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Patient Care Planning Group
Meeting
November 13-14, 2012
Sherry Riley
Program Administrator
HIV/AIDS and Hepatitis Program
Overview
• HIV/AIDS Reporting Data
• Updates on the Department
• Legal and Legislative Issues
• Uncertainty at the National Level
• Announcements
National HIV/AIDS Strategy
(NHAS)
The United States will become a place
where new HIV infections are rare and
when they do occur, every person,
regardless of age, gender, race/ethnicity,
sexual orientation, gender identity or
socio-economic circumstance, will have
unfettered access to high quality, life-
extending care, free from stigma and
discrimination.
0
1,000
2,000
3,000
4,000
5,000
6,000
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year of Report
Nu
mb
er
of
Ca
se
s
last year's this year's
Note: AIDS cases increased in 2004 due to increased CD4 testing statewide. Electronic laboratory reporting delays in late 2007 decreased cases in that year, while contributing to a spike in 2008. The expansion of electronic lab reporting increased the timeliness of reporting, which further contributed to the artificial spike in 2008 followed by the artificial dip in 2009 & 2010 followed by an approach to leveling in 2011 followed by a decrease in 2012. These trends were observed across most race/sex/risk groups. *Source: Population estimates are provided by FloridaCHARTS **2012 DATA ARE ESTIMATED BASED ON A CURRENT YTD DECREASE OF 18%.
PROJECTED AIDS Cases and Rates*,
by Year of Report, 2002-2012**, Florida Last year’s numbers vs. This year’s numbers
Estimated
18% decrease
Note, last year’s 2011 numbers were
Artificially inflated by duplicates that were not
Deleted until 2012.
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year of Report
Nu
mb
er
of
Cases
last year's this year's
PROJECTED HIV Infection Cases and Rates*,
by Year of Report, 2002-2012**, Florida Last year’s numbers vs. This year’s numbers
Note: Since 2002 newly reported HIV infection cases have decreased each year until 2007. Since then, changes in the reporting laws caused fluctuations in the reporting of new HIV infection cases. Enhanced reporting laws were implemented in November 2006, and the expansion of electronic lab reporting in 2007 led to an artificial peak in HIV cases in 2007 and 2008 followed by an artificial decrease in 2009 and 2010. New HIV infection cases increased in 2011 and began to decrease again in 2012. These trends were observed across most race/sex/risk groups. *Source: Population estimates are provided by FloridaCHARTS **2012 DATA ARE ESTIMATED BASED ON A CURRENT YTD INCREASE OF 5.4%.
Estimated
5.4% increase,
From 2011 to 2012,
as of 10/31/2012
Note, last year’s 2011 numbers were
Artificially inflated by duplicates that were not
Deleted until 2012.
HIV Infection Cases by Year of Report vs. Year of Diagnosis
Florida, 2002-2011
0
2000
4000
6000
8000
10000
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Cases
HIV/AIDS report HIV/AIDS Diagnosis
HIV Infection reporting represents newly reported HIV cases, regardless of AIDS at time of report, that
have not previously been reported as of 10/13/2012.
Newly reported cases do NOT imply that they are newly diagnosed cases
HIV Infection diagnosis represents newly diagnosed HIV cases, regardless of AIDS at time of diagnosis,
that have NOT previously been diagnosed as of 10/13/2012. More closely represents incidence.
Note: Reporting laws changed 11/20/06, resulting in artificial blips in the year following the change.
Department of Health • New Leadership
• Focus
– Healthiest state in the nation
– Strong partnership with CHDs
– Continuous Performance Improvement - Accreditation
Accreditation
• DOH has applied to the Public Health Accreditation Board for accreditation as an integrated health agency.
• The Board is a nonprofit organization that advances the performance of health departments. Health departments must meet a set of standards to continuously improve performance.
• Florida is one of 2 states participating in a pilot accreditation process.
Accreditation Components
• Pre Application
• Application
• Document Selection and Submission
• Site Visit
• Accreditation Decision
• Annual Reports
• Re-accreditation
Reorganization of the Department
Moving forward!!
• Reduced the # of Divisions (from 11 to 8)
• Reduced the # of Bureaus (from 50 to 33)
Division of Disease Control and
Health Protection Interim
Division Director Jennifer
Bencie, MD, MSA
Bureau of Environmental
Health
Bureau of Epidemiology
Bureau of Communicable
Disease
Bureau of Communicable Diseases
Bureau of Communicable
Diseases (vacant chief
position)
Immunization Program Charles
Alexander
STD Program Stacy Shiver
TB Program Carol Tanner
Interim
HIV/AIDS and Hepatitis Program
Sherry Riley
Legal/Legislative Issues
Administrative Rules
• Filed rules to streamline HIV counseling and testing in the CHD clinics.
• Clients will be given the opportunity for face-to-face pre and post-test counseling.
• The process will not change for registered test sites and CHD “testing only” programs.
Harm Reduction
• The Florida Medical Association passed a
resolution that supports legislation on
syringe exchange.
• Students for Sensible Drug Policy will
address this issue at their
Florida/Southeast Regional Conference,
on November 17-18th at USF-Tampa.
National Effort to Decriminalize
HIV/AIDS Specific Laws
• In November of 2010, the Center for HIV Law
and Policy released an analysis of HIV specific
laws and prosecutions in the US. (37 states
have these laws)
• According to the report, the laws are:
– Based on exaggerated fears
– Have no positive impact on risk behavior
– Promote stigma and discrimination
HHS Streamlining Data
Requirements • HHS published a Request for Information in the Federal
Register on ways to streamline reporting on HIV prevention, treatment and care grantees. (closed on 9/21/2012)
• How much time, resources, and personnel are required to meet reporting requirements?
• Which requirements are most burdensome and which are most useful for program planning, monitoring, evaluation, or program improvements?
Uncertainty at the National Level
Sequestration
• Congress voted to increase the country’s debt limit, but only with a reduction in government spending.
• The Budget Control Act of 2011 required Congress to reduce the federal deficit by $1.2 trillion over the next decade. The Act created a “Super Committee” to develop a deficit-reduction plan by Nov. 23, 2011.
• If the committee did not reach an agreement, automatic budget cuts would begin on January 2, 2013. This enforcement mechanism is called “sequestration”.
Sequestration
• The first-year cut is $109 billion. Cuts will continue each fiscal year until 2021.
• Fiscal Cliff – Sequestration and Bush tax cuts, the payroll tax, unemployment benefits and a host of other tax breaks that are all scheduled to expire Dec. 31.
• Millions in federal spending reductions for HIV/AIDS programs will automatically begin in early January.
Sequestration
• 118 HIV/AIDS organizations signed a letter to congressional leaders about the devastating impact of sequesration cuts would have on HIV/AIDS programs
• 15,708 enrolled clients will be removed from ADAP
• Ryan White would lose $196 million
• HIV prevention would lose $64 million
• AIDS research cut by $251 million
• HOPWA would lose $27 million
Sequestration
• Senate attempting to establish a framework for deficit reduction before the end of this year to replace the scheduled sequester and tax increases.
• Led by Senators Lamar Alexander (R-TN) and Michael Bennet (D-CO).
• The next Congress to come up with alternative spending cuts and revenue increases.
Affordable Care Act (ACA)
• What is the impact in Florida?
• Although the Supreme Court upheld the law, the Supreme Court ruled that states cannot be forced to expand Medicaid to citizens at or below 133% of FPL
• FL Governor Scott has stated that the state will not expand Medicaid or establish an exchange; The federal government will implement the exchange in FL.
Affordable Care Act
• The Ryan White Care Act is up for reauthorization by the U.S. Congress in 2013.
• Whether a state expands Medicaid or not, the Ryan White Program must continue to fulfill its core public health function of providing access to care and treatment to people who have nowhere else to go.
Affordable Care Act
• 2010
– Young adults can stay on parents’ insurance until
they turn 26
– Pre-Existing Condition Insurance Plan (PCIP) for
people who have been uninsured for 6 months
– Insurance companies banned from rescinding
people’s coverage when they get sick or imposing
lifetime caps on coverage
– Protection for children with pre-existing conditions
– Free preventive care
Affordable Care Act (ACA) • 2011
– Medicare Part D recipients in the donut hole receive a 50% discount when buying Medicare Part D covered brand-name prescription drugs.
– Limits on non-medical spending by health plans (plans in the large group market must spend 85% on medical care and those in small-group or individual markets have to spend 80%)
• 2012 – Medicare will reduce payments for preventable
hospital readmissions for select conditions
– Medicare will reward hospitals for better patient outcomes
Affordable Care Act (ACA)
• 2013
– The Medicaid option to provide screening and preventive services will be expanded.
• 2014
– Insurance exchanges
– HHS will establish an essential standard benefits package for policies sold in the exchanges.
– Premium subsidies for families with annual incomes between $30,000 and $88,000 who purchase plans through the exchanges
Affordable Care Act
• 2014 – Medicaid expansion for persons with incomes of up to
133% FPL
– Insurers will be banned from restricting coverage or basing premiums on health status or gender
• 2018
– 40% tax for insurers on policies with premiums over $10,200 for individuals or $27,000 for families (thresholds are higher for retirees or those in high risk industries)
Staff survey
• Phill Wilson – Black AIDS Institute
• Conducted a knowledge, ability, and belief (KAB) survey at the U.S. Conference on AIDS.
• Pilot survey to assess knowledge of front line staff. It consists of 21 demographic and screening questions, 26 knowledge questions and 15 questions about biomedical prevention. Participants had 60 seconds to answer each knowledge question, but there was no time limit for the other questions.
• Cross Training Opportunity
