BILL NUMBER: AB 1739	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 19, 2016
	AMENDED IN ASSEMBLY  MARCH 16, 2016

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 to  treat those tests as medically
necessary   provide the same standard of coverage for
either test  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:
   
  SECTION 1.    The Legislature finds and declares
all of the following:
   (a) Historically, allergies were diagnosed by an allergist who
used a percutaneous, or "skin-prick," test to infect the skin of a
patient with varying allergens for the purpose of determining the
patient's reaction to those allergens. This procedure required the
patient to be referred by his or her primary care physician to an
allergist, and required the patient to undergo a series of pricks to
his or her skin.
   (b) Advances in blood testing technology using serologic-specific
IgE quantitative testing allow a patient to be diagnosed without a
referral to a specialist.
   (c) Professional literature and guidance from the National Heart,
Lung, and Blood Institute at the National Institutes of Health has
determined that blood tests and skin tests for allergies are equal in
their diagnostic value, and that blood testing is preferred in the
case of testing for food allergies.
   (d) Private health care insurance plans recognize the professional
literature and guidelines regarding the efficacy of blood testing
and cover blood testing for the diagnosis of allergies.
   (e) Medi-Cal does not cover blood testing for allergies in the
same manner as private health care insurance.
   (f) Fee-for-service Medi-Cal patients are not receiving the same
level of care as patients with private health insurance coverage. Due
to an insufficient number of allergists available to diagnose and
treat Medi-Cal patients, the diagnosis of many patients covered by
Medi-Cal is delayed or never occurs.
   (g) Medi-Cal coverage decisions must be based on the latest and
most current medical literature and studies. 
   SEC. 2.   SECTION 1.   Section 14133.75
is added to the Welfare and Institutions Code, to read:
   14133.75.  (a) The department shall treat serologic-specific IgE
tests and percutaneous skin tests as equivalent confirmatory tests in
terms of their sensitivity and accuracy, and shall  treat
them as medically necessary   provide the same standard
of coverage for either test  for those individuals with a
medical history consistent with any of the following:
   (1) An inhalant allergy.
   (2) A food allergy.
   (3) Hymenoptera venom allergy or an allergy to stinging insects.
   (4) Allergic bronchopulmonary aspergillosis (ABPA).
   (5) Certain parasitic diseases.
   (6) Allergies to specific drugs.
   (b) The department shall update its provider bulletins, as
necessary, to reference the most current professional literature and
guidance related to allergy testing.