Seniors, Pregnant Women to be Screened, Counseled for STD: US Medicare Panel

by Lakshmi Gopal on  August 30, 2011 at 1:44 PM Health Insurance News   - G J E 4
Sexually active at-risk seniors, pregnant women and others who are covered by Medicare in the US, may soon have coverage for STD screenings.
 Seniors, Pregnant Women to be Screened, Counseled for STD: US Medicare Panel
Seniors, Pregnant Women to be Screened, Counseled for STD: US Medicare Panel

These groups will be screened for diseases like chlamydia, gonorrhea, syphilis and hepatitis B, and will also be given 'high intensity behavioral counseling'. The proposal has been forwarded by The Federal Centers for Medicare and Medicaid Services (CMS).

CMS believes the coverage under Medicare Parts A and B is warranted because counseling and early detection of the sexually transmitted diseases can save lives and costs later.

Disease prevention experts said the move is the right one - an ounce of prevention, the old saying goes, is worth a pound of cure. And in this case, an ounce of prevention might prevent costly, and life-threatening complications down the road.

The "proposed decision memo" was issued this month, six months after CMS first began to study the issue and collect public comments. Now that the proposed decision has been issued, the public has another chance to comment on the issue, through Sept. 9.

"Hepatitis B is a leading cause of liver cancer," said Susan Maloney, a managing senior fellow and program officer at the Partnership for Prevention, a Washington, D.C.-based organization that advocates preventive screenings.

"The human papilloma virus, known as HPV, well known for its link to cervical cancer in women, is now being studied for a link to throat cancer in men," Ms. Maloney said.

"That's why the screenings are important," she said, not just because of the infections themselves, but because of what the infections can lead to.

While the screenings will cover "at-risk" seniors - those who have multiple sex partners, don't use condoms, have sex while under the influence of alcohol or drugs, or men who have sex with other men, among other risk factors - they also will cover the 10 per cent or so of Medicare beneficiaries who are under 65.

That cohort primarily consists of younger people who are disabled and are already entitled to disability benefits under Social Security or through the Railroad Retirement Board for 24 months, or those under 65 who have Amyotrophic Lateral Sclerosis, known as Lou Gehrig's disease.

Recent coverage recommendations issued by CMS, including this one, are notable because they stress screening and counseling as a means of prevention. These recommendations arise out of President Bush-era Medicare legislation, called the Medicare Improvements for Patients and Providers Act of 2008, which allows CMS to consider adding "additional preventive services" to its menu of covered services.

This month, CMS proposed that Medicare should pay for "intensive behavioral therapy" to ward off cardiovascular disease. The therapies would consist of three components: encouraging regular aspirin use, screening for high blood pressure in Medicare beneficiaries aged 18 years and older, and diet counseling for adults with hypertension or other risk factors.

Last month, CMS issued a proposal that said "screening and behavioral counseling to reduce alcohol misuse (is) reasonable and necessary for the prevention of early illness or disability, and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B." That means Medicare would cover alcohol screenings and "up to four brief, face-to-face, behavioral counseling interventions per year" for those who misuse alcohol.

CMS is also considering paying for obesity counseling.

Once CMS has finished analyzing the proposals, the next step is a "national coverage determination," which sets the policy on how the recommendations are put into action.

Also this week, CMS announced it is launching a program to "bundle" insurance payments for multi-step procedures, hoping to save money for the Medicare system by getting doctors and hospitals to reduce readmissions and duplicative procedures.

The bundling process could also reduce the amount of co-payments charged to patients themselves, CMS says.

Source: Medindia

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