BILL NUMBER: AB 1739	AMENDED
	BILL TEXT

	AMENDED IN SENATE  AUGUST 2, 2016
	AMENDED IN SENATE  JUNE 2, 2016
	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 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.  
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.  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  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:   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.  
   (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.