April 30, 2013
Washington, D.C. -- The U.S. Preventive Services Task Force (USPSTF) finalized its recommendation yesterday in strong support of routine HIV testing for ALL adolescents and adults ages 15 through 65. Until now, the Task Force recommended testing only for people who are at risk for HIV and pregnant women.
"This marks a monumental shift in how HIV in the United States can be prevented, diagnosed and treated," commented Carl Schmid, Deputy Executive Director of The AIDS Institute. He added, "It will also favorably impact the reimbursement of HIV testing across payers which removes one of the barriers to HIV testing."
Grades issued by the USPSTF are often the basis for payers to cover preventive services. This is even more significant under the Affordable Care Act (ACA), which bases reimbursement for many preventive services by private insurers, Medicare and Medicaid on USPSTF grades. For example, under ACA, most private plans will be required to cover all Grade A and B USPSTF services without cost-sharing. The USPSTF had previously given routine HIV screening a "C" grade; now it will be an "A."
With this grade change, all primary payers, including Medicaid and Medicare, will be required or incentivized to cover routine HIV screening.
Risk-based HIV testing has proven to be an ineffective screening strategy. Therefore, in 2006, the Centers for Disease Control and Prevention (CDC) recommended routine testing for anyone between the ages of 13 and 64. The USPSTF revised grade is now more in line with the CDC recommendation for routine HIV testing.
Almost one in five people living with HIV in the U.S. -- over 200,000 individuals -- continue to be unaware of their HIV status. Additionally, there are 50,000 new infections each year. Testing people early and linking those found to be positive to care and treatment is critical not only for individual health outcomes but also in preventing new infections.
Early awareness of HIV status is important because when someone knows they are HIV-positive, they can take steps to prevent transmission of the virus. Over half of all new infections are attributable to someone who is not aware of their infection. Currently, 40 percent of people diagnosed with HIV progress to full blown AIDS within one year of their diagnosis, meaning that they have carried the virus for many years without detection.
Testing is the only way to learn of one's HIV status and when an individual tests positive, they can be linked to care and treatment, which helps prevent the spread of HIV. A recent study has shown that individuals on continuous antiretroviral treatment can reduce the amount of virus in their body to such a low level that the risk of transmission is reduced by 96 percent.
"While this is a significant step forward, we are cognizant that a USPSTF positive recommendation is only one step in facilitating increased access to HIV screening," remarked Schmid. "Changing the grade for HIV testing will go a long way towards improving access to HIV screening. However, providers still must offer the test and patients must be willing to take it."
Providers and clinics must also develop the infrastructure to bill for HIV testing. President Obama's FY14 budget proposes to allocate $10 million of CDC's HIV Prevention budget to assist public health agencies to seek reimbursement for infectious disease testing covered under the ACA.
The U.S. Preventive Services Task Force (USPSTF) is an independent group of experts supported by the Agency for Healthcare Research and Quality (AHRQ), an agency of the U.S. Department of Health and Human Services. The panel is charged with making evidence-based recommendations regarding clinical preventive services.