QUEST Integration – HIV/AIDS

Original Effective Date:

08/01/1994

Current Effective Date:

01/01/2015

Testing is covered. Positive results on a screening test must be followed with a Blot Test for positive diagnosis. Free testing also is available through the Department of Health. All testing is confidential.

Payment for initial and confirmation tests for patients obtaining services from private physicians is capped at $175.00

Viral load testing, an important tool for physicians in making treatment decisions relating to HIV/AIDS, also is covered.

Case Management

A specialist in HIV/AIDS may serve as a member’s PCP.

Confidentiality must be maintained; therefore, information about a patient with HIV/AIDS cannot be released without his/her written consent.

Case management includes nutritional counseling and pharmacy counseling. With the new drug protocols involving protease inhibitors, meals and the timing of medications is critical. Therefore, it is important that you explain to the patient that HMSA offers case management assistance to help a patient with his/her treatment plan should the patient or you feel that such help is needed. Because there is no single triple therapy regime that is accepted, the state of the art is changing, and there are no clinical practice guidelines, it is important that you and the patient work together to determine when to start protease inhibitors, the frequency of viral load testing, etc.

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