BILL ANALYSIS Ó AB 521 Page 1 ASSEMBLY THIRD READING AB 521 (Nazarian) As Amended June 2, 2015 Majority vote ------------------------------------------------------------------- |Committee |Votes |Ayes |Noes | | | | | | | | | | | |----------------+------+---------------------+---------------------| |Health |13-5 |Bonta, Bonilla, |Maienschein, Chávez, | | | |Burke, Chiu, Gomez, |Lackey, Patterson, | | | |Gonzalez, |Steinorth | | | | | | | | | | | | | |Roger Hernández, | | | | |Nazarian, | | | | |Ridley-Thomas, | | | | |Rodriguez, Santiago, | | | | |Thurmond, Waldron | | | | | | | |----------------+------+---------------------+---------------------| |Appropriations |12-5 |Gomez, Bonta, |Bigelow, Chang, | | | |Calderon, Daly, |Gallagher, Jones, | | | |Eggman, |Wagner | | | | | | | | | | | | | |Eduardo Garcia, | | | | |Gordon, Holden, | | | | |Quirk, Rendon, | | | | |Weber, Wood | | AB 521 Page 2 | | | | | | | | | | ------------------------------------------------------------------- SUMMARY: Applies existing human immunodeficiency virus (HIV) testing requirements for primary care clinics to patients admitted by hospital emergency departments (EDs), as specified. Specifically, this bill: 1)Requires each patient who has blood drawn in a hospital ED, and who is subsequently admitted to the hospital, and who has consented to an HIV test, to be offered an HIV test. Requires the test to conform with the United States Preventative Services Task Force (USPS Task Force) recommendation. Exempts from testing if the patient was tested, or offered testing and declined, within the last 12 months. Requires subsequent testing to be consistent with the most recent guidelines of the USPS Task Force. 2)Allows a hospital ED to charge a patient to cover the cost of HIV testing. 3)Indicates that a hospital ED has complied with these requirements if an HIV test is offered. 4)Requires a hospital ED to attempt to provide test results to the patient prior to departure from the hospital. Allows the hospital to inform the patient of a negative result by letter or telephone if the patient leaves the hospital before test result is available. Requires the hospital to inform a patient with a positive test result in a manner consistent with state law. EXISTING LAW: Requires each patient who has blood drawn in a AB 521 Page 3 primary care clinic, and who has consented to an HIV test, to be offered an HIV test. Requires the test to conform with the USPS Task Force recommendation. Exempts from testing if the patient was tested, or offered testing and declined, within the last 12 months. Requires subsequent testing to be consistent with the most recent guidelines of the USPS Task Force. FISCAL EFFECT: According to the Assembly Appropriations Committee: 1)Assuming this ED testing mandate identifies 150 individuals eligible for treatment through state programs, including Medi-Cal and AIDS Drug Assistance Program (ADAP), and that 65% of those are linked to care, state costs as follows: 2)Potential Medi-Cal costs (in fee-for service Medi-Cal) or cost pressure (in managed care) of $450,000 (General Fund (GF)/federal) for increased testing. 3)$650,000 annually (GF/federal) to Medi-Cal for increased HIV/acquired immune deficiency syndrome (AIDS) treatment costs. 4)$250,000 annually (potential GF/federal) to the ADAP and the Office of AIDS Health Insurance Premium Program (OA/HIPP) for increased HIV/AIDS treatment costs, on a net basis. 5)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. AB 521 Page 4 COMMENTS: 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. Until the Patient Protection and Affordable Care Act has been fully implemented, EDs will continue to play a critical role in delivering primary care services to many new enrollees and the uninsured. Given that there are more than 5,000 new HIV infections in California every year, this bill will bridge the gap in lack of HIV testing by requiring EDs to uniformly provide HIV testing. According to the sponsor, the AIDS Healthcare Foundation (AHF), this bill simply requires the offer of an HIV test in an ED if blood is already being drawn for another purpose. AHF writes that they recognize that EDs are constantly under pressure to meet the immediate needs of their patients. AHF concludes, this bill seeks to balance the public health demands of controlling this epidemic with the operational needs of an ED. AHF points at the Emergency Room as the last remaining major source for the identification of new people with HIV. In opposition, the California Chapter of the American College of Emergency Physicians (Cal/ACEP) argues that while this bill may appear to be an easy and efficient way to increase HIV diagnosis and treatment, it is unfortunately extremely problematic. Although fewer than 5% of doctors are emergency physicians, they handle a quarter of all acute care encounters and more than half of acute care visits by the uninsured. Diagnosing and treating HIV is an important public health endeavor, but EDs are not the proper venue for a diagnostic public health campaign. According to Cal/ACEP, this bill would place additional stress on California's overcrowded and burdened EDs, while diverting precious time away from patients with critical conditions toward public health screening. AB 521 Page 5 Analysis Prepared by: Max Mikalonis / HEALTH (916) 319-2097 FN: 0000854