BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 521|
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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.
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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
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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
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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.
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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,
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Steinorth, Wagner
NO VOTE RECORDED: Cooper, Dahle, Frazier, Gallagher, Mayes,
Medina, Perea, Wilk
Prepared by:Melanie Moreno / HEALTH /
9/8/15 16:19:43
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