Evaluating the Nation’s First State-Level Hepatitis C Testing Law

​October 18, 2016
By: Colleen Flanigan, R.N., M.S., Director, Viral Hepatitis Section, New York State Department of Health

​Summary: Impact of the New York State hepatitis C testing law

New York State (NYS) implemented the nation’s first hepatitis C testing law , on January 1, 2014, resulting in an increase in the number of people who were screened for hepatitis C and linked to care. The law is an important policy to help achieve a major goal of the Viral Hepatitis Action Plan: increasing the proportion of people who know their hepatitis C status.
The NYS hepatitis C testing law mirrors the 2012 recommendations from the Centers for Disease Control and Prevention (CDC) - PDF, which expanded hepatitis C screening to all persons born between 1945 and 1965, often called baby boomers. Many people living with hepatitis C have no symptoms and have not been diagnosed. The testing law is particularly important because more than 75% of people living with hepatitis C are baby boomers - PDF.
The NYS law requires health care providers to offer the one-time hepatitis C screening test to patients in primary care settings. The test must also be offered to anyone receiving services as an inpatient of a hospital or from a physician, physician assistant, or nurse practitioner providing primary care, regardless of the setting. If the test is reactive, the patient must receive follow-up health care, including an HCV RNA test (to confirm infection).
Impact of the NYS Testing Law
The law required the NYS Department of Health to conduct an evaluation of its impact with respect to:

• the number of persons who are screened for hepatitis C and
• the number of persons who have accessed care following a positive test. 

All activities related to the testing law evaluation were coordinated by the NYSDOH AIDS Institute.
Results from the evaluation reflect progress in people learning their hepatitis C status:

• From a survey of 106 laboratories, the number of hepatitis C test specimens from Baby Boomers increased by 275,000 -- from 538,000 in 2013 to 813,000 in 2014 -- representing an increase of 51% in hepatitis C screening tests performed one year after the law was enacted.
• NYS Medicaid data showed a 74% increase in total Medicaid hepatitis C testing in recipients aged 50 to 70 in the year immediately following the implementation of the law compared to the previous year.
• Data from a sample of electronic health records (EHRs) maintained by the NYC Primary Care Information Project showed a 46% increase in the number of Baby Boomers who had hepatitis C screening ordered by medical providers in a single year.
• NYS Behavioral Risk Factor Surveillance System (BRFSS) data showed an increase of 270,000 baby boomers who said they had ever been tested for hepatitis C between 2013 and 2014. 

The evaluation also reveals progress in linking people to care:

• A review of NYS hepatitis C surveillance data showed a 40% increase in linkage to care rates among newly diagnosed cases in NYS outside of NYC.
• NYS Medicaid data showed a 35% increase in linkage to care rates among newly diagnosed cases.

Additional strategies have been implemented to improve the impact of the law including:

• Changing NYS Education Law  to allow registered nurses to conduct a hepatitis C screening test using a non-patient specific order.  This policy broadens the capacity of the health care system to screen more people for hepatitis C.
• Promoting hepatitis C reflex testing to ensure that patients who have a positive antibody test receive confirmatory testing, requiring only one blood sample which leads to efficient, high quality care. 
• Requiring laboratories to electronically report negative HCV RNA tests results, in addition to positive results - PDF , to more easily identify individuals have not been linked to care.

Read the key findings from the evaluation in the full report posted on the New York State Department of Health  website at: www.nyhealth.gov/hepatitis 

Summary: 
Impact of the New York State hepatitis C testing law
New York State (NYS) implemented the nation’s first hepatitis C testing law , on January 1, 2014, resulting in an increase in the number of people who were screened for hepatitis C and linked to care. The law is an important policy to help achieve a major goal of the Viral Hepatitis Action Plan: increasing the proportion of people who know their hepatitis C status.
The NYS hepatitis C testing law mirrors the 2012 recommendations from the Centers for Disease Control and Prevention (CDC) - PDF, which expanded hepatitis C screening to all persons born between 1945 and 1965, often called baby boomers. Many people living with hepatitis C have no symptoms and have not been diagnosed. The testing law is particularly important because more than 75% of people living with hepatitis C are baby boomers - PDF.
The NYS law requires health care providers to offer the one-time hepatitis C screening test to patients in primary care settings. The test must also be offered to anyone receiving services as an inpatient of a hospital or from a physician, physician assistant, or nurse practitioner providing primary care, regardless of the setting. If the test is reactive, the patient must receive follow-up health care, including an HCV RNA test (to confirm infection).
Impact of the NYS Testing Law
The law required the NYS Department of Health to conduct an evaluation of its impact with respect to:

• the number of persons who are screened for hepatitis C and
• the number of persons who have accessed care following a positive test. 

All activities related to the testing law evaluation were coordinated by the NYSDOH AIDS Institute.
Results from the evaluation reflect progress in people learning their hepatitis C status:

• From a survey of 106 laboratories, the number of hepatitis C test specimens from Baby Boomers increased by 275,000 -- from 538,000 in 2013 to 813,000 in 2014 -- representing an increase of 51% in hepatitis C screening tests performed one year after the law was enacted.
• NYS Medicaid data showed a 74% increase in total Medicaid hepatitis C testing in recipients aged 50 to 70 in the year immediately following the implementation of the law compared to the previous year.
• Data from a sample of electronic health records (EHRs) maintained by the NYC Primary Care Information Project showed a 46% increase in the number of Baby Boomers who had hepatitis C screening ordered by medical providers in a single year.
• NYS Behavioral Risk Factor Surveillance System (BRFSS) data showed an increase of 270,000 baby boomers who said they had ever been tested for hepatitis C between 2013 and 2014. 

The evaluation also reveals progress in linking people to care:

• A review of NYS hepatitis C surveillance data showed a 40% increase in linkage to care rates among newly diagnosed cases in NYS outside of NYC.
• NYS Medicaid data showed a 35% increase in linkage to care rates among newly diagnosed cases.

Additional strategies have been implemented to improve the impact of the law including:

• Changing NYS Education Law  to allow registered nurses to conduct a hepatitis C screening test using a non-patient specific order.  This policy broadens the capacity of the health care system to screen more people for hepatitis C.
• Promoting hepatitis C reflex testing to ensure that patients who have a positive antibody test receive confirmatory testing, requiring only one blood sample which leads to efficient, high quality care. 
• Requiring laboratories to electronically report negative HCV RNA tests results, in addition to positive results - PDF , to more easily identify individuals have not been linked to care.

Read the key findings from the evaluation in the full report posted on the New York State Department of Health  website at: www.nyhealth.gov/hepatitis 
​http://www.hhs.gov/hepatitis/blog/2016/10/18/evaluating-the-nations-first-state-level-hepatitis-c-testing-law.html