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Medicare (CMS) Announces 'Covers HCV Screenings'
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CMS targets boomers, those at high risk for hepatitis C screenings
from Jules: although the federal govt underestimates the HCV prevalence in the USA at about 3 million (new NHANES- http://www.natap.org/2013/HCV/011314_12.htm] studies estimate the true HCV prevalence in the USA to be 5 to 7 million, Edlin [http://www.natap.org/2005/AASLD/aasld_49.htm] & Chak studies, Chak et al [http://www.natap.org/2011/HCV/HepatitisCvirusinfectioninUSAAnestimatetrue prevalenceLiverInternational9.2011.pdf]says 5 mill conservatively & 7 mill which includes additional groups not often included, which I certainly agree, but neither study I think considers immigrants from countries where HCV is highly prevalent such as China, India, Pakistan etc, so I think this might add another 1 million HCV prevalence making the higher estimate 8 million. Gary Davis in his famous 2010 paper said: "our findings suggest that the CH-C that we have become familiar with during the last 30 years is much different than the hepatitis C we will come to know during the next decade or 2......Currently, only a small proportion of those with CH-C are aware of their infection and, of these, just 10% to 27% are offered treatment.......the proportion of cases with advanced fibrosis will continue to rise during the next 2 decades (Cirrhosis accounted for just 5% of all cases (diagnosed and undiagnosed) of CH-C in 1989, 10% in 1998, and 20% in 2006, the proportion with cirrhosis is projected to reach 24.8% in 2010, 37.2% in 2020, and 44.9% in 2030).....HCC in persons older than the age of 65 years with HCV infection has doubled during the last several years"
The CMS has finalized its coverage decision to reimburse for hepatitis C virus screenings for two target populations, including baby boomers.
"Pursuant to 1861(ddd) of the Social Security Act, the Secretary may add coverage of "additional preventive services" if certain statutory requirements are met......."
"Screening for HCV infection could identify persons at earlier stages of disease, before they develop serious or irreversible liver damage, and lead to treatments to improve clinical outcomes or reduce transmission risk. Up to three quarters of HCV-infected persons are unaware of their status." (USPSTF Screening for HCV, Systematic Review 2012 http://www.uspreventiveservicestaskforce.org/uspstf12/hepc/hepcscrart.htm)
CMS- Decision Memo for Screening for Hepatitis C Virus (HCV) in Adults (CAG-00436N)........http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=272
The Centers for Medicare & Medicaid Services (CMS) has determined the following:
The evidence is adequate to conclude that screening for Hepatitis C Virus (HCV), consistent with the grade B recommendations by the U.S. Preventive Services Task Force (USPSTF), is reasonable and necessary for the prevention or early detection of an illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B, as described below.
Therefore, CMS will cover screening for HCV with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, used consistent with FDA approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations, when ordered by the beneficiary's primary care physician or practitioner within the context of a primary care setting, and performed by an eligible Medicare provider for these services, for beneficiaries who meet either of the following conditions.
1. A screening test is covered for adults at high risk for Hepatitis C Virus infection. "High risk" is defined as persons with a current or past history of illicit injection drug use; and persons who have a history of receiving a blood transfusion prior to 1992. Repeat screening for high risk persons is covered annually only for persons who have had continued illicit injection drug use since the prior negative screening test.
2. A single screening test is covered for adults who do not meet the high risk as defined above, but who were born from 1945 through 1965.
The determination of "high risk for HCV" is identified by the primary care physician or practitioner who assesses the patient's history, which is part of any complete medical history, typically part of an annual wellness visit and considered in the development of a comprehensive prevention plan. The medical record should be a reflection of the service provided.
For the purposes of this national coverage determination (NCD), a primary care setting is defined by the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities, clinics providing a limited focus of health care services, and hospice are examples of settings not considered primary care settings under this definition.
For the purposes of this NCD, a "primary care physician" and "primary care practitioner" will be defined consistent with existing sections of the Social Security Act (1833(u)(6), 1833(x)(2)(A)(i)(I) and 1833(x)(2)(A)(i)(II)).
1833(u)
(6) Physician Defined.-For purposes of this paragraph, the term "physician" means a physician described in section 1861(r)(1) and the term "primary care physician" means a physician who is identified in the available data as a general practitioner, family practice practitioner, general internist, or obstetrician or gynecologist.
1833(x)(2)(A)(i)
(I) is a physician (as described in section 1861(r)(1)) who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine; or
(II) is a nurse practitioner, clinical nurse specialist, or physician assistant (as those terms are defined in section 1861(aa)(5));
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The USPSTF recommends screening for HCV infection in persons at high risk for infection. (Grade: B recommendation) The USPSTF also recommends offering 1-time screening for HCV infection to adults born between 1945 and 1965. (Grade: B recommendation).
"In 1998, the highest prevalence rates of the anti-HCV antibody occurred in persons with significant direct percutaneous exposures, such as injection drug users and persons with hemophilia (60% to 90%); persons with less significant percutaneous exposures involving smaller amounts of blood, such as patients receiving hemodialysis (10% to 30%), had more moderate prevalence rates. Persons engaging in high-risk sexual behaviors (1% to 10%); recipients of blood transfusions (6%); and persons with infrequent percutaneous exposures, such as health care workers (1% to 2%), had the lowest prevalence rates."
"In reviewing the prevalence data on high-risk groups and the potential for reduced transmission, the USPSTF concluded that screening in high-risk persons (prevalence ≥50%) and the birth cohort (prevalence of about 3% to 4%) would result in a moderate net benefit."
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