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Provider Notice issued 06/27/12
Women: HIV testing is covered as a family planning - related Reproductive Health Service for all women enrolled in Medicaid. HIV testing is also covered for women enrolled in the Illinois Healthy Women program. Illinois law mandates that all pregnant women be counseled and offered an HIV test to prevent mother-to-child transmission. If the mother’s HIV status is not known at the time of birth, the mother will be offered a rapid HIV test and if she declines, the infant must be tested for HIV as soon as possible after birth. Medicaid will pay for such testing.
Children: Under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, Medicaid-eligible children under the age of 21 are covered for HIV testing. This includes routine testing for Medicaid-eligible children at state-specified intervals as part of the child’s well-child exam, and otherwise medically necessary HIV testing. Routine HIV testing for such children is covered by states under the preventive or screening benefit in Section 1905(a)(13) of the Social Security Act, and otherwise medically necessary HIV testing is covered under the benefit for laboratory services in Section 1905(a)(3) of the Act.
Men: Medicaid-eligible adults are covered for medically necessary HIV testing through the mandatory laboratory benefit under Section 1905(a)(3) of the Social Security Act.
Illinois Medicaid HIV Testing Recommendation and Policy
| To: | Physicians, Community Mental Health Providers, SASS Providers, DASA Treatment Providers, Advanced Practice Nurses, Federally Qualified Health Centers, Encounter Rate Clinics, Rural Health Clinics, Local Health Departments, School-based Clinics, Pharmacies, Hospitals and Home Health Agencies |
| Date: | June 27, 2012 |
| Re: | Illinois Medicaid HIV Testing Recommendation and Policy |
Every year, National HIV Testing Day is held on June 27, 2012. With an estimated 46,000 people living with HIV in Illinois, and over 1,000 new HIV cases diagnosed each year in the state, we are using this opportunity to remind you of current routine HIV screening recommendations, Medicaid coverage for HIV testing, and the Illinois law and rules on HIV testing.
CDC HIV testing recommendation: The U.S. Centers for Disease Control and Prevention (CDC) recommends that opt-out HIV testing be a part of routine clinical care in all health care settings for all adults and adolescents aged 13-64. Opt-out testing preserves the patient's choice to decline HIV testing and ensures a provider-patient relationship conducive to optimal clinical and preventive care. These recommendations were published in the September 22, 2006, issue of the Morbidity and Mortality Weekly Report. Illinois law permits opt-out testing.
All providers should routinely offer and recommend that patients be tested for HIV: In Illinois and across the U.S., an estimated one in five people with HIV — 10,000 in Illinois alone — do not know they are infected. These undiagnosed individuals are responsible for the majority of new HIV infections because they do not know to take precautions against transmitting the virus. Moreover, they cannot receive the life-saving benefits of HIV medications and expert clinical care. Undiagnosed HIV drives the HIV epidemic among the most-impacted populations, especially gay men and men who have sex with men of all races, African American women and men, Latinos, and injection drug users. Routine HIV testing of everyone aged 13-64 and linking people with HIV to expert medical care is essential to help people live long healthy lives and control this costly, still-deadly communicable disease.
Illinois law now permits opt-out HIV testing and makes HIV testing easier for providers: The Illinois AIDS Confidentiality Act (410 ILCS 305/) changed in 2008. State law now permits opt-out HIV testing, as recommended by CDC. Pre-test counseling is not required; instead, pre-test information can be provided verbally, in writing, or by video or other electronic means. Written informed consent is not mandated. Consent may be obtained verbally (with documentation in the medical record), in writing, or through a general consent to medical treatment with a provision allowing an opt-out of HIV testing.
Confidentiality of HIV testing, status, and test results: A patient’s HIV status is subject to the confidentiality protections under the Health Insurance Portability and Accountability Act of 1996, including the implementing regulations at 45 C.F.R. Part 164, Subpart D. In addition, the Illinois AIDS Confidentiality Act prohibits disclosure of a patient’s HIV status to anyone without the patient’s written informed consent. Providers can be fined up to $10,000 for violations.
Illinois Medicaid HIV testing policies:
Additional Resources
Our goal is to remind Illinoisans that HIV remains a major health concern. We also want to acknowledge your efforts to serve this vulnerable population and hope that this notice will encourage you to conduct routine HIV testing to keep your patients and communities healthy.
Theresa A. Eagleson, Administrator
Division of Medical Programs