BILL ANALYSIS Ó
AB 446
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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
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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