Medicare Proposes Coverage for Annual HIV Test, Invites Public Comment

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: February 04, 20152 min read
Ronald Valdiserri

Dr. Ronald ValdiserriThe Centers for Medicare and Medicaid Services (CMS) has proposed expanding coverage for HIV screening for Medicare beneficiaries.

In a Proposed Decision Memo dated January 29, 2015, the agency states “CMS proposes that the evidence is adequate to conclude that screening for HIV infection for all individuals between the ages of 15 and 65 years, as is recommended with a grade of A by the United States Preventive Services Task Force (USPSTF), is reasonable and necessary for the early detection of HIV and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.

Specifically, CMS is proposing that a maximum of one annual voluntary HIV screening be covered for all Medicare beneficiaries who are:

  • adolescents and adults between the age of 15 and 65, without regard to perceived risk.
  • adolescents younger than 15 and adults older than 65 who are at increased risk for HIV infection.

In addition, CMS is proposing coverage for a maximum of three, voluntary HIV screenings of pregnant Medicare beneficiaries: (1) when the diagnosis of pregnancy is known, (2) during the third trimester, and (3) at labor, if ordered by the woman’s clinician.

As part of its National Coverage Determination process, CMS has invited public comment on this proposed decision before it issues a final decision. Online comments are being accepted until February 28, 2015. CMS is expected to publish its final decision by the end of April.