BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2439
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|AUTHOR: |Nazarian |
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|VERSION: |May 31, 2016 |
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|HEARING DATE: |June 29, 2016 | | |
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|CONSULTANT: |Melanie Moreno |
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SUBJECT : HIV testing
SUMMARY : Creates a pilot project, to be administered by the Department
of Public Health (DPH), in order to assess and make
recommendations regarding the effectiveness of the routine
offering of an HIV test in the emergency department (ED) of a
hospital. Requires DPH to select four hospitals that have EDs to
voluntarily participate in the pilot project, as specified.
Existing law:
1)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.
2)Requires a medical provider, prior to ordering an HIV test to
inform the patient that the test is planned, provide
information about the test, inform the patient that there are
numerous treatment options available for a patient who tests
positive for HIV and that a person who tests negative for HIV
should continue to be routinely tested, and advise the patient
that he or she has the right to decline the test. If a patient
declines the test, the medical care provider is required to
note that fact in the patient's medical file. These
provisions do not apply when a person independently requests
an HIV test from a medical care provider.
3)Requires the medical provider or other person administering
the test, after the results of an HIV test have been received,
to ensure that the patient receives timely information and
counseling, as appropriate, to explain the results and the
implications for the patient's health. If the patient tests
positive for HIV infection, the medical provider or the person
AB 2439 (Nazarian) Page 2 of ?
who administers the test is required to inform the patient
that there are numerous treatment options available and
identify follow-up testing and care that may be recommended,
including contact information for medical and psychological
services. If the patient tests negative but is known to be at
high risk for HIV infection, the medical provider or the
person who administers the test is required to advise the
patient of the need for periodic retesting, explain the
limitations of current testing technology and the current
window period for verification of results, and is permitted
offer prevention counseling or a referral to prevention
counseling.
This bill:
1)Creates a pilot project, to be administered by DPH, in order
to assess and make recommendations regarding the effectiveness
of the routine offering of an HIV test in the ED of a
hospital. Requires DPH to select four hospitals that have EDs
to voluntarily participate in the pilot project, as follows:
a) Two of the hospitals from large urban areas;
b) One hospital from a small urban or suburban
area; and,
c) One hospital from a rural area.
2)Requires each hospital in the pilot project to offer an HIV
test to any patient in the ED who has consented to the HIV
test. Requires the ED to comply with existing law related to
HIV testing, and permits the ED to comply either by using
hospital personnel or engaging the services of an HIV
organization that has experience in prevention counseling for
persons at risk for HIV.
3)Prohibits a hospital in the pilot project from offering a test
to any person who is being treated for a life-threatening
emergency or who lacks the capacity to consent to an HIV test.
4)Requires a hospital in the pilot project to offer HIV tests to
individuals between 15 and 65 years of age pursuant to USPSTF
recommendations.
5)Authorizes a hospital in the pilot project to charge a patient
for the cost of the HIV testing.
6)Requires a hospital in the pilot project to be directed by DPH
AB 2439 (Nazarian) Page 3 of ?
to collect and report data on:
a) The frequency of HIV test offers;
b) The frequency of consent or non-consent to an
HIV test and any reasons given by the patient for the
consent or the non-consent;
c) The time taken to offer an HIV test and secure
consent from a patient and the time taken to provide
information and counseling, as specified;
d) The aggregate HIV positivity rate;
e) The frequency with which patients agree to
participate in a session to receive information and
counseling pursuant to existing law related to HIV
testing and the reasons that patients give for
refusing to participate; and,
f) The frequency of patients leaving the ED
without receiving their test results.
7)Requires a hospital in the pilot project to provide
information to DPH regarding its practices and protocols for
implementing the offer of an HIV test and the required
followup to the test, as well as an assessment of the
effectiveness of those practices and protocols.
8)Commences the pilot project on March 1, 2017, and ends it on
February 28, 2019.
9)Requires DPH, by July 1, 2019, to complete a report to the
Legislature on the findings of the four hospitals in the pilot
project and make recommendations about routine HIV testing in
EDs, as specified. Requires DPH, in preparing the report to
the Legislature, to solicit input from a broad range of HIV
testing and hospital stakeholders. Makes this provision
inoperative on July 1, 2023, as specified.
10)Permits DPH to seek or use private funding to cover the costs
of administering the pilot project.
FISCAL
EFFECT : According to the Assembly Appropriations Committee:
1)Staff costs to DPH 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
(General Fund (GF) or private funds).
AB 2439 (Nazarian) Page 4 of ?
2)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 Centers for Disease Control and Prevention
(CDC) grant provides $270,000 per year to each hospital
participating in a similar pilot project (GF or private
funds).
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.
PRIOR
VOTES :
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|Assembly Floor: |54 - 24 |
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|Assembly Appropriations Committee: |14 - 6 |
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|Assembly Health Committee: |14 - 1 |
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COMMENTS :
1)Author's statement. According to the author, the National
Association of State and Territorial AIDS Directors declared
in its most recent report that "hospital emergency rooms
continue to play a critical role in the successful expansion
of HIV testing." Given that there are more than 5,000 new HIV
infections in California every year, AB 2439 will bridge the
gap in lack of HIV testing by requiring the four selected
hospitals to offer an HIV test to patients that have been
admitted via the emergency department. The emergency room
trigger is key, as emergency rooms will continue to play a
AB 2439 (Nazarian) Page 5 of ?
critical role in delivering primary care services to many new
enrollees and to those who remain uninsured. AB 2439
recognizes that emergency rooms continue to play a vital role
in helping to identify individuals with HIV.
2)Background. According to a 2015 CDC 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 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 (MSM) 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 US,
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.
AB 2439 (Nazarian) Page 6 of ?
4)Related legislation. AB 2640 (Gipson) would require a medical
care provider or person administering a test for HIV to inform
individuals who test negative for HIV infection, yet are at
high risk for HIV infection, of the effectiveness and safety
of all federal Food and Drug Administration approved methods
that prevent or reduce the risk of contracting HIV, including
pre-exposure prophylaxis and post-exposure prophylaxis,
consistent with guidance of the CDC. AB 2640 is set to the
heard in the Senate Health Committee on June 29, 2016.
5)Prior legislation. AB 521 (Nazarian of 2015) would have
required a patient admitted as an inpatient to a hospital
through the ED that had blood drawn after being admitted to
the hospital, and who consented, to be offered an HIV test.
AB 521 was vetoed by the Governor, stating in part:
"?hospitals are not appropriately staffed nor are they the
place to provide counseling, routine preventive screenings, or
follow-up care for sensitive HIV testing. Limited resources
would be better spent supporting outreach and education
activities by existing providers which have the staff and
training for HIV testing and follow-up care."
6)Support. The AIDS Healthcare Foundation (AHF) is the sponsor
of this bill and states despite dramatic advances in treatment
options, there are more than 5,000 new infections in
California every year, and everyday more than a dozen
Californians are being infected with HIV. AHF contends that
while almost every imaginable location that provides routine
HIV testing has been employed to capture as many people as
possible who may have engaged in risk behaviors, we continue
to come up short in large part because HIV testing is
occurring only sporadically in hospital EDs, the last major
health care institution where HIV testing does not occur
routinely.
7)Author's amendments. The author requests that the Committee
approve the following amendments respond to concerns about the
offer of an HIV test when an ED patient is in too much pain or
distress to give consent or when a minor patient does not feel
free to make a decision about consent because of the presence
of a parent or guardian.
a) On page 2, between lines 24 and 25, insert:
(2) If an emergency department physician at a hospital in
AB 2439 (Nazarian) Page 7 of ?
the pilot project determines that a patient is in
significant pain or distress, including psychological
distress, the hospital shall not offer a HIV test to the
patient. Once an emergency department physician
determines that the patient has stabilized and is no
longer in significant pain or distress, including
psychological distress, the hospital shall offer a HIV
test to the patient.
b) On page 2, in line 28, after the period insert:
In order to protect the confidentiality and privacy
interests of minors, the hospital shall not offer HIV
test to individuals 15 to 17 years of age, inclusive, in
the presence of their parent or legal guardian.
SUPPORT AND OPPOSITION :
Support: AIDS Healthcare Foundation (sponsor)
Beyond AIDS
City of West Hollywood
Oppose: None Received
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