BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 1739 (Waldron) - Medi-Cal: allergy testing
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|Version: August 2, 2016 |Policy Vote: HEALTH 8 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 8, 2016 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 1739 would require the Department of Health Care
services to use standards of coverage and medical necessity for
allergy tests that are consistent with national clinical
guidelines.
Fiscal
Impact: Likely increased Medi-Cal costs in the hundreds of
thousands per year (General Fund and federal funds). The fiscal
impact of the bill is subject to some uncertainty. The
Department of Health Care Services indicates that under the bill
it would likely change its current policy that limits the number
of allergen units in a blood test from the current limit of 24
to the current limit for skin tests of 65. It is not clear to
what extent physicians ordering blood tests would actually
increase the number of units per test. However, because the per
unit cost of blood tests is considerably higher than the per
unit costs for skin tests, any increase in the number of units
per test would increase state costs. For comparison, the cost
difference between the current maximum number of units for blood
tests and the maximum number of units allowed for skin tests (at
AB 1739 (Waldron) Page 1 of
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current utilization rates) would be about $1 million per year.
Background: Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to low income individuals, families, and children.
Medi-Cal provides coverage to childless adults and parents with
household incomes up to 138% of the federal poverty level and to
children with household incomes up to 266% of the federal
poverty level. The federal government provides matching funds
that vary from 50% to 90% of expenditures depending on the
category of beneficiary.
Under current practice in the fee-for-service Medi-Cal system,
the Department of Health Care Services places certain limits on
the utilization of allergy tests. Department policy limits the
number of allergen units that can be included in a blood test to
24, whereas policy limits the number of units that can be
included in a skin test to 65. (Utilization controls in the
Medi-Cal managed care system are determined by the managed care
plans.)
Proposed Law:
AB 1739 would require the Department to use standards for
coverage and medical necessity for allergy tests that are
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.
Staff
Comments: Medi-Cal policy does not limit the use of either
blood tests or skin prick tests to specialists; primary care
physicians can order either test, if medically necessary.
However interpretation of those tests is often done by
specialists who have more experience interpreting test results.
It is not clear whether changes in the bill would substantially
change the utilization of specialists to interpret test results.
Currently, there are about 6,000 IgE blood tests ordered for
fee-for-service Medi-Cal beneficiaries per year, versus about
1,200 skin prick tests per year.
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