TESTIMONY OF THE MAINE MEDICAL ASSOCIATION

NEITHER FOR NOR AGAINST LD 531,

An Act Regarding the Drug Crisis

and Ensuring Access to HIV Testing

Joint Committee on Health and Human Services

Room 209, Cross State Office Building

Monday, March 27, 2017, 1:00 p.m.

Senator Brakey, Representative Hymanson and members of the Committee on Health and Human Services. I am Peter Michaud, Associate General Counsel for the Maine Medical Association and a registered nurse licensed to practice in Maine. It is my privilege to testify before you today in the category of neither for/nor against LD 531, An Act Regarding the Drug Crisis and Ensuring Access to HIV Testing. As you know, the Association represents the interest of over 4000 physicians, residents in training and medical students in the state. The mission of the Association is to support Maine physicians, advance the quality of medicine in Maine and promote the health of all Maine citizens.

We have chosen to testify in the "neither for/nor against" category as we support the goal of increasing the numbers of Mainers tested for HIV infection but we do not support a mandate for testing as broad as the language in LD 531. We do appreciate Representative Fecteau's desire to promote universal testing and we very much have appreciated his willingness to discuss the language in the bill with representatives of medicine and public health. We have had a steady dialogue with Rep. Fecteau for the last several months and we are in hopes that following the testimony today the interested parties can get together and come up with some strategies to increase testing on a voluntary basis through increased education of clinicians and advocacy. We have already begun work on the educational effort.

As you have likely already heard today from proponents or opponents of the bill, only two states and the City of Pittsburgh currently have a mandate for testing that is as broad as LD 531. The state of New York has a mandate but caps the age at 64.  Such a cap would better align the bill with the recommendations of the U.S. Preventative Services Task Force that clinicians screen for HIV infection in adolescents and adults aged 15 to 65. But given the following information, we believe that a continued effort to increase testing through education of clinicians and the public is preferred.

• As of 2013, 32% of Maine adults had received an HIV test, which is a fairly high percentage for a state with a low incidence of HIV infection.
• In 2007, the Maine CDC introduced changes to Maine law related to HIV testing in order to routinize testing and increase access to the tests.
• Given that Maine has the oldest population in the nation, the burden of overtesting in the elder population could be significant.  There is both a personal and financial cost to over-testing and since no test is flawless, the more that low risk individuals are tested, the more false positives occur.
• An increase in testing that is broader than necessary will drive up costs in the MaineCare program resulting in a fiscal note to the bill.
• Title 5, Chapter 501 in Maine Law already includes requirements for testing during pregnancy, for some newborns and following a sexual assault.
• Maine law should remain consistent with national guidelines. Since most health plans reimburse for tests according to such guidelines, if a broader mandate is imposed some of the cost may be incurred by the patient.
• Having the requirement in statute may result in providers feeling compelled to test if they do not have immediate access to the patient's past medical records, even if it is likely the person has previously been tested.

For all the above reasons, while we support the intent to test more Mainers for HIV infection, we prefer that the approach remain voluntary beyond the statutory requirements that already exist. Thank you for the opportunity to testify and I am happy to answer any questions you may have.