AIDS Institute Applauds Medicare Decision to Cover Routine HIV Tests

The AIDS Institute applauds the Center for Medicare and Medicaid Services' (CMS) announcement of its proposed decision that Medicare will cover routine HIV testing for its beneficiaries.

Until now, Medicare has only paid for HIV tests for people who are at an increased risk of HIV and pregnant women. The AIDS Institute has led an effort to urge CMS to make this change in order to increase the number of people who know their HIV status and to bring people who test positive into care and treatment.

"Ensuring that all people living with HIV are aware of their status is critical to their individual health and the public health," said Carl Schmid, Deputy Executive Director of The AIDS Institute. "We thank CMS for taking this step and look forward to its final decision later this spring."

There are currently more than 1.2 million people living with HIV in the United States, and 168,000 of them are unaware of their infection. Additionally, there are approximately 50,000 new infections each year.

The CMS proposed decision will bring Medicare coverage policies more in line with both the CDC and the U.S. Preventive Services Task Force's (USPSTF) recommendations in support of routine HIV testing. Basing testing decisions only on perceived risk leaves many people unaware of their HIV status and leads to late diagnoses.

CMS' proposed decision will help improve the overall continuum of care for people with HIV in the US, which has been a central component of the National HIV/AIDS Strategy. Currently, 86 percent of people with HIV know of their diagnosis, 37 percent are prescribed antiretroviral medications, and only 30 percent are virally suppressed. Achieving viral suppression is important not only to the individual's health but lessens the chance of transmission.

Under the CMS proposed decision, Medicare will cover a maximum of one, annual voluntary test for all adolescents and adults between the ages of 15 and 65, without regard to perceived risk. Medicare beneficiaries younger than 15 and older than 65 who are at increased risk for HIV infection will continue to be allowed one, annual voluntary screening. Coverage for pregnant Medicare beneficiaries will remain unchanged.

A second 30-day public comment period now begins. It ends on February 28. The statutory deadline for CMS to publish the final decision memorandum is April 29.

"The AIDS Institute looks forward to commenting on this proposed decision. For some people, especially those who are at a greater risk of HIV, more frequent testing than just one time per year may be advantageous," added Schmid. "However, expanded Medicare coverage of HIV testing is welcome news. The next step will be educating Medicare beneficiaries and the medical community about the importance of HIV testing, and the expanded coverage beneficiaries will soon have," he concluded.

The AIDS Institute is a national nonprofit organization that promotes action for social change through public policy research, advocacy and education.

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