Library: Policy

317:30-5-1159. Tuberculosis

Issued 6-25-07

The purpose of the Tuberculosis program is to identify and treat clients with tuberculosis, insure appropriate measures are taken to prevent the occurrence and transmission of tuberculosis, analyze tuberculosis related data for program planning and evaluation, and ultimately eliminate tuberculosis in Oklahoma. Payment is made for tuberculosis clinic services pursuant to (1) - (7) of this Section.

(1) Nursing visit - regular with disease. Nursing visit - regular with disease requires an initial intensive interview by Health Department personnel for gathering clinical and epidemiologic data and administration of a tuberculosis skin test.
- (A) The nursing visit in this paragraph includes:
  - (i) one x-ray every two months;
  - (ii) a monthly blood test;
  - (iii) one series (3 samples) of sputum tests every two months;
  - (iv) monitoring of side effects; and
  - (v) provision of medication.
- (B) Notification and consultation with the Tuberculosis Control Officer must be established and maintained during the treatment regimen as required by State law.
- (C) The nursing visit in this paragraph is appropriate for a patient with the disease of tuberculosis that is drug susceptible and a treatment regimen of six to 12 months is prescribed.
(2) Nursing visit - multi-drug resistant with disease. A nursing visit - multi-drug resistant with disease requires an initial intensive interview by Health Department personnel for gathering clinical and epidemiologic data and administration of a tuberculosis skin test.
- (A) This nursing visit in this paragraph includes:
  - (i) one x-ray every two months;
  - (ii) a monthly blood test;
  - (iii) one series (3 samples) of sputum tests each month;
    - (iv) monitoring of side effects; and
    - (v) provision of medication.
- (B) Notification and consultation with the Tuberculosis Control Officer must be established and maintained during the treatment regimen as required by State law.
- (C) The nursing visit in this paragraph is appropriate for a patient with the disease of tuberculosis that is multi-drug resistant and a treatment regimen of 18 to 24 months has been prescribed.
(3) Nursing visit - regular preventive therapy with infection. A nursing visit - regular preventive therapy with infection requires an initial intensive interview by Health Department personnel for gathering clinical and epidemiologic data and administration of a tuberculin skin test.
- (A) The nursing encounter in this paragraph includes:
  - (i) one x-ray every three months;
  - (ii) four blood tests in six months;
  - (iii) one series (3 samples) of sputum tests;
  - (iv) monitoring of side effects; and
  - (v) provision of medication.
- (B) Notification and consultation with the Tuberculosis Control Officer must be established and maintained during the treatment regimen as required by State law.
- (C) The nursing visit in this paragraph is appropriate for a patient with an infection of drug susceptible tuberculosis and a treatment regimen of 12 months has been prescribed.
(4) Nursing visit - multi-drug resistant preventive therapy with infection. A nursing visit - multi-drug resistant preventive therapy with infection requires an initial intensive interview by Health Department personnel for gathering clinical and epidemiologic data and administration of a tuberculin skin test.

(A) The nursing visit in this paragraph includes:

(i) one x-ray every two months;
(ii) eight blood tests in 12 months;
(iii) two series (6 samples) of sputum tests each 12 months;
(iv) monitoring of side effects; and
(v) provision of medication.

(B) Notification and consultation with Tuberculosis Control Officer must be established and maintained during the treatment regimen as required by State law.
(C) The nursing visit in this paragraph is appropriate for a patient with a multi-drug resistant tuberculosis infection and a treatment regimen of 12 months has been prescribed.

(5) Nursing visit - other. A nursing visit - other - requires an interview by Health Department personnel for gathering clinical data. This nursing visit may include an x-ray, blood test, sputum sample and monitoring of side effects. It does not include medication. Consultation with the Tuberculosis Control Officer may be required. This visit may be appropriate for either a patient with a tuberculosis infection or disease if the patient is continuing to experience symptoms or on orders of a physician.
(6) Screening. In a TB screening, Health Department personnel perform tuberculin skin testing of contacts to all TB cases and suspects, high risk population groups and nursing home residents. Tuberculin skin testing is always done at least one time. For negative skin tests, a two-step boosted skin test one to two weeks later will be performed and repeated three months later for contact individuals with a negative boosted skin test.
(7) Direct Observed Therapy (DOT). The DOT provider delivers medication to the patient and observes and records the patient's ingestion of medication. Visits may be as frequent as three times a day, seven days a week. The DOT provider is responsible for monitoring side effects of medication and the collection of sputum samples.