The Centers for Medicare and Medicaid Services (CMS) proposes the following:
The evidence is adequate to conclude that screening for HIV infection, which is recommended with a grade of A by the U.S. Preventive Services Task Force (USPSTF) for certain individuals, is reasonable and necessary for early detection of HIV and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.
Therefore CMS proposes to cover HIV screening with an FDA-approved enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA) or rapid HIV antibody test for:
- Annual voluntary HIV screening of Medicare beneficiaries at increased risk for HIV infection per USPSTF guidelines:
Voluntary HIV screening of pregnant Medicare beneficiaries.
- Men who have had sex with men after 1975
- Men and women having unprotected sex with multiple [more than one] partners
- Past or present injection drug users
- Men and women who exchange sex for money or drugs, or have sex partners who do
- Individuals whose past or present sex partners were HIV-infected, bisexual or injection drug users
- Persons being treated for sexually transmitted diseases
- Persons with a history of blood transfusion between 1978 and 1985
- Persons who request an HIV test despite reporting no individual risk factors, since this group is likely to include individuals not willing to disclose high-risk behaviors; and
They are requesting public comments on this proposed determination pursuant to Section 1862(l) of the Social Security Act. After considering the public comments, they will make a final determination and issue a final decision memorandum.