Amended IN Senate June 10, 2024 Amended IN Assembly February 27, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2132Introduced by Assembly Member Low(Coauthors: Assembly Members Ting, Mike Fong, and Gipson)(Coauthors: Senators Durazo and Wiener)February 06, 2024An act to add Section 1316.8 to the Health and Safety Code, relating to health care services.LEGISLATIVE COUNSEL'S DIGESTAB 2132, as amended, Low. Health care services.Existing law provides for the licensure and regulation of health facilities and clinics, including primary care clinics, by the State Department of Public Health. A violation of these provisions is a crime. Existing law requires an adult patient receiving primary care services in certain health care settings to be offered a screening test for hepatitis B and hepatitis C, as specified.This bill would require an adult patient receiving primary a patient who is 18 years of age or older receiving health care services in a facility, clinic, unlicensed clinic, center, office, or other setting, as specified, to be offered a the tuberculosis (TB) risk assessment and TB screening test, if TB risk factors are identified, to the extent these services are covered under the patients health insurance, unless the health care provider reasonably believes certain conditions apply. except as specified. The bill would also require the health care provider or health care entity to offer the patient followup health care or refer the patient to a health care provider who can provide followup health care if a screening test is positive, as specified. positive. The bill would prohibit a health care provider who fails to comply with these provisions from being subject to any disciplinary action related to their licensure or certification, or to any civil or criminal liability liability, for that failure. The bill would require the State Department of Public Health to work with stakeholders to implement these provisions and notify primary care facilities about these provisions. The bill would make related findings and declarations.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NOYES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares all of the following:(a) According to the World Health Organization, an estimated 10,600,000 people fell ill with tuberculosis (TB) during 2022. Despite being a preventable and curable disease, 1,300,000 people died from TB in 2022, making it the worlds second leading infectious killer after COVID-19.(b)According to the federal Centers for Disease Control and Prevention, TB incidence in the United States increased during 2022, compared with that during 2020 and 2021, but remained lower than incidence during the prepandemic years. After a substantial 20.2-percent decline in 2020 and partial rebound (a 9.8-percent increase) in 2021, incidence appears to be returning to prepandemic levels among United States-born and non-United States-born populations.(c)TB is a life-threatening disease. It spreads through the air with profound medical and economic consequences. More than 2,000,000 Californians (6 percent of the population) are infected with TB, of whom only 20 percent are aware of their infection and just 12 percent have been treated. In 2022, California reported 1,848 new TB cases (a 5-percent increase from the 1,749 cases in 2021), approximately 5 (4.7) out of every 100,000 California residents. This is nearly double the national TB incidence of 2.5 out of every 100,000 persons. Among people with TB disease, one-half are hospitalized and one in six dies within five years of diagnosis. TB hospitalizations are twice as expensive as and four times longer than hospitalizations for other conditions, which is usually about 11 days. In 2022, California medical and societal costs of TB reached $217,000,000.(d)TB does not impact Californians equally. Those born in countries where TB is endemic, and those living in economically disadvantaged communities, are more often impacted by TB disease. The TB disease rate among people born outside the United States is 13 times higher than United States-born persons. TB disease rates among people who are non-United States-born Asian or Black are 73 and 38 times higher, respectively, than United States-born White people. The TB disease rate among non-United States-born Hispanic people is 34 times that of United States-born White people. Furthermore, persons living in census tracts with low socioeconomic status have higher TB disease incidence rates than those living in high socioeconomic status census tracts, whether measured by education level, poverty, crowding, or California Healthy Places Index (HPI) quartiles. Additionally, persons with TB disease who experience homelessness are 30 percent more likely to die with TB disease than those not experiencing homelessness.(b) According to the federal Centers for Disease Control and Prevention, TB incidence in the United States increased 16 percent during 2023 as compared to 2022, returning to the number of TB cases last observed in 2013. Since 2020, TB case counts and rates have increased each year. This postpandemic increase in cases highlights the importance of continuing to engage communities with higher TB rates and their medical providers in TB elimination efforts and strengthening the capacity of public health programs to carry out critical disease control and prevention strategies.(c) TB is a life-threatening disease. It spreads through the air with profound medical and economic consequences. More than 2,000,000 Californians (6 percent of the population) have a latent TB infection (LTBI), of whom only 23 percent are aware of their infection and just 13 percent have been treated. In 2023, California reported 2,113 new active TB disease cases (a 15-percent increase from the 1,842 cases in 2022) with an incidence of 5.4 cases out of every 100,000 California residents. This is nearly double the national TB incidence of 2.9 out of every 100,000 people. TB cases in California have increased every year since 2020, representing a total increase of 24 percent over the last four years, returning to case numbers not seen since before the COVID-19 pandemic. Among people with TB disease, one-half are hospitalized and one in six dies within five years of diagnosis. A TB hospitalization is twice as expensive as, and four times longer than, a hospitalization for other conditions, which is usually about 11 days. In 2023, California medical and societal costs of TB reached $265,000,000. (d) TB does not impact Californians equally. People born in countries where TB is endemic and people living in economically disadvantaged communities are more often impacted by TB. The TB disease rate among people born outside the United States is 13 times higher than United States-born people. TB disease rates among a person who is non-United States-born Asian or Black are 43 and 28 times higher, respectively, than a United States-born White person. The TB disease rate among non-United States-born Hispanic people is 21 times that of a United States-born White person. Furthermore, people living in census tracts with low socioeconomic status have higher TB disease incidence rates than those living in high socioeconomic status census tracts, whether measured by education level, poverty, crowding, or California Healthy Places Index quartiles. Additionally, a person with TB disease who is experiencing homelessness is 30 percent more likely to die with TB disease than a person who is not experiencing homelessness.(e) The bacteria that causes TB can remain in a latent status for many years without symptoms. Detection of LTBI by a screening test, followed by preventive treatment, can greatly reduce the risk of later active TB disease. Assessment based on TB risk factors identified in the latest United States Preventive Services Task Force screening recommendations and present in the California TB risk assessment can help identify persons who may have undiagnosed latent TB infection, or active TB disease if further diagnostic testing indicates, so it can be treated.(e)(f) Currently, high-risk patients receiving primary care services do not routinely undergo a TB risk assessment and TB screening test. TB risk assessments and TB screening tests with followup for positive results.SEC. 2. Section 1316.8 is added to the Health and Safety Code, to read:1316.8. (a) An adult patient A patient who is 18 year of age or older and who receives primary health care services in a facility, clinic, unlicensed clinic, center, office, or other setting where primary care services are provided, shall be offered a the tuberculosis (TB) risk assessment distributed by the State Department of Public Health and TB screening test, if TB risk factors are identified, to the extent these services are covered under the patients health insurance, based on the latest screening indications recommended by the United States Preventive Services Task Force, unless the health care provider reasonably believes that one of the following conditions applies: Force.(b) Subdivision (a) does not apply if any of the following situations exist unless a health care provider determines that the TB risk assessment, TB screening test, or both, should be offered again:(1) The patient is being treated for a life-threatening emergency.(2) (A)The patient has previously been offered or has been the subject of a the TB risk assessment, TB screening test, or both, and has no new TB risk factors since the last TB risk assessment or TB screening test.(B)This paragraph does not apply if the health care provider determines that a TB risk assessment, TB screening test, or both should be offered again.(3) (A) The patient has had a documented, previously positive Interferon-Gamma Release Assays Assay (IGRA) test or has previously tested positive for a latent tuberculosis TB infection (LTBI).(B) If the patient has no documented followup health care, followup is required in accordance with subdivision (c).(4) The patient lacks capacity to consent to a the TB risk assessment, TB screening test, or both.(5)The patient is being treated in the emergency department of a general acute care hospital, as defined in subdivision (a) of Section 1250.(b)(c) If a patient accepts the offer of the TB screening test and the test is positive, a health care provider or health care entity shall offer the patient followup health care or refer the patient to a health care provider who can provide followup health care.(d) This section does not apply to the emergency department of a general acute care hospital as defined in subdivision (a) of Section 1250.(c)(e) This section shall not affect the scope of practice of any health care provider or diminish any authority or legal or professional obligation of any health care provider to offer a TB risk assessment, TB screening test, or both, or to provide services or care for the patient of a TB risk assessment, TB screening test, or both.(d)(f) A health care provider that fails to comply with the requirements of this section shall not be subject to any disciplinary actions related to their licensure or certification, or to any civil or criminal liability, because of the health care providers failure to comply with the requirements of this section.(e)(g) Section 1290 does not apply to a violation of this section.(h) The State Department of Public Health shall do both of the following:(1) Work with stakeholders, including, but not limited to, primary care clinics, health care providers, and TB experts, to implement this section.(2) Notify primary care facilities about the requirements of this section.(f)(i) For purposes of this section, the following definitions apply:(1) Followup health care includes evaluating the patient for a diagnosis of TB infection or active TB disease and providing medical management and treatment for TB according to the latest national clinical practice guidelines recommended by the federal Centers for Disease Control and Prevention and the American Thoracic Society. Prevention, the American Thoracic Society, or the State Department of Public Health for California-specific TB management.(2) Health care entity includes a payer, provider, or fully integrated health care system.(2)(3) Tuberculosis risk assessment or TB risk assessment means a risk assessment questionnaire the California Adult Tuberculosis Risk Assessment and User Guide developed by the State Department of Public Health, in consultation with the California Tuberculosis Controllers Association, to be used to conduct TB risk assessments and identify TB risk factors pursuant to this section.(3)(4) Tuberculosis screening test or TB screening test means either an approved intradermal tuberculin test skin test (TST), IGRA blood test, which is the preferred approach, or any other test for TB infection that is recommended by the federal Centers for Disease Control and Prevention and licensed by the United States Food and Drug Administration.
Amended IN Senate June 10, 2024 Amended IN Assembly February 27, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2132Introduced by Assembly Member Low(Coauthors: Assembly Members Ting, Mike Fong, and Gipson)(Coauthors: Senators Durazo and Wiener)February 06, 2024An act to add Section 1316.8 to the Health and Safety Code, relating to health care services.LEGISLATIVE COUNSEL'S DIGESTAB 2132, as amended, Low. Health care services.Existing law provides for the licensure and regulation of health facilities and clinics, including primary care clinics, by the State Department of Public Health. A violation of these provisions is a crime. Existing law requires an adult patient receiving primary care services in certain health care settings to be offered a screening test for hepatitis B and hepatitis C, as specified.This bill would require an adult patient receiving primary a patient who is 18 years of age or older receiving health care services in a facility, clinic, unlicensed clinic, center, office, or other setting, as specified, to be offered a the tuberculosis (TB) risk assessment and TB screening test, if TB risk factors are identified, to the extent these services are covered under the patients health insurance, unless the health care provider reasonably believes certain conditions apply. except as specified. The bill would also require the health care provider or health care entity to offer the patient followup health care or refer the patient to a health care provider who can provide followup health care if a screening test is positive, as specified. positive. The bill would prohibit a health care provider who fails to comply with these provisions from being subject to any disciplinary action related to their licensure or certification, or to any civil or criminal liability liability, for that failure. The bill would require the State Department of Public Health to work with stakeholders to implement these provisions and notify primary care facilities about these provisions. The bill would make related findings and declarations.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NOYES Local Program: NO
Amended IN Senate June 10, 2024 Amended IN Assembly February 27, 2024
Amended IN Senate June 10, 2024
Amended IN Assembly February 27, 2024
CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION
Assembly Bill
No. 2132
Introduced by Assembly Member Low(Coauthors: Assembly Members Ting, Mike Fong, and Gipson)(Coauthors: Senators Durazo and Wiener)February 06, 2024
Introduced by Assembly Member Low(Coauthors: Assembly Members Ting, Mike Fong, and Gipson)(Coauthors: Senators Durazo and Wiener)
February 06, 2024
An act to add Section 1316.8 to the Health and Safety Code, relating to health care services.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 2132, as amended, Low. Health care services.
Existing law provides for the licensure and regulation of health facilities and clinics, including primary care clinics, by the State Department of Public Health. A violation of these provisions is a crime. Existing law requires an adult patient receiving primary care services in certain health care settings to be offered a screening test for hepatitis B and hepatitis C, as specified.This bill would require an adult patient receiving primary a patient who is 18 years of age or older receiving health care services in a facility, clinic, unlicensed clinic, center, office, or other setting, as specified, to be offered a the tuberculosis (TB) risk assessment and TB screening test, if TB risk factors are identified, to the extent these services are covered under the patients health insurance, unless the health care provider reasonably believes certain conditions apply. except as specified. The bill would also require the health care provider or health care entity to offer the patient followup health care or refer the patient to a health care provider who can provide followup health care if a screening test is positive, as specified. positive. The bill would prohibit a health care provider who fails to comply with these provisions from being subject to any disciplinary action related to their licensure or certification, or to any civil or criminal liability liability, for that failure. The bill would require the State Department of Public Health to work with stakeholders to implement these provisions and notify primary care facilities about these provisions. The bill would make related findings and declarations.
Existing law provides for the licensure and regulation of health facilities and clinics, including primary care clinics, by the State Department of Public Health. A violation of these provisions is a crime. Existing law requires an adult patient receiving primary care services in certain health care settings to be offered a screening test for hepatitis B and hepatitis C, as specified.
This bill would require an adult patient receiving primary a patient who is 18 years of age or older receiving health care services in a facility, clinic, unlicensed clinic, center, office, or other setting, as specified, to be offered a the tuberculosis (TB) risk assessment and TB screening test, if TB risk factors are identified, to the extent these services are covered under the patients health insurance, unless the health care provider reasonably believes certain conditions apply. except as specified. The bill would also require the health care provider or health care entity to offer the patient followup health care or refer the patient to a health care provider who can provide followup health care if a screening test is positive, as specified. positive. The bill would prohibit a health care provider who fails to comply with these provisions from being subject to any disciplinary action related to their licensure or certification, or to any civil or criminal liability liability, for that failure. The bill would require the State Department of Public Health to work with stakeholders to implement these provisions and notify primary care facilities about these provisions. The bill would make related findings and declarations.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares all of the following:(a) According to the World Health Organization, an estimated 10,600,000 people fell ill with tuberculosis (TB) during 2022. Despite being a preventable and curable disease, 1,300,000 people died from TB in 2022, making it the worlds second leading infectious killer after COVID-19.(b)According to the federal Centers for Disease Control and Prevention, TB incidence in the United States increased during 2022, compared with that during 2020 and 2021, but remained lower than incidence during the prepandemic years. After a substantial 20.2-percent decline in 2020 and partial rebound (a 9.8-percent increase) in 2021, incidence appears to be returning to prepandemic levels among United States-born and non-United States-born populations.(c)TB is a life-threatening disease. It spreads through the air with profound medical and economic consequences. More than 2,000,000 Californians (6 percent of the population) are infected with TB, of whom only 20 percent are aware of their infection and just 12 percent have been treated. In 2022, California reported 1,848 new TB cases (a 5-percent increase from the 1,749 cases in 2021), approximately 5 (4.7) out of every 100,000 California residents. This is nearly double the national TB incidence of 2.5 out of every 100,000 persons. Among people with TB disease, one-half are hospitalized and one in six dies within five years of diagnosis. TB hospitalizations are twice as expensive as and four times longer than hospitalizations for other conditions, which is usually about 11 days. In 2022, California medical and societal costs of TB reached $217,000,000.(d)TB does not impact Californians equally. Those born in countries where TB is endemic, and those living in economically disadvantaged communities, are more often impacted by TB disease. The TB disease rate among people born outside the United States is 13 times higher than United States-born persons. TB disease rates among people who are non-United States-born Asian or Black are 73 and 38 times higher, respectively, than United States-born White people. The TB disease rate among non-United States-born Hispanic people is 34 times that of United States-born White people. Furthermore, persons living in census tracts with low socioeconomic status have higher TB disease incidence rates than those living in high socioeconomic status census tracts, whether measured by education level, poverty, crowding, or California Healthy Places Index (HPI) quartiles. Additionally, persons with TB disease who experience homelessness are 30 percent more likely to die with TB disease than those not experiencing homelessness.(b) According to the federal Centers for Disease Control and Prevention, TB incidence in the United States increased 16 percent during 2023 as compared to 2022, returning to the number of TB cases last observed in 2013. Since 2020, TB case counts and rates have increased each year. This postpandemic increase in cases highlights the importance of continuing to engage communities with higher TB rates and their medical providers in TB elimination efforts and strengthening the capacity of public health programs to carry out critical disease control and prevention strategies.(c) TB is a life-threatening disease. It spreads through the air with profound medical and economic consequences. More than 2,000,000 Californians (6 percent of the population) have a latent TB infection (LTBI), of whom only 23 percent are aware of their infection and just 13 percent have been treated. In 2023, California reported 2,113 new active TB disease cases (a 15-percent increase from the 1,842 cases in 2022) with an incidence of 5.4 cases out of every 100,000 California residents. This is nearly double the national TB incidence of 2.9 out of every 100,000 people. TB cases in California have increased every year since 2020, representing a total increase of 24 percent over the last four years, returning to case numbers not seen since before the COVID-19 pandemic. Among people with TB disease, one-half are hospitalized and one in six dies within five years of diagnosis. A TB hospitalization is twice as expensive as, and four times longer than, a hospitalization for other conditions, which is usually about 11 days. In 2023, California medical and societal costs of TB reached $265,000,000. (d) TB does not impact Californians equally. People born in countries where TB is endemic and people living in economically disadvantaged communities are more often impacted by TB. The TB disease rate among people born outside the United States is 13 times higher than United States-born people. TB disease rates among a person who is non-United States-born Asian or Black are 43 and 28 times higher, respectively, than a United States-born White person. The TB disease rate among non-United States-born Hispanic people is 21 times that of a United States-born White person. Furthermore, people living in census tracts with low socioeconomic status have higher TB disease incidence rates than those living in high socioeconomic status census tracts, whether measured by education level, poverty, crowding, or California Healthy Places Index quartiles. Additionally, a person with TB disease who is experiencing homelessness is 30 percent more likely to die with TB disease than a person who is not experiencing homelessness.(e) The bacteria that causes TB can remain in a latent status for many years without symptoms. Detection of LTBI by a screening test, followed by preventive treatment, can greatly reduce the risk of later active TB disease. Assessment based on TB risk factors identified in the latest United States Preventive Services Task Force screening recommendations and present in the California TB risk assessment can help identify persons who may have undiagnosed latent TB infection, or active TB disease if further diagnostic testing indicates, so it can be treated.(e)(f) Currently, high-risk patients receiving primary care services do not routinely undergo a TB risk assessment and TB screening test. TB risk assessments and TB screening tests with followup for positive results.SEC. 2. Section 1316.8 is added to the Health and Safety Code, to read:1316.8. (a) An adult patient A patient who is 18 year of age or older and who receives primary health care services in a facility, clinic, unlicensed clinic, center, office, or other setting where primary care services are provided, shall be offered a the tuberculosis (TB) risk assessment distributed by the State Department of Public Health and TB screening test, if TB risk factors are identified, to the extent these services are covered under the patients health insurance, based on the latest screening indications recommended by the United States Preventive Services Task Force, unless the health care provider reasonably believes that one of the following conditions applies: Force.(b) Subdivision (a) does not apply if any of the following situations exist unless a health care provider determines that the TB risk assessment, TB screening test, or both, should be offered again:(1) The patient is being treated for a life-threatening emergency.(2) (A)The patient has previously been offered or has been the subject of a the TB risk assessment, TB screening test, or both, and has no new TB risk factors since the last TB risk assessment or TB screening test.(B)This paragraph does not apply if the health care provider determines that a TB risk assessment, TB screening test, or both should be offered again.(3) (A) The patient has had a documented, previously positive Interferon-Gamma Release Assays Assay (IGRA) test or has previously tested positive for a latent tuberculosis TB infection (LTBI).(B) If the patient has no documented followup health care, followup is required in accordance with subdivision (c).(4) The patient lacks capacity to consent to a the TB risk assessment, TB screening test, or both.(5)The patient is being treated in the emergency department of a general acute care hospital, as defined in subdivision (a) of Section 1250.(b)(c) If a patient accepts the offer of the TB screening test and the test is positive, a health care provider or health care entity shall offer the patient followup health care or refer the patient to a health care provider who can provide followup health care.(d) This section does not apply to the emergency department of a general acute care hospital as defined in subdivision (a) of Section 1250.(c)(e) This section shall not affect the scope of practice of any health care provider or diminish any authority or legal or professional obligation of any health care provider to offer a TB risk assessment, TB screening test, or both, or to provide services or care for the patient of a TB risk assessment, TB screening test, or both.(d)(f) A health care provider that fails to comply with the requirements of this section shall not be subject to any disciplinary actions related to their licensure or certification, or to any civil or criminal liability, because of the health care providers failure to comply with the requirements of this section.(e)(g) Section 1290 does not apply to a violation of this section.(h) The State Department of Public Health shall do both of the following:(1) Work with stakeholders, including, but not limited to, primary care clinics, health care providers, and TB experts, to implement this section.(2) Notify primary care facilities about the requirements of this section.(f)(i) For purposes of this section, the following definitions apply:(1) Followup health care includes evaluating the patient for a diagnosis of TB infection or active TB disease and providing medical management and treatment for TB according to the latest national clinical practice guidelines recommended by the federal Centers for Disease Control and Prevention and the American Thoracic Society. Prevention, the American Thoracic Society, or the State Department of Public Health for California-specific TB management.(2) Health care entity includes a payer, provider, or fully integrated health care system.(2)(3) Tuberculosis risk assessment or TB risk assessment means a risk assessment questionnaire the California Adult Tuberculosis Risk Assessment and User Guide developed by the State Department of Public Health, in consultation with the California Tuberculosis Controllers Association, to be used to conduct TB risk assessments and identify TB risk factors pursuant to this section.(3)(4) Tuberculosis screening test or TB screening test means either an approved intradermal tuberculin test skin test (TST), IGRA blood test, which is the preferred approach, or any other test for TB infection that is recommended by the federal Centers for Disease Control and Prevention and licensed by the United States Food and Drug Administration.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. The Legislature finds and declares all of the following:(a) According to the World Health Organization, an estimated 10,600,000 people fell ill with tuberculosis (TB) during 2022. Despite being a preventable and curable disease, 1,300,000 people died from TB in 2022, making it the worlds second leading infectious killer after COVID-19.(b)According to the federal Centers for Disease Control and Prevention, TB incidence in the United States increased during 2022, compared with that during 2020 and 2021, but remained lower than incidence during the prepandemic years. After a substantial 20.2-percent decline in 2020 and partial rebound (a 9.8-percent increase) in 2021, incidence appears to be returning to prepandemic levels among United States-born and non-United States-born populations.(c)TB is a life-threatening disease. It spreads through the air with profound medical and economic consequences. More than 2,000,000 Californians (6 percent of the population) are infected with TB, of whom only 20 percent are aware of their infection and just 12 percent have been treated. In 2022, California reported 1,848 new TB cases (a 5-percent increase from the 1,749 cases in 2021), approximately 5 (4.7) out of every 100,000 California residents. This is nearly double the national TB incidence of 2.5 out of every 100,000 persons. Among people with TB disease, one-half are hospitalized and one in six dies within five years of diagnosis. TB hospitalizations are twice as expensive as and four times longer than hospitalizations for other conditions, which is usually about 11 days. In 2022, California medical and societal costs of TB reached $217,000,000.(d)TB does not impact Californians equally. Those born in countries where TB is endemic, and those living in economically disadvantaged communities, are more often impacted by TB disease. The TB disease rate among people born outside the United States is 13 times higher than United States-born persons. TB disease rates among people who are non-United States-born Asian or Black are 73 and 38 times higher, respectively, than United States-born White people. The TB disease rate among non-United States-born Hispanic people is 34 times that of United States-born White people. Furthermore, persons living in census tracts with low socioeconomic status have higher TB disease incidence rates than those living in high socioeconomic status census tracts, whether measured by education level, poverty, crowding, or California Healthy Places Index (HPI) quartiles. Additionally, persons with TB disease who experience homelessness are 30 percent more likely to die with TB disease than those not experiencing homelessness.(b) According to the federal Centers for Disease Control and Prevention, TB incidence in the United States increased 16 percent during 2023 as compared to 2022, returning to the number of TB cases last observed in 2013. Since 2020, TB case counts and rates have increased each year. This postpandemic increase in cases highlights the importance of continuing to engage communities with higher TB rates and their medical providers in TB elimination efforts and strengthening the capacity of public health programs to carry out critical disease control and prevention strategies.(c) TB is a life-threatening disease. It spreads through the air with profound medical and economic consequences. More than 2,000,000 Californians (6 percent of the population) have a latent TB infection (LTBI), of whom only 23 percent are aware of their infection and just 13 percent have been treated. In 2023, California reported 2,113 new active TB disease cases (a 15-percent increase from the 1,842 cases in 2022) with an incidence of 5.4 cases out of every 100,000 California residents. This is nearly double the national TB incidence of 2.9 out of every 100,000 people. TB cases in California have increased every year since 2020, representing a total increase of 24 percent over the last four years, returning to case numbers not seen since before the COVID-19 pandemic. Among people with TB disease, one-half are hospitalized and one in six dies within five years of diagnosis. A TB hospitalization is twice as expensive as, and four times longer than, a hospitalization for other conditions, which is usually about 11 days. In 2023, California medical and societal costs of TB reached $265,000,000. (d) TB does not impact Californians equally. People born in countries where TB is endemic and people living in economically disadvantaged communities are more often impacted by TB. The TB disease rate among people born outside the United States is 13 times higher than United States-born people. TB disease rates among a person who is non-United States-born Asian or Black are 43 and 28 times higher, respectively, than a United States-born White person. The TB disease rate among non-United States-born Hispanic people is 21 times that of a United States-born White person. Furthermore, people living in census tracts with low socioeconomic status have higher TB disease incidence rates than those living in high socioeconomic status census tracts, whether measured by education level, poverty, crowding, or California Healthy Places Index quartiles. Additionally, a person with TB disease who is experiencing homelessness is 30 percent more likely to die with TB disease than a person who is not experiencing homelessness.(e) The bacteria that causes TB can remain in a latent status for many years without symptoms. Detection of LTBI by a screening test, followed by preventive treatment, can greatly reduce the risk of later active TB disease. Assessment based on TB risk factors identified in the latest United States Preventive Services Task Force screening recommendations and present in the California TB risk assessment can help identify persons who may have undiagnosed latent TB infection, or active TB disease if further diagnostic testing indicates, so it can be treated.(e)(f) Currently, high-risk patients receiving primary care services do not routinely undergo a TB risk assessment and TB screening test. TB risk assessments and TB screening tests with followup for positive results.
SECTION 1. The Legislature finds and declares all of the following:(a) According to the World Health Organization, an estimated 10,600,000 people fell ill with tuberculosis (TB) during 2022. Despite being a preventable and curable disease, 1,300,000 people died from TB in 2022, making it the worlds second leading infectious killer after COVID-19.(b)According to the federal Centers for Disease Control and Prevention, TB incidence in the United States increased during 2022, compared with that during 2020 and 2021, but remained lower than incidence during the prepandemic years. After a substantial 20.2-percent decline in 2020 and partial rebound (a 9.8-percent increase) in 2021, incidence appears to be returning to prepandemic levels among United States-born and non-United States-born populations.(c)TB is a life-threatening disease. It spreads through the air with profound medical and economic consequences. More than 2,000,000 Californians (6 percent of the population) are infected with TB, of whom only 20 percent are aware of their infection and just 12 percent have been treated. In 2022, California reported 1,848 new TB cases (a 5-percent increase from the 1,749 cases in 2021), approximately 5 (4.7) out of every 100,000 California residents. This is nearly double the national TB incidence of 2.5 out of every 100,000 persons. Among people with TB disease, one-half are hospitalized and one in six dies within five years of diagnosis. TB hospitalizations are twice as expensive as and four times longer than hospitalizations for other conditions, which is usually about 11 days. In 2022, California medical and societal costs of TB reached $217,000,000.(d)TB does not impact Californians equally. Those born in countries where TB is endemic, and those living in economically disadvantaged communities, are more often impacted by TB disease. The TB disease rate among people born outside the United States is 13 times higher than United States-born persons. TB disease rates among people who are non-United States-born Asian or Black are 73 and 38 times higher, respectively, than United States-born White people. The TB disease rate among non-United States-born Hispanic people is 34 times that of United States-born White people. Furthermore, persons living in census tracts with low socioeconomic status have higher TB disease incidence rates than those living in high socioeconomic status census tracts, whether measured by education level, poverty, crowding, or California Healthy Places Index (HPI) quartiles. Additionally, persons with TB disease who experience homelessness are 30 percent more likely to die with TB disease than those not experiencing homelessness.(b) According to the federal Centers for Disease Control and Prevention, TB incidence in the United States increased 16 percent during 2023 as compared to 2022, returning to the number of TB cases last observed in 2013. Since 2020, TB case counts and rates have increased each year. This postpandemic increase in cases highlights the importance of continuing to engage communities with higher TB rates and their medical providers in TB elimination efforts and strengthening the capacity of public health programs to carry out critical disease control and prevention strategies.(c) TB is a life-threatening disease. It spreads through the air with profound medical and economic consequences. More than 2,000,000 Californians (6 percent of the population) have a latent TB infection (LTBI), of whom only 23 percent are aware of their infection and just 13 percent have been treated. In 2023, California reported 2,113 new active TB disease cases (a 15-percent increase from the 1,842 cases in 2022) with an incidence of 5.4 cases out of every 100,000 California residents. This is nearly double the national TB incidence of 2.9 out of every 100,000 people. TB cases in California have increased every year since 2020, representing a total increase of 24 percent over the last four years, returning to case numbers not seen since before the COVID-19 pandemic. Among people with TB disease, one-half are hospitalized and one in six dies within five years of diagnosis. A TB hospitalization is twice as expensive as, and four times longer than, a hospitalization for other conditions, which is usually about 11 days. In 2023, California medical and societal costs of TB reached $265,000,000. (d) TB does not impact Californians equally. People born in countries where TB is endemic and people living in economically disadvantaged communities are more often impacted by TB. The TB disease rate among people born outside the United States is 13 times higher than United States-born people. TB disease rates among a person who is non-United States-born Asian or Black are 43 and 28 times higher, respectively, than a United States-born White person. The TB disease rate among non-United States-born Hispanic people is 21 times that of a United States-born White person. Furthermore, people living in census tracts with low socioeconomic status have higher TB disease incidence rates than those living in high socioeconomic status census tracts, whether measured by education level, poverty, crowding, or California Healthy Places Index quartiles. Additionally, a person with TB disease who is experiencing homelessness is 30 percent more likely to die with TB disease than a person who is not experiencing homelessness.(e) The bacteria that causes TB can remain in a latent status for many years without symptoms. Detection of LTBI by a screening test, followed by preventive treatment, can greatly reduce the risk of later active TB disease. Assessment based on TB risk factors identified in the latest United States Preventive Services Task Force screening recommendations and present in the California TB risk assessment can help identify persons who may have undiagnosed latent TB infection, or active TB disease if further diagnostic testing indicates, so it can be treated.(e)(f) Currently, high-risk patients receiving primary care services do not routinely undergo a TB risk assessment and TB screening test. TB risk assessments and TB screening tests with followup for positive results.
SECTION 1. The Legislature finds and declares all of the following:
### SECTION 1.
(a) According to the World Health Organization, an estimated 10,600,000 people fell ill with tuberculosis (TB) during 2022. Despite being a preventable and curable disease, 1,300,000 people died from TB in 2022, making it the worlds second leading infectious killer after COVID-19.
(b)According to the federal Centers for Disease Control and Prevention, TB incidence in the United States increased during 2022, compared with that during 2020 and 2021, but remained lower than incidence during the prepandemic years. After a substantial 20.2-percent decline in 2020 and partial rebound (a 9.8-percent increase) in 2021, incidence appears to be returning to prepandemic levels among United States-born and non-United States-born populations.
(c)TB is a life-threatening disease. It spreads through the air with profound medical and economic consequences. More than 2,000,000 Californians (6 percent of the population) are infected with TB, of whom only 20 percent are aware of their infection and just 12 percent have been treated. In 2022, California reported 1,848 new TB cases (a 5-percent increase from the 1,749 cases in 2021), approximately 5 (4.7) out of every 100,000 California residents. This is nearly double the national TB incidence of 2.5 out of every 100,000 persons. Among people with TB disease, one-half are hospitalized and one in six dies within five years of diagnosis. TB hospitalizations are twice as expensive as and four times longer than hospitalizations for other conditions, which is usually about 11 days. In 2022, California medical and societal costs of TB reached $217,000,000.
(d)TB does not impact Californians equally. Those born in countries where TB is endemic, and those living in economically disadvantaged communities, are more often impacted by TB disease. The TB disease rate among people born outside the United States is 13 times higher than United States-born persons. TB disease rates among people who are non-United States-born Asian or Black are 73 and 38 times higher, respectively, than United States-born White people. The TB disease rate among non-United States-born Hispanic people is 34 times that of United States-born White people. Furthermore, persons living in census tracts with low socioeconomic status have higher TB disease incidence rates than those living in high socioeconomic status census tracts, whether measured by education level, poverty, crowding, or California Healthy Places Index (HPI) quartiles. Additionally, persons with TB disease who experience homelessness are 30 percent more likely to die with TB disease than those not experiencing homelessness.
(b) According to the federal Centers for Disease Control and Prevention, TB incidence in the United States increased 16 percent during 2023 as compared to 2022, returning to the number of TB cases last observed in 2013. Since 2020, TB case counts and rates have increased each year. This postpandemic increase in cases highlights the importance of continuing to engage communities with higher TB rates and their medical providers in TB elimination efforts and strengthening the capacity of public health programs to carry out critical disease control and prevention strategies.
(c) TB is a life-threatening disease. It spreads through the air with profound medical and economic consequences. More than 2,000,000 Californians (6 percent of the population) have a latent TB infection (LTBI), of whom only 23 percent are aware of their infection and just 13 percent have been treated. In 2023, California reported 2,113 new active TB disease cases (a 15-percent increase from the 1,842 cases in 2022) with an incidence of 5.4 cases out of every 100,000 California residents. This is nearly double the national TB incidence of 2.9 out of every 100,000 people. TB cases in California have increased every year since 2020, representing a total increase of 24 percent over the last four years, returning to case numbers not seen since before the COVID-19 pandemic. Among people with TB disease, one-half are hospitalized and one in six dies within five years of diagnosis. A TB hospitalization is twice as expensive as, and four times longer than, a hospitalization for other conditions, which is usually about 11 days. In 2023, California medical and societal costs of TB reached $265,000,000.
(d) TB does not impact Californians equally. People born in countries where TB is endemic and people living in economically disadvantaged communities are more often impacted by TB. The TB disease rate among people born outside the United States is 13 times higher than United States-born people. TB disease rates among a person who is non-United States-born Asian or Black are 43 and 28 times higher, respectively, than a United States-born White person. The TB disease rate among non-United States-born Hispanic people is 21 times that of a United States-born White person. Furthermore, people living in census tracts with low socioeconomic status have higher TB disease incidence rates than those living in high socioeconomic status census tracts, whether measured by education level, poverty, crowding, or California Healthy Places Index quartiles. Additionally, a person with TB disease who is experiencing homelessness is 30 percent more likely to die with TB disease than a person who is not experiencing homelessness.
(e) The bacteria that causes TB can remain in a latent status for many years without symptoms. Detection of LTBI by a screening test, followed by preventive treatment, can greatly reduce the risk of later active TB disease. Assessment based on TB risk factors identified in the latest United States Preventive Services Task Force screening recommendations and present in the California TB risk assessment can help identify persons who may have undiagnosed latent TB infection, or active TB disease if further diagnostic testing indicates, so it can be treated.
(e)
(f) Currently, high-risk patients receiving primary care services do not routinely undergo a TB risk assessment and TB screening test. TB risk assessments and TB screening tests with followup for positive results.
SEC. 2. Section 1316.8 is added to the Health and Safety Code, to read:1316.8. (a) An adult patient A patient who is 18 year of age or older and who receives primary health care services in a facility, clinic, unlicensed clinic, center, office, or other setting where primary care services are provided, shall be offered a the tuberculosis (TB) risk assessment distributed by the State Department of Public Health and TB screening test, if TB risk factors are identified, to the extent these services are covered under the patients health insurance, based on the latest screening indications recommended by the United States Preventive Services Task Force, unless the health care provider reasonably believes that one of the following conditions applies: Force.(b) Subdivision (a) does not apply if any of the following situations exist unless a health care provider determines that the TB risk assessment, TB screening test, or both, should be offered again:(1) The patient is being treated for a life-threatening emergency.(2) (A)The patient has previously been offered or has been the subject of a the TB risk assessment, TB screening test, or both, and has no new TB risk factors since the last TB risk assessment or TB screening test.(B)This paragraph does not apply if the health care provider determines that a TB risk assessment, TB screening test, or both should be offered again.(3) (A) The patient has had a documented, previously positive Interferon-Gamma Release Assays Assay (IGRA) test or has previously tested positive for a latent tuberculosis TB infection (LTBI).(B) If the patient has no documented followup health care, followup is required in accordance with subdivision (c).(4) The patient lacks capacity to consent to a the TB risk assessment, TB screening test, or both.(5)The patient is being treated in the emergency department of a general acute care hospital, as defined in subdivision (a) of Section 1250.(b)(c) If a patient accepts the offer of the TB screening test and the test is positive, a health care provider or health care entity shall offer the patient followup health care or refer the patient to a health care provider who can provide followup health care.(d) This section does not apply to the emergency department of a general acute care hospital as defined in subdivision (a) of Section 1250.(c)(e) This section shall not affect the scope of practice of any health care provider or diminish any authority or legal or professional obligation of any health care provider to offer a TB risk assessment, TB screening test, or both, or to provide services or care for the patient of a TB risk assessment, TB screening test, or both.(d)(f) A health care provider that fails to comply with the requirements of this section shall not be subject to any disciplinary actions related to their licensure or certification, or to any civil or criminal liability, because of the health care providers failure to comply with the requirements of this section.(e)(g) Section 1290 does not apply to a violation of this section.(h) The State Department of Public Health shall do both of the following:(1) Work with stakeholders, including, but not limited to, primary care clinics, health care providers, and TB experts, to implement this section.(2) Notify primary care facilities about the requirements of this section.(f)(i) For purposes of this section, the following definitions apply:(1) Followup health care includes evaluating the patient for a diagnosis of TB infection or active TB disease and providing medical management and treatment for TB according to the latest national clinical practice guidelines recommended by the federal Centers for Disease Control and Prevention and the American Thoracic Society. Prevention, the American Thoracic Society, or the State Department of Public Health for California-specific TB management.(2) Health care entity includes a payer, provider, or fully integrated health care system.(2)(3) Tuberculosis risk assessment or TB risk assessment means a risk assessment questionnaire the California Adult Tuberculosis Risk Assessment and User Guide developed by the State Department of Public Health, in consultation with the California Tuberculosis Controllers Association, to be used to conduct TB risk assessments and identify TB risk factors pursuant to this section.(3)(4) Tuberculosis screening test or TB screening test means either an approved intradermal tuberculin test skin test (TST), IGRA blood test, which is the preferred approach, or any other test for TB infection that is recommended by the federal Centers for Disease Control and Prevention and licensed by the United States Food and Drug Administration.
SEC. 2. Section 1316.8 is added to the Health and Safety Code, to read:
### SEC. 2.
1316.8. (a) An adult patient A patient who is 18 year of age or older and who receives primary health care services in a facility, clinic, unlicensed clinic, center, office, or other setting where primary care services are provided, shall be offered a the tuberculosis (TB) risk assessment distributed by the State Department of Public Health and TB screening test, if TB risk factors are identified, to the extent these services are covered under the patients health insurance, based on the latest screening indications recommended by the United States Preventive Services Task Force, unless the health care provider reasonably believes that one of the following conditions applies: Force.(b) Subdivision (a) does not apply if any of the following situations exist unless a health care provider determines that the TB risk assessment, TB screening test, or both, should be offered again:(1) The patient is being treated for a life-threatening emergency.(2) (A)The patient has previously been offered or has been the subject of a the TB risk assessment, TB screening test, or both, and has no new TB risk factors since the last TB risk assessment or TB screening test.(B)This paragraph does not apply if the health care provider determines that a TB risk assessment, TB screening test, or both should be offered again.(3) (A) The patient has had a documented, previously positive Interferon-Gamma Release Assays Assay (IGRA) test or has previously tested positive for a latent tuberculosis TB infection (LTBI).(B) If the patient has no documented followup health care, followup is required in accordance with subdivision (c).(4) The patient lacks capacity to consent to a the TB risk assessment, TB screening test, or both.(5)The patient is being treated in the emergency department of a general acute care hospital, as defined in subdivision (a) of Section 1250.(b)(c) If a patient accepts the offer of the TB screening test and the test is positive, a health care provider or health care entity shall offer the patient followup health care or refer the patient to a health care provider who can provide followup health care.(d) This section does not apply to the emergency department of a general acute care hospital as defined in subdivision (a) of Section 1250.(c)(e) This section shall not affect the scope of practice of any health care provider or diminish any authority or legal or professional obligation of any health care provider to offer a TB risk assessment, TB screening test, or both, or to provide services or care for the patient of a TB risk assessment, TB screening test, or both.(d)(f) A health care provider that fails to comply with the requirements of this section shall not be subject to any disciplinary actions related to their licensure or certification, or to any civil or criminal liability, because of the health care providers failure to comply with the requirements of this section.(e)(g) Section 1290 does not apply to a violation of this section.(h) The State Department of Public Health shall do both of the following:(1) Work with stakeholders, including, but not limited to, primary care clinics, health care providers, and TB experts, to implement this section.(2) Notify primary care facilities about the requirements of this section.(f)(i) For purposes of this section, the following definitions apply:(1) Followup health care includes evaluating the patient for a diagnosis of TB infection or active TB disease and providing medical management and treatment for TB according to the latest national clinical practice guidelines recommended by the federal Centers for Disease Control and Prevention and the American Thoracic Society. Prevention, the American Thoracic Society, or the State Department of Public Health for California-specific TB management.(2) Health care entity includes a payer, provider, or fully integrated health care system.(2)(3) Tuberculosis risk assessment or TB risk assessment means a risk assessment questionnaire the California Adult Tuberculosis Risk Assessment and User Guide developed by the State Department of Public Health, in consultation with the California Tuberculosis Controllers Association, to be used to conduct TB risk assessments and identify TB risk factors pursuant to this section.(3)(4) Tuberculosis screening test or TB screening test means either an approved intradermal tuberculin test skin test (TST), IGRA blood test, which is the preferred approach, or any other test for TB infection that is recommended by the federal Centers for Disease Control and Prevention and licensed by the United States Food and Drug Administration.
1316.8. (a) An adult patient A patient who is 18 year of age or older and who receives primary health care services in a facility, clinic, unlicensed clinic, center, office, or other setting where primary care services are provided, shall be offered a the tuberculosis (TB) risk assessment distributed by the State Department of Public Health and TB screening test, if TB risk factors are identified, to the extent these services are covered under the patients health insurance, based on the latest screening indications recommended by the United States Preventive Services Task Force, unless the health care provider reasonably believes that one of the following conditions applies: Force.(b) Subdivision (a) does not apply if any of the following situations exist unless a health care provider determines that the TB risk assessment, TB screening test, or both, should be offered again:(1) The patient is being treated for a life-threatening emergency.(2) (A)The patient has previously been offered or has been the subject of a the TB risk assessment, TB screening test, or both, and has no new TB risk factors since the last TB risk assessment or TB screening test.(B)This paragraph does not apply if the health care provider determines that a TB risk assessment, TB screening test, or both should be offered again.(3) (A) The patient has had a documented, previously positive Interferon-Gamma Release Assays Assay (IGRA) test or has previously tested positive for a latent tuberculosis TB infection (LTBI).(B) If the patient has no documented followup health care, followup is required in accordance with subdivision (c).(4) The patient lacks capacity to consent to a the TB risk assessment, TB screening test, or both.(5)The patient is being treated in the emergency department of a general acute care hospital, as defined in subdivision (a) of Section 1250.(b)(c) If a patient accepts the offer of the TB screening test and the test is positive, a health care provider or health care entity shall offer the patient followup health care or refer the patient to a health care provider who can provide followup health care.(d) This section does not apply to the emergency department of a general acute care hospital as defined in subdivision (a) of Section 1250.(c)(e) This section shall not affect the scope of practice of any health care provider or diminish any authority or legal or professional obligation of any health care provider to offer a TB risk assessment, TB screening test, or both, or to provide services or care for the patient of a TB risk assessment, TB screening test, or both.(d)(f) A health care provider that fails to comply with the requirements of this section shall not be subject to any disciplinary actions related to their licensure or certification, or to any civil or criminal liability, because of the health care providers failure to comply with the requirements of this section.(e)(g) Section 1290 does not apply to a violation of this section.(h) The State Department of Public Health shall do both of the following:(1) Work with stakeholders, including, but not limited to, primary care clinics, health care providers, and TB experts, to implement this section.(2) Notify primary care facilities about the requirements of this section.(f)(i) For purposes of this section, the following definitions apply:(1) Followup health care includes evaluating the patient for a diagnosis of TB infection or active TB disease and providing medical management and treatment for TB according to the latest national clinical practice guidelines recommended by the federal Centers for Disease Control and Prevention and the American Thoracic Society. Prevention, the American Thoracic Society, or the State Department of Public Health for California-specific TB management.(2) Health care entity includes a payer, provider, or fully integrated health care system.(2)(3) Tuberculosis risk assessment or TB risk assessment means a risk assessment questionnaire the California Adult Tuberculosis Risk Assessment and User Guide developed by the State Department of Public Health, in consultation with the California Tuberculosis Controllers Association, to be used to conduct TB risk assessments and identify TB risk factors pursuant to this section.(3)(4) Tuberculosis screening test or TB screening test means either an approved intradermal tuberculin test skin test (TST), IGRA blood test, which is the preferred approach, or any other test for TB infection that is recommended by the federal Centers for Disease Control and Prevention and licensed by the United States Food and Drug Administration.
1316.8. (a) An adult patient A patient who is 18 year of age or older and who receives primary health care services in a facility, clinic, unlicensed clinic, center, office, or other setting where primary care services are provided, shall be offered a the tuberculosis (TB) risk assessment distributed by the State Department of Public Health and TB screening test, if TB risk factors are identified, to the extent these services are covered under the patients health insurance, based on the latest screening indications recommended by the United States Preventive Services Task Force, unless the health care provider reasonably believes that one of the following conditions applies: Force.(b) Subdivision (a) does not apply if any of the following situations exist unless a health care provider determines that the TB risk assessment, TB screening test, or both, should be offered again:(1) The patient is being treated for a life-threatening emergency.(2) (A)The patient has previously been offered or has been the subject of a the TB risk assessment, TB screening test, or both, and has no new TB risk factors since the last TB risk assessment or TB screening test.(B)This paragraph does not apply if the health care provider determines that a TB risk assessment, TB screening test, or both should be offered again.(3) (A) The patient has had a documented, previously positive Interferon-Gamma Release Assays Assay (IGRA) test or has previously tested positive for a latent tuberculosis TB infection (LTBI).(B) If the patient has no documented followup health care, followup is required in accordance with subdivision (c).(4) The patient lacks capacity to consent to a the TB risk assessment, TB screening test, or both.(5)The patient is being treated in the emergency department of a general acute care hospital, as defined in subdivision (a) of Section 1250.(b)(c) If a patient accepts the offer of the TB screening test and the test is positive, a health care provider or health care entity shall offer the patient followup health care or refer the patient to a health care provider who can provide followup health care.(d) This section does not apply to the emergency department of a general acute care hospital as defined in subdivision (a) of Section 1250.(c)(e) This section shall not affect the scope of practice of any health care provider or diminish any authority or legal or professional obligation of any health care provider to offer a TB risk assessment, TB screening test, or both, or to provide services or care for the patient of a TB risk assessment, TB screening test, or both.(d)(f) A health care provider that fails to comply with the requirements of this section shall not be subject to any disciplinary actions related to their licensure or certification, or to any civil or criminal liability, because of the health care providers failure to comply with the requirements of this section.(e)(g) Section 1290 does not apply to a violation of this section.(h) The State Department of Public Health shall do both of the following:(1) Work with stakeholders, including, but not limited to, primary care clinics, health care providers, and TB experts, to implement this section.(2) Notify primary care facilities about the requirements of this section.(f)(i) For purposes of this section, the following definitions apply:(1) Followup health care includes evaluating the patient for a diagnosis of TB infection or active TB disease and providing medical management and treatment for TB according to the latest national clinical practice guidelines recommended by the federal Centers for Disease Control and Prevention and the American Thoracic Society. Prevention, the American Thoracic Society, or the State Department of Public Health for California-specific TB management.(2) Health care entity includes a payer, provider, or fully integrated health care system.(2)(3) Tuberculosis risk assessment or TB risk assessment means a risk assessment questionnaire the California Adult Tuberculosis Risk Assessment and User Guide developed by the State Department of Public Health, in consultation with the California Tuberculosis Controllers Association, to be used to conduct TB risk assessments and identify TB risk factors pursuant to this section.(3)(4) Tuberculosis screening test or TB screening test means either an approved intradermal tuberculin test skin test (TST), IGRA blood test, which is the preferred approach, or any other test for TB infection that is recommended by the federal Centers for Disease Control and Prevention and licensed by the United States Food and Drug Administration.
1316.8. (a) An adult patient A patient who is 18 year of age or older and who receives primary health care services in a facility, clinic, unlicensed clinic, center, office, or other setting where primary care services are provided, shall be offered a the tuberculosis (TB) risk assessment distributed by the State Department of Public Health and TB screening test, if TB risk factors are identified, to the extent these services are covered under the patients health insurance, based on the latest screening indications recommended by the United States Preventive Services Task Force, unless the health care provider reasonably believes that one of the following conditions applies: Force.
(b) Subdivision (a) does not apply if any of the following situations exist unless a health care provider determines that the TB risk assessment, TB screening test, or both, should be offered again:
(1) The patient is being treated for a life-threatening emergency.
(2) (A)The patient has previously been offered or has been the subject of a the TB risk assessment, TB screening test, or both, and has no new TB risk factors since the last TB risk assessment or TB screening test.
(B)This paragraph does not apply if the health care provider determines that a TB risk assessment, TB screening test, or both should be offered again.
(3) (A) The patient has had a documented, previously positive Interferon-Gamma Release Assays Assay (IGRA) test or has previously tested positive for a latent tuberculosis TB infection (LTBI).
(B) If the patient has no documented followup health care, followup is required in accordance with subdivision (c).
(4) The patient lacks capacity to consent to a the TB risk assessment, TB screening test, or both.
(5)The patient is being treated in the emergency department of a general acute care hospital, as defined in subdivision (a) of Section 1250.
(b)
(c) If a patient accepts the offer of the TB screening test and the test is positive, a health care provider or health care entity shall offer the patient followup health care or refer the patient to a health care provider who can provide followup health care.
(d) This section does not apply to the emergency department of a general acute care hospital as defined in subdivision (a) of Section 1250.
(c)
(e) This section shall not affect the scope of practice of any health care provider or diminish any authority or legal or professional obligation of any health care provider to offer a TB risk assessment, TB screening test, or both, or to provide services or care for the patient of a TB risk assessment, TB screening test, or both.
(d)
(f) A health care provider that fails to comply with the requirements of this section shall not be subject to any disciplinary actions related to their licensure or certification, or to any civil or criminal liability, because of the health care providers failure to comply with the requirements of this section.
(e)
(g) Section 1290 does not apply to a violation of this section.
(h) The State Department of Public Health shall do both of the following:
(1) Work with stakeholders, including, but not limited to, primary care clinics, health care providers, and TB experts, to implement this section.
(2) Notify primary care facilities about the requirements of this section.
(f)
(i) For purposes of this section, the following definitions apply:
(1) Followup health care includes evaluating the patient for a diagnosis of TB infection or active TB disease and providing medical management and treatment for TB according to the latest national clinical practice guidelines recommended by the federal Centers for Disease Control and Prevention and the American Thoracic Society. Prevention, the American Thoracic Society, or the State Department of Public Health for California-specific TB management.
(2) Health care entity includes a payer, provider, or fully integrated health care system.
(2)
(3) Tuberculosis risk assessment or TB risk assessment means a risk assessment questionnaire the California Adult Tuberculosis Risk Assessment and User Guide developed by the State Department of Public Health, in consultation with the California Tuberculosis Controllers Association, to be used to conduct TB risk assessments and identify TB risk factors pursuant to this section.
(3)
(4) Tuberculosis screening test or TB screening test means either an approved intradermal tuberculin test skin test (TST), IGRA blood test, which is the preferred approach, or any other test for TB infection that is recommended by the federal Centers for Disease Control and Prevention and licensed by the United States Food and Drug Administration.