BILL ANALYSIS Ó SENATE COMMITTEE ON HEALTH Senator Ed Hernandez, O.D., Chair BILL NO: AB 521 --------------------------------------------------------------- |AUTHOR: |Nazarian | |---------------+-----------------------------------------------| |VERSION: |June 29, 2015 | --------------------------------------------------------------- --------------------------------------------------------------- |HEARING DATE: |July 8, 2015 | | | --------------------------------------------------------------- --------------------------------------------------------------- |CONSULTANT: |Melanie Moreno | --------------------------------------------------------------- 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 : ----------------------------------------------------------------- |Assembly Floor: |51 - 21 | |------------------------------------+----------------------------| |Assembly Appropriations Committee: |12 - 5 | |------------------------------------+----------------------------| |Assembly Health Committee: |13 - 5 | | | | ----------------------------------------------------------------- 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 -- END --