DEPARTMENT: Health
DEPARTMENT HEAD: Vincent R. Nathan, PhD, MPH
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 $120,000.00 for a term beginning October 1, 2016 and ending September 30, 2017 with the option to renew for up to one, one-year term funded by the General Fund; and
(B) A Professional Services Agreement for TB physician services related to the treatment of patients with latent TB infection (LTBI) 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 for an amount not to exceed $198,735.00 for a term beginning October 1, 2016 to September 30, 2017.
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). Metro Health’s TB Clinic operations also comprises of patient care for active TB patients. The UTHSCT is one of five Regional Training and Medical Consultation Centers (RTMCCs) in the United States, and is 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 to provide these services.
Therefore, through the agreement in (A), Metro Health seeks to secure expert TB physician services through the UTHSCT for full medical coverage for all active TB patients referred to Metro Health’s TB clinic. During the annual FY 2017 budget development process, funding for agreement in (A) was reduced from $128,500.00 to $60,000.00. In order to ensure continuity of operations at the TB Clinic, and ensure resources are available to treat active TB infection, a contagious condition, Metro Health increased funding for agreement (A) to $120,000.00 for the period of October 1, 2016 through September 30, 2017. This agreement is necessary for Metro Health to provide one of the 10 essential services of public health with regards to the threat of TB.
In addition, 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 infections from evolving into active TB cases. This project is being implemented in partnership with DSHS Region 8, The Texas Center for Infectious Disease (TCID), University Health System 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. Increased testing and treatment will focus on persons at higher risk for contracting TB such as refugees, persons living in congregate settings such as homeless shelters and drug rehabilitation centers and individuals living with HIV and diabetes.
ISSUE:
TB continues to be a significant and expensive public health problem in Texas. 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, incarcerated and those that work in health care. Many individuals in this population also are uninsured and lack access to appropriate treatment and care.
The agreements with the University of Texas Health Science Center at Tyler will allow Metro Health to better facilitate treatment for individuals with suspected LTBI and active TB disease.
ALTERNATIVES:
If these agreements are not authorized, Metro Health will need to identify alternative mechanisms to provide expert TB physician services for patients identified in the community with active TB disease. In addition, Metro Health will be unable to meet the goals of the DSHS TB Project which aims to increase targeted testing and treatment for LTBI in high risk populations.
FISCAL IMPACT:
The total amount of funding required for the agreements with the University of Texas Health Science Center at Tyler is $318,735.00 for the terms proposed. The agreement in (A) will be supported by the General Fund for an amount not to exceed $120,000.00 with an option to renew for a one year term. The agreement in (B) will be supported by the DSHS TB Project grant funded through the Texas Medicaid 1115 Waiver for an amount not to exceed $198,735.00. The term of these agreements is October 1, 2016 through September 30, 2017.
RECOMMENDATION:
Staff recommends approval of the Ordinance authorizing agreements with the University of Texas Health Science Center at Tyler for expert TB physician services related to the treatment of patients with active and latent TB (LTBI) infection.