LAW OFFICE OF BRIAN GARVES

With budgets being tightened or cut all over, everyone is looking to maximize all funding opportunities; the State of Michigan is no different. In fact, Michigan is working to ensure that the amounts of federal funds coming to Michigan for treatment of HIV infection and AIDS, as well as case management for infected persons is as much as possible. The problem was the underreporting of infected persons in Michigan. According to the Michigan Department of Community Health, only 58% of HIV-infected persons were reported to MDCH. And since federal funding to states is linked to the number of that state’s HIV-infected residents, Michigan was losing out on over 40% of the available federal money. Additionally, a large amount of federal funding is linked, not to the number of HIV-infections, but to the number of AIDS cases; thus, to the extent that the State has not been getting follow-up testing information on previously-reported persons, this has resulted in received less federal funding than Michigan was entitled to.

Recent legislation, just signed into law by Governor Jennifer Granholm and set to go into effect on April 1, 2005 works toward that end, but to achieve it, it places an increased onus on the backs of clinical laboratories, hospitals and physicians.

The old law required any physician or health facility – excluding clinical laboratories – to report to the State, any positive HIV or AIDS test, along with all of the patient’s demographic information so the MDCH could track not only the number of HIV-infected persons, but where they lived, when they were first diagnosed and how they became infected. The underreporting was mainly a result of people failing to complete and file the reporting form, either through negligence, being overwhelmed with forms, or through patient pleading not to be reported due to confidentiality concerns, even though the reporting to the State did not contain any patient-identifying information.

In addition, while the old statute required reporting of each positive HIV test, a number of non-traditional tests were used to monitor HIV-infected patients, such as the CD4 cell count, which was not one of the reportable tests, meaning the State would not be able to track a patient’s progress. While this is not relevant to the underreporting problem, it is related to the State’s desire to track HIV-infected persons for demographic and contact notification (PCRS) reasons.

The new law, which merely modifies the old language (and is found in MCL §333.5114), makes two main changes. First, now clinical laboratories must report positive HIV-related tests. Since labs are already obligated to report more than 40 other infectious diseases, this is a relatively-small incremental burden on the labs. Second, along with reporting any positive HIV tests, any testing from "a test subject who has already been diagnosed as HIV infected . . . ordered to evaluate immune system status, to quantify HIV levels, or to diagnose acquired immunodeficiency syndrome" must be reported.

There is a smaller change to the statute that will make little overall difference. The old law allowed the reporting to the State of only the patient’s demographic information, that is, the test result, county of residence, mode of transmission, but the identifying information would not be sent to the State, but only to the local health department, for use in contact notification. The new statute provides that all of the reporting is to include the patient’s name and identifying information. This change will have little effect as that identifying information was already going to the local health department anyway.

The new law preserves the right of a patient in a physician’s private office, or who is a patient of an HMO, to request all identifying information be kept off the reporting forms. Now, a physician ordering a reportable test for such a patient would not have to provide that information to the lab running the test.

The statutory changes should make the number of HIV-infected persons in Michigan closer to be accurate and the quality of the information and the State’s tracking ability should be improved, which will increase the amount of federal funding, and will also allow the State to better allocate these funds and its resources to more effectively care for infected persons.