BILL ANALYSIS Ó
AB 521
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Date of Hearing: May 6, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
521 (Nazarian) - As Amended April 23, 2015
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill applies existing human immunodeficiency virus (HIV)
testing requirements for primary care clinics to hospital
emergency departments (EDs), requiring most patients seeking
emergency care in an ED to be offered an HIV test any time blood
AB 521
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is drawn.
FISCAL EFFECT:
The California Department of Public Health reports nearly 20,000
individuals in California are infected with HIV and don't know
it. It is unknown how many HIV-positive individuals would be
identified through these new testing requirements. Assuming this
ED testing mandate identifies1,500 individuals eligible for
treatment through state programs, including Medi-Cal and ADAP,
and that 65% of those are linked to care, state costs as
follows:
1)Potential Medi-Cal costs (in fee-for service Medi-Cal) or cost
pressure (in managed care) of $4.5 million (GF/federal) for
increased testing.
2)$6.5 million annually (GF/federal) to Medi-Cal for increased
HIV/AIDS treatment costs.
3)$2.5 million annually (potential GF/federal) to the AIDS Drug
Assistance Program (ADAP) and the Office of AIDS Health
Insurance Premium Program (OA/HIPP) for increased HIV/AIDS
treatment costs, on a net basis. Actual expenditures would be
higher, but approximately 70% of ADAP expenditures return to
the state in the form of rebate revenues. This estimate is
net of rebate revenue funds. As the availability of
additional federal funds made available to the state through
the state's current Medi-Cal Section 1115 waiver, and because
the amount of federal funds for these purposes are capped, it
is likely that at least a portion of any additional increased
ADAP costs would be borne by the GF.
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4)Costs are potentially offset by unknown long-term state cost
avoidance by identifying HIV infection and beginning treatment
earlier before significant medical complications arise, and by
potentially preventing additional transmission. Currently,
about 5,000 people are newly diagnosed with HIV in California
every year.
COMMENTS:
1)Purpose. According to the author, California has led the way
in identifying people living with HIV and linking them with
care and treatment. For example, AB 446 (Mitchell), Chapter
589, Statues of 2013, requires public health clinics to offer
an HIV test. The author states EDs continue to play a
critical role in delivering primary care services to many
individuals, and this bill will bridge the gap in lack of HIV
testing by requiring EDs to uniformly provide HIV testing.
2)Background. HIV destroys cells that are crucial to the normal
function of the human immune system. Although a person
infected with HIV may not show symptoms until several years
later, the virus is active in the body and, if untreated, the
HIV disease will progress to AIDS. An AIDS diagnosis is made
when the count of CD4+, or T cells, falls below a certain
level or when the person has a history of infections commonly
associated with AIDS. HIV/AIDS can be treated with a complex
regimen of antiretroviral medications. Although fewer people
are dying from AIDS, the total number of HIV cases in
California is still increasing every year because of new
diagnoses, and because the mortality rate from AIDS has
declined dramatically.
3)HIV Testing. Identifying those with HIV and linking them to
treatment can allow them to live a normal life span, and also
prevent the spread of the virus by suppressing their viral
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load. However, many HIV-positive people have not achieved
viral suppression because many people do not know their
status, and because some who do are not in care. Despite
recommendations for universal testing, identifying those who
are HIV-positive and do not know it has proven challenging.
The challenges and opportunities of providing HIV testing in
emergency departments have been well-documented in the public
health literature. On one hand, testing is fairly efficient
with high prevalence rates. Models for such testing appear to
be public health department-driven, such as local
collaborations with EDs where public health departments
provide either direct funding or staffing to provide testing
services within EDs, or provide technical assistance,
training, free test kits, or other related services.
4)Opposition. The California Hospital Association, California
Medical Association, and emergency department doctors oppose
this bill as an unfunded mandate on EDs and doctors, whose
primary mission is to stabilize patients with emergent
conditions, to conduct a widespread and ongoing public health
diagnostic screening campaign.
5)Related Legislation. AB 383 (Gipson), pending in this
committee, requires primary care clinics to screen for
Hepatitis C.
6)Previous Legislation.
a) AB 446 required primary care clinics to offer an HIV
test when taking a blood draw.
b) AB 1894 (Krekorian), Chapter 631, Statutes of 2008,
requires health care service plans and disability insurers
selling health insurance to offer testing for HIV
antibodies and AIDS, regardless of whether the testing is
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related to a primary diagnosis.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081