Medicare to Cover HIV Testing


The Centers for Medicare and Medicaid Services (CMS) has proposed to expand Medicare coverage to include routine HIV testing.

The Centers for Medicare and Medicaid Services (CMS) has proposed to expand Medicare coverage to include routine HIV testing.

Expanding coverage in section 210.7 of the Medicare National Coverage Determinations (NCD) Manual will enable people ages 15 to 65 to receive an annual HIV screening. Additionally, those below age 15 and above age 65 would be allowed the opportunity to receive an annual voluntary screening provided they have an increased risk for HIV.

If approved, the CMS proposes to cover HIV screening with US Food and Drug Administration (FDA) approved laboratory and point of care tests and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations — ensuring the tests would solely be performed by eligible Medicare providers and/or suppliers.

People categorized with an increased risk of contracting HIV, according to the CMS, include men who have sex with men, men and women who have unprotected sex, men and women who exchange sex for money or drugs, those whose past partners were HIV-infected, intravenous drug users or bisexuals, and those with a history of blood transfusions between 1978 and 1985.

Also, it’s important to note, Medicare coverage for pregnant women will not change, as they will still receive 3 voluntary HIV screenings: when the pregnancy is diagnosed, during the third trimester, and at the time of labor.

The AIDS Institute has been pushing for this amendment for quite some time. “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, the Institute’s deputy executive director, in a news release.

There are approximately 50,000 new HIV infections reported annually. The AIDS Institute takes the position that this expansion of Medicare coverage for HIV screenings would, at the very least, tremendously increase awareness of individuals’ HIV status.

The public has 30 days to comment on the rule, as the CMS is slated to publish its final decision by the end of April.

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