BILL ANALYSIS Ó Senate Appropriations Committee Fiscal Summary Senator Christine Kehoe, Chair AB 499 (Atkins) Hearing Date: 08/25/2011 Amended: As Introduced Consultant: Jolie Onodera Policy Vote: Judiciary 3-1 _________________________________________________________________ ____ BILL SUMMARY: AB 499 would authorize a minor who is 12 years of age or older to consent to medical care related to the prevention of a sexually transmitted disease. _________________________________________________________________ ____ Fiscal Impact (in thousands) Major Provisions 2011-12 2012-13 2013-14 Fund Medi-Cal vaccination $1,200 - $2,500 per 5 to 10 percentFed/General* administrative fee of eligible cases Post-exposure Unknown; potentially significant costs ofFed/General* prophylactic HIV treatment $750 to $1,550 per 1,000 cases Healthy Families Program Unknown; potential cost pressure on Fed/General impact plan rates Preventive services Potential future cost savings Fed/General* in diagnosis and treatment costs *Costs shared 50 percent General Fund, 50 percent federal funds. _________________________________________________________________ ____ STAFF COMMENTS: SUSPENSE FILE. Existing law authorizes a minor who is 12 years of age or older to consent to medical care related to the diagnosis or treatment of an infectious, contagious, or communicable disease if it is related to a sexually transmitted disease. This bill would additionally authorize a minor who is 12 years of age or older to consent to medical care related to the prevention of a AB 499 (Atkins) Page 1 sexually transmitted disease. Time-critical preventive services for sexually transmitted diseases include the hepatitis B vaccine, post-exposure prophylactic (PEP) HIV medication (which must be administered within 72 hours of exposure), and the human papilloma virus (HPV) vaccine which, if given prior to exposure, may significantly reduce the risk of certain cancers. As this bill could result in the administration of vaccinations for hepatitis B and the HPV to Medi-Cal beneficiaries between the ages of 12-17 inclusive that would otherwise not have received these vaccinations, there could be increased costs to the Medi-Cal program, which pays a $9 administrative fee to physicians who administer the vaccines to Medi-Cal beneficiaries. All other costs related to vaccines for Medi-Cal beneficiaries under age 19 are paid for by the federally funded Vaccines for Children Program. Based on Medi-Cal counts as of January 2010, it is assumed there are over 466,000 females and 457,000 males (923,000 total) aged 12 through 17 who are Medi-Cal beneficiaries. Although the main focus of HPV prevention has been on young women, there has been recent research indicating the case for also routinely vaccinating young men for the HPV as well. As a result, there could be costs to administer vaccinations for both young women and men. For the 923,000 minors aged 12 through 17, a five to ten percent immunization rate for HPV, which is a three-dose series, would result in administrative costs ranging from $1.2 million to $2.5 million in total funds, fifty percent of which would be a cost to the General Fund. In addition to immunizations, preventive services for sexually transmitted diseases include the administration of PEP HIV medication, which must be given within 72 hours of exposure to be effective. As these medications are administered orally by prescription, there would be no costs associated with a Medi-Cal administrative fee for these medications. PEP medication costs are estimated at $400 to $1,200 per patient for a 28-day course, which is the typical time for treatment. Additional treatment costs associated with the administration of PEP medication could cost over $350 per individual and would include the accompanying office visit, required HIV informed consent counseling, and HIV AB 499 (Atkins) Page 2 blood testing to evaluate the patient's HIV status pre- and post-administration of the medication. To the extent Medi-Cal covers these services, all costs would be shared 50 percent federal funds and 50 percent General Fund. It is unknown at this time if the PEP medication and services would be allowable Medi-Cal costs without parental consent. If costs are not allowable, the PEP medication and treatment costs would be 100 percent state-funded. The number of potential cases who would be impacted is unknown, but the estimated cost per 1,000 individuals is estimated at $750,000 to $1,550,000. The Healthy Families Program (HFP), administered by the Managed Risk Medical Insurance Board (MRMIB) provides low-cost health coverage to over 870,000 children up to the age of 19 whose families' income meet eligibility requirements and are not eligible for Medi-Cal. As the costs for vaccinations for children covered under the HFP are not eligible under the federal vaccination program, costs for vaccinations are negotiated into the plan rates. To the extent this bill results in increased vaccinations and preventative STD services provided to HFP recipients could increase utilization rates and create future cost pressure on HFP plan rates. According to the Department of Health Care Services, Medi-Cal expenditures of $379 million were incurred in 2009-10 for the Minor Consent Program, which serves on average 130,600 individuals between the ages of 12 and 19, and provides over 128,000 minors with family planning and/or sexually transmitted disease diagnosis and treatment services. Due to the authorization of preventive services to minors provided for in this bill, there could be substantial future cost savings to the Medi-Cal and HFP programs in the millions of dollars to the extent that immunizations and other medical care lead to decreased incidences of disease, diagnosis, and treatment costs.