CMA 2013
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COMMITTEE
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2. Resolution 102-13: TREATMENT OF TUBERCULOSIS AN ESSENTIAL HEALTH
BENEFIT
Author: Peter R. Kerndt, MD, MPH
RESOLVED: That CMA write the Board of Covered California to urge that Covered
California recognize that the diagnosis and treatment of TB disease and
infection is and should be recognized as an essential health benefit and a
prevention activity and therefore should be available without any
requirement for cost sharing and that insurance coverage must provide
medical care and anti-TB medications to patients with TB disease and
TB infection free of charge and that any attempt at cost sharing through
insurance co-pays or deductibles should be prohibited.
RESOLVED:
That CMA write the Board of Covered California to urge that Covered
California recognize that the diagnosis and treatment of TB disease and
infection is and should be recognized as an essential health benefit and a
prevention activity and therefore should be available without any
requirement for cost sharing and that insurance coverage must provide
medical care and anti-TB medications to patients with TB disease and TB
infection free of charge and that any attempt at cost sharing through
insurance co-pays or deductibles should be prohibited.
RECOMMENDED ACTION:
YOUR REFERENCE COMMITTEE RECOMMENDS
APPROVAL OF RESOLUTION #102-13 AS
AMENDED AND ASKS FOR A "YES" VOTE ON IT.
THE RESOLVED PORTION IS AMENDED TO
READ:
RESOLVED: That CMA advocate that medical care and anti-tuberculosis
medications for patients with both TB disease and TB infection be
provided by payors without cost-sharing; and be it further
RESOLVED: That CMA advocate to Covered California that the diagnosis and
treatment of TB disease and infection is and should be recognized as
an integral part of the preventive care provided to patients with TB
disease and TB infection, and that any attempt to impose costsharing on such services and anti-TB medications must be
prohibited.
CMA 2013
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Reason(s) for Recommendation:
A. The term “cost-sharing” is more comprehensive and covers cost-sharing mechanism
not explicitly mentioned by the author (e.g., coinsurance).
B. The term “advocate” grants CMA staff greater flexibility in the means of achieving the
author’s desired result.
C. The mention of essential health benefits has been removed because TB treatment and
anti-TB medications are already clearly included in that definition. Thus, advocating
for such inclusion would be unnecessary. The key point of advocacy here would be
getting TB treatment and anti-TB medications considered an integral part of
preventive care, which would prohibit cost-sharing for such services under recent
federal guidance.
D. The amended version would allow CMA to write a letter as requested in testimony,
but leaves flexibility to determine content and to whom a letter should be sent.
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3. Resolution 103-13: USE OF THE CALIFORNIA IMMUNIZATION REGISTRY TO
CONTROL AND PREVENT TUBERCULOSIS
Author: Peter R. Kerndt, MD, MPH
RESOLVED: That CMA support legislation and/or policy and/or regulatory change to
allow the California Department Public Health and local health
jurisdictions access to and the use of the California Immunization
Registry (CAIR) for the control and prevention of tuberculosis; and be it
further
RESOLVED: That CMA encourage medical providers to utilize CAIR to document TB
screening results and that this health information exchange be directly
linked when possible from the patient/provider electronic medical record.
RECOMMENDED ACTION:
YOUR REFERENCE COMMITTEE RECOMMENDS
APPROVAL OF RESOLUTION #103-13 AS
AMENDED AND ASKS FOR A "YES" VOTE ON IT.
THE RESOLVED PORTION IS AMENDED TO
READ:
RESOLVED: That CMA encourage that the California Department Public
Health and local health jurisdictions be permitted to access and
use tuberculosis screening data reported to the California
Immunization Registry, when consent has not been withheld for
the screened person, for the control and prevention of
tuberculosis; and, be it further
RESOLVED: That CMA encourage medical providers to utilize the California
Immunization Registry to document tuberculosis screening results
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REPORT OF
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COMMITTEE
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and that this health information exchange be directly linked when
possible from the patient/provider electronic medical record.
Reason(s) for Recommendation:
A. TB continues to be a public health issue in California and CAIR could be an important
tool to help quickly initiate treatment to prevent the development of TB.
B. The changes to the first resolved allow for greater flexibility in finding solutions.
C. The issue of ensuring that access is consistent with the screened person’s consent was
raised in testimony.