Florida Senate - 2012 COMMITTEE AMENDMENT
Bill No. CS for SB 478
Barcode 368304
LEGISLATIVE ACTION
Senate . House
Comm: FAV .
01/27/2012 .
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The Committee on Budget Subcommittee on Health and Human
Services Appropriations (Sobel) recommended the following:
1 Senate Amendment (with title amendment)
2
3 Between lines 10 and 11
4 insert:
5 Section 2. Section 381.9815, Florida Statutes, is created
6 to read:
7 381.9815 Hepatitis virus; surveillance, education, and
8 testing.—
9 (1) SHORT TITLE.—This act may be cited as the “Viral
10 Hepatitis Testing Act.”
11 (2) HEPATITIS B AND HEPATITIS C SURVEILLANCE, EDUCATION,
12 AND TESTING PROGRAMS.—The Department of Health shall, in
13 accordance with this section, carry out surveillance, education,
14 and testing programs with respect to hepatitis B and hepatitis C
15 virus infections. The department may carry out such programs
16 directly and through grants to public and nonprofit private
17 entities, including counties, political subdivisions, and
18 public-private partnerships.
19 (3) STATEWIDE GOALS.—In carrying out the duties prescribed
20 in subsection (2), the department shall cooperate with counties
21 and other public or nonprofit private entities to seek to
22 establish a statewide system of surveillance, education, and
23 testing with respect to hepatitis B and hepatitis C with the
24 following goals:
25 (a) To determine the incidence and prevalence of such
26 infections, including providing for the reporting of chronic
27 cases.
28 (b) With respect to the population of individuals who have
29 such an infection, to carry out testing programs to increase the
30 number of individuals who are aware of their infection to 50
31 percent by 2014 and 75 percent by 2016.
32 (c) To develop and disseminate public information and
33 education programs for the detection and control of hepatitis B
34 and hepatitis C infections, with priority given to changing
35 behaviors that place individuals at risk of infection.
36 (d) To provide appropriate referrals for counseling and
37 medical treatment of infected individuals and to ensure, to the
38 extent practicable, the provision of appropriate followup
39 services.
40 (e) To improve the education, training, and skills of
41 health professionals in the detection, control, and treatment of
42 hepatitis B and hepatitis C infections, with priority given to
43 pediatricians and other primary care physicians, and
44 obstetricians and gynecologists.
45 (4) HIGH-RISK POPULATIONS; CHRONIC CASES.—The department
46 shall determine the populations that, for purposes of this
47 section, are considered at high risk for hepatitis B or
48 hepatitis C. The department shall include the following among
49 those considered at high risk:
50 (a) For hepatitis B, individuals born in counties in which
51 2 percent or more of the population has hepatitis B.
52 (b) For hepatitis C, individuals born between 1945 and
53 1965.
54 (c) Those who have been exposed to the blood of infected
55 individuals or of high-risk individuals, are family members of
56 such individuals, or are sexual partners of such individuals.
57 (5) PROGRAM PRIORITY.—In providing for programs under this
58 section, the department shall give priority to:
59 (a) Early diagnosis of chronic cases of hepatitis B or
60 hepatitis C in high-risk populations; and
61 (b) Education, and referrals for counseling and medical
62 treatment, for individuals diagnosed under paragraph (a) in
63 order to:
64 1. Reduce their risk of dying from end-stage liver disease
65 and liver cancer and of transmitting the infection to others.
66 2. Determine the appropriateness for treatment to reduce
67 the risk of progression to cirrhosis and liver cancer.
68 3. Receive ongoing medical management, including regular
69 monitoring of liver function and screenings for liver cancer.
70 4. Receive, as appropriate, drug, alcohol abuse, and mental
71 health treatment.
72 5. In the case of women of childbearing age, receive
73 education on how to prevent hepatitis B perinatal infection and
74 alleviate fears associated with pregnancy or raising a family.
75 6. Receive such other services as the department determines
76 to be appropriate.
77 (6) CULTURAL CONTEXT.—In providing for services for
78 individuals who are diagnosed under paragraph (5)(a), the
79 department shall seek to ensure that the services are provided
80 in a culturally and linguistically appropriate manner.
81 (7) REPORT.—The department shall prepare a report on the
82 implementation of the programs required under this section, the
83 effectiveness of such programs, and the progress made in
84 achieving the statewide goals established under this section.
85 The report shall be submitted to the President of the Senate,
86 the Speaker of the House of Representatives, and the committees
87 having jurisdiction over issues relating to public health no
88 later than January 31 of each year. The report must also
89 address:
90 (a) Effectiveness issues with respect to current guidelines
91 of the Centers for Disease Control and Prevention for screenings
92 for hepatitis virus infection.
93 (b) The importance of responding to the perception that
94 receiving such screenings may be stigmatizing.
95 (c) Whether age-based screenings would be effective,
96 considering the use of age-based screenings with respect to
97 breast and colon cancer.
98 (d) New and improved treatments for hepatitis virus
99 infection.
100
101 ================= T I T L E A M E N D M E N T ================
102 And the title is amended as follows:
103 Delete line 5
104 and insert:
105 awareness program; creating s. 381.9815, F.S.;
106 creating the “Viral Hepatitis Testing Act”; providing
107 a short title; requiring that the Department of Health
108 carry out surveillance, education, and testing
109 programs with respect to hepatitis B and hepatitis C
110 virus infections; requiring that the department
111 establish a statewide system for such surveillance,
112 education, and testing; specifying goals of the
113 system; requiring that the department determine
114 populations within the state which are considered at
115 high risk for hepatitis B or hepatitis C; providing
116 for priority of programs; requiring that the
117 department seek to ensure that specified services are
118 provided in a culturally and linguistically
119 appropriate manner; requiring an annual report to the
120 Legislature; providing an effective date.
121
122 WHEREAS, approximately 5.3 million Americans are
123 chronically infected with the hepatitis B virus, referred to in
124 this preamble as “HBV,” the hepatitis C virus, referred to in
125 this preamble as “HCV,” or both, and
126 WHEREAS, in the United States, chronic HBV and HCV are the
127 most common causes of liver cancer, one of the most lethal and
128 fastest growing cancers in the United States. Chronic HBV and
129 HCV are the most common causes of chronic liver disease, liver
130 cirrhosis, and the most common indication for liver
131 transplantation. Chronic HCV is also a leading cause of death in
132 Americans living with HIV/AIDS, many of whom are coinfected with
133 chronic HBV, HCV, or both. At least 15,000 deaths per year in
134 the United States can be attributed to chronic HBV and HCV, and
135 WHEREAS, according to the Centers for Disease Control and
136 Prevention, referred to in this preamble as the “CDC,”
137 approximately 2 percent of the population of the United States
138 is living with chronic HBV, HCV, or both. The CDC has recognized
139 HCV as the nation’s most common chronic bloodborne virus
140 infection and HBV as the deadliest vaccine-preventable disease,
141 and
142 WHEREAS, HBV is easily transmitted and is 100 times more
143 infectious than HIV. According to the CDC, HBV is transmitted
144 percutaneously, by puncture through the skin, or through mucosal
145 contact with infectious blood or body fluids. HCV is transmitted
146 by percutaneous exposures to infectious blood, and
147 WHEREAS, the CDC conservatively estimates that in 2008,
148 approximately 18,000 Americans were newly infected with HCV and
149 more than 38,000 Americans were newly infected with HBV, and
150 WHEREAS, there were 10 outbreaks reported to the CDC for
151 investigation in 2009 related to healthcare acquired infection
152 of HBV and HCV. There were another 6,748 patients potentially
153 exposed to one of the viruses, and
154 WHEREAS, chronic HBV and chronic HCV usually do not cause
155 symptoms early in the course of the disease but, after many
156 years of a clinically “silent” phase, CDC estimates show that
157 more than 33 percent of infected individuals develop cirrhosis,
158 end-stage liver disease, or liver cancer. Since most individuals
159 with chronic HBV, HCV, or both are unaware of their infection,
160 they do not know to take precautions to prevent the spread of
161 their infection and can unknowingly exacerbate their own disease
162 progression, and
163 WHEREAS, HBV and HCV disproportionately affect certain
164 populations in the United States. Although representing only 5
165 percent of the population, Asian and Pacific Islanders account
166 for more than half of the 1.4 million domestic chronic HBV
167 cases. Baby boomers born between 1945 and 1965 account for more
168 than 75 percent of domestic chronic HCV cases. In addition,
169 African-Americans, Latinos and Latinas, American Indians, and
170 Native Alaskans are among the groups that have
171 disproportionately high rates of HBV infections, HCV infections,
172 or both in the United States, and
173 WHEREAS, for both chronic HBV and chronic HCV, behavioral
174 changes can slow disease progression if diagnosis is made early.
175 Early diagnosis, which is determined through simple diagnostic
176 tests, can reduce the risk of transmission and disease
177 progression through education and vaccination of household
178 members and other susceptible persons at risk, and
179 WHEREAS, advancements have led to the development of
180 improved diagnostic tests for viral hepatitis. These tests,
181 including rapid, point-of-care testing and other forms of
182 testing in development can facilitate diagnosis, notification of
183 results, post-test counseling, and referral to care at the time
184 of the testing visit. In particular, these tests are also
185 advantageous because they can be used simultaneously with HIV
186 rapid testing for persons at risk for both HCV and HIV
187 infections, and
188 WHEREAS, for those chronically infected with HBV or HCV,
189 regular monitoring can lead to the early detection of liver
190 cancer at a stage at which a cure is still possible. Liver
191 cancer is the second deadliest cancer in the United States.
192 However, liver cancer has received little funding for research,
193 prevention, or treatment, and
194 WHEREAS, treatment for chronic HCV can eradicate the
195 disease in approximately 75 percent of those currently treated.
196 The treatment of chronic HBV can effectively suppress viral
197 replication in the overwhelming majority, or more than 80
198 percent, of those treated, thereby reducing the risk of
199 transmission and progression to liver scarring or liver cancer,
200 even though a complete cure is much less common than for HCV,
201 and
202 WHEREAS, to combat the viral hepatitis epidemic in the
203 United States, in May 2011, the United States Department of
204 Health and Human Services released, “Combating the Silent
205 Epidemic of Viral Hepatitis: Action Plan for the Prevention,
206 Care & Treatment of Viral Hepatitis.” The Institute of Medicine
207 of the National Academies produced a 2010 report on the federal
208 response to HBV and HCV titled “Hepatitis and Liver Cancer: A
209 National Strategy for Prevention and Control of Hepatitis B and
210 C.” The recommendations and guidelines provide a framework for
211 HBV and HCV prevention, education, control, research, and
212 medical management programs, and
213 WHEREAS, the annual health care costs attributable to viral
214 hepatitis in the United States are significant. For HBV, it is
215 estimated to be approximately $2.5 billion, or $2,000 per
216 infected person. In 2000, the lifetime cost of HBV, before the
217 availability of most of the current therapies, was approximately
218 $80,000 per chronically infected person, or more than $100
219 billion. For HCV, medical costs for patients are expected to
220 increase from $30 billion in 2009 to more than $85 billion in
221 2024. Avoiding these costs by screening and diagnosing
222 individuals earlier and connecting them to appropriate treatment
223 and care will save lives and critical health care dollars.
224 Currently, without a comprehensive screening, testing, and
225 diagnosis program, most patients are diagnosed too late when
226 they need a liver transplant costing at least $314,000 for
227 uncomplicated cases or, when the patient has liver cancer or
228 end-stage liver disease, costing between $30,980 and $110,576
229 per hospital admission. As health care costs continue to grow,
230 it is critical that the Federal Government make investments in
231 effective mechanisms to avoid documented cost drivers, and
232 WHEREAS, according to the Institute of Medicine report in
233 2010, chronic HBV and HCV infections cause substantial morbidity
234 and mortality despite being preventable and treatable.
235 Deficiencies in the implementation of established guidelines for
236 the prevention, diagnosis, and medical management of chronic HBV
237 and HCV infections perpetuate personal and economic burdens.
238 Existing grants are not sufficient for the scale of the health
239 burden presented by HBV and HCV, and
240 WHEREAS, screening and testing for chronic HBV and HCV are
241 aligned with the United States Department of Health and Human
242 Services’ Healthy People 2020 goal to increase immunization
243 rates and reduce preventable infectious diseases. Awareness of
244 disease and access to prevention and treatment remain essential
245 components for reducing infectious disease transmission, and
246 WHEREAS, support is necessary to increase knowledge and
247 awareness of HBV and HCV and to assist both federal and local
248 prevention and control efforts in reducing the morbidity and
249 mortality of these epidemics, NOW, THEREFORE,