"Prevention efforts have stalled" on HIV, with 40,000 new infections now occurring annually in the U.S., CDC chief Julie Gerberding, MD, says. She announced a new federal initiative April 17 to "open the door" to HIV diagnostic testing. An estimated 200,000 out of 800,000 HIV-positive Americans are unaware of their status, Gerberding said. Federal agencies will work with individual clinicians "in medical settings and make HIV testing a routine component of medical care," testing anyone who admits to having unsafe sex. CDC will end its requirement that patients participate in what Gerberding called "a fairly comprehensive behavioral counseling intervention" before being tested. Counseling is important, but "it's a barrier."
The rule now takes effect Jan. 7, 2004.
The program will also increase access to a new rapid HIV test in communities with high rates of infection; focus prevention programs more on HIV-infected people rather than on the uninfected people who were the main emphasis of such efforts in the past; and make HIV testing a routine part of perinatal care.
Many of the exceptions to the Stark rule that apply to compensation arrangements can be invoked only if the amount of compensation is set in advance. CMS is grappling with whether its interpretation of "set in advance" automatically excludes percentage compensation deals from the Stark exceptions - a reading that could leave teaching hospitals, physician practices and medical foundations scrambling to rework thousands of contracts.