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Provider Notice issued 06/19/14
Illinois Medicaid Policy and Recommendation for Routine Human Immunodeficiency Virus (HIV) Screening
| To: | All Medical Assistance Providers |
| Date: | June 19, 2014 |
| Re: | Illinois Medicaid Policy and Recommendation for Routine Human Immunodeficiency Virus (HIV) Screening |
Every year, National HIV Testing Day is held on June 27. With an estimated 43,000 people living with HIV in Illinois, and over 1,000 new HIV cases diagnosed each year in the state, this notice highlights current HIV screening recommendations, Medicaid coverage for HIV testing, and the Illinois law and rules on HIV testing.
One in five people with HIV, approximately 8,600 in Illinois, do not know they are infected. These undiagnosed individuals contribute to 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. Routine HIV testing of everyone aged 13-64 and linking clients with HIV to expert medical care are essential to help people live long healthy lives and control this costly, still-deadly communicable disease.
All providers should routinely offer and recommend that patients be tested for HIV. Routine HIV screening is covered for all adolescents and adults enrolled in Medicaid.
Center for Disease and Control (CDC) HIV screening recommendation:
CDC recommends that opt-out HIV testing (pdf) 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.
United States Preventive Services Task Force (USPSTF) Recommendations:
USPSTF gave routine HIV testing of people ages 15-64 an “A” recommendation (pdf). This A grade indicates with “high certainty that the net benefit of screening for HIV infections in adolescents, adults and pregnant women is substantial.”
Illinois law permits opt-out HIV testing and makes HIV testing easier for providers:
The Illinois AIDS Confidentiality Act (410 ILCS 305/) changed in 2008 permitting 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 CFR 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. Legislation passed in 2014 by the General Assembly but not yet signed into law (HB 5925 (pdf)) will allow greater electronic sharing of HIV testing and treatment information within health care settings.
Additional Resources
Our goal is to remind Healthcare and Family ServiesHFS Medical Assistance providers 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 screening to keep our clients and communities healthy.
Theresa A. Eagleson, Administrator
Division of Medical Programs