Tuberculosis Reimbursement Program


KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT (KDHE)

Bureau of Community Health Systems
KANSAS STATEWIDE FARMWORKER HEALTH PROGRAM (KSFHP)

Bureau of Disease Control and Prevention
TUBERCULOSIS (TB) REIMBURSEMENT PROGRAM

COVERAGE FOR TUBERCULOSIS SERVICES POLICY AND PROCEDURES

The Kansas Statewide Farmworker Health Program also manages the supplemental fund to expand coverage for individuals needing health care services requiring evaluation and/or treatment of tuberculosis. The fund is limited to uninsured clients with household incomes at or below 200% of the federal poverty guidelines. Eligible clients include those who have shown significant test results from a TB screening test 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 Control and Prevention, and is available as funds exist for those who do not reside in a county that receives a direct grant from the KDHE TB Control Program. Counties that receive direct funding include Finney, Ford, Johnson, Saline, Sedgwick, Shawnee, and Wyandotte Counties.


ELIGIBILITY:

  • Eligibility requires income of 200% of poverty or below,
  • Uninsured status (not covered by Medicaid, Medicare, or any other type of health insurance),
  • A positive TB screening test. Screening tests for farmworkers and their dependents can be paid through separate funding. 

NOTE: 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.


DESCRIPTION OF THE VOUCHER SYSTEM:
Delivery of tuberculosis services is managed through the Kansas Statewide Farmworker Health Program (KSFHP) voucher/case manager system. Eligible clients are admitted through authorized Access Point Agencies, which may be state or federal funded primary care clinics or local health departments. Services are provided at this site or through coordination with other healthcare providers. Case Management support is provided both regionally and at the state level through KSFHP, Bureau of Community Health Systems, in collaboration with the Kansas Tuberculosis Control Program of the Bureau of Disease Control and Prevention. CDC recommendations and guidelines for the management of tuberculosis disease and tuberculosis infection are available from the Kansas Tuberculosis Control Program at (786) 296-5589 or online at http://www.cdc.gov/tb/publications/guidelines/default.htm.
The KSFHP Family Registration Form is used to enroll patients for tuberculosis coverage. A pre-numbered Voucher Form is used to identify health problems and to document treatment provided. In addition, it is utilized as a referral form for service required from outside healthcare providers as well as to initiate payment for services.


COVERED TB-RELATED SERVICES:

  • Covers additional diagnostic and therapeutic services related to positive TB screening test, such as chest x-rays, office visits, hepatic enzymes, etc.
  • Does not cover TB medicine or TB-related hospitalization
  • Does not cover if patient is asymptomatic and TB testing is because of work, post-secondary educational institutions (per KSA 65-129e) or adjustment of immigration status

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

Chest X-Ray:
A poster-anterior (PA) and a lateral (LAT) chest x-ray are covered for all patients with significant TB screening 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 Control Program, (785) 296-5589. There will be no reimbursement for TB medications obtained elsewhere.

Laboratory:
Hepatic enzymes if clinically indicated on individuals who need baseline lab work or individuals who experience symptoms of hepatitis and are receiving prescribed tuberculosis 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 and CBC for adult patients prescribed therapy for active disease or if patient has complications due to drug therapy. The panel must include: baseline hepatic enzymes (AST, ALT, alkaline phosphatase, and bilirubin), serum creatinine, and complete blood count with platelet count. Payment limited to Medicaid fee-for-service.

All AFB 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 (DOT) on TB cases or high risk infected individuals by local health departments is no longer reimbursed by the Kansas Statewide Farmworker Health Program-TB Coverage, but may be reimbursed through the KDHE TB Control Program (785) 296-5589.

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 one-time 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:
 Directly Observed Therapy (DOT) in the home is no longer reimbursed by the Kansas Statewide Farmworker Health Program-TB Coverage, but may be reimbursed through the TB Care Program at the referral of the KDHE TB Control Program (785) 296-5589.

Tuberculosis Screening Test (PPD Skin Test, IGRA, etc): Not an allowable charge.


LIMITATIONS: The Kansas 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
  • TB medicine
  • If patient is asymptomatic and TB testing is because of work, post-secondary educational institutions (per KSA 65-129e) or adjustment of immigration status
  • Services which exceed the parameters of this policy
  • Services over $150 that have not been authorized through the KSFHP Regional Case Manager or Program Director

Exceptions to these restrictions may be made on a case by case basis by preauthorization through the Regional Case Managers and/or the TB Control Program at KDHE. However, clients may also be eligible for some of these services through the Kansas Department for Children and Families.


MORE INFORMATION:

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

The TB Control Program at KDHE can be reached at (785) 296-5589 and online at http://www.kdheks.gov/tb/index.html

Kansas Legislature 2012 Statute — KSA 65-129e