By John Peller
Although summer is in full swing, Illinois health care providers have an unprecedented opportunity to re-examine their routine HIV testing practices, thanks to new regulations and information provided by the state of Illinois.
First, the Illinois Department of Public Health released after a nearly four-year delay final regulations implementing updates to the state's HIV testing law passed in 2007. The regulations are the final piece needed to align state HIV testing policies with the U.S. Centers for Disease Control and Prevention's recommendations that providers routinely offer HIV testing to all patients ages 13-64.
The new regulations make clear that providers can make sweeping changes to the way they conduct HIV testing. Patients can give informed consent for HIV testing verbally or in writing, and consent can be obtained as part of a general consent for HIV testing. Opt-out testing is explicitly permitted. Providers can provide common-sense pre-test information verbally, in writing, by showing a video, or through electronic means. The law maintains strong protections against testing without a patient's consent, including steep fines for providers who test patients for HIV without their permission.
Of course, providers need more than clear state procedures to conduct HIV testing; they also need to get reimbursed for the service. Thanks to a letter from the Illinois Department of Healthcare and Family Services issued on National HIV Testing Day (June 27), there's finally some clarity about when Medicaid will pay for routine HIV testing. Routine testing advocates - including the AIDS Foundation of Chicago, MATEC, and Public Health Institute of Metropolitan Chicago - asked the state to release the letter.
Sent to all Medicaid providers in the state, the letter raised awareness about the importance of routine HIV testing, the high number of undiagnosed people with HIV in Illinois, and the CDC's 2006 routine testing recommendation.
So, when will Medicaid pay for routine HIV testing? The short answer is "almost always." Just as importantly, the letter clarified that the state will pay for HIV screening for children under the Early Periodic Screening, Diagnosis, and Treatment Program (EPSTD) and women as part of routine preventive testing. The state will pay for HIV testing if the provider believes is it is "medically necessary", a broad coverage definition that will cover nearly all situations. Of course, you should consult the relevant sections of the Medicaid manuals to determine the exact testing rules.
Although these two policy announcements provide greater clarity about the state's HIV testing policies, anecdotal evidence shows that many health care providers remain hesitant to routinely offer HIV testing to patients. More education and technical assistance is needed to help providers understand current policies and determine how to best integrate testing into their practice flow.
New IDPH HIV testing rules (77 Ill. Adm. Code 697):