MEMO SERIES DSL 99-06
(This original copy with strike through lines is followed by a MEMO SERIES DSL 99-06 Updated Copy)
April 22, 1999
STATE OF WISCONSIN
Department of Health and Family Services
Division of Supportive Living
To:
AODA Coordinators
Area Administrators/Assistant Area Administrators
Bureau/Office Directors
County Departments of Community Program Directors
County Departments of Developmental Disabilities
Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Section Chiefs
Tribal Chairpersons/Human Services Facilitators
From: Sinikka McCabe, Administrator
Re: TUBERCULOSIS (TB) SCREENING - AODA OUTPATIENT PROGRAMS Supersedes: # Memo DCS-93-05
DOCUMENT SUMMARY
This memo describes updates memo DCS 93-05, a new federal requirement for alcohol and other drug abuse (AODA) outpatient treatment entities that receive funds under the
Substance Abuse Block Grant to make available tuberculosis services to each individual receiving treatment. AODA outpatient treatment programs are required to provide tuberculosis (TB) verbal
evaluations of TB risk factors to individuals. The evaluation must be conducted by the AODA outpatient program and may include providing on-site TB testing, conducted by trained medical personnel.
Those clients testing positive for TB must be referred to the local public health agency for appropriate TB treatment.
Tuberculosis (TB) Services - AODA Outpatient Programs
On July 10, 1992, the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reorganization Act established a new requirement regarding tuberculosis (TB) services. According to Subpart II,
Section 1924 of the ADAMHA Reorganization Act, the state must require all alcohol and other drug abuse (AODA) outpatient treatment programs that receive federal Substance Abuse Block Grant funds to,
directly or through arrangements with other public or non-profit private entities, routinely make available TB services (counseling, testing, and treatment) to each individual receiving AODA
outpatient treatment.
The intent of this DCS DSL updated numbered memo is that, with the following exceptions, the federal requirement relating to TB services will be applied to all AODA outpatient service providers
that receive federal Substance Abuse Block Grant funds. Inpatient programs and programs that do not receive any federal funding are not subject to this requirement. In addition, client
assessments under the Intoxicated Driver Program are excluded from this requirement. Finally, community-based residential facilities (CBRFs) are already subject to a requirement which has the same
provisions regarding communicable diseases.
Effective June 1, 1993, aAll AODA outpatient programs that are not specifically excluded by the above paragraph must conduct an oral interview of TB risk factors on all
clients and staff members, upon admission and at least once a year. If the individual has been evaluated for TB risk factors within the previous six months, it is not necessary for the AODA outpatient
treatment provider to conduct a new evaluation, unless the client exhibits TB symptoms. The basic evaluation consists of the following questions:
- Does the client have signs and symptoms of TB, such as a persistent cough, coughing or spitting up blood, unintentional weight loss, loss of appetite, fever, chills, night sweats, hoarseness or
chest pain?
- Does the client have any of the following socioeconomic risk factors: homeless; living in a shelter or prison/jail; injecting drug use; crack user; or immigrant from an area with a high incidence
of TB, such as Haiti, Africa, Southeast Asia, South/Central America, or the Caribbean?
- Has the client been around anyone with active TB within the last 90 days?
- Has the client had a TB skin test? When was the most recent test? What was the outcome (reading)?
- Has the client had a chest x-ray within the past three months?
- Has the client had TB diagnosed prior to admission to the program?
- Has the client ever been under treatment for TB? If YES, when? How long did the client take medication, and did the client complete treatment?
- Is the client currently under treatment for TB at the time of admission to the program?
If the client answered YES to #1, 2, or 3 of the above questions, the program must then either: (1) conduct the Mantoux (PPD) skin test application and subsequent reading of the test or (2)
refer the client to an appropriate agency, including the client’s physician or the local public health agency in that area, for in-depth testing to determine if the client has TB and what TB
treatment services are necessary.
If an AODA outpatient treatment program conducts the Mantoux skin testing for TB, the AODA outpatient program must inform the local public health agency if a client tests positive for TB in
addition to referring the client to an appropriate agency for TB treatment. The cost of conducting the Mantoux skin test may be paid for by client’s personal assets, private insurance,
Medical Assistance, Community Aids, or AODA funds. For example, clients with an ability to pay may be charged a $5 fee. Under the TB Control Program, the Division of Public Health funds the
cost of treatment and any prophylactic medication for all individuals who have TB without regard to clients’ ability to pay. This program is administered by local public health agencies.
Each AODA outpatient program must make its own determination as to whether it will continue to provide AODA outpatient services to people who refuse to be verbally evaluated, tested, or treated for
TB. (See SUPPLEMENTAL INFORMATION notice for more detail.)
As part of intake and assessment, AODA outpatient treatment providers must provide counseling and general information regarding TB to all clients. Information should include the significance of TB
as a health risk in the AODA outpatient population, TB symptoms, the importance of seeking TB testing and treatment, and where clients can seek TB treatment.
If an AODA outpatient program denies an individual admission due to the lack of treatment capacity of the program to admit the individual, the AODA outpatient program must refer the individual to
the local public health agency in that area for a TB evaluation, test(s), and necessary TB treatment.
Since counties have differing organizational structures, each county should determine the least restrictive and most cost-effective method for implementing these requirements. As further
described in the SUPPLEMENTAL INFORMATION notice, The following is a range of options that could be employed:
- At a minimum, orally interview all clients for TB risk factors and refer clients for TB skin testing.
- Provide on-site TB skin testing, conducted by trained medical personnel, and refer those clients who test positive for further testing and treatment.
- Provide on-site TB skin testing and treatment, conducted by trained medical personnel.
AODA patient treatment programs that decide to provide on-site testing or treatment must do so in accordance with the recommendations of the Center for Disease Control.
ACTION SUMMARY STATEMENT:
AODA outpatient treatment programs are required to provide tuberculosis (TB) screening to individuals.
REGIONAL OFFICE CONTACT:
Area Administrator
CENTRAL OFFICE CONTACT:
Deborah Powers
Bureau of Substance Abuse Services
Division of Supportive Living
1 West Wilson Street
P. O. Box 7851
Madison, WI 53707-7851
(608) 266-9218
e-mail: powerdj@wisconsin.gov
STATE OF WISCONSIN
Department of Health and Family Services
Division of Supportive Living
To:
AODA Coordinators
Area Administrators/Assistant Area Administrators
Bureau/Office Directors
County Departments of Community Program Directors
County Departments of Developmental Disabilities
Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Section Chiefs
Tribal Chairpersons/Human Services Facilitators
From: Sinikka McCabe, Administrator
Re: TUBERCULOSIS (TB) SCREENING - AODA OUTPATIENT PROGRAMS
Supersedes: # Memo DCS-93-05
DOCUMENT SUMMARY
This memo updates memo DCS 93-05, a new federal requirement for alcohol and other drug abuse (AODA) outpatient treatment entities that receive funds under the Substance Abuse Block Grant to
make available tuberculosis services to each individual receiving treatment. AODA outpatient treatment programs are required to provide tuberculosis (TB) verbal evaluations of TB risk factors to
individuals. The evaluation must be conducted by the AODA outpatient program and may include providing on-site TB testing, conducted by trained medical personnel. Those clients testing positive for TB
must be referred to the local public health agency for appropriate TB treatment.
Tuberculosis (TB) Services - AODA Outpatient Programs
On July 10, 1992, the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reorganization Act established a new requirement regarding tuberculosis (TB) services. According to Subpart II,
Section 1924 of the ADAMHA Reorganization Act, the state must require all alcohol and other drug abuse (AODA) outpatient treatment programs that receive federal Substance Abuse Block Grant funds to,
directly or through arrangements with other public or non-profit private entities, routinely make available TB services (counseling, testing, and treatment) to each individual receiving AODA
outpatient treatment.
The intent of this DSL updated numbered memo is that, with the following exceptions, the federal requirement relating to TB services will be applied to all AODA outpatient service providers that
receive federal Substance Abuse Block Grant funds.
All AODA outpatient programs must conduct an oral interview of TB risk factors on all clients and staff members, upon admission and at least once a year. If the individual has been evaluated for TB
risk factors within the previous six months, it is not necessary for the AODA outpatient treatment provider to conduct a new evaluation, unless the client exhibits TB symptoms. The basic evaluation
consists of the following questions:
- Does the client have signs and symptoms of TB, such as a persistent cough, coughing or spitting up blood, unintentional weight loss, loss of appetite, fever, chills, night sweats, hoarseness or
chest pain?
- Does the client have any of the following socioeconomic risk factors: homeless; living in a shelter or prison/jail; injecting drug use; crack user; or immigrant from an area with a high incidence
of TB, such as Haiti, Africa, Southeast Asia, South/Central America, or the Caribbean?
- Has the client been around anyone with active TB within the last 90 days?
- Has the client had a TB skin test? When was the most recent test? What was the outcome (reading)?
- Has the client had a chest x-ray within the past three months?
- Has the client had TB diagnosed prior to admission to the program?
- Has the client ever been under treatment for TB? If YES, when? How long did the client take medication, and did the client complete treatment?
- Is the client currently under treatment for TB at the time of admission to the program?
If the client answered YES to #1, 2, or 3 of the above questions, the program must then either: (1) conduct the Mantoux (PPD) skin test application and subsequent reading of the test or (2)
refer the client to an appropriate agency, including the client’s physician or the local public health agency in that area, for in-depth testing to determine if the client has TB and what TB
treatment services are necessary.
If an AODA outpatient treatment program conducts the Mantoux skin testing for TB, the AODA outpatient program must inform the local public health agency if a client tests positive for TB in
addition to referring the client to an appropriate agency for TB treatment. Under the TB Control Program, the Division of Public Health funds the cost of treatment and any prophylactic medication for
all individuals who have TB without regard to clients’ ability to pay. This program is administered by local public health agencies.
Each AODA outpatient program must make its own determination as to whether it will continue to provide AODA outpatient services to people who refuse to be verbally evaluated, tested, or treated for
TB.
As part of intake and assessment, AODA outpatient treatment providers must provide counseling and general information regarding TB to all clients. Information should include the significance of TB
as a health risk in the AODA outpatient population, TB symptoms, the importance of seeking TB testing and treatment, and where clients can seek TB treatment.
If an AODA outpatient program denies an individual admission due to the lack of treatment capacity of the program to admit the individual, the AODA outpatient program must refer the individual to
the local public health agency in that area for a TB evaluation, test(s), and necessary TB treatment.
Since counties have differing organizational structures, each county should determine the least restrictive and most cost-effective method for implementing these requirements. The following is a
range of options that could be employed:
- At a minimum, orally interview all clients for TB risk factors and refer clients for TB skin testing.
- Provide on-site TB skin testing, conducted by trained medical personnel, and refer those clients who test positive for further testing and treatment.
- Provide on-site TB skin testing and treatment, conducted by trained medical personnel.
AODA patient treatment programs that provide on-site testing or treatment must do so in accordance with the recommendations of the Center for Disease Control.
ACTION SUMMARY STATEMENT:
AODA outpatient treatment programs are required to provide tuberculosis (TB) screening to individuals.
REGIONAL OFFICE CONTACT:
Area Administrator
CENTRAL OFFICE CONTACT:
Deborah Powers
Bureau of Substance Abuse Services
Division of Supportive Living
1 West Wilson Street
P. O. Box 7851
Madison, WI 53707-7851
(608) 266-9218
e-mail: powerdj@wisconsin.gov
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