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California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more
California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more

22-401m New Law Requires Coverage for At-Home Specimen Collection Kits for HIV and STD

Date: 05/13/22

Follow these guidelines for at-home HIV and STD test kits for members

Effective January 1, 2022, California Senate Bill (SB) 306 provides greater testing and treatment for sexually transmitted diseases (STDs). SB 306 mandates coverage of home test kits and lab costs for processing those kits. This change allows members to self-collect specimens for HIV and STDs that are ordered directly by an in-network clinician or furnished by a standing order for patient use based on clinical guidelines and member’s health needs. The bill defines “home test kit” as a product recommended by the Centers for Disease Control and Prevention (CDC) guidelines or the U.S. Preventive Services Task Force (USPSTF). Those guidelines say:

  • Clinical Laboratory Improvement Amendment (CLIA) waived,
  • The U.S. Food and Drug Administration (FDA) cleared or approved or
  • Developed by a lab in accordance with established regulations and quality standards.

SB 306 Requirements

The new California law expands access to HIV and STDs testing and requires:

  • Coverage of at-home test kits for HIV and STDs and the associated lab costs, when deemed medically necessary and ordered for an enrollee by an in-network provider.
  • Coverage for members enrolled in the Family Planning, Access, Care, and Treatment (Family PACT) Program, the State Only Family Planning Program, Medi-Cal, commercial health plans and health insurers.
  • The in-network provider to arrange or provide the at-home test kits in the same manner that specimen collection kits for other tests are provided to members.

Guidelines to obtain at-home HIV and STD test kits

  • In-network physician orders are required for the test kit(s).
  • Physician must provide a written order/prescription with FDA & CLIA approved lab company directly.
    • Participating Physician Groups (PPG) affiliated physicians will need to check with the PPG for their preferred labs.
    • Direct Network and PPO physicians can use California Health & Wellness Plan’s (CHWP’s) preferred labs.
  • Test kit(s) will be mailed to the member’s address.
  • Member will need to register test kit(s) per instructions included with the kit.
  • Member will need to mail back specimen to the lab in the self-addressed envelope provided.
  • Provider to review results with member.

Claims submission

  • Claims should be billed as usual for laboratory services.
  • Claims will process according to in-network guidelines for laboratory services.

Additional information

Providers are encouraged to access CHWP’s provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CHWP at 877-658-0305.