1. 1 Tuberculosis Services To Bill or Not to Bill? Presented by: Lisa Park June 1, 2015

2. 2 Charging (or not) for TB Services How to charge for Tuberculosis services is covered in the VDH Eligibility Guidance Document (EGD) under Non-chargeable Services Section Header – Services provided at no charge to the patient Health districts may charge patients’ private health insurance

3. 3 NO CHARGE No charge to Individuals for assessment, exam or testing if they are: suspected of having or known to have TB disease contacts of individuals with known active TB individuals with a newly positive TB skin test No charge for DOT or DOPT

4. 4 CHARGEABLE Assessment, examination or testing is chargeable when done for other purposes For example, when needed for employment school admission to nursing facility admission to group home

5. 5 Chargeable-Active TB or LTBI Treatment of active disease or LTBI may be charged to the patient or their health insurer Districts can charge a flat rate or sliding scale for drugs and diagnostic tests Health director determines flat or sliding for all TB tx- must be applied the same for all individuals Patients cannot be charged for anything paid for by the Division of Disease Prevention (DDP)

6. 6 Revenue vs. Public Health Patients with suspected or confirmed TB (active disease or infection) cannot be denied treatment for non- payment Patients having difficulty paying should be assessed for a Waiver of Charges as detailed in the EGD Eligibility determinations should be carefully reviewed to ensure the household size/income has been appropriately identified

7. 7 Revenue vs. Public Health, cont’d Avoid creating potential barriers to care Focus should be on encouraging and facilitating treatment Refrain from worst case scenario cost discussions Discuss payment plan options at the beginning of treatment before an account becomes past due

8. 8 QUESTIONS?