Requires Medicaid coverage of both blood testing and skin prick testing for allergies

1 Co-sponsor

• George Latimer

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

New bill.

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 July 1, 2016.