Tuberculosis Reimbursement Program


KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT

Bureau of Community Health Systems

KANSAS STATEWIDE FARMWORKER HEALTH PROGRAM

Bureau of Disease Prevention and Health Promotion

TUBERCULOSIS REIMBURSEMENT PROGRAM

COVERAGE FOR TUBERCULOSIS SERVICES

POLICY AND PROCEDURES

The KS Statewide Farmworker Health Program also manages the supplemental fund to expand coverage for routinely needed health services for patients with tuberculosis. The fund is limited to uninsured clients with household incomes below 200% of the federal poverty guidelines. Eligible clients include those who have shown significant skin test results and those who require additional diagnostic and/or therapeutic services related to tuberculosis. This expanded coverage is possible through the Kansas Department of Health and Environment (KDHE), Bureau of Disease Prevention and Health Promotion, and is available as funds exist.


NOTE: Eligibility for coverage is not limited to migrant or seasonal farmworkers and may be utilized by any low-income individual in the state (200% of poverty or below, according to federal poverty guidelines) who is not covered by Medicaid or any other type of health insurance. TB funds are supplemental funds to be used as a last resort for people who are not eligible for Medicaid, have no health insurance and no other means of payment for services.

COVERED TB-RELATED SERVICES:

Healthcare agencies may request payment for the following tuberculosis related services:

Chest x-ray:
PA and LAT for all patients with significant skin test results. Repeat chest x-ray requires preauthorization from the regional case manager. Payment limited to Medicaid fee-for-service.

Pharmaceutical:
All tuberculosis medications are provided through the Kansas Department of Health and Environment, TB Program, (785) 296-5589. There will be no reimbursement for TB medications obtained elsewhere.

Laboratory:
Hepatic enzymes should be monitored monthly on patients age 35 and older or for those who experience symptoms of hepatitis who are receiving prescribed prophylactic therapy. Payment limited to Medicaid fee-for-service rates may be charged for each of the required monthly tests as therapy continues.

A baseline Chemistry Panel of 19 or more tests is required for adult patients prescribed therapy for active disease or if patient has complications due to drug therapy. The panel must include: baseline hepatic enzymes, bilirubin, serum creatinine, complete blood count with platelet count and serum uric acid. Payment limited to Medicaid fee-for-service.

The panel of liver function tests listed above should be done only on patients who are under age 35 when symptoms of hepatitis are demonstrated. This condition must be documented on the voucher.

All specimens for smear, culture, and susceptibility testing, from any health provider, must be submitted directly to the Kansas Health and Environmental Laboratories. There will be no reimbursement for services provided by other laboratories.

Nursing Care:
Direct observation of patient therapy on active TB cases or high risk infected individuals by local health departments may be reimbursed.

High risk is defined as:
any suspect case that is being treated as an active case until diagnosis is confirmed.
a confirmed active case of tuberculosis.
any child who lives in the home of an active tuberculosis case; the name of the infected individual must be documented on the voucher.
A minimum of two visits per week is required. Payment is limited to a monthly payment of $40.00 for the duration of treatment.

Brief Office Visit:
A brief office visit is made to a primary care provider for evaluation or follow-up. Payment limited to $30.00. This is limited to a onetime office visit per patient. However, if the patient has active disease or is on prophylactic medication and demonstrating signs of hepatitis or a patient has other complications, two office visits may be reimbursed. Documentation of these conditions must be noted on the voucher. Any further office visits must be preauthorized by the regional case manager.

Home Health Skilled Nursing Visit:
Payment limited to $60. These may be reimbursed on a case by case determination through the regional case manager. DOT in the home is reimbursed under nursing care at $40 a month.

PPD: Not an allowable charge.

LIMITATIONS: The Statewide Farmworker Health Program-TB Coverage will not pay for:

  • Hospitalization or other inpatient services
  • Services provided in the emergency room.
  • Extensive diagnostic testing or treatment, including extensive prescriptions, except as identified in the TB coverage.
  • Services which exceed the parameters of this policy.

Exceptions to these restrictions may be made on a case by case basis by preauthorization through the regional case managers. However, clients may also be eligible for some of these services through the Department of Social and Rehabilitation Services.

If you have questions about the program please do not hesitate to contact the KS Statewide Farmworker Health/TB Coverage at (785) 296-6028.