BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Kevin de León, Chair
AB 446 (Mitchell) - HIV testing.
Amended: July 8, 2013 Policy Vote: Health 9-0, Judic.
6-0
Urgency: No Mandate: No
Hearing Date: August 30, 2013
Consultant: Brendan McCarthy
SUSPENSE FILE.
Bill Summary: AB 446 would revise the regulatory requirements on
providers of HIV tests.
Fiscal Impact:
Minor anticipated costs to provide information and
technical assistance to providers of HIV testing services by
the Department of Public Health (General Fund).
Unknown increase in HIV testing costs by the state's
Medi-Cal program (50% General Fund, 50% federal funds).
Under the bill, the number of Medi-Cal enrollees being
tested for HIV is likely to increase, increasing program
costs.
Unknown increase in treatment costs for HIV positive
Medi-Cal enrollees and participants in the Aids Drug
Assistance Program (General Fund and federal funds). The
state spends about $25,000 per year per HIV positive
Medi-Cal enrollee and about $12,000 per year per HIV
positive Aids Drug Assistance Program enrollee. To the
extent that the bill increases testing rates, HIV positive
Medi-Cal enrollees would become aware of their HIV status
earlier and begin treatment earlier (current clinical
guidelines recommend anti-viral treatment begin immediately
upon diagnosis).
Unknown long-term costs savings to Medi-Cal due to earlier
medical intervention for HIV-positive Medi-Cal enrollees. To
the extent that HIV-positive Medi-Cal enrollees are
diagnosed earlier and begin treatment earlier, it is likely
that the long-term health status of those individuals will
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improve and some of the health effects of HIV will be
delayed or avoided. There are indications that untreated HIV
causes long-term health impacts such as elevated risk of
diabetes and heart disease, even before the effects of
compromised immune system function associated with HIV
infection become evident. Earlier diagnosis and treatment
for HIV-positive individuals is likely to reduce long-term
Medi-Cal expenditures for those individuals.
Background: Current law requires medical providers to provide
certain information about HIV tests and HIV treatment options
before providing an HIV test. In addition, the patient must
provide informed consent to an HIV test. In clinical settings, a
patient may provide such consent orally, but in non-clinical
settings the patient must provide written informed consent
before the test is administered. These requirements do not apply
when the patient independently requests an HIV test. Published
academic literature indicates that written informed consent
requirements reduce testing rates, compared to simplified
written consent procedures or oral consent requirements.
Proposed Law: AB 446 would revise the regulatory requirements on
providers of HIV tests.
Specific provisions of the bill would:
Add a new requirement that medical providers inform a
patient about HIV risk reduction strategies;
Clarify that an exemption from informed consent
requirements in clinical settings applies if the patient
requests an HIV test;
Exempt HIV testing and counseling sites from the informed
consent requirement if the patient requests a test;
Allow informed consent to be provided by the patient orally
or in writing;
Require providers to ensure the recipient of an HIV test
receive information on the test results in a timely manner;
Require providers to inform patients who receive a positive
test about treatment options;
Require primary care clinics to offer an HIV test to
patients under certain circumstances;
Permit test results to be provided to a patient over the
internet, if certain conditions are met.
Related Legislation: AB 506 (Mitchell) provides social workers
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with additional authority to consent to HIV testing of infants
in temporary custody. The Assembly has concurred in the Senate
amendments to that bill.
Staff Comments: The intention of the bill is to increase the
rate at which people are tested for HIV by simplifying informed
consent requirements and other regulatory requirements on
providers. Based on published academic literature, this is
likely to increase the testing rate in the state, although the
magnitude of the increase is not known.
As noted above, there are likely to be increased costs to
Medi-Cal from additional testing of enrollees. In the long-run,
there are also likely to be costs savings to Medi-Cal, due to
earlier diagnosis and treatment, which is likely to reduce
overall healthcare costs for HIV-positive enrollees.
In addition, there are indications that a positive HIV diagnosis
dramatically reduces the chances that an HIV-positive person
will transmit the virus to others, both because treatment
reduces viral loads in the patient and because individuals with
a positive diagnosis seem to reduce risky behavior. To the
extent that increased testing informs more individuals of their
HIV status, there may be a long-term reduction in infection
rates.