BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                       AB 521


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          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


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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  








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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.  









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          Analysis Prepared by:  Max Mikalonis / HEALTH (916) 319-2097        
                       FN: 0000854