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 Page 2 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 AB 2541 Page 3 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 Page 4 None on file. Analysis Prepared by : Martin Radosevich / HEALTH / (916) 319-2097