BILL ANALYSIS

C.S.H.B. 2235

By: Jones, Venton

Public Health

Committee Report (Substituted)

BACKGROUND AND PURPOSE

According to the Department of State Health Services (DSHS), nearly 40 percent of new HIV infections are spread by individuals who are unaware of their HIV status. By default, a medical provider currently does not provide an HIV test as part of routine testing and the burden of testing is placed on patients who may assume that HIV testing is already included or who may think they are not at risk. This leaves, in particular, young people, women, and people of color vulnerable to assumption bias while seeking medical treatment. According to the CDC, approximately 42 percent of new HIV cases are found in Black people while 27 percent are Hispanic/Latino. Moreover, the CDC states that more than 57 percent of people diagnosed with HIV are age 34 or younger. According to DSHS, more than 20,000 people in Texas currently have HIV but do not know it and need testing. DSHS predicts that almost one-third of all people diagnosed with HIV progress to a diagnosis of AIDS within one year. This makes it imperative that those with HIV find out early and receive proper treatment. However, most patients have multiple visits in health care settings where HIV testing was not considered. C.S.H.B. 2235 seeks to address this issue by changing HIV testing from an opt-in service to an opt-out service and requiring that individuals who do receive a positive result be provided information on HIV health services and referrals to community support programs.

CRIMINAL JUSTICE IMPACT

It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.

RULEMAKING AUTHORITY

It is the committee's opinion that rulemaking authority is expressly granted to the executive commissioner of the Health and Human Services Commission in SECTIONS 2 and 3 of this bill.

ANALYSIS

C.S.H.B. 2235 amends the Health and Safety Code to authorize a health care provider who takes a sample of an individual's blood as part of a medical screening to submit the sample for an HIV diagnostic test regardless of whether an HIV test is part of a primary diagnosis, unless the individual opts out of the HIV test. The bill requires a health care provider, before taking a sample of an individual's blood as part of a medical screening, to obtain the individual's consent for an HIV diagnostic test or inform the individual that such a test will be performed unless the individual opts out. The bill requires health care providers submitting blood for an HIV test to provide to each individual who receives a positive test result information on available HIV health services and referrals to community support programs. The bill requires the executive commissioner of the Health and Human Services Commission (HHSC) to adopt rules to implement these provisions not later than January 1, 2024, and, in adopting those rules, to consider the most recent CDC recommendations for HIV testing of adults and adolescents. A health care provider is not required to comply with these provisions until January 1, 2024.

C.S.H.B. 2235 amends the Human Resources Code to require the executive commissioner, not later than January 1, 2024, to adopt rules that require HHSC to provide an HIV test during a medical screening in accordance with the bill's Health and Safety Code provisions to a Medicaid recipient.

C.S.H.B. 2235 provides for the delayed implementation of any provision for which an applicable state agency determines a federal waiver or authorization is necessary for implementation until the waiver or authorization is requested and granted. Implementation of a duty imposed by the bill during a state fiscal year is mandatory only if there is a specific appropriation made to HHSC for that purpose; however, HHSC may implement the provision in that fiscal year to the extent other funding is available to HHSC for the implementation. If HHSC does not implement a provision in a fiscal year on that basis, HHSC, in its legislative budget request for the next state fiscal biennium, must certify that fact to the Legislative Budget Board and include a written estimate of the costs of implementing the provision in each year of that biennium. The authority to suspend implementation expires on September 1, 2027, and any duty suspended due to a lack of funding becomes mandatory on that date.

EFFECTIVE DATE

September 1, 2023.

COMPARISON OF INTRODUCED AND SUBSTITUTE

While C.S.H.B. 2235 may differ from the introduced in minor or nonsubstantive ways, the following summarizes the substantial differences between the introduced and committee substitute versions of the bill.

The substitute revises the provision in the introduced requiring a health care provider, before taking a sample of an individual's blood as part of a medical screening, to obtain the individual's written consent for an HIV diagnostic test or verbally inform the individual that such a test will be performed unless the individual opts out by removing the specifications that the individual's consent be written and that the manner in which the provider must inform the individual that the test will be taken is verbally.

The substitute includes provisions not in the introduced providing for the delayed implementation of a provision of the bill if a federal waiver is needed and authorizing HHSC to temporarily delay implementation of a requirement imposed under the bill in a state fiscal year if no specific appropriation is made to HHSC for that purpose.