BILL ANALYSIS Ó Senate Appropriations Committee Fiscal Summary Senator Christine Kehoe, Chair AB 604 (Skinner) Hearing Date: 7/11/2011 Amended: 4/5/2011 Consultant: Katie Johnson Policy Vote: Health 5-3 _________________________________________________________________ ____ BILL SUMMARY: AB 604 would permit the California Department of Public Health (CDPH) to authorize entities to provide hypodermic needle and syringe exchange programs in any location the department determines needs such a program. _________________________________________________________________ ____ Fiscal Impact (in thousands) Major Provisions 2011-12 2012-13 2013-14 Fund CDPH regulations and $46 $35 $49 Federal* ongoing administration 2014-15 2015-16 $30 - $140 $30 - $140 Federal* *Centers for Disease Control and Prevention Cooperative Agreement Funds _________________________________________________________________ ____ STAFF COMMENTS: This bill would authorize the California Department of Public Health (CDPH) to accept applications for and to establish needle and syringe exchange programs (SEPs) in local jurisdictions where the department determines that there is a need for such programs in order to reduce the spread of HIV, viral hepatitis, and other potentially deadly bloodborne infections. The programs would be required to be consistent with state and federal standards, including those of the United States Public Health Service. Costs to CDPH to promulgate regulations over a period of two and a half years to further define application requirements would be approximately $46,000 in FY 2011-2012, and $35,000 - $50,000 annually through FY 2013-2014. Ongoing costs to review and approve applications and to post specified information on CDPH's AB 604 (Skinner) Page 1 website would range from minor and absorbable to up to $140,000 annually, commencing in FY 2013 -2014. The actual costs would depend on the number of applications received annually, which is unknown and could range from 5 - 50. If the number is more than 10, the workload would no longer be absorbable, although CDPH anticipates approximately 5 applications annually. To the extent there would be non-absorbable workload, it would be covered by a vacant position at the department. Funding would come from the federal Centers for Disease Control and Prevention Cooperative Agreement Funds. An entity's application to CDPH would be required to demonstrate its ability to provide specified SEP services, such as drug abuse treatment, HIV or hepatitis screening, Hepatitis A and B vaccination, screening for sexually transmitted infections, housing for individuals who are homeless and victims of domestic violence, and education services regarding the reduction of sexually risky behaviors. An SEP would additionally be required to show that it has adequate funding to provide needle and syringe exchange services for all participants, HIV and viral hepatitis prevention education services, and the safe recovery and disposal of used syringes and sharps waste. This bill would exempt staff and volunteers participating in the authorized program from any law related to the possession, furnishing, or transfer of hypodermic needles or syringes during participation in the program. Additionally, program participants would be immune from criminal prosecution for the possession of needles or syringes acquired from an authorized program. This bill would require local health officers to report biennially, instead of annually, to the county board of supervisors or city council on local SEPs. Pursuant to this bill, CDPH would also be required to report biennially to a local health officer of a jurisdiction in which the department approved a program. This bill would also permit local government, local health officials, and law enforcement to comment biennially, instead of annually, on local SEPs. To the extent that this bill were to aid in reducing future cases of HIV, viral hepatitis, and other bloodborne diseases, there could be future cost avoidance to publicly funded health care programs. Staff recommends that this bill be amended to sunset December AB 604 (Skinner) Page 2 31, 2018, consistent with the sunset date of the Disease Prevention Demonstration Project (DPDP). DPDP authorizes local jurisdictions to allow pharmacies to distribute up to 10 needles or syringes without a prescription. This bill is nearly identical to AB 1858 (Blumenfield, 2010), which Governor Schwarzenegger vetoed saying, "I signed legislation in 2005 that reflected a careful balance between good public health policy and local decision-making authority. I remain comfortable with that original decision and do not believe it is appropriate to change this balance and instead give authority to the state Department of Public Health to overrule local decisions regarding syringe exchange programs."