California Medical Association House of Delegates

CMA 2013 REPORT OF REFERENC E

1 2 2. Resolution 102-13: TREATMENT OF TUBERCULOSIS AN ESSENTIAL HEALTH 3 BENEFIT 4 Author: Peter R. Kerndt, MD, MPH 5 RESOLVED: That CMA write the Board of Covered California to urge that Covered 6 California recognize that the diagnosis and treatment of TB disease and 7 infection is and should be recognized as an essential health benefit and a 8 prevention activity and therefore should be available without any 9 requirement for cost sharing and that insurance coverage must provide 10 medical care and anti-TB medications to patients with TB disease and 11 TB infection free of charge and that any attempt at cost sharing through 12 insurance co-pays or deductibles should be prohibited. 13 14 RESOLVED: That CMA write the Board of Covered California to urge that Covered 15 California recognize that the diagnosis and treatment of TB disease and 16 infection is and should be recognized as an essential health benefit and a 17 prevention activity and therefore should be available without any 18 requirement for cost sharing and that insurance coverage must provide 19 medical care and anti-TB medications to patients with TB disease and TB 20 infection free of charge and that any attempt at cost sharing through 21 insurance co-pays or deductibles should be prohibited. 22 23 RECOMMENDED ACTION: YOUR REFERENCE COMMITTEE RECOMMENDS 24 APPROVAL OF RESOLUTION #102-13 AS 25 AMENDED AND ASKS FOR A "YES" VOTE ON IT. 26 THE RESOLVED PORTION IS AMENDED TO 27 READ: 28 29 RESOLVED: That CMA advocate that medical care and anti-tuberculosis 30 medications for patients with both TB disease and TB infection be 31 provided by payors without cost-sharing; and be it further 32 33 RESOLVED: That CMA advocate to Covered California that the diagnosis and 34 treatment of TB disease and infection is and should be recognized as 35 an integral part of the preventive care provided to patients with TB 36 disease and TB infection, and that any attempt to impose cost- 37 sharing on such services and anti-TB medications must be 38 prohibited. 39 40 41 CMA 2013 REPORT OF REFERENCE

1 R ea son ( s) f o r R ec omm e n d a tion : 2 A. The term “cost-sharing” is more comprehensive and covers cost-sharing mechanism 3 not explicitly mentioned by the author (e.g., coinsurance). 4 B. The term “advocate” grants CMA staff greater flexibility in the means of achieving the 5 author’s desired result. 6 C. The mention of essential health benefits has been removed because TB treatment and 7 anti-TB medications are already clearly included in that definition. Thus, advocating 8 for such inclusion would be unnecessary. The key point of advocacy here would be 9 getting TB treatment and anti-TB medications considered an integral part of 10 preventive care, which would prohibit cost-sharing for such services under recent 11 federal guidance. 12 D. The amended version would allow CMA to write a letter as requested in testimony, 13 but leaves flexibility to determine content and to whom a letter should be sent. 14 15 16 3. Resolution 103-13: USE OF THE CALIFORNIA IMMUNIZATION REGISTRY TO 17 CONTROL AND PREVENT TUBERCULOSIS 18 Author: Peter R. Kerndt, MD, MPH 19 RESOLVED: That CMA support legislation and/or policy and/or regulatory change to 20 allow the California Department Public Health and local health 21 jurisdictions access to and the use of the California Immunization 22 Registry (CAIR) for the control and prevention of tuberculosis; and be it 23 further 24 RESOLVED: That CMA encourage medical providers to utilize CAIR to document TB 25 screening results and that this health information exchange be directly 26 linked when possible from the patient/provider electronic medical record. 27 28 RECOMMENDED ACTION: YOUR REFERENCE COMMITTEE RECOMMENDS 29 APPROVAL OF RESOLUTION #103-13 AS 30 AMENDED AND ASKS FOR A "YES" VOTE ON IT. 31 THE RESOLVED PORTION IS AMENDED TO 32 READ: 33 34 RESOLVED: That CMA encourage that the California Department Public 35 Health and local health jurisdictions be permitted to access and 36 use tuberculosis screening data reported to the California 37 Immunization Registry, when consent has not been withheld for 38 the screened person, for the control and prevention of 39 tuberculosis; and, be it further 40 41 RESOLVED: That CMA encourage medical providers to utilize the California 42 Immunization Registry to document tuberculosis screening results CMA 2013 REPORT OF REFERENCE

1 and that this health information exchange be directly linked when 2 possible from the patient/provider electronic medical record. 3 4 R ea son ( s) f o r R ec omm e n d a tion : 5 A. TB continues to be a public health issue in California and CAIR could be an important 6 tool to help quickly initiate treatment to prevent the development of TB. 7 B. The changes to the first resolved allow for greater flexibility in finding solutions. 8 C. The issue of ensuring that access is consistent with the screened person’s consent was 9 raised in testimony. 10 11