BILL ANALYSIS Ó
AB 521
Page 1
ASSEMBLY THIRD READING
AB
521 (Nazarian)
As Amended June 2, 2015
Majority vote
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|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
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| | | | |
| | | | |
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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
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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.
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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
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Analysis Prepared by: Max Mikalonis / HEALTH (916) 319-2097
FN: 0000854