The New York Times - October 1, 2008
Rebecca Cathcart

As soon as next year, health care providers in California will no longer have to manipulate the codes on insurance forms to goad private insurers into paying for the tests that screen for H.I.V., the virus that causes AIDS.

Removing the cost barrier is a major step toward making H.I.V. screening more prevalent and, in the process, removing the fear and stigma long attached to the test.

"This kind of test should be as routine as a cholesterol or blood pressure test," said Assemblyman Paul Krekorian, the author of the bill. "It should be a part of basic preventative health care."

The law, said Mr. Krekorian, a Democrat, brings California closer to the routine H.I.V. testing recommended in a 2006 report from the Centers for Disease Control and Prevention.

Last year, California stopped requiring hospital patients to give written consent before being tested for H.I.V. That change, along with this guaranteed cost coverage, Mr. Krekorian said, will eliminate the barriers to routine screening.

The centers said in August that the number of new H.I.V. cases each year was 40 percent higher than previously estimated. Each of the 56,000 people who are infected each year will require $600,000 in care over the course of their lives, according to the AIDS Healthcare Foundation, which operates the largest nongovernment H.I.V. testing program in California and sponsored the insurance mandate.

Routine testing is the most effective way to cut the rate of new infections, said Michael Weinstein, the foundation's president.

Some 40,000 people in California who are infected with H.I.V. are unaware they have the disease, according to the California Office of AIDS. Though the California law does not mandate any change in hospital practice, said Mr. Weinstein, covering the almost $30 cost of an H.I.V. test would encourage doctors and clinicians to offer screening.

Dr. Daniel Ciccarone of the University of California, San Francisco, said removing that cost barrier would encourage physicians to offer H.I.V. testing to their patients. "I certainly feel a little less inhibited," he said.

"I do get letters from time to time from insurance providers asking what justified the use of this code," he said, referring to the codes doctors must assign different procedures on insurance forms to get reimbursed.

In response to those letters, Dr. Ciccarone said, many doctors must either spend time appeasing insurers or cover the cost of testing themselves.

"I imagine a lot doctors just shrug and swallow the cost of the testing," he said. "I try to rethink the case," and use different codes to show a person at risk.

Though an early incarnation of the bill included a provision that the state's public insurance provider, MediCal, would also cover routine testing, California's budget impasse and deficit made any additional payments by the state a tough sell, Mr. Weinstein said.

The law would guarantee coverage for the routine testing of 22.19 million people, according to the academic California Health Benefits Review Program.

This law is one in a series of steps toward more universal coverage across the country, said Mr. Krekorian, the assemblyman.

"This legislation will set the standard throughout the nation by making H.I.V. screening a routine part of ordinary preventive health care," he said.

081001
NYT081002