Important Legislation Related to HIV/PEP for SAFE/SANE Teams

Governor Gavin Newsom signed into law groundbreaking legislation to increase access to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV prevention. Senate Bill 159, authored by Senator Scott Wiener (D-San Francisco), is the first law of its kind in the nation to authorize pharmacists to furnish PrEP and PEP without a physician prescription. The legislation also prohibits insurance companies from requiring patients to obtain prior authorization before using their insurance benefits to obtain these critical HIV prevention medications. 

Malinda Wheeler, NP, Owner/Director, Forensic Nurse Specialists, Long Beach had long recognized the problem affecting sexual assault victims, and brought SB 159 to the attention of the CALSAFE Board. CALSAFE contacted Senator Scott Wiener, wrote a letter of support, and informed the California Pharmacists Association about their collegial recognition and support for the bill.

SB 159, passed the California Legislature with overwhelming bipartisan support, will increase the places where people can access these medications, increase the number of healthcare professionals who can provide them and remove onerous and unnecessary insurance barriers.

PrEP and PEP are critical tools to ending the HIV epidemic in California and across the country. PrEP is a once-daily pill for HIV-negative people that almost entirely eliminates the risk of acquiring HIV. PEP is medication that a person takes after a potential exposure in order to prevent the virus from taking hold. PEP must be started within 72 hours and continued for 28 days to prevent HIV acquisition. With the passage of SB 159, pharmacists will be able to provide a 60-day supply of PrEP, after which the patient will need to see a physician for ongoing PrEP prescriptions. For PEP, pharmacists will be able to furnish the full 28-day medication regimen. Prior to dispensing PrEP and PEP, pharmacists will be required to receive appropriate training and provide necessary testing and counseling consistent with guidelines from the Centers for Disease Control and Prevention. SB 159 directs the California Board of Pharmacy to adopt regulations to implement the legislation by July 1, 2020.

PrEP and PEP are covered by most private insurance plans, as well as by Medicare and Medi-Cal. For individuals who need help paying for PrEP and PEP, California recently launched a statewide PrEP Assistance Program (PrEP-AP). The program is run by the California Office of AIDS and provides financial assistance with PrEP medication and related medical expenses.

SB 159 was co-sponsored by APLA Health, San Francisco AIDS Foundation, Los Angeles LGBT Center, Equality California, and the California Pharmacists Association. SB 159 was co-authored by Senators Steven Glazer (D-Orinda) and Jeffrey Stone (R-La Quinta), and Assembly members Todd Gloria (D-San Diego), Mike Gipson (D-Carson), Lorena Gonzalez (D-San Diego), and David Chiu (D-San Francisco).

For full text of the bill, please click here.

Important Legislative Relief for SAFE/SANE Teams

Important legislation went into effect on January 1, 2020 that bring important relief and clarifications for SAFE/SANE Teams. This bill was sponsored by Cal SAFE. Assemblymember Marc Berman (D–Palo Alto) carried this important legislation on behalf of Cal SAFE, the California Association of Sexual Assault Forensic Examiners. Cal SAFE received support from the California Hospital Association and California Sexual Assault Investigators Association.

Important clarification for exams for undecided patients/survivors

State law was clear for over 40 years. Penal Code section 13823.95 stated that law enforcement agencies were responsible for paying for sexual assault medical forensic examinations dating back to 1977. In 2012, this statute was amended in response to federal VAWA legislation to provide exams for sexual assault victims undecided about reporting the crime to law enforcement agencies. The amendments to Penal Code section 13823.95 caused financial hardship for SAFE/SANE teams because it stated that all exams could only be reimbursed $300 per exam, and that law enforcement agencies could submit a reimbursement request to Cal OES for the $300. This provision conflicted with local contracts between hospitals and exam teams whereby reimbursement rates range from $1,000 to $1,800 per exam. This was a sleeper for many years. About four or five years ago, law enforcement agencies pointed to state law stating they were only responsible for paying $300 per exam. AB 538, now Penal Code section 13823.95, solved this problem. It distinguishes between two types of exams. Exams for victims who choose to cooperate with law enforcement exams must be reimbursed at the locally negotiated contract rate. Exams for undecided victims must be paid by law enforcement agencies at the locally negotiated rate, and they can submit a reimbursement request for $300 to offset the cost of this exam.

Important clarification for Sexual Assault Forensic Examiners (SAFEs)

SB 538 clarified a mix of existing statutory provisions about who can be sexual assault forensic examiners. They can be registered nurses, nurse practitioners, physician assistants, and physicians, and identified as SAFEs. This means that an LVN cannot serve as an examiner on an exam team. The term “SANE” was created by the International Association of Forensic Nurses (IAFN). Nurses meeting the IAFN qualifications and who acquire 300 clinical practice hours are eligible to take a standardized test to quality as a SANE-A (for adult/adolescent examiners) and SANE-P (for pediatric sexual abuse examiners). Physician assistants and physicians are not eligible to take the exam and they can have a limited membership with the IAFN as associate members. As a result, the professional direction in California is to identify exam teams as SAFE teams. For further details, see Penal Code section 13823.5–13823.11.

Important clarifications for CCFMTC

SB 538 added provisions to the scope of work for CCFMTC: training on strangulation, developing a supplemental standard state form to record findings, developing electronic as well as paper forensic medical report forms, and strengthening the scope of work as it relates to domestic/interpersonal violence, elder and dependent adult abuse, and child physical abuse. For further details, see Penal Code section 13823.93.

New SAFE Kit and Law Requiring Prompt Testing of SAFE Kits

The new SAFE (Sexual Assault Forensic Evidence Kit) is now available. The standardized kit developed by crime laboratories in California, formerly called a “rape kit,” went into production in September 2019 and is now available. It is consistent with the standard state Sexual Assault Forensic Medical Examination Report (Cal OES 2-923). Exam teams can order SAFE Kits for training examiners.

Penal Code Section 13823.14 authored by Assemblyman Jim Cooper, effective January 2018, directed the California Clinical Forensic Medical Training Center (CCFMTC) to work collaboratively with the California Crime Laboratory Directors Association (CACLD) and California Criminalists Association (CAC) to develop a standardized evidence kit for use in California. The SAFE Kit is used by sexual assault forensic medical examiners to collect, package, and label evidence identified during an exam, and includes both blood/alcohol toxicology and urine/alcohol toxicology kits. The SAFE Kit is submitted by the examination teams to their local crime laboratory. It was a two-year development process to gain consensus. 

Penal Code Section 13823.14 directed the Department of Justice’s Bureau of Forensic Services, the California Association of Crime Laboratory Directors, and the California Association of Criminalists to provide leadership and work collaboratively  to develop a standardized sexual assault forensic medical evidence kit for use by all California jurisdictions. CLICK HERE for details and photos of the new SAFE Kit components.

Penal Code 680 effective January 1, 2020 requires law enforcement agencies to submit the SAFE Kit within 20 days after being booked into evidence to the crime laboratory. This bill (SB 22), introduced by State Senator Connie Leyva, requires crime laboratories to process SAFE kits, create DNA profiles when able, and upload qualifying DNA profiles into CODIS as soon as practically possible, but no later than 120 days after initially receiving the evidence.