quality services

within available funds.

DIA states the main purpose of the bill is to ensure that consumers are the focus of funding and

services provided. To this end, a statewide HIV and AIDS plan would need to include tribal in-

Senate Bill 314/aSPAC -- Page 4

put, to address any impediments to accessing services and programs for Native Americans, and

to ensure that funding for consumer-based programs that serve Native American populations are

maintained or expanded. Finally, a coordinated plan that is reflective of the New Mexico popu-

lation and based on the needs of persons living with HIV and AIDS, including the unique needs

of tribes and individual Native Americans living with HIV and AIDS is important.

DVR indicates the bill centers on a committee with a focus on health care issues, but people liv-

ing with HIV/AIDS require coordinated services inclusive of psycho-social adjustment. DVR

indicates the committee would do well in considering the larger array of services needed by peo-

ple living with HIV/AIDS. The committee should be knowledgeable of psycho-social services

available and how these services will augment and enhance health care services. DVR states

people living with HIV/AIDS should be referred to DVR for employment services, to either re-

turn to employment, maintain employment or seek employment for the first time. Coordination

of referrals to DVR is critical as well as communication and networking.

HPC notes, in a recent report by the Canadian HIV/AIDS Legal Network, Privacy Protection and

the Disclosure of Health Information, recommendations were made for governments to take

steps to ensure that legislation protects personal health information of people living with

HIV/AIDS. Among those recommendations to consider that will ensure confidentiality when

legislation is being proposed that includes sharing of information and oversight of an ombuds-

man are:

.

Governments should ensure that legislation limits the circumstances in which health informa-

tion of a person is disclosed without consent.

.

Legislation to include principles and practices that are to be followed where personal health

information is to be disclosed without consent.

.

The custodian of health information to take measures to ensure that the information is as

complete and accurate as possible prior to disclosure.

.

The disclosure is limited to the minimum amount necessary to accomplish the purpose for

which the information is transmitted.

.

The custodian should make best efforts to inform the person with HIV/AIDS of the antici-

pated disclosure of his or her personal information and attempt to seek consent to the disclo-

sure.

DOH New Mexico HIV/AIDS Statistics

.

As of December 2003, 1,910 New Mexicans are living with HIV/AIDS or 103.0 per 100,000

population. 1,158 (60.6 percent) have been diagnosed with AIDS. The breakdown by eth-

nicity is White (47.9 percent), Hispanic (39.7 percent), Native American (6.6 percent), Black

(5.2 percent) and Asian/Pacific Islander (.5 percent).

.

In 2003, 47 percent of people diagnosed with AIDS were Hispanic followed by White (34.2

percent), Native Americans (14.5 percent) and Black (4.3 percent). The Hispanic population

continues to have the largest number of AIDS diagnoses annually since HIV/AIDS reporting

began in 1998.

.

Individuals living with HIV/AIDS in New Mexico nearly doubled from 892 in 1990 to 1,910

at the end of 2003.

.

As of December 2003, 3,247 cumulative HIV/AIDS cases in New Mexico have been re-

ported since 1981. 1,337 (41 percent) are known to have died.

.

In 2003, the AIDS diagnoses and deaths reported in New Mexico represent the highest an-

nual figures since 1998.

Senate Bill 314/aSPAC -- Page 5

.

From 1981 to 1996, diagnosed AIDS cases in New Mexico increased each year. With the

availability of antiretroviral therapy in 1996 the number of cases reported each year has de-

clined.

ALTERNATIVES

DIA suggests an alternative would be for the respective department staff to meet with Native

American clients and providers to discuss state HIV and AIDS services and inter-agency oppor-

tunities with the goal of maximizing resources and ensuring best practices to this population.

KBC/njw:yr