evekhm/cms_iom_500 huggingface dataset:
(Medicare National Coverage Determinations Manual)
 All adolescents and adults between the ages of 15 to 65 years,   Younger adolescents and older adults who are at increased risk of HIV infection, and,  All pregnant women.   B. Nationally Covered Indications   Effective for claims with dates of service on and after April 13, 2015, CMS has determined that the evidence is adequate to conclude that screening for HIV infection for all individuals between the ages of 15 and 65 years, as recommended with a Grade of A by the USPSTF, is reasonable and necessary for early detection of HIV and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.   CMS shall cover screening for HIV with the appropriate U.S. Food and Drug Administration (FDA) -approved laboratory tests and point -of-care tests, used consistent with FDA -approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLI A) regulations, when ordered by the beneficiarys physician or practitioner within the context of a healthcare setting and performed by an eligible Medicare provider for these services, for beneficiaries who meet one of the following conditions:   1. Except for pregnant Medicare beneficiaries addressed below, a maximum of one, annual, voluntary screening for all adolescents and adults between the age of 15 and 65, without regard to perceived risk.   2. Except for pregnant Medicare beneficiaries addressed below, a maximum of one, annual, voluntary screening for adolescents younger than 15 and adults older than 65 who are at increased risk for HIV infection.  Increased risk for HIV infection is defined as follows:    Men who have sex with men,   Men and women having unprotected vaginal or anal intercourse,   Past or present injection drug users,   Men and women who exchange sex for money or drugs, or have sex partners who do,  Individuals whose past or present sex partners were HIV -infected, bisexual, or injection drug users,   Persons who have acquired or request testing for other sexually transmitted infectious diseases,   Persons with a history of blood transfusions between 1978 and 1985,   Persons who request an HIV test despite reporting no individual risk factors,
(Medicare National Coverage Determinations Manual)
Persons with new sexual partners,   Persons who, based on individualized physician interview and examination, are deemed to be at increased risk for HIV infection.  The determination of increased risk for HIV infection is identified by the health care practitioner who assesses the patient s history, which is part of any complete medical history, typically part of an annual wellness visit and considered in the development of a comprehensive prevention plan.  The medical recommendation should be a reflection of the service provided.   3. A maximum of three, voluntary, HIV screenings of pregnant Medicare beneficiaries: (1) when the diagnosis of pregnancy is known, (2) during the third trimester, and, (3) at labor, if ordered by the womans clinician.   C. Nationally Non -Covered Indications   Effective for claims with dates of service on and after April 13, 2015:   -Medicare beneficiaries with any known diagnosis of an HIV -related illness are not eligible for this screening test.   -Medicare beneficiaries between the ages of 15 and 65 who have had a prior HIV screening test within 1 year are not eligible for HIV screening (i.e., at least 11 full months must have elapsed following the month in which the previous test was performed in order for the subsequent test to be covered).    -Medicare beneficiaries younger than 15 or older than 65, at increased risk for HIV -related illnesses, who have had a prior HIV screening test within 1 year are not eligible for HIV screening (i.e., at least 11 full months must have elapsed following the m onth in which the previous test was performed in order for the subsequent test to be covered).   -Pregnant Medicare beneficiaries who have had three specified screening tests within each respective term of pregnancy are not eligible for further HIV screening during their pregnancy.   D. Other   N/A  (This NCD last reviewed April 2015.)   210.8  Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse  (Effective October 14, 2011)  (Rev. 138, Issued: 11- 23-11, Effective: 10 -14-11, Implementation: 12- 27-11 non -system changes, 04- 02-12 shared system changes, 07- 02-12 CWF/HICR/MCS MCSDT)   A. General
(Medicare National Coverage Determinations Manual)
A. General   Based upon authority to cover additional preventive services for Medicare beneficiaries if certain statutory requirements are met, the Centers for Medicare & Medicaid Services (CMS) initiated a new national coverage analysis on annual screening and brief  behavioral counseling in primary care to reduce alcohol misuse in adults, including pregnant women.  Annual screening and behavioral counseling for alcohol misuse in adults is recommended with a grade of B by the U.S. Preventive Services Task Force (USPST F) and is appropriate for individuals entitled to benefits under Part A and Part B.  CMS will cover annual alcohol screening and up to four, brief face -to-face behavioral counseling in primary care settings to reduce alcohol misuse. CMS does not identify specific alcohol misuse screening tools.  Rather, the decision to use a specific tool is at the discretion of the clinician in the primary care setting. Various screening tools are available for screening for alcohol misuse.   B. Nationally Covered Indications   Effective for claims with dates of service on or after October 14, 2011, CMS will cover annual alcohol screening, and for those that screen positive, up to four brief, face -to-face, behavioral counseling interventions per year for Medicare beneficiaries, i ncluding pregnant women:    Who misuse alcohol, but whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence (defined as at least three of the following: tolerance, withdrawal symptoms, impaired control, preoccupation with acquisition and/or use, persistent desire or unsuccessful efforts to quit, sustains social, occupational, or recreational disability, use continues despite adverse consequences); and   Who are competent and alert at the time that counseling is provided; and,   Whose counseling is furnished by qualified primary care physicians or other primary care practitioners in a primary care setting.   Each of the behavioral counseling interventions should be consistent with the 5As approach that has been adopted by the USPSTF to describe such services. They are:   1. Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.  2. Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.   3. Agree: Collaboratively select appropriate treatment goals and methods based on the patients interest in and willingness to change the behavior.
(Medicare National Coverage Determinations Manual)
3. Agree: Collaboratively select appropriate treatment goals and methods based on the patients interest in and willingness to change the behavior.   4. Assist: Using behavior change techniques (self -help and/or counseling), aid the patient in achieving agreed upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treat ments when appropriate.   5. Arrange: Schedule follow -up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.   For the purposes of this policy, a primary care setting is defined as one in which there is provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities and hospices are not considered primary care settings under this definition.  For the purposes of this policy a primary care physician and primary care practitioner are to be defined based on two existing sections of the Social Security Act, 1833(u)(6), 1833(x)(2)(A)(i)(I) and 1833(x)(2)(A)(i)(II):   1833(u)  (6)Physician Defined. For purposes of this paragraph, the term physician means a physician described in section 1861(r)(1) and the term primary care physician means a physician who is identified in the available data as a general practitioner, family p ractice practitioner, general internist, or obstetrician or gynecologist.  1833(x)(2)(A)(i)  (I) is a physician (as described in section 1861(r)(1)) who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine; or   (II) is a nurse practitioner, clinical nurse specialist, or physician assistant (as those terms are defined in section 1861(aa)(5)).   C. Nationally Non -Covered Indications   1. Alcohol screening is non- covered when performed more than one time in a 12- month period.
(Medicare National Coverage Determinations Manual)
C. Nationally Non -Covered Indications   1. Alcohol screening is non- covered when performed more than one time in a 12- month period.  2. Brief face -to-face behavioral counseling interventions are non- covered when performed more than once a day; that is, two counseling interventions on the same day are non- covered.   3. Brief face -to-face behavioral counseling interventions are non- covered when performed more than four times in a 12- month period  D. Other  Medicare coinsurance and Part B deductible are waived for this preventive service   (This NCD last reviewed October 2011.)   210.9  Screening for Depression in Adults (Effective October 14, 2011)  (Rev. 139, Issued: 11- 23-11, Effective: 10 -14-11, Implementation: 12- 27-11 non -shared system edits/04 -02-12 shared system edits/07- 02-12 CWF, HICR, MCS MCSDT)   A. General   Among persons older than 65 years, one in six suffers from depression.  Depression in older adults is estimated to occur in 25% of those with other illness including cancer, arthritis, stroke, chronic lung disease, and cardiovascular disease.  Other stress ful events, such as the loss of friends and loved ones, are also risk factors for depression.  Opportunities are missed to improve health outcomes when mental illness is under -recognized and under -treated in primary care settings.   Older adults have the highest risk of suicide of all age groups.  These patients are important in the primary care setting because 50 -75% of older adults who commit suicide saw their medical doctor during the prior month for general medical care, and 39% w ere seen during the week prior to their death. Symptoms of major depression that are felt nearly every day include, but are limited to, feeling sad or empty; less interest in daily activities; weight loss or gain when not dieting; less ability to think or concentrate; tearfulness, feelings of worthlessness, and thoughts of death or suicide.
(Medicare National Coverage Determinations Manual)
Based upon authority to cover additional preventive services for Medicare beneficiaries if certain statutory requirements are met, the Centers for Medicare & Medicaid Services (CMS) initiated a new national coverage analysis on screening for depression i n adults.  Screening for depression in adults is recommended with a grade of B by the U.S. Preventive Services Task Force (USPSTF) and is appropriate for individuals entitled to benefits under Part A and Part B.   Therefore, effective October 14, 2011, CMS will cover annual screening for depression for Medicare beneficiaries in primary care settings that have staff -assisted depression care supports in place to assure accurate diagnosis, effective treatment, and follow -up.  Various screening tools are available for screening for depression.  CMS does not identify specific depression screening tools.  Rather, the decision to use a specific tool is at the discretion of the clinician in the primary care setting.   Coverage is limited to screening services and does not include treatment options for depression or any diseases, complications, or chronic conditions resulting from depression, nor does it address therapeutic interventions such as pharmacotherapy, combinat ion therapy (counseling and medications), or other interventions for depression.   B. Nationally Covered Indications   Effective for claims with dates of service on or after October 14, 2011, CMS will cover annual screening up to 15 minutes for Medicare beneficiaries when staff -assisted depression care supports are in place to assure accurate diagnosis, effective treatment , and follow -up.  At a minimum level, staff -assisted supports consist of clinical staff (e.g., nurse, physician assistant) in the primary care setting who can advise the physician of screening results and who can facilitate and coordinate referrals to ment al health treatment.   C. Nationally Non -Covered Indications   Screening for depression is non- covered when performed more than one time in a 12- month period. In addition, self -help materials, telephone calls, and web -based counseling are not separately reimbursable by Medicare and are not part of this NCD.  D. Other  Medicare coinsurance and Part B deductible are waived for this preventive service   (This NCD last reviewed October 2011.)
(Medicare National Coverage Determinations Manual)
Medicare coinsurance and Part B deductible are waived for this preventive service   (This NCD last reviewed October 2011.)   210.10 - Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs  (Rev. 141, Issued: 01- 26-12, Effective: 11 -08-2011, Implementation: 02- 27-12)  A. General   Sexually transmitted infections (STIs) are infections that are passed from one person to another through sexual contact.  STIs remain an important cause of morbidity in the United States and have both health and economic consequences.  Many of the complications of STIs are borne by women and children  Often, STIs do not pres ent any symptoms so can go untreated for long periods of time  The presence of an STI during pregnancy may result in significant health complications for the woman and infant.  In fact, any person who has an STI may develop health complications.  Screening  tests for the STIs in this national coverage determination (NCD) are laboratory tests.   Under 1861(ddd) of the Social Security Act (the Act), the Centers for Medicare & Medicaid Services (CMS) has the authority to add coverage of additional preventive services if certain statutory requirements are met.  The regulations provide:   410.64 Additional preventive services   (a) Medicare Part B pays for additional preventive services not described in paragraph (1) or (3) of the definition of preventive services under 410.2, that identify medical conditions or risk factors for individuals if the Secretary determines through the national coverage determination process (as defined in section 1869(f)(1)(B) of the Act) that these services are all of the following: (1) reasonable and necessary for the prevention or early detection of illness or disability.(2) recommended with a grade of A or B by the United States Preventive Services Task Force, (3) appropriate for individuals entitled to benefits under Pa rt A or enrolled under Part B.
(Medicare National Coverage Determinations Manual)
(b) In making determinations under paragraph (a) of this section regarding the coverage of a new preventive service, the Secretary may conduct an assessment of the relation between predicted outcomes and the expenditures for such services and may take into account the results of such an assessment in making such national coverage determinations.  The scope of the national coverage analysis for this NCD evaluated the evidence for the following STIs and high intensity behavioral counseling (HIBC) to prevent STIs for which the United States Preventive Services Task Force (USPSTF) has issued either an A or B recommendation:    Screening for chlamydial infection for all sexually active non- pregnant young women aged 24 and younger and for older non- pregnant women who are at increased risk,   Screening for chlamydial infection for all pregnant women aged 24 and younger and for older pregnant women who are at increased risk,    Screening for gonorrhea infection in all sexually active women, including those who are pregnant, if they are at increased risk,    Screening for syphilis infection for all pregnant women and for all persons at increased risk,    Screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit,    HIBC for the prevention of STIs for all sexually active adolescents, and for adults at increased risk for STIs.   B. Nationally Covered Indications   CMS has determined that the evidence is adequate to conclude that screening for chlamydia, gonorrhea, syphilis, and hepatitis B, as well as HIBC to prevent STIs, consistent with the grade A and B recommendations by the USPSTF, is reasonable and necessary f or the early detection or prevention of an illness or disability and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.  Therefore, effective for claims with dates of services on or after November 8, 2011, CMS will cover screening for these USPSTF -indicated STIs with the appropriate Food and Drug Administration (FDA) -approved/cleared laboratory tests, used consistent with FD A-approved labeling, and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations, when ordered by the primary care physician or practitioner, and performed by an eligible Medicare provider for these services.   Screening for chlamydia and gonorrhea:
(Medicare National Coverage Determinations Manual)
Screening for chlamydia and gonorrhea:    Pregnant women who are 24 years old or younger when the diagnosis of pregnancy is known, and then repeat screening during the third trimester if high- risk sexual behavior has occurred since the initial screening test.    Pregnant women who are at increased risk for STIs when the diagnosis of pregnancy is known, and then repeat screening during the third trimester if high- risk sexual behavior has occurred since the initial screening test.    Women at increased risk for STIs annually.   Screening for syphilis:    Pregnant women when the diagnosis of pregnancy is known, and then repeat screening during the third trimester and at delivery if high- risk sexual behavior has occurred since the previous screening test.   Men and women at increased risk for STIs annually.  Screening for hepatitis B:    Pregnant women at the first prenatal visit when the diagnosis of pregnancy is known, and then rescreening at time of delivery for those with new or continuing risk factors.   In addition, effective for claims with dates of service on or after November 8, 2011, CMS will cover up to two individual 20-  to 30- minute, face -to-face counseling sessions annually for Medicare beneficiaries for HIBC to prevent STIs, for all sexually acti ve adolescents, and for adults at increased risk for STIs, if referred for this service by a primary care physician or practitioner, and provided by a Medicare eligible primary care provider in a primary care setting.  Coverage of HIBC to prevent STIs is c onsistent with the USPSTF recommendation.  HIBC is defined as a program intended to promote sexual risk reduction or risk avoidance, which includes each of these broad topics, allowing flexibility for appropriate patient -focused elements:    education,   skills training,   guidance on how to change sexual behavior.   The high/increased risk  individual sexual behaviors, based on the USPSTF guidelines, include any of the following:    Multiple sex partners   Using barrier protection inconsistently  Having sex under the influence of alcohol or drugs   Having sex in exchange for money or drugs   Age (24 years of age or younger and sexually active for women for chlamydia and gonorrhea)   Having an STI within the past year   IV drug use (for hepatitis B only)   In addition for men  men having sex with men (MSM) and engaged in high risk sexual behavior, but no regard to age
(Medicare National Coverage Determinations Manual)
In addition to individual risk factors, in concurrence with the USPSTF recommendations, community social factors such as high prevalence of STIs in the community populations should be considered in determining high/increased risk for chlamydia, gonorrhea, syphilis, and for recommending HIBC.   High/increased risk sexual behavior for STIs is determined by the primary care provider by assessing the patients sexual history which is part of any complete medical history, typically part of an annual wellness visit or prenatal visit and considered in the development of a comprehensive prevention plan. The medical record should be a reflection of the service provided.  For the purposes of this NCD, a primary care setting  is defined as the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.  Emergency departments, inpatient hospital settings, ambulatory surgical centers, independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation facilities, clinics providing a limited focus of health care services, and hospice are examples of settings not considered primary care settings under this definition.  For the purposes of this NCD, a  primary care physician  and primary care practitioner  will be defined based on existing sections of the Social Security Act (1833(u)(6), 1833(x)(2)(A)(i)(I) and 1833(x)(2)(A)(i)(II)).   1833(u)  (6) Physician Defined. For purposes of this paragraph, the term physician means a physician described in section 1861(r)(1) and the term primary care physician means a physician who is identified in the available data as a general practitioner, family practice practitioner, general internist, or obstetrician or gynecologist.  1833(x)(2)(A)(i)  (I) is a physician (as described in section 1861(r)(1) ) who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine; or   (II) is a nurse practitioner, clinical nurse specialist, or physician assistant (as those terms are defined in section 1861(aa)(5) );  C. Nationally Non -Covered Indications