BILL ANALYSIS                                                                                                                                                                                                    Ó

          |SENATE RULES COMMITTEE            |                        AB 521|
          |Office of Senate Floor Analyses   |                              |
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                                   THIRD READING 

          Bill No:  AB 521
          Author:   Nazarian (D)
          Amended:  6/29/15 in Senate
          Vote:     21  

           SENATE HEALTH COMMITTEE:  6-2, 7/8/15
           AYES:  Hernandez, Hall, Monning, Pan, Roth, Wolk
           NOES:  Nguyen, Nielsen
           NO VOTE RECORDED:  Mitchell

           AYES:  Lara, Beall, Hill, Leyva, Mendoza
           NOES:  Bates, Nielsen

           ASSEMBLY FLOOR:  51-21, 6/4/15 - See last page for vote

           SUBJECT:   HIV testing

          SOURCE:    AIDS Healthcare Foundation
          DIGEST:    This bill 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.

          ANALYSIS:   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  


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            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  

          3)Requires the hospital clinician to offer an HIV test  
            consistent with the USPSTF recommendation for screening HIV  

          4)Makes related technical, conforming changes to existing law.  

          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 ED.  
            The ED trigger is key, as emergency rooms will continue to  
            play a critical role in delivering 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 Centers for Disease Control  
            and Prevention 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 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.  


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            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  
            United States, 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. 
          Prior Legislation

          AB 446 (Mitchell, Chapter 589, Statues of 2013), among other  
          provisions related to consent for HIV testing, required  
          community clinics to offer an HIV test.  

          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   No

          According to the Senate Appropriations Committee:

           By requiring hospitals to offer additional HIV testing to  
            patients, this 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  


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            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  
            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  


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            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 this bill results in new diagnoses of HIV and  
            that newly diagnosed individuals are able to access  
            appropriate medical care, this bill is likely to prevent  
            future HIV infections.

          SUPPORT:   (Verified8/28/15)

          AIDS Healthcare Foundation (source)
          AIDS Project Los Angeles
          Beyond AIDS 
          The Wall Las Memorias Project

          OPPOSITION:   (Verified8/28/15)

          California Hospital Association
          Cedars-Sinai Medical Center

          ASSEMBLY FLOOR:  51-21, 6/4/15
          AYES:  Achadjian, Alejo, Baker, Bloom, Bonilla, Bonta, Brown,  
            Burke, Calderon, Campos, Chau, Chiu, Chu, Cooley, Dababneh,  
            Daly, Dodd, Eggman, Cristina Garcia, Eduardo Garcia, Gatto,  
            Gipson, Gomez, Gonzalez, Gordon, Hadley, Roger Hernández,  
            Holden, Jones-Sawyer, Levine, Lopez, Low, Maienschein,  
            McCarty, Mullin, Nazarian, O'Donnell, Quirk, Rendon,  
            Ridley-Thomas, Rodriguez, Salas, Santiago, Mark Stone,  
            Thurmond, Ting, Waldron, Weber, Williams, Wood, Atkins
          NOES:  Travis Allen, Bigelow, Brough, Chang, Chávez, Beth  
            Gaines, Gray, Grove, Harper, Irwin, Jones, Kim, Lackey,  
            Linder, Mathis, Melendez, Obernolte, Olsen, Patterson,  
            Steinorth, Wagner
          NO VOTE RECORDED:  Cooper, Dahle, Frazier, Gallagher, Mayes,  
            Medina, Perea, Wilk

          Prepared by:Melanie Moreno / HEALTH / 
          8/31/15 12:47:56


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