Bill requires HMOs to give referrals to AIDS patients

The Associated Press
Saturday September 16, 2000

SACRAMENTO – California HMOs will be required to let HIV-positive patients get standing referrals to doctors with expertise in treating AIDS under a bill signed by the governor this week. 

While HMOs are required to have specialists for many conditions, from allergies to urology, the treatment of HIV and AIDS isn’t a certified specialty yet. 

But AIDS activists say finding a doctor who has expertise in treating HIV is necessary because of the complex health problems and treatment regimes needed for those infected. 

“Anyone who has a relationship with an HMO knows how difficult it is to navigate the system to get a referral to a specialist. For people with HIV, any delay in getting proper care from a specialist can be fatal,” said Cesar Portillo of the AIDS Healthcare Foundation, the sponsor of the bill. 

Gov. Gray Davis signed the measure Tuesday. The requirement takes effect Jan. 1. 

Portillo said he believes that California’s law is the first to direct HMOs to use HIV/AIDS specialists. Other states have used “special needs” provisions in the law to require health plans to use HIV/AIDS specialists, he said. 

The California Association of Health Plans supported the bill, which was sponsored by Assemblyman Martin Gallegos, D-Baldwin Park. 

Most of the 36 HMOs that belong to the organization already sent HIV patients to physicians with expertise in that area, spokesman Bobby Pena said. 

“There’s a standing definition of what health plans are required to send people to specialists for. This just puts AIDS and HIV patients into that category,” Pena said. 

The change in the law shouldn’t cost the HMOs any additional money, since it was the norm for most, he said. 

Portillo estimated the bill will ensure proper care for about 20,000 HMO patients infected with HIV or AIDS. 

There is a national effort to get HIV acknowledged as a specialty by the AMA, Portillo said. 

“You really do need a specialist to prescribe the right combination of prescriptions to the patient and to understand the relatively complex tests to find if that particular treatment is helping that patient,” he said.