California Gov. Gray Davis Proposes Clarification to Referral Law to Allow HIV/AIDS Patients Easier Access to Specialists Through HMOs
California Gov. Gray Davis (D) on Sunday announced that he will propose changes to the state's patient rights law to ensure that people with HIV/AIDS are referred to qualified HIV specialists through their HMOs, the San Jose Mercury News reports. In a telephone press conference orchestrated to preview the health care initiatives contained in Davis' State of the State address tomorrow night, Davis said the proposed revisions would "close a loophole" in the law that allows HMOs to refer patients to doctors who may have never dealt with HIV/AIDS patients before (Feder, San Jose Mercury News, 1/7). The 1999 Standing Referral Law (AB 2168) requires managed care companies to refer HIV/AIDS patients to specialists in the disease, but regulators "found that some of the HMOs were using the lack of a clear definition of an HIV/AIDS specialist to send those patients to people who are not qualified," Daniel Zingale, director of the state Department of Managed Health Care, said. The proposed revisions, which were drafted by the DMHC in conjunction with the American Academy of HIV Medicine, would require that doctors have a "minimum amount of current, up-to-date clinical experience" with HIV/AIDS patients before they can be declared HIV/AIDS specialists by HMOs. Such specialists would also have to participate in continuing education initiatives on HIV/AIDS to maintain their designation (Durham, Associated Press, 1/7). The revisions must be approved by the Office of Administrative Law before taking effect on July 1, but approval is expected "in a matter of weeks," Zingale said.
HIV/AIDS practitioners and advocates were pleased by the proposed revisions. "This is a huge first step," Dr. R. Scott Hitt, head of the American Academy of HIV Medicine, said, citing several studies that demonstrated that patients who see a physician who specializes in the disease have better health outcomes. John Stansell, acting chief of the University of California-San Francisco's Positive Health Program, agreed, adding that patients who have "had to fight and cajole their HMOs to be seen by an HIV specialist will now have ready access" to specialized treatment (San Jose Mercury News, 1/7). Cesar Portillo, a spokesperson for the AIDS Healthcare Foundation, which sued PacifiCare of California last year for allegedly failing to "provide adequate care" for members with HIV/AIDS, said that an HIV specialist's "ability to prescribe the right medication at the right time makes the difference between life and death." He added that managed care organizations need to "stop the excuses and start saving lives." There was no response from managed care companies yesterday (Associated Press, 1/7).