Medicare Announces Coverage for Annual HIV Test

Content From: Ronald Valdiserri, M.D., M.P.H., Deputy Assistant Secretary for Health, Infectious Diseases, and Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human ServicesPublished: April 15, 20152 min read


Ronald Valdiserri
Dr. Ronald Valdiserri

The Centers for Medicare and Medicaid Services (CMS) announced this week that it has expanded coverage to include one, annual voluntary screening for HIV infection for all adolescent and adult Medicare beneficiaries between the ages of 15 and 65, without regard to perceived risk. Coverage for pregnant Medicare beneficiaries will remain unchanged.

The addition of routine annual HIV screening to the list of covered services brings Medicare practice into alignment with HIV testing recommendations of both the Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task ForceExit Disclaimer (USPSTF).

Concluding that screening for HIV infection “provides direct benefit to the Medicare population,” the National Coverage Determination Decision Memo states that effective for claims with dates of service on or after April 13, 2015:

“CMS shall cover screening for HIV with the appropriate U.S. Food and Drug Administration (FDA) approved laboratory tests and point of care tests, used consistent with FDA approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations, when ordered by the beneficiary’s physician or practitioner within the context of a healthcare setting and performed by an eligible Medicare provider or supplier for these services.”

This coverage expansion will contribute to national efforts to improve outcomes across the HIV care continuum, which begins with identifying those living with undiagnosed HIV infection and linking them to care. According to the CDC, about 14% (or approximately 1 in 7) of the estimated 1.2 million people in the United States living with HIV do not know they are infected. Unaware of their infection, they are unable to access effective care and treatment that can keep the virus under control nor take steps to prevent transmission to partners.

Key to realizing the potential of this coverage expansion will be raising awareness among healthcare providers so that more individuals who can benefit from HIV screening can now access it.