Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Existing law generally imposes penalties on a person who negligently, willfully, or maliciously discloses the results of a human immunodeficiency virus (HIV) test to a third party in a manner that identifies or provides identifying characteristics of the person to whom the test results apply, as specified.

Existing law, notwithstanding the above-described restrictions, authorizes the recording of the HIV test results by the physician who ordered the test in the test subject’s medical record and authorizes other disclosure of the results without written authorization of the test subject, or the subject’s representative, to the test subject’s providers of health care, excluding a regulated health care service plan, for purposes of diagnosis, care, or treatment of the patient.

This bill would authorize a provider of health care to disclose the results of an HIV test that identifies or provides identifying characteristics of a Medi-Cal beneficiary without written authorization of the test subject, or the subject’s representative, to the Medi-Cal managed care plan to which the beneficiary is assigned, if applicable, and to external quality review organizations conducting external quality reviews of Medi-Cal managed care plans, for the purpose of administering quality improvement programs, including, but not limited to, value-based payment programs and healthy behavior incentive programs, designed to improve HIV care for Medi-Cal beneficiaries.

Under the bill, HIV test results that do not identify or provide identifying characteristics of the test subjects would be authorized for disclosure without written authorization by the Medi-Cal managed care plan to departmental staff for the above-described purpose.

The bill would make certain clarifying or declaratory statements with regard to related provisions.