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Wisconsin AIDS/HIV Laboratory Reimbursement
Program
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The Wisconsin
AIDS/HIV Laboratory Reimbursement Program covers the cost of CD4+ T cell
counts, plasma HIV RNA levels, antiretroviral resistance testing, and two
tests needed for the use of specific antiviral medications for
uninsured, HIV-positive individuals who live in Wisconsin, regardless of
where they receive services.
The program is funded by a portion of the federal Ryan White Part B
(formerly Title II) Grant. The
program began July 2, 2007 and retroactively covers the cost of laboratory
tests performed from April 1, 2007 through the end of the Ryan White
fiscal year (March 31, 2008). The
program may be renewed in future years based on the continuing availability
of funds.
Patient
Eligibility
To be eligible to
receive benefits under the program, the HIV-positive individual must:
-
live in Wisconsin and
-
lack insurance coverage.
Persons with public (Medicaid,
Medicare, VA, GAMP, HIRSP) or private insurance of any
kind are NOT eligible for the program. Note that individuals who are in
the 6-month waiting period for HIRSP are eligible for this program.
Because HIV infection is a reportable condition, reimbursement
is contingent on receipt of the patient's case report by AIDS/HIV Program.
If a reimbursement request is submitted for a patient who has not
yet been reported, staff from the AIDS/HIV Program will contact
the submitting physician to generate a case report via telephone.
Once a case report has been generated, the request will be processed.
It is the
responsibility of the claimant to verify that the patient meets the
eligibility criteria and that this program is being used as the payer of
last resort.
Covered
Laboratory Tests
Reimbursement requests
may be submitted for the following laboratory tests:
·
CD4 T cell count/percentage
o
Up to 4 tests in a 12-month
period per individual, consistent with current recommendations
·
Plasma HIV RNA level (i.e.
Viral Load)
o
Up to 4 tests in a 12-month
period per individual, consistent with current recommendations
·
Antiretroviral resistance
o
Up to 2 tests in a 12-month
period per individual, consistent with the accepted time frames defining
virologic failure.
·
CCR5 Co-receptor Trofile
Assay
o
Once per individual.
·
HLA B5701 (Abacavir
Hypersensitivity)
o
Once per individual.
Reimbursement requests
shall be submitted only for tests that conform to
current recommendations for AIDS/HIV disease management and antiretroviral
resistance testing in pediatric, adolescent and adult populations.
Wisconsin
AIDS/HIV Laboratory Program
Information Sheet
(PDF, 49 KB)
Agency Enrollment Form
(PDF, 8 KB)
Reimbursement Request
Form
(PDF, 50 KB)
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Last Revised: October 31, 2007 |
