SECTIONS 120900-120920 - California Statutes

HEALTH AND SAFETY CODE

SECTION 120900-120920

120900. (a) The director shall award contracts to early
intervention projects to provide long-term services to persons
infected with HIV. The purposes of the early intervention projects
shall be to provide appropriate medical treatment to prevent or delay
the progression of disease that results from HIV infection, to
coordinate services available to HIV infected persons, and to provide
information and education, including behavior change support, to HIV
infected persons to prevent the spread of HIV infection to others.
The director shall award contracts to early intervention projects
from a variety of geographical areas. In selecting projects, the
director shall ensure that each early intervention project will
respond to the needs of its projected service area, will be sensitive
to linguistic, ethnic, and cultural differences, and will
accommodate the special needs of clients by taking into account the
circumstances that placed them at risk for becoming infected with
HIV. The director shall award contracts for early intervention
services at a pace that reflects the availability of private, state,
and federal reimbursement pursuant to Section 120920. Prior to
awarding contracts to new programs, the director shall consider
utilizing existing services and programs with which it currently
contracts, or that are currently in operation, and that provide
HIV-related services.
(b) Early intervention projects that are awarded contracts
pursuant to this section shall provide all of the following services:
(1) Health assessment of HIV infected persons, including, but not
limited to, a physical examination and immunologic and clinical
monitoring.
(2) Health education and behavior change support related to
reducing the risk of spreading HIV infection to others and to
maximize the healthy and productive lives of HIV infected persons.
(3) Psychosocial counseling services.
(4) Information and referrals for social services.
(5) Information and referrals on available research for the
treatment of HIV infection.
(6) Covered outpatient preventative or therapeutic health care
services related to HIV infection, as determined by the director.
(7) Case management.
(c) An early intervention project shall establish a core case
management team for each client to assess the needs of the client and
to develop, implement, and evaluate the client's written individual
service plan. As needed by the client, the individual service plan
shall include services specified in subdivision (b), other support
services, legal services, public assistance, insurance, and inpatient
and outpatient health care services needs of the client. A core case
management team shall include, but not be limited to, a physician
and surgeon, a physician assistant or nurse practitioner, a health
educator, a case manager, and the client. Case management in an early
intervention project shall incorporate an interdisciplinary
approach. Other professionals, paraprofessionals, and other
interested persons deemed appropriate by the members of the core case
management team also may be included. The case manager shall
coordinate the objectives specified in the client's individual
service plan. The case manager also shall monitor and assist the
client through all services provided by the project and shall provide
information, guidance, and assistance to the client regarding
support services, legal services, public assistance, insurance, and
inpatient and outpatient health care services. The project shall
designate a sufficient number of case managers to reflect case
manager-to-client ratios established by the department.

120905. (a) The director shall commence awarding contracts to
projects on or before July 1, 1990. In awarding contracts to early
intervention projects, the director may select projects from each of
the following models:
(1) A privately operated profit or nonprofit clinic that is not
licensed as part of a health facility and that provides all of the
services specified in subdivision (b) of Section 120900.
(2) A publicly operated clinic that is not licensed as part of a
health facility and that provides all of the services specified in
subdivision (b) of Section 120900.
(3) A combination of independent privately operated clinics,
publicly operated clinics, and other health care providers that in
total provide all of the services specified in subdivision (b) of
Section 120900.
(4) Any other model that the director considers worthy of
receiving funds.
(b) An applicant for a contract to operate an early intervention
project that is not a part of a county health department shall submit
its application to the county health department for review and
comment. The county health department shall provide comment on the
application to the department within a time period to be specified by
the department. The failure by a county health department to comment
on an application submitted to it within the time period specified
by the department shall not jeopardize the application, and the
department in a case of this nature may process and award a contract
in the absence of comment by the county health department.
(c) An applicant for a contract to operate an early intervention
project shall indicate in its application how it intends to
coordinate with county health department programs, community-based
organizations that provide HIV-related services, and other public and
private entities that may provide services to a person who is
infected with HIV.

120910. (a) The department shall collect data from the early
intervention projects, assess the effectiveness of the different
models of early intervention projects, and report its findings to the
Legislature on or before January 1, 1992, and on or before January 1
of each subsequent year.
(b) The department shall continuously collect data from each early
intervention project. The data collected may include, but not be
limited to, the following:
(1) The total number of clients served.
(2) The number of clients utilizing each service provided by the
project.
(3) Demographics on clients in the aggregate.
(4) The source of funding for each type of service provided.
(5) The cost of each type of service provided.
(6) Medical treatment modalities utilized in the aggregate.
(7) Changes in the clinical status of clients in the aggregate.
(8) Changes in behaviors that present risks of transmitting HIV
infection of the clients in the aggregate.
(9) The psychosocial changes of clients in the aggregate.
(10) Referrals made by the project.
(11) Perceived unmet needs of the clients served by the project.
(c) The department shall develop and distribute to each early
intervention project forms for data collection that are designed to
elicit information necessary for the department to comply with the
requirements of subdivision (b). The data may be used by the
department to comply with the requirements of subdivision (a).

120915. (a) The department shall establish a reimbursement schedule
for all of the services detailed in subdivision (b) of Section
120900. The amounts to be reimbursed for these services shall be
commensurate with the costs of providing these services.
(b) The department shall develop and disseminate guidelines to
assist early intervention projects in identifying appropriate public
and private payers of early intervention services. The guidelines
shall take into account each client's access to, and eligibility for,
private health insurance and public medical assistance. The
guidelines shall include, but not be limited to, the reimbursement
schedule established pursuant to subdivision (a) and the elements
identified in subdivisions (c) to (h), inclusive.
(c) Reimbursement under Sections 120900 to 120920, inclusive,
shall not be made for any services that are available to the client
under a private health insurance program. Early intervention projects
shall inquire of each client as to the client's coverage by a
private health insurance policy. Where a client has a private health
insurance policy, the early intervention project shall bill the
insurer for those services in subdivision (b) of Section 120900 that
are covered by the client's policy.
(d) The department shall develop and implement, or cause to be
implemented by an early intervention project, a uniform sliding fee
schedule for services provided to individuals under Sections 120900
to 120920, inclusive. The schedule shall be based on the client's
ability to pay.
(e) The department may apply for any funds available from the
federal government for the reimbursement of those services to be
provided by early intervention projects, including, but not limited
to, funds available pursuant to Section 2318 of the Public Health
Service Act, as added by Public Law 100-607, that provides for the
development of model protocols for the clinical care of individuals
who are infected with HIV.
(f) To the extent permitted under existing law, the Medi-Cal
program shall provide reimbursement to early intervention projects
for services provided under Sections 120900 to 120920, inclusive,
that are covered under the Medi-Cal program. This subdivision shall
not be construed to confer Medi-Cal eligibility on any person who
does not meet existing Medi-Cal eligibility requirements.
(g) The department shall use federal and state general funds that
are appropriated for the purpose of purchasing HIV-related drug
treatments and related services, to reimburse for covered outpatient
preventative or therapeutic health care services, as defined by the
director, provided that the client is eligible for a federal or state
program that subsidizes the cost of HIV-related drugs and related
services. If Assembly Bill 2251 of the 1989-90 Regular Session is
enacted, the department shall use the provisions in Chapter 6
(commencing with Section 120950) to implement this subdivision.
(h) The department shall use moneys from the General Fund to cover
expenses for early intervention services that are not otherwise
reimbursed, to the extent that moneys from the General Fund are
expressly appropriated to the department for early intervention
services.

120917. (a) An HIV counselor who meets the requirements of
subdivision (e) may do all of the following:
(1) Perform any HIV test that is classified as waived under the
federal Clinical Laboratory Improvement Act (CLIA) (42 U.S.C. Sec.
263a and following) if all of the following conditions exist:
(A) The performance of the HIV test meets the requirements of CLIA
and, subject to subparagraph (B), Chapter 3 (commencing with Section
1200) of Division 2 of the Business and Professions Code.
(B) Notwithstanding Section 1246 of the Business and Professions
Code, an HIV counselor may perform skin punctures for the purpose of
withdrawing blood for HIV testing, upon specific authorization from a
licensed physician and surgeon, provided that the person meets both
of the following requirements:
(i) He or she works under the direction of a licensed physician
and surgeon.
(ii) He or she has been trained in both rapid HIV test proficiency
for skin puncture blood tests and oral swab tests and in universal
infection control precautions, consistent with best infection control
practices established by the Division of Occupational Safety and
Health in the Department of Industrial Relations and the federal
Centers for Disease Control and Prevention.
(C) The person performing the HIV test meets the requirements for
the performance of waived laboratory testing pursuant to subdivision
(a) of Section 1206.5 of the Business and Professions Code. For
purposes of this subdivision and subdivision (a) of Section 1206.5 of
the Business and Professions Code, an HIV counselor who meets the
requirements of subdivision (e) shall be "other health care personnel
providing direct patient care" as referred to in paragraph (12) of
subdivision (a) of Section 1206.5 of the Business and Professions
Code.
(D) The patient is informed that the preliminary result of the
test is indicative of the likelihood of HIV infection and that the
result must be confirmed by an additional more specific test, or, if
approved by the federal Centers for Disease Control and Prevention
for that purpose, a second different rapid HIV test. Nothing in this
subdivision shall be construed to allow an HIV counselor to perform
any HIV test that is not classified as waived under the CLIA.
(2) Notwithstanding Sections 1246.5 and 2053 of the Business and
Professions Code, order and report HIV test results from tests
performed pursuant to paragraph (1) to patients without authorization
from a licensed health care professional or his or her authorized
representative. Patients with indeterminate or positive test results
from tests performed pursuant to paragraph (1) shall be referred to a
licensed health care provider whose scope of practice includes the
authority to refer patients for laboratory testing for further
evaluation.
(b) An HIV counselor who has been certified pursuant to
subdivision (b) of Section 120871 prior to September 1, 2009, and who
will administer rapid HIV skin puncture tests shall obtain training
required by clause (ii) of subparagraph (B) of paragraph (1) of
subdivision (a) prior to September 1, 2011. The HIV counselor shall
not, unless also certified as a limited phlebotomist technician,
perform a skin puncture pursuant to this section until he or she has
completed the training required by that clause.
(c) An HIV counselor who meets the requirements of this section
with respect to performing any HIV test that is classified as waived
under the CLIA may not perform any other test unless that person
meets the statutory and regulatory requirements for performing that
other test.
(d) This section shall not be construed to certify an HIV
counselor as a phlebotomy technician or a limited phlebotomy
technician, or to fulfill any requirements for certification as a
phlebotomy technician or a limited phlebotomy technician, unless the
HIV counselor has otherwise satisfied the certification requirements
imposed pursuant to Section 1246 of the Business and Professions
Code.
(e) (1) An HIV counselor shall meet one of the following criteria:
(A) Is trained by the Office of AIDS and working in an HIV
counseling and testing site funded by the department through a local
health jurisdiction, or its agents.
(B) Is working in an HIV counseling and testing site that meets
both of the following criteria:
(i) Utilizes HIV counseling staff who are trained by the Office of
AIDS or its agents.
(ii) Has a quality assurance plan approved by the local health
department in the jurisdiction where the site is located and has HIV
counseling and testing staff who comply with the quality assurance
requirements specified in Section 1230 of Article 1 of Group 9 of
Subchapter 1 of Chapter 2 of Division 1 of Title 17 of the California
Code of Regulations.
(2) (A) The Office of AIDS or its agents may charge a fee for
training HIV counseling staff.
(B) The local health department may charge a fee for the quality
assurance plan approval.

120920. The Legislature hereby finds and declares that people with
HIV infection may not avail themselves of early intervention services
unless they are aware of the availability of the services and the
efficacy of early intervention in prolonging life. This awareness by
HIV-infected persons is critical to maximizing the benefits of early
intervention. Therefore, it is the intent of the Legislature that the
department includes early intervention education as a component of
information and education grants in the first grant cycle following
enactment of Sections 120900 to 120920, inclusive.