Saturday, September 26, 2009

How Do You Cover HIV Screening for High Risk Beneficiaries?

Review how your coverage compares with CMS (Medicare) proposed coverage for HIV Screening.

On September 9, 2009 CMS proposed to cover annual HIV screening for certain Medicare populations, including any beneficiary who requested the service, all pregnant women, and individuals who have engaged in certain high-risk behaviors. This is the first time CMS has used new authority granted under MIPPA to cover new preventive services using the national coverage determination (NCD) process. Before MIPPA, CMS could not cover new preventive services without Congressional action. The new policy stipulates that CMS must cover preventive services that are reasonable and necessary for prevention or early detection of an illness, Grade A or B-recommended by the U.S. Preventive Services Task Force (USPSTF), and appropriate for Medicare beneficiaries. MIPPA also granted CMS the authority to use cost-effectiveness analysis to determine coverage for a preventive service. HIV screening received a Grade A recommendation from the USPSTF, and CMS concluded that recurrent HIV screening is economically favorable for populations with higher incidence of HIV. Comments are due October 9. A final coverage decision will be made by December 8.

Go to CMS HIV for details.

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