DEPARTMENT: Health
DEPARTMENT HEAD: Dr. Thomas L. Schlenker
COUNCIL DISTRICTS IMPACTED: City Wide
SUBJECT:
Authorizing Agreements with the University of Texas Health Science Center at Tyler
SUMMARY:
This Ordinance authorizes the following agreements related to the San Antonio Metropolitan Health District's (Metro Health's) Tuberculosis (TB) Prevention and Control Program (TB Program) with the University of Texas Health Science Center at Tyler (UTHSCT):
(A) A Professional Services Agreement for TB physician services related to the treatment of patients with active TB infection in an amount not to exceed $50,000.00 for a term beginning October 1, 2014 to September 30, 2015 with the option to renew for up to two successive one-year terms funded by the General Fund;
(B) A Professional Services Agreement for TB physician services related to the treatment of patients with latent TB (LTBI) infection as part of the Metro Health's participation in the Texas Department of State Health Services Tuberculosis Identification and Treatment Project (DSHS TB Project) under the Texas Medicaid 1115 Waiver in an amount not to exceed $293,268.00 for a term beginning October 1, 2014 to September 30, 2015 with the option to renew for an additional one-year term; and
(C) A Memorandum of Agreement for provision of medical and technical consultation related to various aspects of TB control beginning on October 1, 2014, and terminating on December 31, 2015 with the option to renew for two additional one year terms at no cost to the City.
BACKGROUND INFORMATION:
As the local health department for the City of San Antonio and Bexar County, Metro Health is charged with investigating all suspected and confirmed cases of active TB and provides prompt diagnosis and treatment through a process of Directly Observed Therapy (DOT). A significant component of Metro Health's TB Clinic operations is comprised of patient care that is provided to confirmed active TB patients. Therefore, through the agreement in (A), Metro Health seeks to authorize an agreement with UTHSCT to provide expert TB physician services through Drs. Barbara Seaworth and Lisa Armitage for full medical coverage for all active TB patients referred to Metro Health's TB clinic. Active TB case contacts identified as having a latent tuberculosis infection will be provided services and treatment under the agreement in (B).
The UTHSCT is one of five Regional Training and Medical Consultation Centers (RTMCCs) in the United States, and the only one in Texas funded by the Center for Disease Control and Prevention's Division of TB Elimination, to provide medical and technical consultation services related to various aspects of TB control. As such, the UTHSCT is the only entity with this level of expertise available within the state.
On June 19, 2014, City Council authorized the acceptance of funding from the Texas Department of State Health (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 and is being implemented in partnership with DSHS Region 8, The Texas Center for Infectious Disease (TCID) and the UTHSCT. The agreement in (B) will provide TB physician services for high risk individuals identified as having LTBI through increased targeted TB testing for placement on a new three month treatment regimen known as 3HP to reduce the spread of TB. Treatment consists of a 12 dose, 12 week regimen administered by DOT to improve patient adherence and completion of treatment. 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.
Through the agreement in (C), UTHSCT staff will assist with and provide input on contact investigations upon request and will provide education to Metro Health through discussions, consultations, Cohort and Board Reviews. Metro Health will provide for an on-site educational experience for medical and non-medical professional fellows enrolled in clinical, contact investigation and programmatic fellowships provided by UTHSCT.
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.
Metro Health seeks authorization of agreements with the University of Texas Health Science Center at Tyler (UTHSCT) for TB physician services related to the treatment of patients with active TB infection as well as LTBI as part of the Metro Health's participation in the DSHS TB Project under the Texas Medicaid 1115 Waiver.
ALTERNATIVES:
The Metro Health TB Clinic has relied on UTHSCT, specifically the physician services of Dr. Barbara Seaworth and Dr. Lisa Armitage, in supporting the TB Clinic for the past three years. If these agreements are not authorized, Metro Health will need to identify alternative mechanisms to provide patient care and physician services for the TB Program.
FISCAL IMPACT:
The total amount of funding required for the professional services contracts with the University of Texas Health Science Center at Tyler is $343,268.00 for the terms proposed. These contracts will be supported by the General Fund in a cumulative amount not to exceed $50,000.00 and by the DSHS TB Project under the Texas Medicaid 1115 Waiver in a cumulative amount not to exceed $293,268.00.
RECOMMENDATION:
Staff recommends approval of an Ordinance authorizing agreements with the University of Texas Health Science Center at Tyler for physician services for Metro Health's TB Program.