The CMS has granted tentative coverage for HIV screening of all beneficiaries without regard to perceived risk behavior, it announced via a proposed national coverage memo.
“CMS concludes that screening for HIV infection provides direct benefit to the Medicare population,” the agency says in its decision memo. “Evidence is adequate to conclude that screening for HIV infection for all individuals between the ages of 15 and 65 years … is reasonable and necessary for the early detection of HIV.”
Testing had been covered only for pregnant woman and those at high risk for the virus. The proposed national coverage decision brings Medicare policy in line with a 2013 U.S. Preventive Services Task Force recommendation, although that recommendation applies only to people between ages 15 and 65.
Of the estimated total 1.1 million persons with HIV infection living in the U.S. in 2010, people age 55 and older accounted for 217,000 or 19% of the persons living with the disease, data show. It is estimated that by this year, half of the HIV infected persons in the U.S. will be 50 years of age or older, research shows.
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 made the decision following a comment period that ended Sept. 3, 2014, and plans to release a final decision by May 5.
The existing policy was problematic because it relies on beneficiaries to identify themselves as at-risk, Chandra Ford, an assistant professor in the Department of Community Health Sciences at the Fielding School at UCLA, told Modern Healthcare last year.
“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. It is unlikely doctors are proactively broaching sex and other behaviors with elderly patients, she said. “People, for some reason, assume once people hit a certain age, they no longer engage in risky behavior,” Ford said.
Medicare spending on HIV totaled $6.6 billion in 2014. The agency requested an additional $400 million for fiscal 2015, federal data show.
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