BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 2541
                                                                  Page  1

          Date of Hearing:   April 20, 2010

                            ASSEMBLY COMMITTEE ON HEALTH
                              William W. Monning, Chair
           AB 2541 (Portantino and Fletcher) - As Amended:  April 13, 2010
          
          SUBJECT  :  Reporting of certain communicable diseases.  

          SUMMARY  :  Deletes the exemption from the electronic reporting  
          requirement for Human immunodeficiency virus (HIV) infections  
          and requires the chief medical officer of an adult prison to  
          report HIV infections, using the name of the patient, to the  
          local health officer (LHO) of the jurisdiction where the inmate  
          resided prior to incarceration.  

           EXISTING LAW  :

          1)Requires health care providers and laboratories to report  
            cases of HIV infection to the LHO using patient names.   
            Requires LHOs to report unduplicated HIV cases by name to DPH.

          2)Requires laboratories to submit disease reports on reportable  
            diseases, except HIV, to the LHO electronically, and requires  
            the Department of Public Health (DPH) to specify the reporting  
            mechanism and timeliness requirements for laboratory reports.

          3)Requires each county to make HIV tests available within its  
            jurisdiction on an anonymous, rather than confidential, basis,  
            as specified.

           FISCAL EFFECT  :   This bill has not been analyzed by a fiscal  
          committee. 

           COMMENTS  :   

           1)PURPOSE OF THIS BILL  .  According to the author, this bill will  
            ensure that California maintains federal funds and works  
            toward having a complete count of HIV positive individuals in  
            California.  The author cites a recent Legislative Analyst's  
            Office (LAO) report that states that California has only  
            collected roughly 36,000 cases of HIV reported by name out of  
            an estimated 68,000 to 106,000 persons living with HIV.  The  
            LAO recommends that the Department of Corrections and  
            Rehabilitation be authorized to exchange HIV data with state  
            and local public health officials, and that HIV reports be  








                                                                  AB 2541
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            included in the state's new electronic reporting system.    


          2)BACKGROUND  .  The LAO states that California spends roughly  
            $1.2 billion a year ($455 million from the General Fund) on  
            medical treatment and HIV/AIDS programs.  In 2005, Congress  
            reauthorized the Ryan White Comprehensive AIDS Resources  
            Emergency (CARE) Act, which is the main federal funding source  
            for HIV/AIDS programs.  While the initial version of the Act  
            required states to report HIV and AIDS cases by name, a  
            compromise was eventually reached to allow states like  
            California, who reported cases by using a code-based system,  
            from losing federal funds.  However, states were expected to  
            immediately begin reporting HIV infections by name.  In  
            response, the Legislature enacted SB 699 (Soto) Chapter 20,  
            Statutes of 2006, which requires health care providers and  
            laboratories to report HIV cases by the patient's name rather  
            than code beginning in 2006.  In 2009, the reauthorized  
            version of the CARE Act increases the penalty for states that  
            do not report HIV and AIDS cases by name beginning in 2012.   
            Federal funds will be allocated based entirely on the number  
            of HIV and AIDS cases reported by names by 2013.  DPH  
            estimates that code-based reporting cost California $3.5-$6.5  
            million in federal funds in 2009, which is due to penalties  
            that result from California's history of having non-names  
            based HIV reporting until 2006.  

          According to a February 2010 report by the LAO, California still  
            lacks a complete names-based list of HIV cases, which puts our  
            state at risk of losing federal HIV/AIDS funds.  The LAO made  
            the following policy suggestions to enhance reporting of HIV  
            and AIDS cases and draw down more federal funds:  Include HIV  
            reporting in the new DPH electronic database; clarify that  
            correctional health systems are authorized to exchange  
            confidential public health data for the purpose of public  
            health surveillance; require Office of Aids (OA) to assess the  
            discrepancy between various databases by regularly cross  
            checking the data;  and require OA to annually report to the  
            Legislature its progress toward addressing the data gap.  

          Shortly after the release of the LAO report, DPH responded to  
            their recommendations.  Using data from 2007, DPH cross  
            checked between care and treatment databases and the HIV/AIDS  
            surveillance database and found that 100% of persons with AIDS  
            receiving state services were reported in the surveillance  








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            system.  However, DPH found that 31% of AIDS Drug Assistance  
            Program (ADAP) clients and 42% of AIDS Regulation Information  
            and Evaluation System (ARIES) clients were not reported in the  
            state surveillance system.  As a result, OA sent a letter on  
            August 3, 2009 to ADAP and ARIES providers, HIV/AIDS  
            surveillance coordinators, California Conference of Local AIDS  
            Directors, and California Conference of Local Health Officers  
            members alerting them of the problem of under reporting and  
            encouraging them to work with local ADAP and ARIES providers  
            to identify underreported individuals, and providers and labs  
            that are failing to report HIV cases to LHOs.  DPH states that  
            OA will perform annual cross checks between HIV/AIDS data  
            bases.  

           3)ELECTRONIC REPORTING SYSTEM  .  AB 2658, Horton, Chapter 449,  
            Statutes of 2008 requires laboratories to submit all cases of  
            "reportable diseases and conditions" electronically, within  
            one year of the establishment of the new state electronic  
            laboratory reporting system.  However, the bill exempted HIV  
            reports from this requirement to allow DPH sufficient time to  
            ensure the new system's data architecture is in line with  
            HIV-specific reporting requirements and that the system would  
            meet federal standards for HIV reporting.  As a result,  
            laboratories still report HIV by using methods of hand  
            delivery or registered mail.    

           4)SUPPORT  .  According to the sponsor, AIDS Healthcare  
            Foundation, this bill will implement two important  
            recommendations by the LAO, ensuring that California does not  
            lose federal funds for HIV/AIDS health care programs.  Given  
            the current fiscal climate, and the fact that the number of  
            HIV transmissions is increasing each year, California cannot  
            afford to lose any additional revenue for these vital  
            programs.   

           


          REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          AIDS Healthcare Foundation (sponsor)

           Opposition 








                                                                 AB 2541
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          None on file. 
           
          Analysis Prepared by  :    Martin Radosevich / HEALTH / (916)  
          319-2097