Library: Policy

317:30-3-46. Services for persons infected with tuberculosis

Revised 9-12-14

(a) Oklahoma Medicaid provides optional coverage of tuberculosis (TB) related services for certain TB infected individuals. Services covered under this program are not restricted to the Medicaid scope of coverage or limitations.  Services for TB infected individuals that exceed the scope of Medicaid services must be prior authorized. Individuals eligible only under the optional TB-related services program can receive TB related services such as:

• (1) Prescribed medications:

  • (A) Prescription drugs indicated for the treatment of TB up to the Medicaid established prescription limit; and

  • (B) Other drugs related to the treatment of TB beyond the prescriptions covered under Medicaid, require prior authorization obtained from the University of Oklahoma College of Pharmacy using form "Petition for TB Related Therapy".

• (2) Physician services:

  • (A) Physician services include:

    • (i) ambulatory physician services;

    • (ii) office visits; and

    • (iii) ambulatory surgery and such, but not including inpatient services.

  • (B) Office visits are not limited for TB infected persons.  However, prior authorization is required when the limit under Medicaid is exceeded;

• (3) Outpatient hospital services;

• (4) Rural Health Clinic services;

• (5) Federally Qualified Health Clinic services;

• (6) Laboratory and x-ray services. Necessary laboratory and x-ray services (including services to confirm presence of TB infection) are covered for infected persons. Screening tests to detect and confirm presence of TB do not require prior authorization;

• (7) Tuberculosis Clinic services (See 317:30-5-1159 for description of these services); and

• (8) Targeted Case Management services.

(b) Persons eligible for services only under optional TB coverage do not receive the full range of Medicaid benefits. Coverage is limited as set out in this Section.

(c) Persons eligible under Medicaid who are infected with TB may also be eligible for TB services and receive these extended benefits.