BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 521 (Nazarian) - HIV testing
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|Version: June 29, 2015 |Policy Vote: HEALTH 6 - 2 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 17, 2015 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 521 would require a general acute care hospital to
offer an HIV test to any individual who has been admitted to the
hospital through the emergency department and who has blood
drawn after admission to the hospital.
Fiscal
Impact:
By requiring hospitals to offer additional HIV testing to
patients, the bill will increase the number of tests provided
and the number of previously undiagnosed individuals who will
be diagnosed with HIV, typically leading to treatment. The
number of additional tests provided and the number of
previously undiagnosed cases of HIV discovered through those
tests is subject to uncertainty. Based on information
developed by the Office of Statewide Planning and Development,
there are about 11.6 million emergency department patient
encounters per year, of which about 160,000 lead to an
inpatient admission at a hospital. If 50% of those admissions
lead to an HIV test and the population accepting the test has
AB 521 (Nazarian) Page 1 of
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roughly the same rate of undiagnosed HIV as the overall state
population, there would be about 60 newly diagnosed cases of
HIV identified under the bill per year. This would result in
the following state costs:
o About $300,000 per year for additional HIV testing
(including follow up testing for positive test results)
by the Medi-Cal program (General Fund and federal funds).
o About $300,000 per year to provide medical care
Medi-Cal enrollees newly diagnosed with HIV (General Fund
and federal funds).
o About $200,000 per year to provide medical care to
new Aids Drug Assistance Program enrollees (federal funds
and drug rebate funds).
Unknown long-term cost savings to Medi-Cal due to earlier
medical intervention for HIV-positive Medi-Cal enrollees. To
the extent that HIV-positive Medi-Cal enrollees are diagnosed
earlier and begin treatment earlier, it is likely that the
long-term health status of those individuals will improve and
some of the health effects of HIV will be delayed or avoided.
There are indications that untreated HIV causes long-term
health impacts such as elevated risk of diabetes and heart
disease, even before the effects of compromised immune system
function associated with HIV infection become evident. Earlier
diagnosis and treatment for HIV-positive individuals may to
reduce long-term Medi-Cal expenditures for those individuals.
However, to some unknown extent the improvement in health
status and reduction in health care needs will be offset by
longer lifespans, potentially offsetting cost savings.
Unknown cost savings due to reduced HIV infections in the
state, including amongst Medi-Cal beneficiaries. There is
academic findings that diagnosis of HIV significantly reduces
the likelihood that an HIV positive individual will infect
others. This is due both to a reduction in risky behavior by
those aware of their HIV positive status and reductions in
viral loads in the blood due to antiretroviral treatments. To
the extent that the bill results in new diagnoses of HIV and
that newly diagnosed individuals are able to access
appropriate medical care, the bill is likely to prevent future
HIV infections.
AB 521 (Nazarian) Page 2 of
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Background: Under current law, patients who have blood drawn at primary
care clinics must be offered an HIV test by the clinic.
Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to low income individuals, families, and children.
Medi-Cal provides coverage to childless adults and parents with
household incomes up to 138% of the federal poverty level and to
children with household incomes up to 266% of the federal
poverty level. The federal government provides matching funds
that vary from 50% to 90% of expenditures depending on the
category of beneficiary.
In addition, the Department of Public Health manages the Aids
Drug Assistance Program which offers coverage for treatment of
HIV to those who do not qualify for Medi-Cal.
Current law mandates that all individual and group health plans
and insurance policies provide coverage for HIV testing.
Proposed Law:
AB 521 would require a general acute care hospital to offer an
HIV test to any individual who has been admitted to the hospital
through the emergency department and who has blood drawn after
admission to the hospital.
The bill would specify that the emergency department of a
hospital is not required to offer an HIV test.
Related
Legislation: AB 446 (Mitchell, Statutes of 2013) requires
community clinics to offer HIV testing to patients.
Staff
Comments: Current law requires health plans and health insurers
AB 521 (Nazarian) Page 3 of
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to cover HIV testing. However, the enrollee cost sharing for
such testing will vary based on the individual's plan and the
network status of the hospital providing the HIV test. An
individual with commercial health insurance may be required to
pay a deductible or copay associated with the test required in
the bill. In addition, if the hospital is not in the enrollee's
plan network, the enrollee may be required to cover a larger
share of cost, potentially the entire cost of the test,
depending on the terms of coverage.
The state's Medi-Cal program covers HIV testing with no cost
sharing for beneficiaries. However, because regular HIV
screening has not been recommended for all individuals by the
United States Preventative Services Taskforce, the Department of
Health Care Services indicates that it is not clear whether
federal matching funds would be available for HIV tests
requested by individuals who do not meet the criteria for
regular HIV screening. Under state law, hospitals would not be
allowed to bill a Medi-Cal beneficiary for the costs of an HIV
test.
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