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Elizabeth M. Whitehorn, Director

Provider Notice issued 09/26/16

Screening, Treatment, Medical Monitoring, Counseling and Preventative Drugs for Persons at Risk of Exposure to Human Immunodeficiency Virus (HIV)

To: All Enrolled Providers
Date: September 26, 2016
Re: Screening, Treatment, Medical Monitoring, Counseling and Preventative Drugs for Persons at Risk of Exposure to Human Immunodeficiency Virus (HIV)

The purpose of this notice is to inform providers that pursuant to Public Act 99-0772, and upon federal approval, the Department of Healthcare and Family Services (HFS) shall provide coverage for all drugs that are approved for marketing by the federal Food and Drug Administration and that are recommended by the federal Public Health Service or the United States Centers for Disease Control and Prevention for pre-exposure prophylaxis and related pre-exposure prophylaxis services.

 

The HCBS waiver serves persons with HIV/AIDS who are at risk for nursing facility level of care. The waiver allows individuals to remain in their homes and receive a wide array of services.

 

HFS currently covers screening, treatment, medical monitoring, labs and counseling for persons at high risk of exposure to HIV. In addition, the Department provides preventative care services including, Truvada, which is currently approved for prevention for pre-exposure prophylaxis. This medication is available with a prescription to any Medicaid participant without prior approval.

 

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.

 

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.

 

Additional Resources: 


Questions regarding this notice should be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Felicia F. Norwood
Director