BILL ANALYSIS �
AB 1667
Page 1
Date of Hearing: April 30, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 1667 (Williams) - As Amended: April 2, 2014
Policy Committee: HealthVote:18-0
Education Vote: 7-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: Yes
SUMMARY
This bill replaces current mandatory tuberculosis (TB) testing
for school employees and volunteers with a TB risk assessment
and targeted testing structure, and requires testing only in
instances where individuals are deemed high-risk. It also:
1)Applies TB assessment requirements to individuals employed
under contract.
2)Requires the state Department of Public Health, in
consultation with the California TB Controllers Association,
to develop a TB risk assessment questionnaire for use by
schools.
FISCAL EFFECT
1)Minor staff costs, likely under $100,000 GF, to DPH to develop
regulations clarifying roles and responsibilities for TB
testing at schools, and a TB risk assessment questionnaire.
2)Unknown, potentially significant annual state reimbursable
mandate costs if schools are successful in filing mandate
claims for the imposition of a new TB risk assessment
requirement and the addition of contractors to the TB
requirements. As many school districts are choosing to
receive a block grant in lieu of filing mandate claims, actual
potential mandate costs are unknown, but costs could easily
exceed $150,000 annually.
COMMENTS
AB 1667
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1)Purpose . According to the author, the best public health and
medical evidence suggests that universal TB testing is neither
necessary nor cost-effective. As such, this bill seeks to
replace mandatory testing for all employees with a more
targeted approach.
2)Background . According to the Centers for Disease Control and
Prevention (CDC), TB is a bacterial infection that usually
infects the lungs. It can be spread through the air from one
person to another. Certain individuals are more likely to get
TB disease, and are recommended for TB testing. Current law
requires all school employees and volunteers be tested for TB.
CDC has stated that blanket testing of low-risk populations
should be replaced by targeted testing. This is particularly
important because there is a shortage of drugs used for TB
treatment, and the false positives generated by blanket
testing of low-risk populations can worsen the shortage and
subject individuals without TB to potentially toxic treatment
regimens.
3)Staff Comment . This bill does not specify who is responsible
for conducting risk assessments and making the determination
of who needs TB testing pursuant to the risk assessment. In
the absence of such specification, it is assumed DPH will need
to issue regulations to clarify roles. In addition, the lack
of such specification increases risk for confusion at the
school level with respect to who is responsible, and increases
the likelihood that mandate claims will be successful, as the
bill appears to require a new activity on the part of schools.
The author may wish to clarify the language to specify the
risk assessment/testing is conducted by a health care
professional and the school is only responsible for verifying
compliance with the assessment/testing requirement, similar to
what schools do under current law with respect to verifying
compliance with TB testing.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081