BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 2439 (Nazarian) - HIV testing
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|Version: August 1, 2016 |Policy Vote: HEALTH 7 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 8, 2016 |Consultant: Brendan McCarthy |
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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
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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
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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
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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
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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.
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