BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 2439|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: AB 2439
Author: Nazarian (D)
Amended: 8/15/16 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 7-0, 6/29/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Pan, Roth
NO VOTE RECORDED: Nielsen, Wolk
SENATE APPROPRIATIONS COMMITTEE: 5-2, 8/11/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NOES: Bates, Nielsen
ASSEMBLY FLOOR: 54-24, 6/2/16 - See last page for vote
SUBJECT: HIV testing
SOURCE: AIDS Healthcare Foundation
DIGEST: This bill 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.
ANALYSIS:
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,
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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 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:
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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) Permits DPH to select fewer hospitals if an insufficient
number of hospital express willingness to voluntarily
participate.
3) 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.
4) 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.
5) Requires a hospital in the pilot project to offer HIV tests
to individuals between 15 and 65 years of age pursuant to
USPSTF recommendations.
6) Authorizes a hospital in the pilot project to charge a
patient for the cost of the HIV testing.
7) Requires a hospital in the pilot project to be directed by
DPH, in a form, manner, and timeframe determined by DPH, 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;
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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.
8) 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
follow-up to the test, as well as an assessment of the
effectiveness of those practices and protocols.
9) Commences the pilot project on March 1, 2017, and ends it on
February 28, 2019.
10)Requires DPH, by December 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.
11)Requires this bill to be implemented only to the extent that
DPH identifies available funding for its purposes. Permits
DPH to seek or use private funding to cover the costs of
administering the pilot project.
Background
According to a 2015 Centers for Disease Control and Prevention
(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
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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 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.
1)HIV positive but unaware. According to the CDC, of the nearly
1.2 million people estimated to be living with HIV in the
U.S., 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.
Comments
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
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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
ED. The emergency room trigger is key, as emergency rooms will
continue to play a 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
1)One-time costs of $305,000 in 2016-17 and $560,000 in 2017-18
for the DPH to oversee the pilot project (General Fund).
2)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 ED 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:
a) 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).
b) About $200,000 per year to provide medical care Medi-Cal
enrollees newly diagnosed with HIV (General Fund and
federal funds).
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c) About $50,000 per year to provide medical care to new
AIDS Drug Assistance Program enrollees (federal funds and
drug rebate funds).
3)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.
4)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
HIV infections.
SUPPORT: (Verified 8/12/16)
AIDS Healthcare Foundation (source)
Beyond AIDS
City of West Hollywood
OPPOSITION: (Verified8/12/16)
None received
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ARGUMENTS IN 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.
ASSEMBLY FLOOR: 54-24, 6/2/16
AYES: Achadjian, Alejo, Atkins, Baker, Bloom, Bonilla, Bonta,
Brown, Burke, Calderon, Campos, Chau, Chiu, Chu, Cooley,
Cooper, Dababneh, Daly, Dodd, Eggman, Frazier, Cristina
Garcia, Eduardo Garcia, Gipson, Gomez, Gonzalez, Hadley, Roger
Hernández, Holden, Irwin, Jones-Sawyer, Levine, Linder, Lopez,
Low, Maienschein, Mayes, McCarty, Mullin, Nazarian, O'Donnell,
Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Mark Stone,
Thurmond, Ting, Waldron, Weber, Williams, Wood, Rendon
NOES: Travis Allen, Arambula, Bigelow, Brough, Chang, Chávez,
Dahle, Beth Gaines, Gallagher, Gatto, Gray, Grove, Harper,
Jones, Kim, Lackey, Mathis, Melendez, Obernolte, Olsen,
Patterson, Steinorth, Wagner, Wilk
NO VOTE RECORDED: Gordon, Medina
Prepared by: Melanie Moreno / HEALTH / (916) 651-4111
8/15/16 20:33:29
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