HIV Testing and Counseling
- Participating Physician Groups (PPG)
Participating providers provide confidential HIV testing, counseling and follow-up services for Medi-Cal members. Providers must provide information about HIV testing, treatment options and additional testing needed, and advise members of their right to decline testing. If a member declines HIV testing, the provider must document this information in their medical records.
When a member requests confidential HIV testing, counseling or follow-up services, the provider or staff person with authority and license to do so, must administer pre-test counseling services, obtain a complete history and physical (if indicated), and order the requisite lab work. The provider must follow the Centers for Disease Control and Prevention (CDC) guidelines for pre- and post-testing counseling.
Medi-Cal members may also obtain confidential or anonymous HIV testing and counseling services from a local health department (LHD), community-based organization testing site, or a non-participating family planning provider. The member's primary care physician must perform follow-up services.
Participating providers rendering confidential HIV testing and counseling services are reimbursed at the allowable Medi-Cal fee-for-service (FFS) rate established by the Department of Health Care Services (DHCS), unless a specific rate is included in the provider's contract.
Participating providers are required to coordinate all follow-up services with the member's primary care physician (PCP). Referrals and authorizations must be obtained from the PCP. If a participating provider treats a member for follow-up HIV services without the PCP's approval, payment of claims for the services may be denied.
Claims for reimbursement are processed within 45 business days of receipt. Providers are notified in writing of any contested claim in suspense longer than 45 business days.
The custodian of records is responsible for controlling the release of records related to HIV testing to any third party not involved in the member's care.
If a copy of the member's medical record is requested, the custodian of records must review the record and remove the confidential consent form or the HIV test results, along with any other portion of the record that contains documentation of the HIV test being ordered or the HIV test results (for example, history, physical, consultations, and progress notes). If the HIV test or HIV test results are mentioned anywhere in the medical record, the information is protected. If necessary, the custodian must explain that the protected portion of the record requires special written authorization from the member. The custodian of records must not identify in any way that the record is confidential because of the HIV or AIDS test. It must state that disclosure of it is protected under state law and requires special authorization from the member. After removing all confidential material, the record may be released to the requestor.
Requests by a member for access to medical records containing HIV test result information should be processed according to established guidelines. Prior to providing a member access to the medical record, verify with the provider that the member has been previously informed of the test results. The provider must disclose the results of an HIV test to the subject of the test in a confidential manner. Disclosure must be in person only and not by telephone.