2005 ADAP bill draft

A bill for an act relating to human services; creating a program for individuals with HIV; proposing coding for new law in Minnesota Statutes, chapter 256; repealing Minnesota Statutes 2004, section 256.9365.

Section 1. [HIV PREVENTION AND HEALTH CARE ACCESS PROGRAM.]
Subdivision 1. [PURPOSE] The commissioner of human services shall establish an HIV prevention and health care access program for low-income Minnesotans that:

1. provides access to HIV treatment consistent with the Centers for Disease Control guidelines;
2. promotes reduction of HIV transmission through continuous and uninterrupted access to treatment consistent with the most current Public Health Services HIV treatment guidelines;
3. provides uniform benefits to best meet HIV needs with a minimum of administrative cost and efforts;
4. ensures service delivery accountability to the people it serves, including due notice, opportunities for community input, and uniform, transparent procedures communicated to current and eligible individuals, their health care and social service providers, community planning and advisory groups or agencies established under the Ryan White Care Act;
   
5. provides access to HIV treatment inclusive of treatment for substance abuse and mental health treatment as those conditions interfere with HIV treatment adherence;
6. provides initial and continued access to treatment that is, to the maximum extent practicable, without regard to the ability of the individual to pay for such services and without regard to the current or past health condition of the individual with HIV disease.

Subdivision 2. [ESTABLISHMENT] The commissioner of human services shall establish a program to provide prescription drug coverage and basic early intervention diagnostic services and to pay private health plan premiums for persons who have contracted human immunodeficiency virus (HIV) to enable them to secure or continue coverage under a group or individual health plan and to ensure continuous comprehensive treatment.

Subdivision 3. [ELIBILITY REQUIREMENTS.] (a) To be eligible for the program, an applicant must satisfy the following requirements:
(1) the applicant must be HIV positive;
(2) the applicant must:

i. have no health insurance coverage, or be undercovered for their HIV-related medications or treatments;

ii. have no health insurance coverage because of ineligibility due to a pre-existing condition;

iii. face losing health insurance coverage due to a change in employment status; or

iv. have limited coverage not consistent with CDC guidelines for best practice HIV treatment.

(3) the applicant’s monthly gross family income must not exceed 300 percent of the federal poverty guidelines after deducting medical expenses and insurance premiums;

(4) the applicant must not own assets with a combined value of more than $30,000, excluding;

1. all assets excluded under section 256B.056;
2. retirement accounts, Keogh plans, and pension plans; and
3. medical expense accounts set up through the individual’s employer.

(5) To be eligible for drug reimbursement, the applicant may not be a recipient of medical assistance, medical assistance for employed persons with disabilities or general assistance medical care;

1. all assets excluded under section 256B.056;
   retirement accounts, Keogh plans, and pension plans; and

(b) Individuals whose income and assets exceed the amounts established in paragraph (a) but who meet all the other eligibility requirements shall be eligible for this program upon payment of a premium. The premium shall be based on the person’s gross income using a sliding fee scale established by the commissioner. The premium shall not exceed 10 percent of the person’s annual gross income.

Subdivision 4. [BENEFITS.] (a) If an individual is determined to be eligible under subdivision 3, the commissioner shall pay the portion of the group plan premium for which the individual is responsible or shall pay the individual plan premium. The commissioner shall not pay for that portion of a premium that is attributable to other family members or dependents. Requirements for the payment of individual plan premiums under this section must be designed to ensure that the state cost of paying an individual plan premium does not exceed the estimated state cost that would otherwise be incurred in the medical assistance and general assistance medical care program. The commissioner shall purchase the most cost-effective coverage available for eligible individuals.

(b) If an individual is determined to be eligible under subdivision 3, the program benefits shall provide access to HIV drugs and related drug treatments included in the HIV care drug formulary established by the commissioner. The program benefits shall also provide access to early intervention treatment, including initial diagnostics, hepatitis B and C, sexually transmitted infections and tuberculosis screening and tests, and any treatment for HIV that is consistent with the Centers for Disease Control (CDC) guidelines for HIV best practice treatment.

(c)The commissioner shall establish a transparent, public advisory process for establishing and revising an HIV care drug formulary. At a minimum, the process shall include consultation with HIV health care providers, HIV social service providers, persons living with HIV, the Minnesota HIV Services Planning Council, and entities directly contracted by the federal government to administer funds from the Ryan White CARE Act. Participants in this process shall be appointed in equal numbers by the commissioner and by the Minnesota HIV Services Planning Council.

(d) There shall be no co-payments or premiums or cost-shares charged to any individual determined to be eligible under subdivision 3, paragraph (a).
Section 2. [REPEALER.]
Minnesota Statutes 2004, section 256.9365, is repealed.

Other Items to Add to the Bill:

• Funding for the current state program comes from general funds, federal Ryan White CARE Act and drug rebate earnings on the purchase of HIV drugs. We want to establish authority for state funding to include, but not limited to, the general fund and the health care access fund, for continued use of funds from Title II of the Ryan White CARE Act [100 percent of those funds appropriated for the AIDS Drug Assistance Program, but no more than 25 percent of the funds appropriated through the Title II formula allocation], and finally, the priority for use of all funds acquired through rebates on purchases of HIV drugs would be to purchase benefits for eligible persons. Right now, beyond federal guidelines, the Department has considerably flexibility to decide what to do with the Ryan White Funds it receives and any rebate earnings. We want to create a bit more of a balance in terms of the legislative role in shaping the course of the program
  
• Request a biennial appropriation of $12,400,000. Based upon the following:
  Current estimated annual cost is $5 million [see description below from Gov 2004 supplemental budget]. Increase by 7% to account for rate of increase of persons living with HIV in MN. Increase by 15% to account for increases in health care and drug costs.
  
  Gov 2004 Supplemental Budget – “Approximately $5 million is annually spent on purchasing HIV drugs and insurance through this budget activity. 48% of the funds are federal, 35% are dedicated special revenue funds obtained from HIV program drug rebates, and 21% of the funds are state general funds.

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Last Updated: Friday, March 30, 2007
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