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CMS issues Memo requiring Medicare Advantage Plans to cover HIV Screening

March 12, 2010

On February 1, 2010, CMS notified all Medicare Advantage Plans by memo of a recent national coverage decision (NCD) to require the coverage of HIV screening to Medicare-eligible enrollees with high risk profiles.

Generally, Medicare Advantage Plans are required by law to cover all Original Medicare benefits, including new services covered under NCD's, whether or not the cost of the new service or benefit was accounted for in their original bids.

Consequently, effective January 1, 2010, all MAO's must cover both standard and FDA-approved (HIV) rapid screening tests for:

  1. Annual voluntary HIV screening of Medicare beneficiaries at increased risk for HIV infection per USPSTF guidelines, including:
    • Men who have had sex with men after 1975;
    • Men and woman having unprotected sex with multiple partners;
    • Past or present injection drug users;
    • Men and woman 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

  2. Voluntary HIV screening of pregnant Medicare beneficiaries when the diagnosis of pregnancy is known, during the third trimester, and at labor.

  3. CMS notified MAO's that they expected all Medicare Advantage Organizations to notify enrollees about this new screening test and eligibility for coverage as soon as possible, through whatever means is practical including on their websites, or through plan newsletters.

    CMS Memo

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