Amended in Assembly April 19, 2016

Amended in Assembly March 16, 2016

California Legislature—2015–16 Regular Session

Assembly BillNo. 1739


Introduced by Assembly Member Waldron

February 1, 2016


An act to add Section 14133.75 to the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

AB 1739, as amended, Waldron. Medi-Cal: allergy testing.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law provides for a schedule of benefits under the Medi-Cal program, and authorizes the use of utilization controls, including prior authorization, that may be applied to those covered benefits and that are reviewed for, among other things, medical necessity. Under the Medi-Cal program, a service is “medically necessary” or a “medical necessity” when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain.

This bill would require the department to treat serologic-specific IgE allergy tests and percutaneous skin allergy tests as equivalent in their sensitivity and accuracy for confirming the existence of an allergy in a patient, and tobegin delete treat those tests as medically necessaryend deletebegin insert provide the same standard of coverage for either testend insert for those individuals with a medical history consistent with specified conditions. The bill would require the department to update its provider bulletins, as necessary, to reference the most current professional literature and guidance related to allergy testing.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

begin delete
P2    1

SECTION 1.  

The Legislature finds and declares all of the
2following:

3(a) Historically, allergies were diagnosed by an allergist who
4used a percutaneous, or “skin-prick,” test to infect the skin of a
5patient with varying allergens for the purpose of determining the
6patient’s reaction to those allergens. This procedure required the
7patient to be referred by his or her primary care physician to an
8allergist, and required the patient to undergo a series of pricks to
9his or her skin.

10(b) Advances in blood testing technology using
11serologic-specific IgE quantitative testing allow a patient to be
12 diagnosed without a referral to a specialist.

13(c) Professional literature and guidance from the National Heart,
14Lung, and Blood Institute at the National Institutes of Health has
15determined that blood tests and skin tests for allergies are equal
16in their diagnostic value, and that blood testing is preferred in the
17case of testing for food allergies.

18(d) Private health care insurance plans recognize the professional
19literature and guidelines regarding the efficacy of blood testing
20and cover blood testing for the diagnosis of allergies.

21(e) Medi-Cal does not cover blood testing for allergies in the
22same manner as private health care insurance.

23(f) Fee-for-service Medi-Cal patients are not receiving the same
24level of care as patients with private health insurance coverage.
25Due to an insufficient number of allergists available to diagnose
26and treat Medi-Cal patients, the diagnosis of many patients covered
27by Medi-Cal is delayed or never occurs.

28(g) Medi-Cal coverage decisions must be based on the latest
29and most current medical literature and studies.

end delete
P3    1

begin deleteSEC. 2.end delete
2
begin insertSECTION 1.end insert  

Section 14133.75 is added to the Welfare and
3Institutions Code
, to read:

4

14133.75.  

(a) The department shall treat serologic-specific
5IgE tests and percutaneous skin tests as equivalent confirmatory
6tests in terms of their sensitivity and accuracy, and shallbegin delete treat them
7as medically necessaryend delete
begin insert provide the same standard of coverage for
8either testend insert
for those individuals with a medical history consistent
9with any of the following:

10(1) An inhalant allergy.

11(2) A food allergy.

12(3) Hymenoptera venom allergy or an allergy to stinging insects.

13(4) Allergic bronchopulmonary aspergillosis (ABPA).

14(5) Certain parasitic diseases.

15(6) Allergies to specific drugs.

16(b) The department shall update its provider bulletins, as
17necessary, to reference the most current professional literature and
18guidance related to allergy testing.



O

    97