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
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            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