BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 521
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|AUTHOR: |Nazarian |
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|VERSION: |June 29, 2015 |
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|HEARING DATE: |July 8, 2015 | | |
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|CONSULTANT: |Melanie Moreno |
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SUBJECT : HIV testing.
SUMMARY : Requires a patient who has been admitted as an inpatient to a
hospital through the emergency department and has blood drawn
after being admitted to the hospital, and who has consented, to
be offered an HIV test.
Existing law: Requires each patient who has blood drawn at a
primary care clinic, and who has consented, to be offered an HIV
test, consistent with the United States Preventive Services Task
Force (USPSTF) recommendation for screening the HIV infection.
This bill:
1)Requires a patient who has been admitted as an inpatient to a
hospital through the emergency department (ED) and has blood
drawn after being admitted to the hospital, and who has
consented, to be offered an HIV test.
2)Prohibits the ED from being responsible for offering an HIV
test.
3)Requires the hospital clinician to offer an HIV test
consistent with the USPSTF recommendation for screening HIV
infection.
4)Makes related technical, conforming changes to existing law.
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 the AIDS Drug Assistance Program (ADAP), and
AB 521 (Nazarian) Page 2 of ?
that 65% of those are linked to care, state costs as follows:
a) 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.
b) $650,000 annually (GF/federal) to Medi-Cal for
increased HIV/acquired immune deficiency
syndrome (AIDS) treatment costs.
c) $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.
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.
PRIOR
VOTES :
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|Assembly Floor: |51 - 21 |
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|Assembly Appropriations Committee: |12 - 5 |
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|Assembly Health Committee: |13 - 5 |
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COMMENTS :
1)Author's statement. According to the author, over the past
decade, California has focused on the need to test, as early
as possible, to reduce HIV infection rates and link people
with HIV treatment. Given that there are more than 5,000 new
HIV infections in California every year, AB 521 will bridge
the gap in lack of HIV testing by requiring hospitals to offer
an HIV test to patients that have been admitted via the
emergency department. The ED trigger is key, as emergency
rooms will continue to play a critical role in delivering
AB 521 (Nazarian) Page 3 of ?
primary care services to many new enrollees and to those who
remain uninsured. AB 521 recognizes that emergency rooms
continue to play a vital role in helping to identify
individuals with HIV.
2)Background. According to a 2015 CDC report, an estimated
1,148,200 persons aged 13 years and older are living with HIV
infection. Over the past decade, the number of people living
with HIV has increased, while the annual number of new HIV
infections has remained relatively stable. Still, the pace of
new infections continues at far too high a level, particularly
among certain groups. The estimated incidence of HIV has
remained stable overall in recent years, at about 50,000 new
HIV infections per year. Within the overall estimates,
however, some groups are affected more than others. Men who
have sex with men (MSM) continue to bear the greatest burden
of HIV infection, and among races/ethnicities, African
Americans continue to be disproportionately affected. In
2013, an estimated 47,352 people were diagnosed with HIV
infection in the United States. In that same year, an
estimated 26,688 people were diagnosed with AIDS. Overall, an
estimated 1,194,039 people in the United States have been
diagnosed with AIDS. An estimated 13,712 people with an AIDS
diagnosis died in 2012, and approximately 658,507 people in
the United States with an AIDS diagnosis have died overall.
The deaths of persons with an AIDS diagnosis can be due to any
cause-that is, the death may or may not be related to AIDS.
3)HIV positive but unaware. According to the CDC, of the nearly
1.2 million people estimated to be living with HIV in the US,
nearly one in seven (more than 168,000) do not know they are
infected. According to the California Office of AIDS, as of
the end of 2011, it is estimated that between 29,523 and
31,948 HIV-positive and unaware individuals reside in
California. Because many new infections are transmitted by
people who do not know they are infected, undiagnosed
infection remains a significant factor fueling the HIV
epidemic. According to the CDC, when HIV is diagnosed early,
appropriately timed interventions, particularly highly active
antiretroviral therapy, can lead to improved health outcomes,
including slower clinical progression and reduced mortality.
Additionally, HIV counseling with testing has been
demonstrated to be an effective intervention for HIV-infected
participants, who increased their safer behaviors and
decreased risk behaviors.
AB 521 (Nazarian) Page 4 of ?
4)Double referral. This bill has been double referred. Should
this bill pass out of this committee, it will be referred to
the Senate Judiciary Committee.
5)Prior legislation. AB 446 (Mitchell, Chapter 589, Statues of
2013), among other provisions related to consent for HIV
testing, requires community clinics to offer an HIV test.
6)Support. According to the sponsor, the AIDS Healthcare
Foundation (AHF), Californians who are HIV-positive but do not
know they are HIV-positive are not getting treatment and
unwittingly expose uninfected people to HIV, and the more than
20,000 Californians who do not know they are HIV-positive are
causing 70% of the new infections, while the 84% of
Californians who are aware they are HIV-positive only cause
30% of new infections. AHF states that this bill's provisions
are triggered by a person's admission to the hospital through
an ED because many people who are served in an ED reflect the
demographics that are often missed in other HIV screening
programs. AHF contends that if the state is to ever get full
control of the HIV epidemic, it must reach the people it is
not reaching now, and a focal point for engaging those people
is through ER-admissions to the hospital. AIDS Project Los
Angeles writes that a recent CDC analysis showed that 90% of
new HIV infections could be prevented by diagnosing people
living with HIV and linking them with ongoing care and
treatment and this bill will help identify Californians living
with HIV, link them to care, and help prevent the spread of
the disease.
7)Opposition. The California Hospital Association (CHA) states
that this bill presents operational and capacity challenges
for acute care hospitals as hospitals would be required to
comply with Health and Safety Code Section 120990, which
details the informed consent process for HIV testing. Staff
time will be required to explain the test and why it is being
offered, and to obtain the patient's consent or refusal. CHA
states that this bill is another unfunded mandate potentially
increasing costs to hospitals and creates a time-consuming
process that will divert staff time and resources away from
in-patient care.
SUPPORT AND OPPOSITION :
Support: AIDS Healthcare Foundation (sponsor)
AB 521 (Nazarian) Page 5 of ?
AIDS Project Los Angeles
Beyond AIDS
The Wall Las Memorias Project
Numerous individuals
Oppose: California Hospital Association
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