BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          AB 2179 (Gipson) - Hepatitis C testing
          
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          |Version: June 22, 2016          |Policy Vote: B., P. & E.D. 9 -  |
          |                                |          0, HEALTH 8 - 0       |
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          |Urgency: No                     |Mandate: No                     |
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          |Hearing Date: August 1, 2016    |Consultant: Brendan McCarthy    |
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          This bill meets the criteria for referral to the Suspense File.

          Bill  
          Summary:  AB 2179 would authorize a hepatitis C counsellor who  
          meets specific requirements to perform certain hepatitis C  
          tests.


          Fiscal  
          Impact:  
           One-time costs of about $150,000 for the development and  
            adoption of regulations by the Department of Health Care  
            Services (General Fund).

           Ongoing costs of about $500,000 per year to develop training  
            curricula, train hepatitis C counselors, and provide technical  
            assistance to local health jurisdictions (General Fund).

           Unknown additional costs to the Medi-Cal program to provide  
            treatment for newly diagnosed hepatitis C cases (General Fund  
            and federal funds). By making it easier for  hepatitis C  
            counsellors working in certain situations to perform hepatitis  
            C tests, the bill is likely to result in additional testing  







          AB 2179 (Gipson)                                       Page 1 of  
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            and additional diagnoses of hepatitis C. For those individuals  
            who are eligible for Medi-Cal, there would likely be increased  
            costs to provide treatment for newly diagnosed hepatitis C  
            cases. The costs to provide such treatment are unknown and  
            would depend on the number of new diagnoses amongst the  
            Medi-Cal population. New hepatitis C drugs on the market have  
            very high upfront costs (in the tens of thousands per course  
            of treatment), but are very effective at curing hepatitis C.  
            In the long-run, early diagnosis and treatment for some  
            patients, may actually save money. However, a very low  
            percentage of hepatitis C patients will ever receive a costly  
            liver transplant. Therefore, it is not known whether  
            widespread use of these very expensive drugs will actually  
            save money for the Medi-Cal program in the long-run.


          Background:  Under current federal and state law, clinical laboratory tests  
          are classified by their complexity. The level of clinical  
          complexity determines the qualifications needed to perform those  
          laboratory tests. The least complex laboratory tests are  
          referred to as "waived". Under current state law, HIV  
          counsellors are authorized to perform HIV, hepatitis C, or a  
          combined test that is categorized as "waived" provided that  
          specified conditions are met.


          Proposed Law:  
            AB 2179 would authorize a hepatitis C counsellor who meets  
          specific requirements to perform certain hepatitis C tests. 
          Specific provisions of the bill would:
                 Require hepatitis C counselors to meet specified  
               criteria - such as having been trained by the Department of  
               Public Health, working in an HIV counselling and testing  
               site, or work at a site approved by a local health  
               jurisdiction to provide hepatitis C testing and  
               counselling;
                 Permit hepatitis C counsellors who meet one of the above  
               criteria to perform hepatitis C tests that are waived, if  
               certain conditions are met;
                 Impose other restrictions on hepatitis C counsellors  
               acting under the authority of the bill.


          Staff  








          AB 2179 (Gipson)                                       Page 2 of  
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          Comments:  The bill does not specifically require the Department  
          of Public Health to develop a training curriculum or train  
          hepatitis C counsellors. However, the Department indicates that  
          it anticipates a demand for such training.
          The supporters of the bill indicate that there is unmet demand  
          for hepatitis C screening, particularly in the rural areas of  
          the state where there is not the same level of HIV-related  
          public health infrastructure. 




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