BILL NUMBER: AB 446 AMENDED
BILL TEXT
AMENDED IN SENATE JULY 8, 2013
AMENDED IN SENATE JUNE 17, 2013
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. Existing law exempts
from these provisions HIV tests that are independently requested by
the patient from specified providers.
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.
except when a person independently requests an HIV
test from an HIV counseling and testing site, as specified. The
bill would require the person administering a test for a provider
covered by the exemption to document the person's independent request
for the test. The bill would also exempt clinical laboratories from
the informed consent requirements.
This bill would require every patient who has blood drawn at a
primary care clinic, as defined, who is between 12 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 code that can access only a single set of test results and
that is 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 that a person who tests negative for HIV
should continue to be routinely tested , 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, provided that the person's
independent request for an HIV test is documented by the person
administering the test. provider.
(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) Subdivision (c) shall not apply when a person independently
requests an HIV test from an HIV counseling and testing site that
employs a trained HIV counselor, pursuant to Section 120917, provided
that the person is provided with information required pursuant to
subdivision (a) and his or her independent request for an HIV test is
documented by the person administering the test.
(d)
(e) 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)
(f) (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)
(g) 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,
who test positive for HIV, or who are presumed to be HIV-positive.
(g)
(h) 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 administers
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.
(h)
(i) This section shall not apply to a clinical
laboratory.
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 12 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 (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 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 code that can access only a single set of test results and
that is 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 or refers to 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) 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 a cost, or be charged a
fee, for electing to receive his or her laboratory results in a
manner other than by Internet posting or other electronic form.
(j) A patient or his or her physician may revoke 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.