BILL ANALYSIS Ó
AB 2179
Page 1
Date of Hearing: April 27, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
AB
2179 (Gipson) - As Amended April 14, 2016
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill allows a new category of personnel, Hepatitis C
counselors, to perform simple, easy-to-use rapid tests for
Hepatitis C virus (HCV) when they are working under specified
supervision, training, and work site conditions.
AB 2179
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FISCAL EFFECT:
Uncertain, potential cost pressure to the California Department
of Public Health (CDPH). This bill does not place direct
requirements on the department, but is intended to allow local
health jurisdictions (LHJs) flexibility to approve and
implemented their own training programs. However, CDPH
indicates cost pressure in the hundreds of thousands of dollars
to promulgate and implement regulations, provide technical
assistance, and review, approve, and potentially implement
Hepatitis C counselor trainings.
COMMENTS:
1)Purpose. This bill is intended to streamline training
requirements for non-medical personnel to perform rapid
Hepatitis C tests, to allow local health departments to
respond in a safe and appropriate manner to the urgency of the
Hepatitis C epidemic. This bill is sponsored by Project
Inform, a statewide HIV and Hepatitis C advocacy group based
in the Bay Area. It has no opposition.
2)Hepatitis C is a contagious liver disease that ranges in
severity from a mild illness lasting a few weeks to a serious,
lifelong illness that attacks the liver. As a leading cause of
liver disease, liver cancer, and liver transplants, chronic
viral hepatitis is an important public health problem in
California and nationwide. Since 2007, the annual number of
deaths due to Hepatitis C nationwide has surpassed those due
to Human Immunodeficiency Virus (HIV). It is estimated 3.5
million in the United States have chronic Hepatitis C.
Current law allows HIV counselors who meet certain training
requirements to perform HIV, HCV, or combined HIV/HCV.
AB 2179
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3)Clinical Laboratory Improvement Act (CLIA)-waived tests. Under
the federal CLIA law, laboratories that perform tests on human
specimens must be certified by the Centers for Medicare and
Medicaid Services. The requirements for CLIA certification
vary depending on the complexity of the laboratory tests
performed-waived, moderate, or high complexity. In general,
the more complicated the test, the more stringent the
requirements under CLIA. Waived tests are simple tests with a
low risk for an incorrect result, which can be performed by
participants without laboratory training, no prior experience
of the test, and no verbal instruction.
4)Impact of this bill. Although HIV/HCV counselor training is
available, limited availability of state-sponsored training in
recent years has led to delays in certifying counselors and
rendered local health jurisdictions unable to afford required
trainings. This bill creates a new "Hepatitis C counselor"
authorization to perform waived HCV tests under prescribed
circumstances, which will allow LHJs to train and deploy the
workforce more rapidly and at a lower cost.
5)Prior legislation.
a) AB 1382 (Roger Hernández), Chapter 643, Statutes of 2011
authorized HIV test counselors to perform HCV or combined
HIV/HCV tests in addition to HIV tests.
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b) AB 1263 (Migden), Chapter 324, Statutes of 2001, among
other things, authorized HIV counselors to perform HIV
tests classified as waived under CLIA.
6)Staff Comments. The intent of the bill appears to be to
empower LHJs to more rapidly train and deploy Hepatitis C
counselors in order to address the Hepatitis C epidemic.
However, if CDPH interprets the bill to require promulgation
of regulations through a multi-year process as well as state
approval and delivery of training, it could negate the intent
of the bill and put additional cost pressure on the state. At
the same time, there may be some role for the state to ensure
quality control and proper oversight. The author may wish to
clarify the role of CDPH and LHJs to ensure this bill delivers
on its intent and does not result in undue state
administrative and cost pressure.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081