BILL ANALYSIS Ó SENATE COMMITTEE ON APPROPRIATIONS Senator Ricardo Lara, Chair 2015 - 2016 Regular Session AB 2439 (Nazarian) - HIV testing ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: August 1, 2016 |Policy Vote: HEALTH 7 - 0 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: No | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: August 8, 2016 |Consultant: Brendan McCarthy | | | | ----------------------------------------------------------------- This bill meets the criteria for referral to the Suspense File. Bill Summary: AB 2439 would create a pilot project to assess the effectiveness of routinely offering HIV tests in the emergency department of a hospital. Fiscal Impact: One-time costs of $305,000 in 2016-17 and $560,000 in 2017-18 for the Department of Public Health to oversee the pilot project (General Fund). By requiring hospitals to offer additional HIV testing to patients, the 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 14 million emergency department patient encounters per year. If 10% of the encounters in participating AB 2439 (Nazarian) Page 1 of ? hospitals 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 10-20 newly diagnosed cases of HIV identified per year. This would result in the following state costs: o About $150,000 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 $200,000 per year to provide medical care Medi-Cal enrollees newly diagnosed with HIV (General Fund and federal funds). o About $50,000 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. 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 are 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 the bill results in new diagnoses of HIV and that newly diagnosed individuals are able to access appropriate medical care, the bill is likely to prevent future AB 2439 (Nazarian) Page 2 of ? HIV infections. Background: Under current law, patients who have blood drawn at primary care clinics must be offered an HIV test by the clinic. Under state and federal law, the Department of Health Care Services operates the Medi-Cal program, which provides health care coverage to low income individuals, families, and children. Medi-Cal provides coverage to childless adults and parents with household incomes up to 138% of the federal poverty level and to children with household incomes up to 266% of the federal poverty level. The federal government provides matching funds that vary from 50% to 90% of expenditures depending on the category of beneficiary. In addition, the Department of Public Health manages the Aids Drug Assistance Program which offers coverage for treatment of HIV to those who do not qualify for Medi-Cal. Current law mandates that all individual and group health plans and insurance policies provide coverage for HIV testing. Proposed Law: AB 2439 would create a pilot project to assess the effectiveness of routinely offering HIV tests in the emergency department of a hospital. Specific provisions of the bill would: Establish a pilot project to assess and make recommendations regarding the effectiveness of routinely offering an HIV test in the emergency department of a hospital; Require the Department of Public Health to administer the pilot project; Require the Department to select four hospitals to voluntarily participate; Require participating hospitals to offer an HIV test to any patient in the hospital emergency department who has consented to the test, with certain exceptions; Require participating hospitals to report specified data to the Department; AB 2439 (Nazarian) Page 3 of ? Make the term of the pilot project March 1, 2017 to February 28, 2019; Require the Department to report to the Legislature by July 1, 2019 on the results of the pilot project; Authorize the Department to seek or use private funding to support the pilot project. Related Legislation: AB 2640 (Gipson) would require a medical provider administering an HIV test to provide information on pre- and post-exposure prophylaxis to individuals with a negative result who are at high risk of HIV infection. That bill will be heard in this committee. AB 521 (Nazarian, 2015) would have required a general acute care hospital to offer an HIV test to any individual who has been admitted to the hospital through the emergency department and who has blood drawn after admission to the hospital. That bill was vetoed by Governor Brown. Staff Comments: Current law requires health plans and health insurers to cover HIV testing. However, the enrollee cost sharing for such testing will vary based on the individual's plan and the network status of the hospital providing the HIV test. An individual with commercial health insurance may be required to pay a deductible or copay associated with the test required in the bill. In addition, if the hospital is not in the enrollee's plan network, the enrollee may be required to cover a larger share of cost, potentially the entire cost of the test, depending on the terms of coverage. The state's Medi-Cal program covers HIV testing with no cost sharing for beneficiaries. Because HIV screening has been recommended for individuals between 15 and 65 years of age by the United States Preventative Services Taskforce, the Department of Health Care Services indicates that the cost of the screening provided under the bill would be covered by Medi-Cal. This bill is narrower than AB 521, in that this bill would require a pilot project limited to four hospitals. However, AB 2439 (Nazarian) Page 4 of ? under AB 521 an HIV test would have been offered only to an individual who was admitted to the hospital through the emergency department. This bill would require an HIV test to be offered as part of any encounter in an emergency department (with some limitations). Because a small portion of emergency department encounters lead to hospital admissions, staff estimates that the overall number of HIV tests that would be offered under this bill would be roughly 25% of those that would have been offered under AB 521. -- END --