Screening for the Human Immunodeficiency Virus (HIV) Infection: Posted proposed decision memo

Decision Summary

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:

  1. Annual voluntary HIV screening of Medicare beneficiaries at increased risk for HIV infection per USPSTF guidelines:
    • 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
  2. Voluntary HIV screening of pregnant Medicare beneficiaries.

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.

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