Dear Provider:

The Centers for Medicare and Medicaid Services (CMS) clarified its obligation to furnish human immunodeficiency virus (HIV) screening to members with high risk profiles given the recent national coverage decision (NCD) on this particular screening.

Effective January 1, 2010, WellCare covers both standard and U.S. Food and Drug Administration (FDA)-approved HIV rapid screen tests for people at risk. These tests are covered under basic lab services.

The CMS guidelines state these test must be covered for: 

• Annual voluntary HIV screening of Medicare members at increased risk for HIV infection per U.S. Preventive Services Task Force (USPSTF) guidelines, including:

o Men who have had sex with men after 1975;
o Men and women having unprotected sex with multiple partners;
o Past or present injection drug users;
o Men and women who exchange sex for money or drugs, or have sex with partners who do;
o Individuals whose past or present sex partners were HIV-infected, bisexual or injection drug users;
o Persons being treated for sexually transmitted diseases;
o Persons with a history of blood transfusion between 1978 and 1985;
o Persons who request an HIV test despite reporting no individual risk factors, since this group is likely to include individuals not willing to disclose high-risk behaviors.

• Voluntary HIV screening of pregnant Medicare members when the diagnosis of pregnancy is known, during the third trimester and at labor.

If you have any questions, please call Customer Service at 1-866-334-7730.

Thank you,
WellCare Health Plans, Inc.

Source: Centers for Medicare and Medicaid Services. Decision Memo for Screening the Human Immunodeficiency Virus (HIV) Infection (CAG-00409N). Available at http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=229&.