Healthcare Business News

CMS considers covering HIV screening for all Medicare beneficiaries

By Virgil Dickson
Posted: August 19, 2014 - 1:15 pm ET

The CMS has accepted a request from HIV/AIDS advocates to consider paying for HIV screening of all Medicare beneficiaries without regard to perceived risk behavior rather than only for pregnant women and those at high risk for the virus.

The change would bring the policy in line with a 2013 U.S. Preventive Services Task Force recommendation, although that recommendation applies to people between ages 15 and 65.

HIV/AIDS advocates, however, argue that seniors should be screened as well even though it's estimated that only 3% of those living with HIV are 65 or older. They point to a recent CDC estimate that by 2017, more than half of those living with HIV will be 50 and older, approaching Medicare eligibility.

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The broader screening coverage also would extend screenings to about 9 million people who are under 65 and on Medicare because of a disability.

The CMS is taking public comments on the suggestion until Sept. 3 and plans to release an initial coverage decision by Feb. 4, 2015, and a final decision by May 5, 2015.

The existing policy is problematic because it relies on beneficiaries to identify themselves as at-risk, said Chandra Ford, an assistant professor in the Department of Community Health Sciences at the Fielding School at UCLA. “If we rely on risk-based screening, we are counting on people to tell us they engaged in stigmatized behaviors, and we know that people underreport those,” she said.

She also said it is unlikely doctors are proactively broaching sex and other behaviors with elderly patients. “People, for some reason, assume once people hit a certain age, they no longer engage in risky behavior,” Ford said.

Making HIV testing more routine could empower patients and providers to talk more about their behavior and the need for testing, said John Peller, interim CEO of AIDS Foundation of Chicago.

Medicare's more limited policy was likely driven by financial considerations, said Dr. Anupam B. Jena, an assistant professor of healthcare policy and medicine at Harvard Medical School.

Jena argued that the government will save money in the lung run, and he suggested the CMS could reimburse one screening for current beneficiaries and for everyone who enters the program. Subsequent screenings, he suggested, might be reimbursed only for beneficiaries who experienced a change in circumstances.

Medicare spending on HIV totaled $6.6 billion in 2014 and the agency requested an additional $400 million for fiscal 2015, federal data show.

The request for coverage comes as Medicare is under some scrutiny for how it's managing its current spending on HIV drugs. HHS' Office of Inspector General released a study (PDF) this month that found that Medicare Part D inappropriately paid $32 million for HIV drugs in 2012.

Follow Virgil Dickson on Twitter: @MHvdickson

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