California Assembly Bill AB1739 Amended / Bill

 BILL NUMBER: AB 1739AMENDED 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.