BILL ANALYSIS
AB 221
Page 1
Date of Hearing: May 6, 2009
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Kevin De Leon, Chair
AB 221 (Portantino) - As Introduced: February 4, 2009
Policy Committee: Health Vote:17-0
Business & Professions 10-1
Urgency: No State Mandated Local Program:
No Reimbursable:
SUMMARY
This bill authorizes HIV counselors to perform rapid testing
skin punctures without regard for current law phlebotomist
training if specified conditions are met. Specifically, this
bill:
1)Requires testing counselors to be supervised and authorized by
a licensed physician or surgeon to conduct rapid testing via
skin puncture.
2)Requires counselors to be trained for skin puncture testing
per requirements established by the Department of Public
Health in current law, a supervising physician, or a licensed
clinical laboratory scientist.
FISCAL EFFECT
1)No direct fiscal impact to authorize counselors meeting
specified oversight, training, and supervisory requirements to
conduct rapid HIV testing via skin punctures.
2)Minor savings to the extent rapid skin tests become less
administratively burdensome and costly to employers who are
required to provide approximately $2,500 in training per
employee to meet current phlebotomy training requirements.
3)Minor savings in testing costs to the extent this bill results
in a shift from a more expensive oral swab test ($12) to a
less expensive skin puncture test ($7). Due to recent budget
cuts, the statewide budget for HIV testing has been reduced
from $10.4 million to $9.8 million. This bill helps ensure
AB 221
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more people are tested with fewer resources.
4)Major potential savings per 10 infections prevented. $3
million in public savings will accrue to the extent this bill
results in informing 10 additional HIV-positive individuals of
their status who would otherwise not be tested. This estimate
assumes a $300,000 (cumulative lifetime savings) lifetime
savings per individual as quantified by research. Research
indicates many HIV positive individuals, once informed of
their status, make behavior changes that reduce transmission
of the virus.
COMMENTS
1)Rationale . This bill is co-sponsored by the San Francisco AIDS
Foundation and the AIDS Healthcare Foundation in Los Angeles,
two of California's largest non-profits supporting
HIV-positive individuals and HIV-prevention activities. This
bill reduces administrative burdens created by training
requirements. According to the author and sponsors, the rapid
test skin puncture procedures require less training that
currently required. This bill establishes a framework for
allowing counselors to conduct these rapid tests safely and
effectively and with adequate oversight to account for the
increased simplicity of testing.
2)Background . Current law authorizes DPH to participate with
the federal Centers for Disease Control and Prevention (CDC)
in a rapid HIV test program and authorizes an HIV counselor at
a DPH-funded HIV testing and counseling site to perform skin
punctures if the counselor meets prescribed requirements.
3)Concerns . The California Nurses Association (CNA) opposes this
bill. CNA is concerned about health care risk for Hepatitis
infection, for example, when skin punctures are used without
adequate training and oversight. CNA indicates dried blood in
clinical settings can remain active for at least a week. CNA
continues to support current law training requirements of 20
hours of training and 25 skin punctures for rapid testing as
addressed by this bill
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Supporters of this bill, including the California Medical
Association, the California Primary Care Association, and
Planned Parenthood Affiliates of California indicate the
balance this legislation strikes supports safe, effective
training of professionals and testing of individuals.
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081