BILL ANALYSIS Ó
AB 2439
Page 1
Date of Hearing: May 4, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
AB
2439 (Nazarian) - As Amended April 21, 2016
-----------------------------------------------------------------
|Policy |Health |Vote:|14 - 1 |
|Committee: | | | |
| | | | |
| | | | |
|-------------+-------------------------------+-----+-------------|
| | | | |
| | | | |
| | | | |
|-------------+-------------------------------+-----+-------------|
| | | | |
| | | | |
| | | | |
-----------------------------------------------------------------
Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill requires the California Department of Public Health
(CDPH) to administer and evaluate a pilot project whereby routine
testing for human immunodeficiency virus (HIV) virus is conducted
in four participating hospital emergency departments (EDs), as
AB 2439
Page 2
specified. It also:
1)Requires participating hospitals to submit specified data and
information to CDPH.
2)Requires HIV tests to be offered to individuals between 15 and
65 years of age and to any patient in the hospital emergency
department who has consented to the test.
3)Specifies the pilot project shall commence on March 1, 2017,
and end on February 28, 2019.
4)Requires, by July 1, 2019, CDPH to submit a report to the
Legislature on the findings of the four hospitals in the pilot
project that includes recommendations about routine HIV testing
in hospital emergency departments. Requires CDPH to solicit
stakeholder input in preparing the report.
FISCAL EFFECT:
1)GF Staff costs to CDPH of $305,000 in fiscal year 2016-17,
$550,000 in 2017-18, and $275,000 in 2018-19 to implement and
manage the pilot project, collect data, and prepare a report.
2)GF cost pressure to provide funding for hospitals to
participate in this project. Although they can be reimbursed
for HIV testing, it is unclear whether hospitals would
participate without funding for enhanced tracking and data
collection efforts. A current CDC grant provides $270,000 per
year to each hospital participating in a similar pilot project.
AB 2439
Page 3
3)Identifying more individuals with HIV could increase testing
and treatment costs to Medi-Cal and the AIDS Drug Assistance
Program, and potentially reduce long-term costs by identifying
HIV infection and beginning treatment earlier before
significant medical complications arise, as well as by
potentially preventing additional transmission. The pilot
project is relatively small and thus any fiscal impact to the
state for additional treatment would be small. The net effect
on costs is unknown.
COMMENTS:
1)Purpose. According to the author, California has led the way in
identifying people living with HIV and linking them with care
and treatment. The pilot project created by this bill will
allow the department to test strategies in a variety of
settings in order to inform development of best practices for
hospital ED testing for HIV. This bill is sponsored by the
AIDS Healthcare Foundation and, in its current form, has no
known opposition.
2)Background. HIV destroys cells that are crucial to the normal
function of the human immune system. Although a person infected
with HIV may not show symptoms until several years later, the
virus is active in the body and, if untreated, the HIV disease
will progress to AIDS. An AIDS diagnosis is made when the count
of CD4+, or T cells, falls below a certain level or when the
person has a history of infections commonly associated with
AIDS. HIV/AIDS can be treated with a complex regimen of
AB 2439
Page 4
antiretroviral medications. Although fewer people are dying
from AIDS, the total number of HIV cases in California is still
increasing every year because of new diagnoses, and because the
mortality rate from AIDS has declined dramatically. There are
around 5,000 new infections in California every year.
3)HIV Testing. Identifying those with HIV and linking them to
treatment can allow them to live a normal life span, and also
prevent the spread of the virus by suppressing their viral
load. However, many HIV-positive people have not achieved
viral suppression because many people do not know their status,
and because some who do are not in care. Despite
recommendations for universal testing, identifying those who
are HIV-positive and do not know it has proven challenging.
The challenges and opportunities of providing HIV testing in
emergency departments have been well-documented in the public
health literature. On one hand, testing is fairly efficient
with high prevalence rates. Models for such testing appear to
be public health department-driven, such as local
collaborations with EDs where public health departments provide
either direct funding or staffing to provide testing services
within EDs, or provide technical assistance, training, free
test kits, or other related services.
4)Current state efforts. CDPH Office of AIDS (OA) currently
provides training and technical assistance (TA) to health care
settings and emergency departments that want to provide routine
HIV testing to their patients. CDPH states training and TA are
critical to the integration of HIV testing in all health care
settings. In 2008, OA received dedicated funding from CDC to
assist three Bay Area EDs to implement and evaluate routine HIV
testing.
5)Prior legislation. AB 521 (Nazarian) required hospitals to
offer an HIV test to consenting patients who have blood drawn
after being admitted through the emergency department. This
AB 2439
Page 5
bill was vetoed by Governor Brown, who was concerned about
appropriateness of the demographics of the target population
and the whether hospitals are appropriate places to provide
counseling, routine preventive screenings, or follow-up care
for sensitive HIV testing.
This bill does not mandate HIV testing, and the demographics of
all ED patients as targeted by this bill provide a higher-risk
population than those who are admitted, improving the
cost-effectiveness of testing. This bill still requires HIV
tests to be conducted in EDs, which the veto message implies
are not an appropriate place to provide necessary follow-up
counseling.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081