Public Hearings 20.
Regular Board of Supervisors Meeting
Health & Social Services
- Meeting Date:
- 06/25/2013
- Title:
- Resolution Establishing A New Fee Schedule For Tubeculosis (TB) Testing Services
- Submitted By:
- Jennifer Steiger, Health & Social Services
- Department:
- Health & Social Services
Presentation:
PowerPoint
Recommendation:
Approve
Document Signatures:
BOS Signature Required
# of ORIGINALS
Submitted for Signature:
Submitted for Signature:
1
NAME
of PRESENTER:
of PRESENTER:
Radi Ann Porter, RN
TITLE
of PRESENTER:
of PRESENTER:
Director of Nursing, CHSS
Mandated Function?:
Federal or State Mandate
Source of Mandate
or Basis for Support?:
or Basis for Support?:
ADHS
Docket Number (If applicable):
Information
Agenda Item Text:
Adopt Resolution 13-15 to establish a new fee schedule for Tuberculosis (TB) Testing Services provided by Cochise Health & Social Services for testing, education, screening and treatment of clients with cases of tuberculosis, effective on and after July 26, 2013.
Background:
Cochise County is mandated to provide services designed to prevent and control the spread of Tuberculosis (TB), and receives state funds to support this program. A major portion of this process is the provision of Tuberculosis Skin Testing (TST) to determine if an individual has been exposed to M. tuberculosis. Many organizations, including our own, require that their employees be screened to ensure that the public they serve is protected from this highly communicable disease. Most group living situations are required to screen their clients to protect all residents in the facility. Additionally Cochise County is required to provide screening for individuals who are attempting to immigrate to the United States. Cochise County also provides TST for any known contacts of an active TB case free of charge as part of our mandate to control TB.
The process of providing TST includes two visits with the nurse. During the first visit the nurse will review standard screening questions and apply the TST which involves inserting a needle just under the skin and injection 0.1 ml of a TB test solution. After 48 to 72 hours the client will return to the clinic to have the test read by the nurse and the client receives a TB clearance card to provide to the employer as evidence of a negative TB status. All of these activities are documented in a client chart and logged for tracking purposes. The cost of administering TST is considered part of routine nursing activities and is not tracked by the site nurse in the time distribution record process, or billed back to the TB contract, and so represents a draw on the general funds of Cochise County.
There have been significant shortages of both the treatment medications and the screening medications used to provide TB services and the cost of screening medications has doubled since 2011. Treatment and screening medications are covered by the TB grant but nursing hours and supplies for routine TB testing are not covered.
If this proposal of a $10/test increase is approved the positive bottom line benefit to the general fund will be approximately $5000.00, and may be greater depending on the needs of the citizens, population growth and the development of businesses requiring testing. This increased revenue would continue to have a positive bottom line impact in future budgets reducing the cost to the taxpayers of Cochise County in the long term. See Exhibit A (attached) for the detailed Tuberculosis (TB) Proposed Fee Schedule.
The process of providing TST includes two visits with the nurse. During the first visit the nurse will review standard screening questions and apply the TST which involves inserting a needle just under the skin and injection 0.1 ml of a TB test solution. After 48 to 72 hours the client will return to the clinic to have the test read by the nurse and the client receives a TB clearance card to provide to the employer as evidence of a negative TB status. All of these activities are documented in a client chart and logged for tracking purposes. The cost of administering TST is considered part of routine nursing activities and is not tracked by the site nurse in the time distribution record process, or billed back to the TB contract, and so represents a draw on the general funds of Cochise County.
There have been significant shortages of both the treatment medications and the screening medications used to provide TB services and the cost of screening medications has doubled since 2011. Treatment and screening medications are covered by the TB grant but nursing hours and supplies for routine TB testing are not covered.
If this proposal of a $10/test increase is approved the positive bottom line benefit to the general fund will be approximately $5000.00, and may be greater depending on the needs of the citizens, population growth and the development of businesses requiring testing. This increased revenue would continue to have a positive bottom line impact in future budgets reducing the cost to the taxpayers of Cochise County in the long term. See Exhibit A (attached) for the detailed Tuberculosis (TB) Proposed Fee Schedule.
Department's Next Steps (if approved):
Your approvals are respectfully requested.
Impact of NOT Approving/Alternatives:
Not approving this fee schedule could cause the Tuberculosis (TB) Services to become a fiscal burden on the general fund. The new fee schedule will allow for continued testing of individuals, improving the overall health of the citizens of Cochise County, which would not be possible without such a program.
To BOS Staff: Document Disposition/Follow-Up:
Original BOS Resolution 13-15, signed by Terry Bannon, sent to BOS Office, via interoffice mail, 5/30/13 for signature. Please return one fully executed copy of the Resoluton.
Budget Information
Information about available funds
Budgeted:
Funds Available:
Adjustment:
Amount Available:
Unbudgeted:
Funds NOT Available:
Amendment:
Account Code(s) for Available Funds
- 1:
Fund Transfers
Fiscal Year: 2013-2014
One-time Fixed Costs? ($$$):
Ongoing Costs? ($$$):
County Match Required? ($$$):
A-87 Overhead Amt? (Co. Cost Allocation $$$):
Source of Funding?: ADHS/Cochise County
Fiscal Impact & Funding Sources (if known):
We provide more than 500 TST to the public annually in Cochise County, in addition to following between 10 and 30 active or latent cases of TB. The state provides an annual grant of $12,000.00 to support these activities, which historically has been flat funding, and the funds are broken down as follows:Personnel & ERE 4,200.00
Professional & outside service 2,600.00
Travel 2,500.00
Other operating 2,700.00
Professional and outside services covers Medical Director fees, charges for X-rays and laboratory testing, while Other Operating expenses provide funding for the cost of screening and treatment medications in active cases for which the County is responsible. As of March 31, 2013 we have expended $11,037.34 of this budget, and we are experiencing a slight increase in active cases over historical numbers. There is cash carry forward of $14,770.00 in this budget, but given the increasing numbers of active Tuberculosis (TB) cases we project that we will need to expend some significant portion of these funds in this year as well as in the coming years.