BILL NUMBER:  S1222

 TITLE OF BILL :  An act to amend the social services law, in relation
to requiring Medicaid coverage of both blood testing and skin prick
testing for allergies

 PURPOSE: :

To ensure that the Medicaid program provides access to blood allergy
testing in parity with skin prick testing, as the tests are clinically
equivalent, cost equivalent, and would expand access to testing, which
would be an important step in addressing health disparities.

 SUMMARY OF PROVISIONS: :

Section 1 creates a new section of the Social Services Law entitled
"blood allergy testing," which would require the department to treat
serologic-specific IgE allergy tests (blood allergy tests) and
percutaneous skin allergy tests (skin prick tests) as equivalent in
their sensitivity and accuracy for confirming the existence of an
allergy in a patient, and to treat those tests as medically necessary
for those individuals with a medical history consistent with specified
conditions. 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.

              

Section 2 is the effective date of the bill.

 JUSTIFICATION :

Historically, allergies were diagnosed by an allergist who used a
percutaneous, or "skin-prick," test to infect the skin of a patient
with varying allergens for the purpose of determining the patient's
reaction to those allergens. This procedure required the patient to be
referred by his or her primary care physician to an allergist, and
required the patient to undergo a series of pricks to his or her skin.

Advances in blood testing technology using serologic-specific IgE
quantitative testing allow a patient to be diagnosed without a
referral to a specialist. Professional literature and guidance from
the National Heart, Lung, and Blood Institute at the National
Institutes of Health has determined that blood tests and skin tests
for allergies are equal in their diagnostic value, and that blood
testing is preferred in the case of testing for food allergies.
Medicaid coverage decisions must be based on the latest and most
current medical literature and studies.

Private health care insurance plans recognize the professional
literature and guidelines regarding the efficacy of blood testing and
cover blood testing for the diagnosis of allergies. New York State
Medicaid does not cover blood testing for allergies at all; only skin
prick testing is covered. Due to an insufficient number of allergists
available to diagnose and treat Medicaid patients, the diagnosis of
many patients covered by Medicaid is delayed or never occurs.
Creating access to this blood test would help improve population
health and address health care disparities, particularly in
underserved communities.

 LEGISLATIVE HISTORY: :

2016: S7450

 FISCAL IMPLICATIONS: :



Because blood allergy testing is cost-equivalent to skin prick
testing, it is not anticipated that this bill will have a significant
fiscal impact.

 EFFECTIVE DATE: :

This act shall take effect the first of July next succeeding the date
upon which it shall become law, effective immediately, the
commissioner of health shall promulgate all rules and regulations
deemed necessary and desirable to implement the provisions of this act
on or before its effective date.