BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 521| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 521 Author: Nazarian (D) Amended: 9/4/15 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 SENATE APPROPRIATIONS COMMITTEE: 5-2, 8/27/15 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. Senate Floor Amendments of 9/4/15 permit a hospital to offer the HIV test at any time during the patient's admission and specify that this bill does not prohibit a patient's health plan from applying any patient cost share or other limitation that is allowed by law and included in the contract between the plan and the patient. AB 521 Page 2 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 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. Permits a hospital to offer the HIV test at any time during the patient's admission 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. 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 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 AB 521 Page 3 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. 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 AB 521 Page 4 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 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. AB 521 Page 5 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 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: (Verified9/4/15) AIDS Healthcare Foundation (source) AIDS Project Los Angeles Beyond AIDS The Wall Las Memorias Project OPPOSITION: (Verified9/4/15) 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, AB 521 Page 6 Steinorth, Wagner NO VOTE RECORDED: Cooper, Dahle, Frazier, Gallagher, Mayes, Medina, Perea, Wilk Prepared by:Melanie Moreno / HEALTH / 9/8/15 16:19:43 **** END ****