AB 1739, 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 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.
The people of the State of California do enact as follows:
Section 14133.75 is added to the Welfare and Institutions Code, to read:
(a) The 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.
(b) The department shall update its provider bulletins, as necessary, to reference the most current professional literature and guidance related to allergy testing.
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