would parallel the current coverage of individuals with end-stage renal disease (ESRD), who qualify for Medicare benefits even though they do not otherwise meet the Medicare eligibility requirements applicable to the aged (i.e., 65 or over and 40 quarters of payroll tax contributions) or the disabled (have received Social Security Disability Insurance payments for 24 months due to total and permanent disability) (CMS, 2003).

Advantages

This approach has four principal advantages. First, because Medicare is a national program, and because the presence of HIV infection is a standardized medical determination, this approach would ensure coverage of individuals with HIV infection regardless of the state in which they reside. Moreover, this approach would qualify an individual for coverage upon a medical determination of HIV infection, without a waiting period and without a disability determination or a financial means test.

Second, while the adequacy of Medicare payment rates for hospital, physician, and laboratory services is the subject of continuous analysis and political debate, there is little question that most providers participate in the program (MedPAC, 2003). In the Committee’s judgment, Medicare payment rates, as a general matter, would be adequate to enable providers to furnish services commensurate with the standard of care for HIV/AIDS.

Third, this approach offers sources of financing—federal payroll tax revenues (Medicare Part A), federal general revenues (Medicare Part B), and beneficiary premiums (Medicare Part B)—that are as broad in scope as the epidemic itself. These financing sources, while not without their challenges, are substantially more stable than the revenue bases of individual states, many of which are ill-equipped to absorb their portion of the costs of a national epidemic.

Finally, this approach relies on existing administrative structures that, while not without their shortcomings, are relatively efficient and have created a high level of uniformity in how the program is operated. The program’s national data collection requirements also allow for tracking, monitoring, and reporting on the program. To supplement the data systems and administrative capacity of the Centers for Medicare and Medicaid Services (CMS), the Congress has established an independent agency, the Medicare Payment Advisory Commission (MedPAC), the mission of which is to monitor, evaluate, and report on the operation of the Medicare program on a continuous basis. Program accountability is promoted by oversight from the Government Accountability Office (GAO) and the Office of Inspector General (OIG) of the Department of Health and Human Services (DHHS).



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