BILL ANALYSIS Ó AB 446 Page 1 Date of Hearing: May 24, 2013 ASSEMBLY COMMITTEE ON APPROPRIATIONS Mike Gatto, Chair AB 446 (Mitchell) - As Amended: May 14, 2013 Policy Committee: JudiciaryVote:10-0 Health 18-0 Urgency: No State Mandated Local Program: No Reimbursable: SUMMARY This bill revises requirements for providing information to, and receiving consent from, patients regarding HIV tests. Specifically, this bill: 1)Allows informed consent to be provided orally prior to an HIV test in a non-clinical setting, but requires the person giving the test to document the test in the client's medical record. 2)Requires the person administering an HIV test to ensure the patient receives timely information and counseling to explain the results. If the results are positive, the patient is to be informed about treatment options and follow-up testing and care. If the results are negative, and the patient is known to be high-risk for HIV, the patient is to be advised of the need for periodic retesting, the limitation of testing technology and the window for verification of results, and the patient may be offered prevention counseling or a referral for counseling. 3)Requires every patient between 18 and 65 who has blood drawn at a primary care clinic and has consented to an HIV test to be offered an HIV test. Compliance can be with a rapid HIV test. 4)Stipulates (3) does not apply if the clinic has tested the patient or the patient has declined the test with the prior 12 months. 5)Stipulates that the clinic is not prohibited from charging a AB 446 Page 2 fee to cover the cost. 6)Requires the clinic to provide the test results before the patient leaves the clinic, if possible, otherwise the clinic may inform the patient of a negative test by letter or telephone. 7)Stipulates that a primary care clinic, for purposes of (3) through (6), means any of the following: a) A community clinic or a free clinic, as defined in statute. b) A clinic operated by any institution of learning that teaches a healing art. c) A clinic operated by a primary care community or free clinic operated separately from a licensed facility only opened up to 20 hours per week. d) Student health centers opened by public institutions of higher education. 8)Provides if a person independently requests an HIV test, existing requirements, such as informing a patient about treatment options and risk reduction strategies that apply to medical providers who order HIV tests, do not apply to the entities listed in (7) nor to an HIV counseling and testing site that employs a trained HIV counselor. 9)Allows internet posting of the results of an HIV test if posted on a secure website that can only be viewed with a secure personal identification number provided to the patient. FISCAL EFFECT 1)The Office of Aids in the Department of Public Health will incur minor absorbable costs to provide technical assistance and guidance regarding the new requirements and procedures to local health departments and HIV counselors. 2)Any additional costs for student health centers at the University of California, the California State University, and the California Community Colleges should be absorbable and would be partially offset by HIV testing fees. COMMENTS AB 446 Page 3 1)Purpose . According to the author, the control of AIDS is possible with the tools at our disposal today. The key is finding those persons living with HIV who do not know they are infected and linking them to care and suppressing the presence of HIV through adherence to anti-retroviral treatment. Over the past decade, California has devoted funding, modified testing protocols, and focused on the need to test as the first line of offense in efforts to reduce HIV infection rates and move more people with HIV into treatment as early as possible. These efforts have reduced the percentage of late testers (those who are diagnosed with AIDS less than one year after testing) from 50% to 35%. Additionally, the author states that the federal Centers for Disease Control and Prevention (CDC) has long recommended that routine HIV testing occur in all health care settings. AB 446 is sponsored by the AIDS Healthcare Foundation is the sponsor of this bill. The Assembly Health Committee analysis of AB 446 includes a detailed discussion on the health care issues regarding this bill. 2)Opposition . The ACLU is opposed unless the bill is amended to remove certain provisions that the ACLU believes inappropriately relax informed consent requirements of current law. 3)Technical Amendment . On page 5, line 12, strike out "(i) and insert "(j)". Analysis Prepared by : Chuck Nicol / APPR. / (916) 319-2081