HIV AIDS Resource Guide/HIV-AIDS Resource Guide.iso/STAT/STATE/UTAH-AC.ASC

Text File | 1993-01-14 | 30KB | 829 lines

/* Utah Administrative Code deals with insurance, schoolchildren,
partner notification, EMS personnel testing, and communicable
diesase procedures which specifically address HIV. */



COMMUNITY HEALTH SERVICES, EPIDEMIOLOGY

R386-702-10. Special Considerations for the Control of HIV
Infection.

1.   Reporting of HIV Infection.

1.1. Any infection with Human Immunodeficiency Virus (HIV) shall
be reported under the authority of Section 26-6-3 and in
accordance with R386-702-3.

1.2. "HIV Infection" is defined as an indication of Human
Immunodeficiency Virus (HIV) infection detected by any of the
following:

1.2.1.    Presence of antibodies to HIV, verified by a positive
confirmatory test, such as Western blot or other method approved
by the Utah Department of Health.

1.2.2.    Presence of HIV antigen.

1.2.3.    Isolation of HIV.

1.2.4.    Demonstration of HIV proviral DNA.

1.3. For reporting purposes, Western blot interpretation shall be
based on criteria recommended by the Association of State and
Territorial Public Health Laboratory Directors (ASTPHLD).

1.4. Evidence of antibodies to HIV obtained by Enzyme Immunoassay
(EIA) shall be reported if repeatedly reactive and confirmatory
testing was not performed. A repeatedly reactive EIA means two or
more positive tests.

1.4.1.    In repeatedly reactive cases, the Utah Department of
Health or the local health department will ensure appropriate
confirmatory tests and counseling are conducted. All identifying
information on persons found to have negative results on confirma
tory tests will be removed from the files of the local health
department and the Utah Department of Health and destroyed by
employees designated by the local health officer or, in the case
of the Utah Department of Health, by the director of the Bureau
of HIV/AIDS Prevention and Control.

1.5. Persons with repeatedly reactive EIA results and
indeterminate confirmatory test results shall also be reported.

1.5.1.    The Utah Department of Health or the local health
department shall maintain records of persons with indeterminate
tests in a separate and confidential file until a final diagnosis
is made.

1.5.2.    The Utah Department of Health or the local health
department may contact persons with indeterminate test results or
their medical providers to ensure appropriate follow-up testing
and counseling are accomplished.

1.5.3.    All identifying information on persons who, after
appropriate follow-up, are determined to be uninfected shall be
removed from the files of the local health department and the
Utah Department of Health and destroyed by employees designated
by the local health officer or, in the case of the Utah Depart
ment of Health, by the director of the Bureau of HIV/AIDS
Prevention and Control.

2.   Exemptions from Reporting of HIV Infection.

2.1. Utah Department of Health studies.

2.1.1.    Seroprevalence and other epidemiological studies
conducted by the Utah Department of Health are exempt from
reporting of HIV infections. Exemption is allowed only for those
tests conducted as part of the study; individuals found to be HIV
infected through other testing are reportable.

2.2. Anonymous testing site.

2.2.1.    "Anonymous Testing" is defined as testing individuals
for infection with HIV without the individual's disclosing his
name.

2.2.2.    The executive director of the Utah Department of Health
may allow one site or agency within the State to administer
anonymous testing.

2.2.3.    The anonymous testing site shall submit to the Utah
Department of Health the demographic information (excluding the
name) and HIV test results from each individual who is tested.

2.2.4.    The anonymous testing site shall conduct HIV counseling
and partner notification for all HIV infected individuals and
submit to the Utah Department of Health information on counseling
and partner notification as required by Section 26-6-3.

2.2.5.    The Utah Department of Health will provide the annual
statistical report to the Legislative Interim Health Committee.

2.2.6.    If the Utah Department of Health finds that anonymous
testing is not resulting in partner notification comparable to
that in confidential testing programs throughout the State, the
anonymous testing program shall be terminated.

2.3. Medical research studies.

2.3.1.    As provided by Section 26-6-3, a university or hospital
research study may be exempted from reporting requirements for
HIV infection. In any case where an exemption from reporting is
requested, the university or hospital shall submit to the Utah De
partment of Health the research protocol, the written approval of
the institutional review board, and a letter showing the funding
sources and the justification for requiring anonymity. Upon
receipt of the required documents, the Utah Department of Health
will review the application and grant an exemption from reporting
if all requirements of Section 26-6-3 have been satisfied.

2.3.2.    The university or hospital that receives an exemption
from reporting shall provide to the Utah Department of Health a
quarterly report indicating the number of HIV infected
individuals enrolled in the study.

3.   Partner Identification and Notification.

3.1. "Partner" is defined as an individual who has shared
needles, syringes, or drug paraphernalia or who has had sexual
contact with an HIV infected individual.

3.2. "Partner Notification" is the identification, location, and
counseling of those persons who are named as partners of an HIV
infected individual.

3.3. When an individual is tested and found to have an HIV
infection, the Utah Department of Health or local health
department shall conduct partner notification activities. The
Utah Department of Health shall establish standards for partner
notification.

4.   Retroactive Reporting.

4.1. Reporting of individuals who were found to have an HIV
infection through testing conducted prior to the effective date
of amendments to Section 26-6-3, April 24, 1989, is not required.
The Utah Department of Health will continue to accept reports, on
a voluntary basis, of HIV infections discovered prior to that
date.

4.2. This subsection does not apply if the individual with an HIV
infection is tested on or after April 24, 1989.

4.3. This subsection does not apply if the individual with an HIV
infection is considered to have a suspect or confirmed case of
Acquired Immunodeficiency Syndrome (AIDS).



R386-702-11. Penalties.

1.   Enforcement provisions and penalties for the violation or
for the enforcement of public health rules, including this Code
of Communicable Disease Rules, are prescribed under Section 26-23-
6.



R388. Community Health Services, HIV/AIDS Prevention and Control.

R388-801. AIDS Testing and Reporting for Emergency Medical
Services Providers Rule.

R388-802. HIV Positive Student or School Employee Rule.

R388-801. AIDS Testing and Reporting for Emergency Medical
Services Providers Rule.

R388-801-1. Authority and Purpose.

R388-801-2. Definitions.

R388-801-3. Emergency Medical Services Provider Responsibility.

R388-801-4. Receiving Facility Responsibility.

R388-801-5. EMS Agency Responsibility.

R388-801-6. Designated Agent Responsibility.

R388-801-7. Department Responsibility.

R388-801-8. Confidentiality Responsibility.

R388-801-9. Penalties.



R388-801-1. Authority and Purpose.

1.   Authority - The AIDS Testing and Reporting for Emergency
Medical Services Providers Rule is established under authority of
Section 26-6a-9.

2.   Purpose - To establish procedures for patient testing and
reporting following a significant exposure of an emergency
medical services provider.



R388-801-2. Definitions.

1.   "Department" means the Utah Department of Health.

2.   "Designated agent" means a person or persons designated by
an agency employing or utilizing emergency medical services
providers as employees or volunteers to receive and distribute
test results in accordance with this rule.

3.   "Disease" means Acquired Immunodeficiency Syndrome, Human
Immunodeficiency Virus (HIV) infection, or Hepatitis B antigen
positivity.

4.   "Emergency medical services (EMS) agency means an agency,
entity or organization that employs or utilizes emergency medical
services providers as employees or volunteers.

5.   "Emergency medical services provider" means an Emergency
Medical Technician as defined in Section 26-8-2, a peace officer
as defined in Section 77-la-1, local fire department personnel,
or officials or personnel employed by the Department of Correc
tions or by a county jail, who provide prehospital emergency
medical care for an emergency medical services agency either as
an employee or as a volunteer.

6.   "Patient" means any individual cared for by an emergency
medical services provider, including but not limited to victims
of accidents or injury, deceased persons, and prisoners or
persons in the custody of the Department of Corrections.

7.   "Receiving facility" means a hospital, health care or other
facility where the patient is delivered by the emergency medical
services provider for care.

8.   "Significant exposure" means:

8.1. Contact of an emergency medical services provider's broken
skin or mucous membrane with a patient's blood or bodily fluids
other than tears or perspiration, or;

8.2. That a needle stick, or scalpel or instrument wound has
occurred to the emergency medical services provider in the
process of caring for a patient.



R388-801-3. Emergency Medical Services Provider Responsibility.

1.   The EMS provider shall document and report all significant
exposures to the receiving facility, the designated agent, and
the department. The reporting process is as follows:

1.1. The exposed EMS provider shall complete the department
Exposure Report Form (ERF) at the time the patient is delivered
and provide a copy to a person at the receiving facility
authorized by the facility to receive that form. In the event
that the exposed EMS provider does not accompany the patient to
the receiving facility, he may report the exposure incident, with
information requested on the ERF, by telephone to a person
authorized by the facility to receive that form. In this event,
the exposed EMS provider shall nevertheless submit a written copy
of the ERF within three days to an authorized person of the
receiving facility.

1.2. The exposed EMS provider shall, within three days of the
incident, also submit copies of the ERF to the designated agent
and, by registered mail or in person, to the department.

1.3. The exposed EMS provider should retain a copy of the ERF for
his own records, in the event that it is subsequently necessary
to file a workers' compensation claim under Sections 26-6a-10
through 26-6a-14.



R388-801-4. Receiving Facility Responsibility.

1.   The receiving facility shall establish a system to receive
ERFs as well as telephoned reports from exposed EMS providers on
a 24-hour per day basis. The facility shall also have available,
within the receiving facility or on call, trained pre-test
counselors for the purpose of obtaining consent and counseling of
patients when HIV testing has been requested by EMS providers.
The counselor shall contact the patient prior to release from the
facility, or if the patient remains in the facility, contact
shall be made within 24 hours.

2.   Upon notification of exposure, the receiving facility shall
request permission from the patient to draw a blood sample for
HIV testing. In conjunction with this request, the patient must
be advised of his right to refuse testing and be advised that if
he refuses to be tested that fact will be forwarded to the depart
ment and the designated agent. Testing is authorized only when
the patient, his next of kin or legal guardian consents to
testing, with the exception that consent is not required from an
individual who has been convicted of a crime and is in the
custody or under the jurisdiction of the Department of
Corrections, or if the patient is dead. If consent is denied, the
receiving facility shall complete the ERF and send it to the
department. If consent is received, the receiving facility shall
draw a sample of the patient's blood and send it, along with the
ERF, to the Utah Department of Health, Division of Laboratory
Services for testing.

3.   The receiving facility shall arrange for Hepatitis B testing
according to standard procedures and report the result to the
designated agent at the EMS agency.



R388-801-5. EMS Agency Responsibility.

The EMS agency shall appoint a representative as designated agent
to fulfill the responsibilities specified in these rules.



report the result, by case number, not name, to the exposed EMS
provider.

3.   The designated agent, upon receipt of the Hepatitis B test
result from the receiving facility, shall immediately report the
result to the exposed EMS provider.

4.   The designated agent, upon receipt of refusal of testing,
shall report that refusal to the EMS provider.

5.   The designated agent shall maintain confidential records in
conformance with Section 26-6a-7.



R388-801-7. Department Responsibility.

1.   The department shall designate a representative or
representatives in the Utah Department of Health, Division of
Laboratory Services who shall receive the HIV blood sample with a
copy of the ERF, conduct the test and report the test result to
the Bureau of HIV/AIDS Prevention and Control, and return the
copy of the ERF to the Bureau of HIV/AIDS Prevention and Control.

2.   The department shall designate a representative(s) in the
Bureau of HIV/AIDS Prevention and Control who shall:

2.1. Receive and process copies of all ERF's submitted by the EMS
provider or receiving facility to the department;

2.2. Report refusals to test or the results of HIV testing, by
case number, not name, to the designated agent; and

2.3. Report HIV test results to the patient and complete all post
test counseling required by Chapter 6a, Title 26.

3.   The department may assess a fee to the EMS agency with which
the EMS provider is affiliated, for the cost of testing and post
test counseling of the patient.

4.   The department shall develop and make available a pre-test
counseling protocol to all receiving facilities.



R388-801-8. Confidentiality Responsibility.

1.   Information concerning test results obtained under these
rules that identify the patient shall be maintained strictly
confidential by the hospital, health care or other facility that
received or tested the patient, designated agent, EMS provider,
EMS agency, and the department, except as provided by these
rules. That information may not be made public upon subpoena,
search warrant, discovery proceedings, or otherwise, except as
provided by this chapter.

2.   The information described in R388-801-8.1 may be released
with the written consent of the patient, or if the patient is
deceased or incapable of giving informed consent, with the
written consent of his next-of-kin, legal guardian, or executor
of his estate.

3.   Information concerning test results obtained under the
authority of these rules may be released in a way that no patient
is identifiable.



R388-801-9. Penalties.

Penalties for violation of R388-801 are prescribed under Sections
26-6a-7 and 26-23-6.



R388-801-10. Designated Agent Responsibility.

1.   The designated agent, upon receipt of an ERF from the EMS
provider, shall review the details regarding the significant
exposure and recommend appropriate measures, if any, considering
the most recent Centers for Disease Control guidelines, to EMS
agency management.

2.   The designated agent, upon receipt of the HIV test result
from the department, shall immediately



R388-802. HIV  Positive  Student  or School Employee Rule.



R388-802-1. Authority and Purpose.

R388-802-2. Definitions.

R388-802-3. Confidentiality.

R388-802-4. Anti-discrimination.

R388-802-5. Requirements for Determining if a Student or Employee
Infected with HIV Should Remain in the Regular Classroom or Job
Assignment.

R388-802-6. Liability.

R388-802-7. Appeal Process.

R388-802-8. Special Procedures.

R388-802-9. Procedures for Handling Blood or Body Fluids.

R388-802-10. Penalties.



R388-802-1. Authority and Purpose.

I.   The HIV Positive Student or School Employee Rule is
established under authority of Section 26-1-30.

2.   The purpose of R388-802 is to establish standards relating
to HIV infection in the schools in order to (a) reduce the risk
to susceptible individuals and (b) protect infected individuals
against both unreasonable health risks and unnecessary
restrictions in activities and associations.



R388-802-2. Definitions.

1.   "Director" means the executive director of the Utah
Department of Health.

2.   "Employee" means anyone employed by a school or serving as a
volunteer with the permission of a school.

3.   "HIV" means human immunodeficiency virus.

4.   "HIV Infection" is defined as an indication of the presence
of human immunodeficiency virus (HIV) as detected by any of the
following:

4.1. Presence of antibodies to HIV, verified by appropriate
confirmatory tests.

4.2. Presence of HIV antigen.

4.3. Isolation of HIV.

4.4. Demonstration of HIV proviral DNA.

5.   "Review committee" or  committee" means a group consisting
of a school administrator, a representative from the local health
department, the subject's physician, the subject or, in the case
of a minor, the subject's parents or guardian. The committee is
appointed and chaired by the school administrator.

6.   "School" means a licensed or unlicensed public or private
nursery school, preschool, elementary or secondary school, day-
care center, child-care facility, family-care facility, or head-
start program.

7.   "School administrator" means the person designated by the
superintendent to implement this rule.

8.   "School board" means the board of education of an affected
public school district or the governing body of an affected
facility or program which is not part of a public school
district.

9.   "Student" means anyone enrolled in a school.

10.  "Subject" means a person who is the focus of deliberations
by a review committee.

11.  "Superintendent" means the superintendent of an affected
school district or the chief administrative officer of an
affected school which is not part of a public school district.



R388-402-3. Confidentiality.

1.   The identities or other case details of HIV-infected
subjects shall not be disclosed to any person other than the
members of the review committee and the pertinent superintendent.

2.   Penalties for violation of confidentiality are prescribed
under Section 26-25a-103.



R388-402-4. Anti-discrimination,

1.   In the school setting, no person shall be discriminated
against, or denied activities or associations, based solely upon
a diagnosis of HIV infection except as permitted under this rule.



R388-402-5. Requirements for Determining if a Student or Employee
infected  with  HIV Should Remain in the Regular Classroom or Job
Assignment.

1.   Upon notification that a student or employee has been
diagnosed with HIV infection, the school administrator shall
convene a review committee.

2.   A student or employee infected with HIV shall continue in
his regular classroom or job assignment until a review committee
can meet and formulate recommendations.

3.   The committee shall review all pertinent information
including current findings and recommendations of the United
States Public Health Service, the American Academy of Pediatrics,
and the Utah Department of Health; apply that information to the
subject and the nature of activities and associations in which
the subject is involved with the school; and establish written
findings of fact and recommendations based upon reasonable
medical judgments and other information concerning the following:

3.1. The nature of the risk of transmission of HIV relevant to
the activities of the subject in the school setting;

3.2. The probability of the risk, particularly the reasonable
likelihood that HIV could be transmitted to other persons by the
subject in the school setting;

3.3. The nature and the probability of any health related risks
to the subject;

3.4. If restrictions are determined to be necessary, what
accommodations could be made by the school to avoid excessive
limitations on activities and associations of the subject.

4.   The review committee shall forward its findings and
recommendations to the superintendent.

5.   The school administrator will implement the recommendations
without delay.

6.   The school administrator shall immediately advise the
subject or, in the case of a minor, the subject's parents or
guardian, in writing, of the decision of the review committee and
that continued participation in the school setting may result in
exposure to other communicable diseases.

7.   The school administrator shall review the committee's
decision on a regular basis and may reconvene the committee if,
in his opinion, the facts of the case have changed.



R388-802-6. Liability.

Responsibility for continued participation in the classroom or
job assignment, despite potential personal risk, shall be left to
the discretion of the subject or, in case of a minor, the
subject's parents or guardian.



R388-802-7. Appeal Process.

1.   The superintendent or any member of the review committee may
appeal the recommendation of the committee by submitting a
written appeal within ten school days for students or ten working
days for employees, after receiving notice of the committee's rec
ommendations. If the appellant's concerns relate to medical
issues, the appeal shall be submitted to the director, and the
director, or designee, may order restrictions on the school-
related activities or associations of the subject or may stay
implementation of the committee's recommendations. If the
concerns relate to the school's ability to provide an
accommodation, the appeal shall be directed to the school board.

2.   The appellant shall submit copies of any appeal to the
director, the superintendent, and all other members of the review
committee.

3.   The director or the school board shall review the findings
and recommendations of the committee and any additional
information that the director or hoard finds to be pertinent to
the question raised in the appeal, and shall render a final
decision in writing within ten school days for students or ten
working days for employees.

4.   Copies of the decision shall be sent to the appellant,
members of the review committee, and the superintendent.

5.   The superintendent shall implement the decision without
delay.

6.   Judicial review of any decision rendered under this section
by the director or the school board may be secured by persons
adversely affected thereby by filing an action for review in the
appropriate court of law.



R388-802-8. Special Procedures.

1.   A superintendent may suspend a subject from school or school
employment for a period not to exceed ten school days for
students or ten working days for employees, prior to receiving
the recommendation of a review committee if the superintendent
determines that there are emergency conditions which present a
reasonable likelihood that suspension is medically necessary to
protect the subject or other persons.

2.   If the subject is unable to obtain the services of a
physician to serve on the review committee, the local health
officer may appoint a licensed physician to provide consultation.



R388-802-9. Procedures for Handling Blood or Body Fluids.

1.   Each school shall adopt routine procedures for handling
blood or body fluids, including sanitary napkins, regardless of
whether students or employees with HIV infections are known to be
present. The procedures should be consistent with recommendations
of the United States Public Health Service, the American Academy
of Pediatrics, and the Utah Department of Health.



R388-802-10. Penalties.

1.   Enforcement provisions and penalties for the violation or
for the enforcement of public health rules, including R388-802,
are prescribed under Section 2623-6.



R590-132. Insurance - Human Immunodeficiency (HIV) Infection.
Treatment   of  Virus

R590-132-1. Authority, Purpose and Scope.

R590-132-2. Definitions.

R590-132-3. Rule.

R590-132-4. Dissemination.

R590-132-5. Penalties.

R590-132-6. Confidentiality.

R590-132-7. Severability.

R590-132-8. Effective Date.



R590-132-1. Authority, Purpose and Scope.

This rule is promulgated by the Insurance Commissioner pursuant
to the authority provided under Subsections 31A-2-201(3) and (4),
General Duties and Powers.

The purpose of this rule is to identify and restrict certain
underwriting, classification, or declination practices regarding
HIV infection, that the commissioner finds are or would be
unfairly discriminatory if engaged in. This rule also provides
guidelines for the confidentiality of AIDS related testing,
which, if not followed, would be unfairly discriminatory or
hazardous to members of the insuring public.

This rule applies to every licensee authorized to engage in the
business of insurance in Utah under Title 31A of the Utah Code.



R590- 132-2. Definitions.

For the purpose of this rule, the commissioner adopts the
definitions set forth in Section 31A-1-301, U.C.A., and in
addition thereto the following:

A.   HIV infection is defined as the presence of Human
Immunodeficiency Virus (HIV) in the blood of a person as detected
by the following;

1.   Presence of antibodies to HIV, verified by appropriate
confirmatory tests.

2.   Presence of HIV antigen.

3.   Isolation of HIV.

4.   Demonstration of HIV proviral DNA.



R590-132-3. Rule.

A.   Persons with HIV infection will not be singled out for
either unfairly discriminatory or preferential treatment for
insurance purposes.

B.   To properly classify risks related to covering prospective
insureds, insurers may require reasonable testing. Application
questions must conform to the following guidelines:

1.   No inquiry in an application for health or life insurance
coverage, or in an investigation conducted by an insurer or an
insurance support organization on its behalf in connection with
an application for such coverage, shall be directed toward
determining the applicant's sexual orientation.

2.   Sexual orientation may not be used in the under-writing
process or in the determination of insurability.

C.   When used, the blood testing of insurance applicants must
not be administered on an unfair basis. If a prospective insured
is to be declined or rated substandard because of HIV infection,
such action must be based on appropriate confirmatory tests.

D.   Notice and Consent. No person engaged in the business of
insurance shall require an HIV test of an individual in
connection with an application for insurance for HIV infection
unless the individual signs a written release on a form which
contains the following information:

1.   A statement of the purpose, content, use and meaning of the
test.

2.   A statement regarding disclosure of the test results,
including information explaining the effect of releasing
information to a person directly engaged in the business of
insurance. The applicant should be advised that the insurer may
disclose test results to others involved in the underwriting and
claims review processes. If the HIV test is positive the results
will be reported by those conducting the test or providers
receiving test results to the local health department and the
Medical Information Bureau (MIB, Inc.) if the insurer is a
member. The insurer shall report the results in a generic code
which signifies only non-specific blood test abnormalities.

3.   A provision where the applicant directs that any positive
screen results be reported to a designated health care
professional of his/her choice for post-test counseling.

For purposes of this section, insurers will use the American
Council of Life Insurance (ACLI) Notice and Consent Form or a
similar form that contains identical language. The ACLI form is
incorporated herein by reference or may be obtained from the ACLI
or the Utah State Insurance Department.



R590- 132-4. Dissemination.

Each insurer is instructed to distribute a copy of this rule or
an equivalent summary to all personnel engaged in activities
requiring knowledge of this rule, and to instruct them as to its
scope and operation.



R590-132-5. Penalties.

Any licensee that violates this rule will be subject to the
forfeiture provisions set forth in Sections 31A-2-308 and 31A-23-
216, U.C.A.



R590-132-6. Confidentiality.

Except as outlined in R590-132-3(D) above, all positive or
indeterminate records of the applicant held by the licensee that
refer to the HIV status shall be held as confidential records
under restricted access and will not be re-released unless re-
disclosure is specifically authorized by the applicant.

Re-release and Re-disclosure are required when the test results
are to be used for purposes other than those included in the
initial release.



R590-132-7. Severability.

If any provision of this rule or its application to any person is
for any reason held to be invalid, the remainder of the rule and
the application of any provision to other persons or
circumstances shall not be affected.



R590-132-8. Effective Date.

This rule shall take effect on September 14, 1989.