title: Routine HIV screening in North Carolina in the era of the Affordable Care Act: update on laws, reimbursement, and tests.
abstract: Eighteen percent of the 1.2 million human immunodeficiency virus (HIV)-infected individuals in the United States are undiagnosed, with North Carolina accounting for the eighth largest number of new HIV diagnoses in 2011. In an effort to identify more HIV-infected individuals by reducing physician barriers to HIV testing, the Centers for Disease Control and Prevention have expanded their HIV screening recommendations to adolescents and adults without HIV risk factors or behaviors, eliminated federal requirements for pretest counseling, and modified the informed consent process. In 2010, the Office of National AIDS (acquired immunodeficiency syndrome) Policy released the first-ever national HIV/AIDS strategy, with the goal of reducing new infections, increasing access to care, improving HIV outcomes, and reducing HIV racial/ethnic disparities. In 2013, the US Preventive Services Task Force released A-level recommendations recommending nonrisk-based HIV screening for adults and adolescents that are consistent with the recommendations of the Centers for Disease Control and Prevention. In concert with these federal recommendations, the majority of states have modified their consent and counseling requirements. The implementation of the Patient Protection and Affordable Care Act will add requirements and incentives for federal (Medicare), state (Medicaid), and private (insurance) payers to reimburse physicians and patients for nonrisk-based HIV screening.
authors.affiliation: From the Department of Medicine, University of North Carolina at Chapel Hill, the Department of Medicine, Rural Health Group, Roanoke Rapids, North Carolina, and the Center for Health Law & Policy Innovation, Harvard Law School, Jamaica Plain, Massachusetts.
authors.forename: Becky L
authors.initials: BL
authors.lastname: White
authors.forename: Yvonne L
authors.initials: YL
authors.lastname: Carter
authors.forename: Katherine
authors.initials: K
authors.lastname: Records
authors.forename: Ian B K
authors.initials: IB
authors.lastname: Martin
mesh_terms: D015492:AIDS Serodiagnosis / Q000191:economics / Q000379:methods; D000293:Adolescent; D000328:Adult; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D006291:Health Policy; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration; D009657:North Carolina / Q000453:epidemiology; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence / Q000458:organization & administration; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence / Q000458:organization & administration; D014481:United States; D055815:Young Adult