Amended in Senate August 2, 2016

Amended in Senate June 2, 2016

Amended in Assembly April 19, 2016

Amended in Assembly March 16, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 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 begin delete department to treat serologic-specific IgE allergy tests and percutaneous skin allergy tests as equivalent in their clinical efficacy for confirming the existence of an allergy in a patient, and to provide the same standard of coverage for either test for those individuals with a medical history consistent with specified conditions. end delete begin insert standard of coverage and medical necessity for allergy tests to be consistent with specified consensus standards and recommendations and peer-reviewed medical literature pertaining to the utilization of modern serologic-specific IgE tests. end insert 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.  

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

14133.75.  

(a) The begin delete department shall treat serologic-specific
IgE tests and percutaneous skin tests as equivalent confirmatory
tests in their clinical efficacy, and shall provide the same standard
of coverage for either test for those individuals with a medical
history consistent with any of the following: end delete begin insert standard of coverage
and medical necessity for allergy tests shall be consistent with
consensus standards and recommendations in clinical guidelines
from the National Institutes of Health, Clinical and Laboratory
Standards Institute, and the most current peer-reviewed medical
literature pertaining to the utilization of modern serologic-specific
IgE tests. end insert

begin delete

(1) An inhalant allergy.

end delete begin delete

(2) A food allergy.

end delete begin delete

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

end delete begin delete

(4) Allergic bronchopulmonary aspergillosis (ABPA).

end delete begin delete

(5) Certain parasitic diseases.

end delete begin delete

(6) Allergies to specific drugs.

end delete

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