BILL NUMBER: AB 446	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MAY 24, 2013
	AMENDED IN ASSEMBLY  MAY 14, 2013
	AMENDED IN ASSEMBLY  APRIL 30, 2013

INTRODUCED BY   Assembly Member Mitchell

                        FEBRUARY 19, 2013

   An act to amend Sections 120990 and 123148 of, and to add Section
120991 to, the Health and Safety Code, relating to HIV testing.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 446, as amended, Mitchell. HIV testing.
   Existing law requires a medical care provider, prior to ordering
an HIV test, to, among other things, provide information about the
test, inform the patient that there are numerous treatment options
available for a patient who tests positive for HIV, and inform the
patient that a person who tests negative for HIV should continue to
be routinely tested. Existing law, with specified exceptions,
requires a written statement documenting the test subject's informed
consent prior to the performance of an HIV test.
   This bill would require that the medical care provider or the
person who administers the test also provide a patient with
information about risk reduction strategies and with specified
information after the test results are received. The bill would
require informed consent, as specified, either orally or in writing,
and would require the person administering the test to record the
informed consent in the person's medical record.
   This bill would require every patient who has blood drawn at a
primary care clinic, as defined, who is between 18 and 65 years of
age and who has consented to the test to be offered an HIV test and
would specify the manner in which the results of that test are
provided.
   Existing law regulates the disclosure of test results for HIV and
other diseases. Existing law prohibits the disclosure of HIV test
results by Internet posting or other electronic means unless the
patient requests the disclosure, the healthcare professional deems it
appropriate, and the health care professional has first discussed
the results in person or over the phone.
   This bill would authorize disclosure of HIV test results by
Internet posting or other electronic means if the result is posted on
a secure Internet Web site and can only be viewed with the use of a
secure personal identification number provided to the patient at the
time of testing.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 120990 of the Health and Safety Code is amended
to read:
   120990.  (a) Prior to ordering a test that identifies infection of
a patient with HIV, a medical care provider shall inform the patient
that the test is planned, provide information about the test, inform
the patient that there are numerous treatment options and risk
reduction strategies available for a patient who tests positive for
HIV, and advise the patient that he or she has the right to decline
the test. If a patient declines the test, the medical care provider
shall note that fact in the patient's medical file.
   (b) Subdivision (a) does not apply when a person independently
requests an HIV test from a medical care provider, a primary care
clinic as defined in subdivision (a) of Section 1204 or any clinic
specified in subdivision (g), (h), or (j) of Section 1206,
laboratory, or HIV counseling and testing site that employs a trained
HIV counselor pursuant to Section 120917.
   (c) Except as provided in subdivision (a), a person shall not
administer a test for HIV infection unless the person being tested or
his or her parent, guardian, conservator, or other person specified
in Section 121020 has provided informed consent for the performance
of the test. Informed consent may be provided orally or in writing,
but the person administering the test shall maintain documentation of
consent, whether obtained orally or in writing, in the client's
medical record. This consent requirement does not apply to a test
performed at an alternative site pursuant to Section 120890 or
120895. This section does not authorize a person to administer a test
for HIV unless that person is otherwise lawfully permitted to
administer an HIV test.
   (d) Nothing in this section shall preclude a medical examiner or
other physician from ordering or performing a test to detect HIV on a
cadaver when an autopsy is performed or body parts are donated
pursuant to the Uniform Anatomical Gift Act (Chapter 3.5 (commencing
with Section 7150) of Part 1 of Division 7).
   (e) (1) The requirements of subdivision (c) do not apply when
blood is tested as part of a scientific investigation conducted
either by a medical researcher operating under the approval of an
institutional review board or by the department, in accordance with a
protocol for unlinked testing.
   (2) For purposes of this subdivision, "unlinked testing" means
blood samples that are obtained anonymously, or that have the name or
identifying information of the individual who provided the sample
removed in a manner that prevents the test results from ever being
linked to the particular individual who participated in the research
or study.
   (f) Nothing in this section permits a person to unlawfully
disclose an individual's HIV status, or to otherwise violate
provisions of Section 54 of the Civil Code, the Americans With
Disabilities Act of 1990 (Public Law 101-336), or the California Fair
Employment and Housing Act (Part 2.8 (commencing with Section 12900)
of Division 3 of Title 2 of the Government Code), which prohibit
discrimination against individuals who are living with HIV, 
or  who test positive for HIV, or  who  are
presumed to be HIV-positive.
   (g) After the results of a test performed pursuant to this section
have been received, the medical care provider or the person who
administers the test shall ensure that the patient receives timely
information and counseling, as appropriate, to explain the results
and the implications for the patient's health. If the patient tests
positive for HIV infection, the medical provider or the person who
adminsters the test shall inform the patient that there are numerous
treatment options available and identify followup testing and care
that may be recommended, including contact information for medical
and psychological services. If the patient tests negative for HIV
infection and is known to be at high risk for HIV infection, the
medical provider or the person who administers the test shall advise
the patient of the need for periodic retesting, explain the
limitations of current testing technology and the current window
period for verification of results, and may offer prevention
counseling or a referral to prevention counseling.
  SEC. 2.  Section 120991 is added to the Health and Safety Code, to
read:
   120991.  (a) Each patient who has blood drawn at a primary care
clinic, who is between 18 and 65 years of age, and who has consented
to the HIV test pursuant to Section 120990 shall be offered an HIV
test. The primary care clinic shall be in compliance with this
subdivision if it chooses to test the patient using a rapid HIV test.
This subdivision shall not apply if the primary care clinic has
tested the patient for HIV or if the patient has been offered the HIV
test and declined the test within the previous 12 months. Any
subsequent testing of a patient who has been tested by the primary
care clinic shall be consistent with the most recent guidelines
issued by the federal Centers for Disease Control and Prevention and
the United States Preventive Services Task Force.
   (b) HIV testing of minors 12 years of age or older shall comply
with Section 6926 of the Family Code.
   (c) This section shall not prohibit a primary care clinic from
charging a patient to cover the cost of HIV testing. The primary care
clinic shall be deemed to have complied with this section if an HIV
test is offered.
   (d) A primary care clinic shall attempt to provide test results to
the patient before he or she leaves the facility. If that is not
possible, the facility may inform the patient who tests negative for
HIV by letter or by telephone, and shall inform a patient with a
positive test result in a manner consistent with state law. However,
in any case, the primary care clinic shall comply with subdivision
(g) of Section 120990.
   (e) For purposes of this section, "primary care clinic" means a
primary care clinic as defined in subdivision (a) of Section 1204 or
subdivision (g), (h), or  (i)   (j)  of
Section 1206.
  SEC. 3.  Section 123148 of the Health and Safety Code is amended to
read:
   123148.  (a) Notwithstanding any other law, a health care
professional at whose request a test is performed shall provide or
arrange for the provision of the results of a clinical laboratory
test to the patient who is the subject of the test if so requested by
the patient, in oral or written form. The results shall be disclosed
in plain language and in oral or written form, except the results
may be disclosed in electronic form if requested by the patient and
if deemed most appropriate by the health care professional who
requested the test. The telephone shall not be considered an
electronic form of disclosing laboratory results subject to the
limits on electronic disclosure of test results for the purpose of
this section.
   (b) (1) Consent of the patient to receive his or her laboratory
results by Internet posting or other electronic means shall be
obtained in a manner consistent with the requirements of Section
56.10 or 56.11 of the Civil Code. In the event that a health care
professional arranges for the provision of test results by Internet
posting or other electronic manner, the results shall be disclosed to
a patient in a reasonable time period, but only after the results
have been reviewed by the health care professional. Access to
clinical laboratory test results shall be restricted by the use of a
secure personal identification number when the results are disclosed
to a patient by Internet posting or other electronic manner.
   (2) Nothing in paragraph (1) shall prohibit direct communication
by Internet posting or the use of other electronic means to disclose
clinical laboratory test results by a treating health care
professional who ordered the test for his or her patient or by a
health care professional acting on behalf of, or with the
authorization of, the treating health care professional who ordered
the test.
   (c) When a patient requests access to his or her laboratory test
results by Internet posting, the health care professional shall
advise the patient of any charges that may be assessed directly to
the patient or insurer for the service and that the patient may call
the health care professional for a more detailed explanation of the
laboratory test results when delivered.
   (d) The electronic disclosure of test results under this section
shall be in accordance with any applicable federal law governing
privacy and security of electronic personal health records. However,
any state statute  , if enacted,  that governs
privacy and security of electronic personal health records, shall
apply to test results under this section and shall prevail over
federal law if federal law permits.
   (e) The test results to be reported to the patient pursuant to
this section shall be recorded in the patient's medical record, and
shall be reported to the patient within a reasonable time period
after the test results are received at the offices of the health care
professional who requested the test.
   (f) Notwithstanding subdivision (a), unless the patient requests
the disclosure, the health care professional deems this disclosure as
an appropriate means, and a health care professional has first
discussed in person, by telephone, or by any other means of oral
communication, the test results with the patient, in compliance with
any other applicable laws, none of the following clinical laboratory
test results and any other related results shall be disclosed to a
patient by Internet posting or other electronic means:
   (1) HIV antibody test, unless the test result is posted on a
secure Internet Web site and can only be viewed with the use of a
secure personal identification number provided to the patient at the
time of testing. The test result shall be posted only if there is no
link to any information that identifies the subject of the test.
   (2) Presence of antigens indicating a hepatitis infection.
   (3) Abusing the use of drugs.
   (4) Test results related to routinely processed tissues, including
skin biopsies, Pap smear tests, products of conception, and bone
marrow aspirations for morphological evaluation, if they reveal a
malignancy.
   (g) Patient identifiable test results and health information that
have been provided under this section shall not be used for any
commercial purpose without the consent of the patient, obtained in a
manner consistent with the requirements of Section 56.11 of the Civil
Code. In no event shall patient identifiable HIV-related test
results and health information disclosed in this section be used in
violation of subdivision (f) of Section 120980.
   (h)  Any   A  third party to whom
laboratory test results are disclosed pursuant to this section shall
be deemed a provider of administrative services, as that term is used
in paragraph (3) of subdivision (c) of Section 56.10 of the Civil
Code, and shall be subject to all limitations and penalties
applicable to that section.
   (i) A patient may not be required to pay  any 
 a  cost, or be charged  any   a 
fee, for electing to receive his or her laboratory results in
 any   a  manner other than by Internet
posting or other electronic form.
   (j) A patient or his or her physician may revoke  any
 consent provided under this section at any time and without
penalty, except to the extent that action has been taken in reliance
on that consent.