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The Centers for Medicare & Medicaid Services says it is considering extending coverage of HIV screening to all Medicare beneficiaries, not just those at risk.
The agency announced on Aug. 4 that it was starting a new analysis, which was prompted by a request from the HIV Testing Reimbursement Working Group and the Federal AIDS Policy Partnership. Those groups include the American Academy of HIV Medicine, GMHC, the HIV Medicine Association, the National Alliance of State and Territorial AIDS Directors, the National Association of County and City Health Officials, and the National Viral Hepatitis Roundtable.
Amanda Mills/CDC
The Centers for Medicare & Medicaid Services is considering extending coverage of HIV screening to all Medicare beneficiaries.
Medicare has covered routine HIV testing as a preventive service since 2009 for adolescents, pregnant women, and adults who are at risk for infection. That coverage decision was made in light of the U.S. Preventive Services Task Force grade A recommendation that such screening was supported by the evidence.
In 2013, the USPTF revised that recommendation, saying that all adolescents and adults aged 15-65 years should be screened, regardless of their risk. All pregnant women should still continue to be screened, said the Task Force. Adolescents younger than 15 years and adults older than 65 years who are at increased risk of HIV infection should also receive screening, it added.
Because the screening recommendation had an A grade, it must be covered by private insurers under the Affordable Care Act.
But the CMS has not updated its policy, which means that "HIV testing coverage for Medicare beneficiaries is limited to those who are perceived to be or identify themselves as at risk and to pregnant women," said the letter from the HIV Testing Reimbursement Working Group and the Federal AIDS Policy Partnership.
"This coverage limitation does not reflect the current science or HHS’s own best practices for HIV medicine," they said.
The groups said that at least 16% of people with the infection, or 181,400 individuals, are unaware that they are HIV positive and that half of all new infections are transmitted by someone who did not know their status. They also noted that about 17% of the Medicare population is young and disabled; with routine testing, they would be more likely to receive earlier diagnosis and treatment.
"It is important for CMS to make a clear statement that HIV infection is an important issue impacting Medicare beneficiaries," added the organizations, noting that, "While only about 3% of those living with HIV are estimated to be 65 or older, the CDC estimates that by 2017 more than half of those living with HIV will be over 50 years old, approaching Medicare eligibility."
The agency is accepting public comments on expanding coverage of screening until Sept. 3.
The CMS said that it expects to issue a proposed decision in Feb. 2015, and to complete its analysis by May next year.
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