Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to prevent STIs

Over the past 25 years, the Congress has expanded the Medicare benefit to include various preventive services to the Medicare Part B program such as Pap smear and screening pelvic exams, screening mammograms, colorectal cancer screening tests, and diabetes screening tests. Effective January 1, 2009, CMS is allowed to add coverage of "additional preventive services" if certain statutory requirements are met, as provided under section 101(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. L. 110-275). Among other things, this new benefit allows CMS under 42 CFR 410.64 to cover "additional preventive services", if it determines through the NCD process that the service is recommended with a grade A (strongly recommends) or grade B (recommends) rating by the United States Preventive Services Task Force (USPSTF) and meets certain other requirements.

After reviewing various preventive services given a grade A or grade B recommendation by the USPSTF, CMS has decided to initiate a new national coverage analysis (NCA) on screening for STIs and HIBC, to include:

• Screening for chlamydial infection for all sexually active non-pregnant young women aged 24 and younger and for older nonpregnant women who are at increased risk,
• Screening for chlamydial infection for all pregnant women aged 24 and younger and for older pregnant women who are at increased risk,
• Screening for gonorrhea infection in all sexually active women, including those who are pregnant, if they are at increased risk,
• Screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit,
• Screening persons at increased risk for syphilis infection, and
• HIBC for the prevention of STIs for all sexually active adolescents and for adults at increased risk for STIs.

The NCA will evaluate the available evidence for the screening for STIs and HIBC for the prevention of STIs. We would be interested in receiving any recommendations on the appropriate frequency of these services and those qualified to provide them, based on documentation from the medical literature, current clinical practice guidelines, or the USPSTF recommendations. HIV screening will not be included in this NCA as it is already covered http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=335&ncdver=1&bc=BAAAgAAAAAAA&

February 24, 2011

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