Hepatitis B and C and HIV Testing

December 31, 2019

The Honorable Susan Lontine, Chair House Health and Insurance Committee 200 E. Colfax Avenue Denver, CO 80203

Dear Representative Lontine:

Enclosed please find a legislative report to the House Health and Insurance Committee from the Department of Health Care Policy and Financing on hepatitis B, hepatitis C and HIV testing.

Pursuant to section 26-1-141(1), C.R.S., on or before December 31, 2019, the executive directors of the Department of Human Services, the Department of Health Care Policy and Financing, and the Department of Corrections shall submit a report to the Public Health Care and Human Services Committee and the Health and Insurance Committee of the House of Representatives and the Health and Human Services Committee of the Senate concerning: (a) the amount of federal funds that each Department is eligible to receive or is currently receiving that may be used for testing for hepatitis b, hepatitis c, or HIV; (b) the number of individuals currently being tested for each disease listed in subsection (1)(a) of this section; and (c) whether each department is planning to increase the number of people being tested for each disease listed in subsection (1)(a) of this section.

This report provides information regarding the number of Health First Colorado members who were screened for hepatitis B, hepatitis C and HIV and the amount the Department paid providers to deliver these services (including the proportion of funding secured through federal funding sources).

If you require further information or have additional questions, please contact the Department’s Legislative Liaison, Nina Schwartz, at [email protected] or 303-866- 6912.

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Sincerely,

Kim Bimestefer Executive Director

KB/JC/RH

Enclosure(s): Hepatitis B, Hepatitis C and HIV Testing

CC: Representative Yadira Caraveo, Vice Chair, Health and Insurance Committee Representative Mark Baisley, Health and Insurance Committee Representative Susan Beckman, Health and Insurance Committee Representative Janet Buckner, Health and Insurance Committee Representative Dominique Jackson, Health and Insurance Committee Representative Sonya Jaquez Lewis, Health and Insurance Committee Representative Kyle Mullica, Health and Insurance Committee Representative Matt Soper, Health and Insurance Committee Representative Brianna Titone, Health and Insurance Committee Representative Perry Will, Health and Insurance Committee Representative Mary Young, Health and Insurance Committee Legislative Council Library State Library John Bartholomew, Finance Office Director, HCPF Tracy Johnson, Medicaid Director, HCPF Bonnie Silva, Community Living Office Director, HCPF Tom Massey, Policy, Communications, and Administration Office Director, HCPF Stephanie Ziegler, Cost Control and Quality Improvement Director, HCPF Parrish Steinbrecher, Health Information Office Director, HCPF Rachel Reiter, External Relations Division Director, HCPF Nina Schwartz, Legislative Liaison, HCPF

December 31, 2019

The Honorable Jonathan Singer, Chair House Public Health Care and Human Services Committee 200 E. Colfax Avenue Denver, CO 80203

Dear Representative Singer:

Enclosed please find a legislative report to the House Public Health Care and Human Services Committee from the Department of Health Care Policy and Financing on hepatitis B, hepatitis C and HIV testing.

If you require further information or have additional questions, please contact the Department’s Legislative Liaison, Nina Schwartz, at [email protected] or 303-866- 6912.

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Sincerely,

Kim Bimestefer Executive Director

KB/JC/RH

Enclosure(s): Hepatitis B, Hepatitis C and HIV Testing

CC: Representative Dafna Michaelson Jenet, Vice Chair, Public Health Care and Human Services Committee Representative Yadira Caraveo, Public Health Care and Human Services Committee Representative Lisa Cutter, Public Health Care and Human Services Committee Representative Serena Gonzales-Gutierrez, Public Health Care and Human Services Committee Representative Cathy Kipp, Public Health Care and Human Services Committee Representative Lois Landgraf, Public Health Care and Human Services Committee Representative Colin Larson, Public Health Care and Human Services Committee Representative Larry Liston, Public Health Care and Human Services Committee Representative Kyle Mullica, Public Health Care and Human Services Committee Representative Rod Pelton, Public Health Care and Human Services Committee Representative Emily Sirota, Public Health Care and Human Services Committee Legislative Council Library State Library John Bartholomew, Finance Office Director, HCPF Tracy Johnson, Medicaid Director, HCPF Bonnie Silva, Community Living Office Director, HCPF Tom Massey, Policy, Communications, and Administration Office Director, HCPF Stephanie Ziegler, Cost Control and Quality Improvement Director, HCPF Parrish Steinbrecher, Health Information Office Director, HCPF Rachel Reiter, External Relations Division Director, HCPF Nina Schwartz, Legislative Liaison, HCPF

December 31, 2019

The Honorable Rhonda Fields, Chair Senate Health and Human Services Committee 200 E. Colfax Avenue Denver, CO 8020

Dear Senator Fields:

Enclosed please find a legislative report to the Senate Health and Human Services Committee from the Department of Health Care Policy and Financing on hepatitis B, hepatitis C and HIV testing.

If you require further information or have additional questions, please contact the Department’s Legislative Liaison, Nina Schwartz, at [email protected] or 303-866- 6912.

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Sincerely,

Kim Bimestefer Executive Director

KB/JC/RH

Enclosure(s): Hepatitis B, Hepatitis C and HIV Testing

CC: Senator Brittany Pettersen, Vice Chair, Health and Human Services Committee Senator Larry Crowder, Health and Human Services Committee Senator Jim Smallwood, Health and Human Services Committee Senator Faith Winter, Health and Human Services Committee Legislative Council Library State Library John Bartholomew, Finance Office Director, HCPF Tracy Johnson, Medicaid Director, HCPF Bonnie Silva, Community Living Office Director, HCPF Tom Massey, Policy, Communications, and Administration Office Director, HCPF Stephanie Ziegler, Cost Control and Quality Improvement Director, HCPF Parrish Steinbrecher, Health Information Office Director, HCPF Rachel Reiter, External Relations Division Director, HCPF Nina Schwartz, Legislative Liaison, HCPF

Hepatitis B, Hepatitis C, and Human

Immunodeficiency Virus Testing

As required by Section 26-1-141(1), C.R.S

December 31, 2019

Submitted to:

House Public Health Care & Human Services Committee House Health & Insurance Committee Senate Health & Human Services Committee

I. Summary This report is submitted pursuant to the provisions of C.R.S. § 26-1-141(1). This section requires the Department of Health Care Policy and Financing (Department) to submit a written report by December 31, 2019, regarding testing for hepatitis B, hepatitis C, and human immunodeficiency virus (HIV).

This report includes: • the amount of federal funds that the Department is eligible to receive or is currently receiving that may be used for testing for hepatitis B, hepatitis C, and HIV; • the number of individuals currently being tested for each disease; and • an outline of the Department’s plan to maintain or increase the number of people being tested for each disease.

II. Hepatitis B Hepatitis B is a liver infection caused by the hepatitis B virus (HBV) which is transmitted when blood, semen, or another body fluid from a person infected with the virus enters the body of someone who is not infected. Hepatitis B can be an acute, or short-term, illness but for others, it can become a long-term, chronic infection. Risk for chronic infection is related to age at infection: approximately 90% of infected infants become chronically infected, compared with 2%–6% of adults1. Chronic hepatitis B infection can be treated and managed clinically, but not cured.

In fiscal year 2018-2019, 24,975 Medicaid members were tested for hepatitis B. The Department paid $1,069,785.86 for hepatitis B testing – of this, $810,189.72 was federally funded. The remaining $259,596.14 was state funded. On average, in 2018-2019, the Department tested 2,081 members monthly at a cost of $89,148.82 ($67,515.81 in federal funding).

In the first three months of fiscal year 2019-2020, 6,627 members were tested for hepatitis B. The Department paid $262,245.80 for hepatitis B testing – of this, $197,789.21 was federally funded. The remaining $64,456.59 was state funded. On average, for the first three months of 2019-2020, the Department tested 2,209 members monthly at a cost of $87,415.27 ($65,929.74 in federal funding). This is an increase of 6.13% in the number of members tested, while the monthly average cost decreased by 1.94%.

The Department promotes testing through member education (e.g., Member Handbook, Health First Colorado Benefits page) and provider reimbursement of testing. Providers screen members and order testing based on established clinical guidelines, clinical expertise, and risk factors and needs of each member. The Department also supports the Colorado

1 Centers for Disease Control and Prevention. (2019, November 21). Hepatitis B. Retrieved from https://www.cdc.gov/hepatitis/hbv/index.htm

2 | Hepatitis B, Hepatitis C and HIV Testing Department of Public Health and Environment’s (CDPHE) initiatives and efforts to improve Coloradans’ engagement in testing and risk reduction.

III. Hepatitis C Hepatitis C is a liver infection caused by the blood-borne hepatitis C virus (HCV). For 70%–85% of people who become infected with the hepatitis C virus, it becomes a long- term, chronic infection2. There is no vaccine for hepatitis C, but short-term treatment can clear the virus and cure the infection.

In fiscal year 2018-2019, 34,673 members were tested for hepatitis C. The Department paid $1,095,822.97 for hepatitis C testing – of this, $836,771.35 was federally funded. The remaining $259,051.62 was state funded. On average, in 2018-2019, the Department tested 2,889 members monthly at a cost of $91,318.58 ($69,730.95 in federal funding).

In the first three months of fiscal year 2019-2020, 9,031 members were tested for hepatitis C. The Department paid $253,169.26 for hepatitis C testing – of this, $191,500.98 was federally funded. The remaining $61,668.28 was state funded. On average, for the first three months of 2019-2020, the Department tested 3,010 members monthly at a cost of $84,389.75 ($63,833.66 in federal funding). This is an increase of 4.18% in the number of members tested, while the monthly average cost decreased by 7.59%.

IV. HIV HIV is a virus spread through certain body fluids that attacks the body’s immune system, specifically the CD4 cells, often called T cells. Untreated, HIV reduces the number of CD4 cells (T cells) in the body, making it harder for the body to fight off infections and other diseases.

HIV testing is fundamental for HIV prevention, treatment, and care efforts. Knowledge of one’s HIV status is important for preventing the spread of virus and for appropriate medical care and services, which in turn have also been shown to have significant public health benefits3.

2 Centers for Disease Control and Prevention. (2019, October 22). Hepatitis C. Retrieved from https://www.cdc.gov/hepatitis/hcv/index.htm. 3 Henry J. Kaiser Family Foundation. (2014, February). State Medicaid Coverage of Routine HIV Screening. Retrieved from https://www.kff.org/wp-content/uploads/2014/02/8286-02-state-medicaid-coverage-of-routine-hiv- screening1.pdf

3 | Hepatitis B, Hepatitis C and HIV Testing The Centers for Disease Control and Prevention’s (CDC) Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings advises routine HIV testing of adults, adolescents, and pregnant women in health care settings in the United States. The recommendations also call for reducing barriers to HIV testing. The CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. For those with specific risk factors, the CDC recommends getting tested at least once a year.

In fiscal year 2018-2019, 62,313 members were tested for HIV. The Department paid $2,394,355.41 for HIV testing – of this, $1,658,628.90 was federally funded. The remaining $737,726.51 was state funded. On average, in 2018-2019, the Department tested 5,193 members monthly at a cost of $199,529.62 ($138,219.07 in federal funding).

In the first three months of fiscal year 2019-2020, 17,367 members were tested for HIV. The Department paid $583,834.12 for HIV testing – of this, $415,912.63 was federally funded. The remaining $167,921.49 was state funded. On average, for the first three months of 2019-2020, the Department tested 5,789 members monthly at a cost of $194,611.37 ($138,637,54 in federal funding). This is an increase of 11.48% in the number of members tested, while the monthly average cost decreased by 2.46%.

4 | Hepatitis B, Hepatitis C and HIV Testing