BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 2541|
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THIRD READING
Bill No: AB 2541
Author: Portantino (D), et al
Amended: 8/20/10 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 8-0, 6/30/10
AYES: Alquist, Strickland, Aanestad, Cedillo, Leno,
Negrete McLeod, Pavley, Romero
NO VOTE RECORDED: Cox
SENATE APPROPRIATIONS COMMITTEE : 11-0, 8/12/10
AYES: Kehoe, Ashburn, Alquist, Corbett, Emmerson, Leno,
Price, Walters, Wolk, Wyland, Yee
SENATE HEALTH COMMITTEE : 7-0, 8/25/10
AYES: Alquist, Strickland, Aanestad, Leno, Negrete McLeod,
Pavley, Romero
NO VOTE RECORDED: Cedillo, Vacancy
ASSEMBLY FLOOR : 72-0, 05/20/10 (Consent) - See last page
for vote
SUBJECT : Reporting of certain communicable diseases
SOURCE : AIDS Healthcare Foundation
DIGEST : This bill deletes the HIV exemption from
authorized electronic reporting in order to increase
federal funding provided to California for HIV and AIDS
services.
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Senate Floor Amendments of 8/20/10 add language from a
related bill to avoid chaptering out conflicts, and to
explicitly provide disclosure authority to state and local
public health personnel for the purpose of providing
complete information regarding sexually transmitted disease
surveillance to the federal government.
ANALYSIS : Existing law:
1. Permits certain laboratory test results to be posted on
the Internet or other electronic method if requested by
the patient and deemed appropriate by the health care
provider who ordered the test.
2. Prohibits the electronic delivery of clinical laboratory
test results or any other related results for HIV
antibody tests, regardless of authorization.
3. Requires health care providers and clinical laboratories
to report HIV infection by patient name to the local
health officer, and mandates local health officers to
report unduplicated HIV cases by patient name to the
Department of Public Health (DPH).
4. Stipulates that public health records relating to HIV or
AIDS, containing personally identifying information,
developed or acquired by state or local public health
agencies or an agent of such an agency, shall be
confidential and shall not be disclosed, except as
provided by law for public health purposes or in
accordance with a written authorization by the person
who is the subject of the record or by his or her
guardian or conservator.
5. Allows state or local public health agencies, or an
agent of such an agency, to disclose personally
identifying information in public health records to
other local, state, or federal public health agencies or
to corroborating medical researchers, when the
confidential information is necessary to carry out the
duties of the agency or researcher in the investigation,
control, or surveillance of disease, as determined by
the state or local public health agency.
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6. Requires DPH to establish a list of communicable and
noncommunicable diseases and conditions which local
health officers are required to report to DPH. Exempts
from civil and criminal penalties any person or facility
that fails to provide notification of a reportable
disease or condition, unless the disease or condition
that is required to be reported has been printed in the
California Code of Regulations for at least six months.
Existing regulations:
1. Require that all reports containing personal
information, including HIV/AIDS Case Reports, shall be
sent to the local health officer (LHO) or his or her
designee by courier service, U.S. Postal Service Express
or registered mail, or other traceable mail, or by
person-to-person transfer with the LHO or his or her
designee.
2. Prohibit the health care provider and laboratory from
submitting reports containing personal information to
the LHO or his or her designee by electronic facsimile
transmission or by electronic mail or by non-traceable
mail.
3. Require all local health department (LHD) employees and
contractors to sign a HIV/AIDS Confidentiality Agreement
prior to accessing confidential HIV-related public
health records, required to be renewed annually.
4. Stipulate that information reported pursuant to these
regulations is acquired in confidence and shall not be
disclosed by the LHO or his or her authorized designee
except as authorized.
This bill:
1. Deletes the provision in existing law that that excludes
HIV infections from being reported electronically.
2. Describes the methods health care providers and LHOs may
submit cases of HIV infection, including facsimile and
electronically by a secure and confidential electronic
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reporting system established by the department, to be
implemented using the existing resources of the
department.
3. Adds a requirement that DPH establish a list of
communicable diseases and conditions for which clinical
laboratories shall submit a culture or a specimen to the
local public health laboratory to undergo further study.
4. Permits DPH to modify the list at any time, after
consultation with specified entities, without being
subject to regular rulemaking requirements under the
Administrative Procedures Act, but requires that DPH
file the revised list with the Secretary of State for
publication in the California Code of Regulations.
5. Exempts physicians, surgeons and clinical labs that fail
to submit cultures or specimens for mandatory diseases
from civil and criminal penalties, unless they had been
notified by DPH and the requirement had been noticed by
DPH for at least six months in the California Code of
Regulations.
6. Authorizes specified disclosures between specified local
public health agency staff, health care providers, and
specified state public health agency staff for the
purposes of enhancing completeness of STD reporting to
the federal Centers for Disease Control and Prevention
(CDC) and offering and coordinating care and treatment
services to HIV positive persons.
7. Increases the penalties for negligent, willful or
malicious disclosure of content of any confidential
public health record to a third party, except as
otherwise authorized by law.
8. Includes chaptering-out provisions.
Background
HIV/AIDS reporting
AIDS has been reportable in California for more than 20
years. Since AIDS cases represent later stages of the
disease, AIDS data are less useful than HIV data for public
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health professionals to monitor the epidemic, and target
and evaluate prevention programs. Historically, HIV has
been treated differently than many other diseases, due in
part to the misperceptions and stigmas associated with its
transmission. Under current law, HIV cannot be reported
electronically and must be reported using methods such as
hand delivery or registered mail. This handling of HIV
reporting is administratively burdensome and does not
maximize data matching opportunities to increase the
identification of HIV-positive patients. Public health
professionals found they needed accurate HIV case data in
addition to AIDS data to assess the spread and impact of
the HIV/AIDS epidemic.
To address this, in 1997, the CDC called for all states to
conduct HIV surveillance as an extension of their on-going
AIDS surveillance programs. CDC published draft guidelines
outlining criteria for ensuring the quality and
confidentiality of HIV data, which set forth the standard
data that needs to be collected from each patient (date of
diagnosis, demographics, risk exposure, etc.), and also set
performance standards that reporting systems must meet.
California responded to this need by implementing
code-based HIV reporting in July 2002. The code contains
information about the patient's gender, date of birth, and
a code derived from the last name and the last four digits
of their social security. Since then, local health
departments have reported over 33,000 cases of HIV,
representing more than 35 percent of reported cases of
individuals living with HIV/AIDS in California. However,
the CDC has since acknowledged that they consider HIV data
from code-based systems to be less reliable than name-based
systems, and would not accept the data and will not confirm
them for use in allocating Ryan White funds, putting some
of the state's federal grant money at risk. It is noted
that, at the time, the state used name-based reporting for
AIDS, and that California had had no documented or reported
cases of illegal or inappropriate disclosure of case
information from the state's AIDS Case Registry. To
address this, SB 699 (Soto) was passed in 2006 to report
HIV cases by patient's name rather than code in order to
comply with federal funding requirements.
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Communicable disease reporting and surveillance
California has a dual reporting system for communicable
diseases. Both health care providers (physicians) and
laboratories are required to report a case, or suspected
case, of notifiable diseases to public health officials.
They are both responsible for reporting dozens of named
conditions, as well as any outbreaks of unusual diseases,
within a specified timeframe of identifying the disease.
Laboratories report these specific conditions to the LHD,
based on the location of the physician's office. The
laboratory report may be submitted to the appropriate LHD
by various means including a phone call, facsimile, mail,
or electronically. Once the LHD receives a laboratory
disease report for a suspected or confirmed case, it
notifies the appropriate public health staff to manage and
track the case. LHDs then report disease case information
directly to the state.
Public health officials use disease reporting to monitor
public health, develop prevention strategies, set
priorities and evaluate programs, allocate resources and
facilitate research. While there are many surveillance
strategies, disease reporting originating from health care
providers and laboratories is at the core of surveillance.
Disease reporting is mandated by the California Code of
Regulations, and California requires health care providers
to confidentially report more than 80 diseases and
conditions to local health officers.
Electronic disease surveillance
At the national level, the CDC initiated an effort to
streamline the collection, management, and reporting of
data - primarily for the surveillance of communicable
diseases. In 1999, the CDC introduced the National
Electronic Disease Surveillance System (NEDSS), designed
to: (1) facilitate the electronic transfer of appropriate
information from clinical information systems used in the
delivery of health services to public health departments;
(2) reduce the burden on health service providers of
collecting and reporting such information; and, (3) enhance
the timeliness and quality of public health information.
In late 2002, the CDC introduced the concept of the Public
Health Information Network, to provide a network of
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information that functionally and organizationally
integrates public health partners across the country.
Other CDC initiatives promoting the integration of
technology in public health, in addition to NEDSS, include
the Health Alert Network, the Laboratory Response Network,
the Epidemic Information Exchange and the redesign of the
CDC website for public information and public health
education. CDC began providing funds to those public
health jurisdictions reporting public health data to CDC
and who are working to develop or procure applications that
comply with the specified requirements of their public
health information technology initiatives.
The California Department of Health Services (now under the
California Department of Public Health) initiated the
California Public Health Information Network (CalPHIN)
initiative to support the CDC efforts and promote the
public health goals of the state. Applications included
within the CalPHIN framework include the California
Electronic Laboratory Reporting (ELR), and the California
Web Based Morbidity Reporting, among others. The overall
objective of the Electronic Laboratory Reporting
application is to enhance and strengthen state and local
disease surveillance capacity and promote public health.
This type of application will improve the ability to
collect more complete and timely surveillance information
from laboratories on a statewide basis, and is used to
increase the efficiency of existing surveillance activities
and the early detection of public health events (e.g.
bioterrorism). This will be accomplished through
automating manual processes such as data importing and
accuracy verification, decreasing paper-based data
submittals, eliminating data redundancy and duplicate data
entry, and providing easy accessibility to data for
planning, analysis, and decision making.
Chapter 278 of Statutes of 2008 (AB 2658, Horton) requires
laboratories to submit all cases of reportable diseases and
conditions electronically within one year of the
establishment of the new state ELR system, which is slated
for completion in 2010. According to the LAO, HIV reports
were specifically excluded from this requirement in order
to allow DPH sufficient time to ensure the new system's
data architecture is not at variance with the HIV-specific
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reporting requirements and that the system would meet
federal standards for HIV reporting.
HIV/AIDS funding
California switched to name-based reporting in 2006 in
order to not risk major losses of federal Ryan White Act
funding. The state has since been in a transition period
between code-based reporting and full name-based reporting.
According to DPH estimates, California's failure to be
fully name-based in HIV reporting, meant the lost of $3
million to $7 million in federal funding in 2009.
According to the LAO, only about 36,000 cases of HIV have
been reported by name to local health jurisdictions. This
number likely represents only one-third to one-half of HIV
cases statewide. According to the LAO, California could
potentially increase receipt of federal Ryan White Act
funding by several million to low tens of millions of
dollars annually simply by increasing the number of HIV
infections reported. California spends roughly $1.2
billion a year (40 percent GF) on medical treatment and
HIV/AIDS programs. The Ryan White Act provides $125
million in federal funding per year to California.
Increased federal funds would likely be used to reduce GF
spending for the treatment of the disease.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12
2012-13 Fund
DPH add HIV module $75 ongoing minor
and General
to ELR system absorbable
Additional federal Cost
pressure in the hundreds of General
funds due to increasedthousands to millions of dollars
HIV case reportingin non-federal matching funds
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SUPPORT : (Verified 8/16/10 - unable to reverify)
AIDS Healthcare Foundation (source)
AIDS Project Los Angeles
American Federation of State, County and Municipal
Employees
ARGUMENTS IN SUPPORT : AIDS Project Los Angeles supports
this measure because they believe it will bring us closer
to a full and accurate database of people living with
HIV/AIDS in the state. They believe the existing
prohibition on electronic reporting has inhibited the
speedy and accurate reporting of HIV cases. The AIDS
Healthcare Foundation believes this bill will provide
additional tools for the state to improve its HIV
surveillance and better ensure our competitiveness for
federal Ryan White CARE Act dollars beginning in the 2012
award cycle. They claim that the state's plan has been to
implement SB 699 and strive for as mature a database as
possible by the 2012 funding award cycle, thereby
minimizing the loss of federal funding.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Bass, Beall,
Bill Berryhill, Tom Berryhill, Blakeslee, Block,
Blumenfield, Bradford, Brownley, Buchanan, Caballero,
Charles Calderon, Carter, Chesbro, Conway, Cook, Coto,
Davis, De Leon, DeVore, Emmerson, Eng, Feuer, Fong,
Fuentes, Fuller, Furutani, Gaines, Galgiani, Garrick,
Gilmore, Hagman, Hall, Hayashi, Hernandez, Hill, Huber,
Huffman, Jeffries, Jones, Knight, Lieu, Logue, Bonnie
Lowenthal, Ma, Mendoza, Miller, Monning, Nestande,
Niello, Nielsen, Norby, V. Manuel Perez, Portantino,
Ruskin, Salas, Saldana, Silva, Skinner, Smyth, Solorio,
Audra Strickland, Swanson, Torlakson, Torres, Torrico,
Tran, Yamada
NO VOTE RECORDED: De La Torre, Evans, Fletcher, Harkey,
Nava, Villines, John A. Perez
CTW:nl 8/27/10 Senate Floor Analyses
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SUPPORT/OPPOSITION: SEE ABOVE
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