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 11, 2016 |Consultant: Brendan McCarthy |
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*********** ANALYSIS ADDENDUM - SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on August 11, 2016
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
AB 2439 (Nazarian) Page 1 of
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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
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
AB 2439 (Nazarian) Page 2 of
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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
HIV infections.
Author
Amendments: Authorize the Department to select fewer than four
hospitals, delay the reporting requirements, and make technical
changes.
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