BILL ANALYSIS Ó
AB 1739
Page 1
GOVERNOR'S VETO
AB
1739 (Waldron)
As Enrolled August 30, 2016
2/3 vote
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|ASSEMBLY: |79-0 |(May 5, 2016) |SENATE: |36-0 |(August 18, |
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|ASSEMBLY: |80-0 |(August 23, | | | |
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Original Committee Reference: HEALTH
SUMMARY: Requires the standard of coverage and medical
necessity for allergy tests to 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
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immunoglobulin E (IgE) tests, as specified.
FISCAL EFFECT: According to the Senate Appropriations
Committee, 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. Department
of Healthcare Services (DHCS) 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
current utilization rates) would be about $1 million per year.
COMMENTS: According to the author, this bill ensures that
Medi-Cal patients with allergies receive the same level of care
as private health insurance patients based on nationally
recognized professional guidelines. Under existing coverage and
payment policies for fee-for-service Med- Cal patients, allergy
testing using an IgE blood test is not treated equally with
percutaneous skin testing for allergies. If a primary care
physician wishes to diagnose allergies, a referral to a
specialist for skin testing is allowed. However, if the primary
care physician wishes to order a blood test to diagnose
allergies without a referral, the physician must document a
contraindication to skin testing for the blood test to be
ordered. This bill will ensure that primary care doctors are
able to diagnose allergies without referral to a specialist and
will therefore save Medi-Cal patients the time and effort it
takes to find, make an appointment and see one of the limited
number of specialists who accept Medi-Cal patients. The author
believes this will further save the Medi-Cal system money by
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reducing the costs associated with referrals to specialists.
Asthma is a chronic inflammatory disease of the airways. Asthma
is widespread; in California an estimated 2.5 million adults
have asthma along with about 700,000 children. It is one of the
most common chronic diseases of childhood. The exact cause of
asthma is unknown and it cannot be cured. Asthma can be
controlled with self-management education, appropriate medical
care, and avoiding exposure to environmental triggers. Allergen
exposure is a significant trigger that can worsen symptoms for
many patients with asthma.
Food allergies are an immune-based disease that has become a
serious health concern in the United States. A recent study
estimates that food allergy affects 5% of children under the age
of five years and 4% of teens and adults, and its prevalence
appears to be on the increase. The symptoms of this disease can
range from mild to severe and, in rare cases, can lead to
anaphylaxis, a severe and potentially life-threatening allergic
reaction. There are no therapies available to prevent or cure
food allergies. The only prevention option for the patient is
to avoid the food allergen.
How best to determine what those allergens are, and how Medi-Cal
coverage policy should approach this issue, was the subject of
an August 12, 2014, Assembly Health Committee informational
hearing, Medi-Cal: When Reimbursement Policies Interfere with
the Standard of Care. Subsequent to the hearing, on May 15,
2015, Medi-Cal removed the requirement that laboratories submit
documentation of medical necessity with claims for IgE testing
reimbursement. However, limitations on Medi-Cal coverage for
IgE which did not apply to skin testing remain.
Anthem Health Insurance and Kaiser Permanente both cover allergy
blood tests and skin tests equivalently. According to
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information requested by the Committee and provided by the
sponsor, two of six Medicare claims processing contractors
(representing 20 states) treat blood tests and skin test
equivalently, the others currently do not. The sponsor states
that it has embarked on an educational campaign with the other
four contractors.
In a December 2010 report of the National Institute of Allergy
and Infectious Diseases (NIAID) sponsored expert panel entitled
Guidelines for the Diagnosis and Management of Food Allergy in
the U.S., published in the Journal of Allergy and Clinical
Immunology, it is stated that both IgE blood tests and skin
tests are safe and useful for identifying food allergies. In a
February 2010 article in the Journal of Allergy and Clinical
Immunology from Johns Hopkins School of Medicine entitled
Clinical Laboratory Assessment of Immediate-type
Hypersensitivity it is stated that: "For food and respiratory
allergy, IgE antibody as detected in the serum by using current
autoanalyzer technology and in the skin by using the
epicutaneous test are considered equivalent as confirmatory
tests in terms of their sensitivity and accuracy." In a
supplement to the March 2008 issue of the Annals of Allergy,
Asthma, & Immunology entitled Allergy Diagnostic Testing: An
Updated Practice Parameter, it is stated that: "There are no
clinical scenarios in which immunoassays for allergen specific
IgE can be considered either absolutely indicated or
contraindicated. There are some situations in which
immunoassays may be preferable to skin testing for the
diagnostic evaluation of patients."
GOVERNOR'S VETO MESSAGE:
I am returning Assembly Bill 1739 without my signature.
This bill codifies a specific standard for allergy testing in
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Medi-Cal.
The Department of Health Care Services already has authority to
set allergy testing standards and will be updating them later
this year. When it does so, the Department should not be
limited, as this bill requires, to considering just the
guidelines from National Institutes of Health.
Analysis Prepared by:
Paula Villescaz / HEALTH / (916) 319-2097 FN:
0005067