BILL ANALYSIS
AB 2541
Page 1
Date of Hearing: April 20, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 2541 (Portantino and Fletcher) - As Amended: April 13, 2010
SUBJECT : Reporting of certain communicable diseases.
SUMMARY : Deletes the exemption from the electronic reporting
requirement for Human immunodeficiency virus (HIV) infections
and requires the chief medical officer of an adult prison to
report HIV infections, using the name of the patient, to the
local health officer (LHO) of the jurisdiction where the inmate
resided prior to incarceration.
EXISTING LAW :
1)Requires health care providers and laboratories to report
cases of HIV infection to the LHO using patient names.
Requires LHOs to report unduplicated HIV cases by name to DPH.
2)Requires laboratories to submit disease reports on reportable
diseases, except HIV, to the LHO electronically, and requires
the Department of Public Health (DPH) to specify the reporting
mechanism and timeliness requirements for laboratory reports.
3)Requires each county to make HIV tests available within its
jurisdiction on an anonymous, rather than confidential, basis,
as specified.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill will
ensure that California maintains federal funds and works
toward having a complete count of HIV positive individuals in
California. The author cites a recent Legislative Analyst's
Office (LAO) report that states that California has only
collected roughly 36,000 cases of HIV reported by name out of
an estimated 68,000 to 106,000 persons living with HIV. The
LAO recommends that the Department of Corrections and
Rehabilitation be authorized to exchange HIV data with state
and local public health officials, and that HIV reports be
AB 2541
Page 2
included in the state's new electronic reporting system.
2)BACKGROUND . The LAO states that California spends roughly
$1.2 billion a year ($455 million from the General Fund) on
medical treatment and HIV/AIDS programs. In 2005, Congress
reauthorized the Ryan White Comprehensive AIDS Resources
Emergency (CARE) Act, which is the main federal funding source
for HIV/AIDS programs. While the initial version of the Act
required states to report HIV and AIDS cases by name, a
compromise was eventually reached to allow states like
California, who reported cases by using a code-based system,
from losing federal funds. However, states were expected to
immediately begin reporting HIV infections by name. In
response, the Legislature enacted SB 699 (Soto) Chapter 20,
Statutes of 2006, which requires health care providers and
laboratories to report HIV cases by the patient's name rather
than code beginning in 2006. In 2009, the reauthorized
version of the CARE Act increases the penalty for states that
do not report HIV and AIDS cases by name beginning in 2012.
Federal funds will be allocated based entirely on the number
of HIV and AIDS cases reported by names by 2013. DPH
estimates that code-based reporting cost California $3.5-$6.5
million in federal funds in 2009, which is due to penalties
that result from California's history of having non-names
based HIV reporting until 2006.
According to a February 2010 report by the LAO, California still
lacks a complete names-based list of HIV cases, which puts our
state at risk of losing federal HIV/AIDS funds. The LAO made
the following policy suggestions to enhance reporting of HIV
and AIDS cases and draw down more federal funds: Include HIV
reporting in the new DPH electronic database; clarify that
correctional health systems are authorized to exchange
confidential public health data for the purpose of public
health surveillance; require Office of Aids (OA) to assess the
discrepancy between various databases by regularly cross
checking the data; and require OA to annually report to the
Legislature its progress toward addressing the data gap.
Shortly after the release of the LAO report, DPH responded to
their recommendations. Using data from 2007, DPH cross
checked between care and treatment databases and the HIV/AIDS
surveillance database and found that 100% of persons with AIDS
receiving state services were reported in the surveillance
AB 2541
Page 3
system. However, DPH found that 31% of AIDS Drug Assistance
Program (ADAP) clients and 42% of AIDS Regulation Information
and Evaluation System (ARIES) clients were not reported in the
state surveillance system. As a result, OA sent a letter on
August 3, 2009 to ADAP and ARIES providers, HIV/AIDS
surveillance coordinators, California Conference of Local AIDS
Directors, and California Conference of Local Health Officers
members alerting them of the problem of under reporting and
encouraging them to work with local ADAP and ARIES providers
to identify underreported individuals, and providers and labs
that are failing to report HIV cases to LHOs. DPH states that
OA will perform annual cross checks between HIV/AIDS data
bases.
3)ELECTRONIC REPORTING SYSTEM . AB 2658, Horton, Chapter 449,
Statutes of 2008 requires laboratories to submit all cases of
"reportable diseases and conditions" electronically, within
one year of the establishment of the new state electronic
laboratory reporting system. However, the bill exempted HIV
reports from this requirement to allow DPH sufficient time to
ensure the new system's data architecture is in line with
HIV-specific reporting requirements and that the system would
meet federal standards for HIV reporting. As a result,
laboratories still report HIV by using methods of hand
delivery or registered mail.
4)SUPPORT . According to the sponsor, AIDS Healthcare
Foundation, this bill will implement two important
recommendations by the LAO, ensuring that California does not
lose federal funds for HIV/AIDS health care programs. Given
the current fiscal climate, and the fact that the number of
HIV transmissions is increasing each year, California cannot
afford to lose any additional revenue for these vital
programs.
REGISTERED SUPPORT / OPPOSITION :
Support
AIDS Healthcare Foundation (sponsor)
Opposition
AB 2541
Page 4
None on file.
Analysis Prepared by : Martin Radosevich / HEALTH / (916)
319-2097