State Legislatures Strengthen Policies to Screen and Treat Sexually Transmitted Diseases

April 19, 2018|9:55 a.m.| ASTHO Staff

On April 6, Virginia Gov. Ralph Northam signed expedited partner therapy (EPT) legislation, which is only fitting, as April is STD awareness month. This year’s theme, “Treat Me Right,” draws attention to the complementary roles, healthcare providers, and others play in addressing the growing problem of sexually transmitted diseases (STDs) in American communities. CDC estimates that each year there are at least 20 million new STD cases, and unfortunately, numbers have been trending in the wrong direction. Rates of gonorrhea, syphilis, and chlamydia increased between 2014 and 2016, with particularly concerning rises in cases of congenital syphilisdrug-resistant gonorrhea, and other STDs among young adults. Furthermore, funding to support evidence-based interventions has declined at federal, state, and local levels, leading to a decreased capacity in state and local health departments to identify and treat STD cases. Researchers estimate that STDs cost the United States 16 billion dollars in direct and healthcare costs annually. If left untreated, STDs can lead to increased rates of cervical and possibly ovarian cancer, as well as infertility and a host of other negative health outcomes.  

Under Virginia’s new law, healthcare practitioners employed by the department of health will be able to prescribe certain antibiotic treatments to the partners of individuals diagnosed with an STD without a physical examination of the partner—a policy consistent with CDC recommendations. Expressly authorizing EPT provides the health department with additional options to reduce the spread of STDs and reduce the risk of reinfection after treatment. Virginia’s law also directs the commissioner of health to convene a workgroup representing public health and private practitioners to evaluate EPT services provided by the department of health and report findings and recommendations about EPT to the legislature by July 1, 2019. With this new law, Virginia joins a majority of U.S. jurisdictions that expressly authorize EPT. Express authorization is important, as researchers have found that patients and their partners are more likely to receive EPT in states that clearly allow the practice. 

Beyond EPT, state policymakers can advance other strategies to encourage individuals to seek treatment for STDs, including ensuring that individuals have access to appropriate screening and treatment for STDs. This year, legislatures in Connecticut, Maine, and New York are considering bills that incorporate STD screening and treatment into state minimum coverage benefits. However, these kinds of mandates alone are often not enough. For example, even though STD screening is a federally required essential health benefit, screening rates remain low. To help increase these rates, state health agencies can partner with healthcare providers and payers to promote improved provision and payment for STD services, such as reimbursing non-clinical personnel (e.g., disease intervention specialists) for contact tracing and collaborating on evaluations of STD screening and treatment programs.

Other policies can be adopted to promote patients’ confidentiality when seeking STD testing and treatment. Protecting a patient’s confidentiality can be particularly relevant for adolescents and young adults. In addition, addressing barriers to care for this population is vital since individuals aged 15-24 account for close to half of new STD cases.

Researchers in Rhode Island found that while many individuals under 20 years old who sought treatment at an STD clinic operated by the health department had health insurance, a majority avoided using it, in part due to concerns that parents, guardians, or others would learn about the treatment through the insurance company’s explanation of benefits (EOBs), a required communication to the policy holder of rendered healthcare services used to combat fraud. EOBs can inadvertently disclose the sensitive health information of young adults enrolled as dependents on another person’s policy.

This year, the Massachusetts legislature passed a bill to restrict the disclosure of certain sensitive health information in EOBs, including sexual and reproductive health information. Health departments can also proactively engage with payers and patients to prevent disclosures when providing and billing for STD services. For example, health departments that negotiate contracts with health insurance plans can include language to limit or redirect EOB disclosures to patients. Additionally, consistent and transparent communication between clinic staff and patients about the risk of disclosure and strategies to mitigate it can encourage individuals to seek care.

All STDs are preventable and most are treatable. With the growing number of cases, the cost of treatment, and related negative health impacts, preventing and controlling STD spread is vital. Law and policy is an important tool for state public health to help prevent STDs. It can also be used to improve access to screening, treatment, and reduce barriers to care. To learn more about STDs and proven prevention strategies, listen to ASTHO’s recent Public Health Review podcast about these issues.