DEPARTMENT: Health
DEPARTMENT HEAD: Dr. Vincent Nathan, Interim Director
COUNCIL DISTRICTS IMPACTED: Citywide
SUBJECT:
Authorizing an Agreement with University Health System related to the Medicaid 1115 Waiver Tuberculosis Project
SUMMARY:
This Ordinance authorizes an agreement with University Health System (UHS) through its Refugee Health Services Clinic for the San Antonio Metropolitan Health District (Metro Health) to provide examination, diagnosis and treatment for individuals suspected or confirmed with active TB disease and latent TB infections. Services provided are related to Metro Health's participation in the Texas Department of State Health Services’ Region 8 Medicaid 1115 Waiver Tuberculosis (TB) Identification and Treatment Project. The goals of the TB Waiver project focus on the early detection and intervention of TB infection and/or disease. This agreement will take effect upon execution through September 30, 2016 and is estimated to value $335,000.
BACKGROUND INFORMATION:
Metro Health’s TB Prevention and Control Program (TB Program) provides examination, diagnosis and treatment for individuals suspected or confirmed with active tuberculosis disease. The TB Program also provides screening and preventive medicine for those with a known exposure to TB or those from high risk populations. Additional services offered include case management, contact investigation and community intervention with prevention measures in order to reduce the rates and control the spread of TB disease.
On June 19, 2014, City Council authorized the acceptance of funding from the Texas Department of State Health Services (DSHS) for Metro Health’s participation in the Tuberculosis Identification and Treatment Project (TB Project) under the Texas Medicaid 1115 Waiver. This project focuses on targeted testing and treatment for latent tuberculosis infection (LTBI) in high risk populations to prevent these cases from evolving into active TB cases. The DSHS TB Project will include increased targeted testing and treatment for high risk populations such as refugees and persons living in congregate settings such as homeless shelters and drug rehabilitation centers. In addition, individuals living with HIV and diabetes will be targeted.
UHS has been providing health screening, lab and immunization services for the refugee population settling in Bexar County since 2008 when these services were transferred from Metro Health to UHS. Through this latest agreement, UHS will refer individuals suspected of having LTBI or active TB disease from their Refugee Health Services clinic to Metro Health for certain medical consultation services to include examination, diagnosis and follow up treatment to reduce the spread of infection.
ISSUE:
TB continues to be a significant and expensive public health problem in Texas. In 2012, there were 1,233 cases of TB disease reported in Texas, a rate of 4.7 per 100,000 population. TB can strike anyone, but is more likely to be found in those born in a foreign country, people with diabetes, people with HIV/AIDS, the homeless, and those that work in health care. Many individuals in this population also are uninsured and lack access to appropriate treatment and care.
This agreement with UHS will allow Metro Health to better facilitate treatment for individuals with suspected LTBI or active TB disease as required for Metro Health’s participation in the DSHS TB Project under the Texas Medicaid 1115 Waiver.
ALTERNATIVES:
If this agreement is not authorized, Metro Health will need to identify alternative mechanisms to meet the goals of the DSHS TB Project which aims to increase targeted testing and treatment for LTBI in high risk populations in order to prevent these cases from evolving into active TB cases.
FISCAL IMPACT:
Metro Health is requesting authorization to execute a Memorandum of Agreement with University Health System through its Refugee Health Services Clinic for a term beginning upon execution through September 30, 2016. This agreement will have no impact on the General Fund and no financial impact on the City.
RECOMMENDATION:
Staff recommends approval of an Ordinance authorizing the agreement with UHS for referrals of individuals suspected to have LTBI or active TB disease to Metro Health to provide certain medical services which will contribute to the early intervention of TB infection or disease.