BILL ANALYSIS
AB 2280
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Date of Hearing: May 10, 2006
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Judy Chu, Chair
AB 2280 (Leno) - As Amended: April 25, 2006
Policy Committee: HealthVote:12-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires the Department of Health Services to develop
a counseling model for all persons who receive HIV testing at an
alternative test site or clinic that receives state funding for
HIV testing, and requires DHS to develop a reimbursement
schedule that accurately reflects the range of services provided
under this model. Specifically, this bill:
1)Requires DHS, in developing the counseling model, to seek
input from stakeholders, including, but not limited to, local
health jurisdictions and organizations that receive state
funding for HIV testing.
2)Requires DHS to consider including specified components in the
counseling model, including a brief risk-assessment mechanism
that allows a clinic to ascertain whether a person seeking
testing is at low or high risk of exposure to HIV, a
self-administered data collection form with only state and
federally required questions, a prevention education module
that comprehensively covers all pertinent information relative
to methods by which a person can protect himself or herself or
his or her sexual or needle-sharing partners from exposure to
HIV, 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,
flexibility for clinics to provide counseling to couples or
small groups, as appropriate, and additional counseling for a
test subject whose preliminary test result is positive.
3)Requires the reimbursement schedule to ensure that a
contractor is reimbursed for individual services, as defined
in the counseling model.
AB 2280
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4)States legislative intent that a new HIV counseling model be
developed that allows clinics to increase the number of
persons seeking an HIV test to be able to be tested, and
appropriately reimburses clinics for the services provided to
those persons.
FISCAL EFFECT
Assuming this bill results in a counseling model that permits
greater testing volume, this bill would likely result in
additional GF costs in excess of $1 million annually. For
example, if there is a 25% increase in testing as a result of
changes made to the counseling model, costs would increase by
$1.7 million GF. These costs may be partially offset if the
counseling model results in lower reimbursement for counseling.
This bill states legislative intent that the new counseling
model and reimbursement schedule be cost-neutral, except to the
extent that there is an increase in the volume of test subjects.
COMMENTS
1)Purpose . This bill is sponsored by the AIDS Healthcare
Foundation (AHF), which argues that counseling has evolved
over the years 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 it is the largest nonprofit provider of
testing services in the state, and it 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 author argues some testing organizations are required
through contract compliance to engage in lengthy processes
that may not be appropriate for their client base, and this
limits the number of people who can be tested. Additionally,
some testing organizations are having difficulty testing all
of 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.
AB 2280
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2)Background . State law does not address the HIV test
counseling model developed by DHS and implemented through
contracts. Because test counseling processes are enforced
through contract compliance, and because various counties
administer these contracts, there has been variation in the
flexibility allowed to testing organizations. DHS indicates
the current number of state-funded tests administered annually
is 150,000 at a cost of approximately $8.5 million, 95% ($8.1
million) of which was GF.
DHS' Office of AIDS 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.
Analysis Prepared by : Scott Bain / APPR. / (916) 319-2081