DCS Comprehensive Health Plan

HIV Testing and AIDS Treatment Services

Statement/Purpose

This policy outlines services for Human Immunodeficiency Virus (HIV) testing and education, and treatment services for Acquired Immune Deficiency Syndrome (AIDS) covered by DCS Comprehensive Health Plan (DCS CHP).

Definitions

Acquired Immunodeficiency Syndrome (AIDS): A chronic disease caused by the Human Immunodeficiency Virus (HIV).

Human Immunodeficiency Virus (HIV):A Sexually Transmitted Infection (STI) that damages white blood cells that are very important in helping the body fight infection and disease.

Policy

DCS CHP, through its contracted MCO, covers evidenced based medically necessary treatment services provided by qualified providers for the treatment of members diagnosed with HIV/AIDS in accordance with DCS and AHCCCS policies, and Centers for Disease Control and Prevention (CDC) guidelines for the testing and treatment of children/youth with HIV/AIDS.

DCS CHP members diagnosed with HIV/AIDS receive care coordination.

DCS CHP provides information regarding the expectations of HIV testing and counseling to pregnant members and their providers.

Procedure

DCS CHP covers HIV/AIDS testing for members when testing is deemed medically necessary and requested by a health care provider to determine diagnosis and identify the member’s medical needs. In these circumstances, an out-of-home caregiver can consent to testing for HIV/AIDS.

Members age 12 and older may request and consent for HIV/AIDS testing. No additional consent is required.

If medically necessary testing is needed for a member over 12 years of age who is refusing testing, a court order is required.

The guardian and caregivers, in concert with members with HIV/AIDS, may use a contracted HIV/AIDS provider of their choice as long as the provider is qualified to provide the treatment, or works in consultation with a qualified HIV/AIDS provider.

DCS CHP covers Sexually Transmitted Infections (STIs), including HIV, screening and treatment services regardless of gender. Information on these topics are provided to members including instruction on where testing and treatment is available and how to obtain these services.

DCS CHP monitors pregnant members to review HIV testing results and treatment in pregnancy for care coordination. Care coordination includes medication adherence, appointment adherence, referral and counselling services.

DCS CHP maintains written protocols to inform pregnant members and maternity care providers of voluntary prenatal HIV/AIDS counseling, treatment and testing, and availability of medical counseling for treatment for the mother and child if the test is positive. This includes information to encourage pregnant members to be tested and instructions on where testing is available at least annually in the member newsletter, new member welcome packet, maternity packet, provider instructions, and the Member Handbook.

Participation in clinical trials or use of experimental therapy for children with HIV/AIDS is considered under strict guidelines (see Policy HS-MM-07 New Technology, Experimental or Investigational Therapies and Clinical Trials).

Reporting

DCS CHP provides a semi-annual report to AHCCCS identifying the number of pregnant members who have been newly diagnosed as HIV/AIDS positive.