BILL ANALYSIS
AB 2280
Page 1
Date of Hearing: April 18, 2006
ASSEMBLY COMMITTEE ON HEALTH
Wilma Chan, Chair
AB 2280 (Leno) - As Amended: April 6, 2006
SUBJECT : HIV counseling.
SUMMARY : Requires the Department of Health Services (DHS), no
later than July 1, 2007, to develop a counseling model, as
specified, for all persons who receive human immunodeficiency
virus (HIV) testing at a clinic that receives funding for HIV
testing. Specifically, this bill :
1)Makes a number of findings and declarations regarding best
practice models of HIV counseling and HIV testing.
2)Requires DHS, no later than July 1, 2007, to develop a
counseling model for all persons who receive HIV testing at a
clinic that receives state funding for HIV testing and
requires DHS to consider in the model:
a) A brief risk-assessment mechanism developed by DHS that
allows a clinic to ascertain whether a person seeking
testing is at low or high risk of exposure to HIV. Permits
DHS to recommend when and how a clinic should use this
mechanism but prohibits it from being used to deny testing
to a subject who requests it;
b) A data collection form that is self-administered by the
test subject, and that includes only questions that must be
reported in accordance with existing state and federal
epidemiology report requirements. Requires consideration
to be given to reducing the length of the form and its
utility including whether state or local resources exist to
analyze the data collected. Permits additional questions
to be added only if new state or federal epidemiology
reports are required. Permits local health agencies to add
questions only with the approval of DHS. Permits the form
to be self-administered and be completed with the
assistance of a counselor at the request of the test
subject;
c) A prevention education module that comprehensively
covers all pertinent information relative to methods by
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which a person can protect himself or herself or his or her
sexual needle-sharing partners from exposure to HIV.
Consideration may be given to allowing clinics alternative
methods of providing the prevention education module,
although no test subject can be denied the opportunity to
receive prevention education privately and individually;
d) Flexibility for clinics to determine the extent of
counseling provided to a test subject based on a test
subject's risk factors or frequency of HIV testing;
e) Flexibility for clinics to provide counseling to couples
or small groups, as appropriate; and,
f) Additional counseling for a test subject whose
preliminary test result is positive. Permits additional
counseling to include, as needed by the test subject,
emotional support, information on confirmatory testing,
referral to care and treatment opportunities, and a review
of methods to prevent exposing others to HIV.
3)Requires DHS to develop a reimbursement schedule that
accurately reflects the range of services provided under this
model.
4)States that it is the intent of the Legislature that this new
model and reimbursement schedule be cost-neutral, except to
the extent that there is an increase in the volume of test
subjects.
EXISTING LAW provides for various programs relating to
treatment of persons with HIV and the acquired immune deficiency
syndrome (AIDS).
FISCAL EFFECT : Unknown
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, currently,
state funded HIV testing is contracted to counties which in
turn sub-contract with testing organizations. State law does
not address the HIV test counseling model that has been
developed by the DHS and implemented through contracts.
Because test counseling processes are enforced through
contract compliance, and because various counties administer
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these contracts, there has been variation in the flexibility
allowed to testing organizations. As a result, some testing
organizations are required through contract compliance to
engage in lengthy processes that may not be most appropriate
for their client base and that limit the number of people who
can be tested. Some testing organizations are having
difficulty testing all the people who wish to be tested
because the counseling protocols demand unnecessary attention
to low risk and serial testers. The purpose of this bill is
to focus resources where they are needed most.
2)DHS STAKEHOLDER MEETING . DHS Office of AIDS (OA) has
scheduled a one-day stakeholder meeting in Sacramento on May
17, 2006 to discuss changes in the programmatic requirements
and the reimbursement schedule of the HIV Counseling and
Testing Program. According to DHS, this review is being
conducted for a variety of reasons. The HIV counseling and
testing model has come under stress as a result of the
implementation of rapid HIV testing. Additionally, concerns
have been expressed by local health jurisdictions and
community-based organizations involved in HIV testing
regarding reimbursement rates and the possibility of adopting
additional methods of informing clients of their HIV status,
while continuing to recognize counseling as a critical
component for those in need. According to DHS, OA conducted
an internal analysis of the program and is attempting to
engage stakeholders in a thorough program review.
3)SUPPORT . The sponsor of this bill, AIDS Healthcare
Foundation (AHF), writes that counseling has evolved over the
years into something different depending on where it is
provided and is inconsistently implemented from county to
county. AHF contends that the current counseling model
required under contractual agreements has resulted in
impediments to testing in some counties because it is so
time-consuming that it limits the number of people that can be
tested. AHF states that it is the largest nonprofit provider
of testing services in the state and has been forced to turn
people away from testing on any given day because the
counseling requirements are so strenuous that there is
insufficient time to test all those who seek it. The San
Francisco AIDS Foundation and the Drug Policy Alliance Network
state that best practice models of HIV counseling have not
kept pace with the changes in the HIV/AIDS epidemic and the
current model employs the same process regardless of whether
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the test subject is at low or high risk of exposure and
whether the test subject is a repeat tester. The American
College of Obstetricians and Gynecologists, District IX writes
that the current clinic model required for counseling does not
take into account different needs to the low-risk and serial
testing populations. The Gay and Lesbian Adolescent Social
Services Inc. states that this bill recognizes that HIV
testing procedures have changed with the availability of rapid
testing and therefore the counseling module needs to be
modified with greater flexibility.
4)POLICY CONCERNS . This bill requires DHS to develop a
counseling model for all persons who receive HIV testing at a
site that receives state funding and specifies components that
must be considered in developing that model. However, the
bill does not require that sites receiving state funding use
the model. This bill also requires DHS to develop a
reimbursement schedule that reflects the services under the
counseling model, but offers no details on how the schedule
should be weighted and does not require DHS to reimburse
according to the schedule. A counseling model and
reimbursement schedule are currently mandated through
contracts between local health jurisdictions and the DHS and
the author's intent is for DHS to update the current
counseling model. It is unclear, however, why legislation is
necessary in order to achieve this goal when these changes
could be accomplished through changes in contractual
agreements. Finally, given that DHS has a meeting planned
with stakeholders for May 2006, it appears that this bill may
be premature.
5)TECHNICAL AMENDMENTS . Committee staff has suggested the
author replace "shall" with "should" on page 3, line 8.
REGISTERED SUPPORT / OPPOSITION :
Support
AIDS Healthcare Foundation (sponsor)
American College of Obstetricians and Gynecologists, District IX
Bienestar Human Services, Inc.
Drug Policy Alliance Network
Gay and Lesbian Adolescent Social Services Inc.
Lambda Letters Project
San Francisco AIDS Foundation
AB 2280
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Opposition
None on file.
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097