The CMS has finalized its decision to cover HIV/AIDS screenings for Medicare beneficiaries without regard to perceived risk behavior, it announced via a national coverage memo.
Medicare previously covered testing only for pregnant woman and those perceived at high risk for the virus. The 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 the ages of 15 and 65.
“CMS has determined that the 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.”
Of the estimated 1.1 million people with HIV/AIDS living in the U.S. in 2010, those age 55 and older accounted for 19%, data show. It is estimated that by this year, half of the HIV-infected Americans will be 50 or older.
The Medicare coverage decision 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, with a proposed decision announcement last January.
Medicare's previous screening coverage policy was problematic because it relied on beneficiaries to identify themselves as at-risk, Chandra Ford, an assistant professor in community health sciences 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.
And it's unlikely that healthcare providers are asking older patients about sex and other risky behaviors, she said. “For some reason, (they) assume once people hit a certain age they no longer engage in risky behavior,” she said.
Medicare spending on HIV/AIDS totaled $6.6 billion in 2014. The CMS requested an additional $400 million for fiscal 2015, federal data show.
