Current through Register Vol. 51, No. 3, September 1, 2024
RELATES TO:
KRS
211.180(1)(a), (c),
214.034(2),
215.520(1),
(2), (4), (5), (8), (9),
215.560
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
215.520 authorizes the Cabinet for Health
Services to discharge all duties relating to all matters of tuberculosis
control, including:
(1) clinical
services for either recalcitrant or drug resistant persons with active
tuberculosis;
(2) the facilitation
of tuberculosis programs in cooperation with the Department of
Education;
(3) the appraisal and
provision of services for persons with tuberculosis; and
(4) provision of direct assistance to local
health departments, and other organizations to assist them in education,
prevention, and treatment programs of tuberculosis control.
KRS
215.520(2) requires the
Cabinet for Health Services to promulgate administrative regulations to
implement statutes governing tuberculosis.
KRS
211.180(1)(a) requires the
Cabinet for Health Services to implement a statewide program for the detection,
prevention, and control of communicable diseases.
KRS
214.034(2) permits a local
health department, with the approval of the Department of Public Health, to
require tuberculosis testing of a first-time enrollee in a public or private
school within the jurisdiction of the local health department.
This administrative regulation establishes:
(1) requirements, forms, and procedures for
the testing of school children for tuberculosis by a local health department;
and
(2) testing and treatment of
persons diagnosed with tuberculosis.
Section
1. Definitions.
(1) "Active
tuberculosis" is defined by
KRS
215.511(1).
(2) "Child" means an individual under
eighteen (18) years of age.
(3)
"Exception patient" means an individual with tuberculosis who has been
identified by a local health department with jurisdiction as an individual in
exceptional or infrequent circumstances.
(4) "Exceptional or infrequent circumstances"
means:
(a) Short-term hospitalization is
required for:
1. Invasive diagnostic
procedures;
2. Respiratory
isolation;
3. Management of
drug-resistant disease; or
4. Other
circumstances that a cabinet physician has determined require hospitalization
to detect, prevent, or control tuberculosis; or
(b) Pursuant to
KRS
215.560, security measures are
required.
(5) "First-time
enrollee" means a child who:
(a) Has never
attended school in Kentucky; and
(b) Is entering private of public school,
entry level through 12th grade, for the first time.
(6) "Isolates" is defined by
KRS
215.511(2).
(7) "Tuberculin skin test" means the
intradermal injection of five (5) tuberculin units of Purified Protein
Derivative (PPD) by the Mantoux technique.
Section 2. Except as provided by
KRS
214.036(2), the provisions
of this administrative regulation shall not apply to children exempted by
KRS
214.036(2).
Section 3.
(1) A reaction to a tuberculin skin test
shall be interpreted in accordance with "Treatment of Tuberculosis and
Tuberculosis Infection in Adults and Children".
(2) If the skin test of a child indicates
that treatment is needed, the child shall be treated in accordance with
"Treatment of Tuberculosis Infection in Adults and
Children".
Section 4.
(1) The department shall authorize a local
health department to test first time enrollees in a school within its
jurisdiction, if it submits to the department the documentation specified by
subsection (2) of this section.
(2)
Required documentation.
(a) Documentation of
continued transmission of at least two (2) years duration of a multidrug
resistance pattern, or more virulent strain, of Mycobacterium tuberculosis;
or
(b) Laboratory analysis that
documents transmission, whether in consecutive or nonconsecutive years, of a
multidrug resistance pattern, or more virulent strain of Mycobacterium
tuberculosis; or
(c) A documented
outbreak of at least two (2) years duration:
1. With multifamily involvement each year
that resulted in at least five (5) cases of tuberculosis per year;
and
2. Is two (2) times greater
than the national tuberculosis rate per 100,000 population; or
(d) Documentation of a
tuberculosis rate per 100,000 that is two (2) times greater than the national
tuberculosis rate in each of the last five (5) years.
(3)
(a) A
local health department that has been authorized by the Department for Public
Health to conduct tuberculin testing of first-time school enrollees may
continue to test for an additional year.
(b) If a local health department has
submitted documentation that the tuberculin reactor rate in the additional year
was at least two (2) times greater than the reactor rate in the previous year,
the department shall approve an additional year of testing.
(4) If a local health department
has been authorized by the Department for Public Health to conduct tuberculin
testing of first-time school enrollees:
(a)
The local health department shall notify, in writing, the parent or guardian of
a first-time enrollee that a tuberculin skin test is required;
(b) Except as provided by paragraph (c) of
this subsection, a first-time enrollee shall be tested for tuberculosis by
tuberculin skin test within eighteen (18) months prior to entering school by a
licensed or certified health professional authorized to administer the
test.
(c) A first-time enrollee who
had been tested for tuberculosis by a tuberculin skin test within eighteen (18)
months prior to his entering school shall not be required to be retested, if a
"Tuberculin Skin Test Certificate", dated and signed by the physician, advanced
registered nurse practitioner, or authorized representative of the local health
department that administered the test, has been submitted to the local health
department with jurisdiction.
(d)
If a physician certifies in writing that tuberculin skin testing is medically
contraindicated, an enrollee shall receive a chest x-ray, unless documentation
is provided of a completed course of prophylaxis or multiple drug treatment for
previously diagnosed tuberculosis infection or disease in accordance with
"Treatment of Tuberculosis and Tuberculosis Infection in Adults and
Children".
(e)
1. If an enrollee has not been tested prior
to entering school, he shall be permitted to attend class for a period not to
exceed thirty (30) days.
2. Before
the expiration of thirty (30) days from entering school, proof of having been
tested for tuberculosis pursuant to the provisions of this subsection shall be
submitted to the local health department with jurisdiction.
3. If the proof required by this subsection
is not submitted within thirty (30) days of entering school, the enrollee shall
not be permitted to attend school until proof is submitted to the local health
department with jurisdiction.
(f) The "Tuberculin Skin Test Certificate"
shall include the following information:
1.
Complete name of student;
2.
Birthdate of student;
3. Address of
student;
4. Date test given to
student;
5. Type of test;
6. Millimeters of induration at forty-eight
(48) hours to seventy-two (72) hours posttesting;
7. Date read;
8. Name of licensed or certified health
professional who read the test; and
9. If the provisions of paragraph (c) of this
subsection are applicable, the date an x-ray was taken.
(g) A copy of a enrollee's "Tuberculin Skin
Test Certificate" shall be transmitted by the local health department with
jurisdiction to the enrollee's school.
Section 5. Drug Susceptibility Testing. Drug
susceptibility testing shall be conducted to determine the efficacy of
prescribed drug therapy for a person with active tuberculosis as provided by
this section.
(1) Drug susceptibility testing
of initial isolates from clinical specimens obtained from a patient with active
tuberculosis shall be performed by a:
(a)
Laboratory:
1. Licensed pursuant to
KRS
333.030; or
2. Exempted from licensure by
KRS
333.040; and
3. Qualified to perform drug susceptibility
testing for Mycobacterium tuberculosis; or
(b) The Division of Laboratory Services of
the Kentucky Department for Public Health.
(2)
(a)
Repeat drug susceptibility testing of a specimen ordered by a physician from a
patient who has continued to produce specimens that are culture positive for
tuberculosis after three (3) months of treatment shall be made on the latest
isolate obtained from the patient.
(b) Testing conducted pursuant to the
provisions of this section shall be performed by a laboratory specified by
paragraphs (c) and (d) of this section.
(c) A laboratory:
1. Licensed pursuant to
KRS
333.030; or
2. Exempted from licensure by
KRS
333.040; and
3. Qualified to perform drug susceptibility
testing for Mycobacterium tuberculosis.
(d) The Division of Laboratory Services of
the Kentucky Department for Public Health.
Section 6.
(1) Within seventy-two (72) hours of the
hospitalization of an exception patient, a local health department shall
interview an exception patient to determine if the patient is covered by health
insurance, including Medicaid.
(2)
If the patient is without health coverage, the local health department shall:
(a) Request the Cabinet for Families and
Children to evaluate the patient for Medicaid eligibility; and
(b) Assist the Cabinet for Families and
Children in efforts to obtain health coverage.
(3) If an exception patient is not covered by
health insurance, and is not eligible for health care insurance, reimbursement
for tuberculosis inpatient services for the patient shall be made to the
provider by the Cabinet for Health Services through the local health department
at:
(a) The Medicaid per diem rate;
or
(b) Other rate, if approved in
advance by the Cabinet for Health Services.
(4) Reimbursement for tuberculosis inpatient
services, or for voluntary placement in a half-way house, for an exception
patient shall be made by time-limited payment through a contract or memorandum
of understanding between the local health department and the admitting facility
if the admitting assess a charge.
Section 7. Incorporation by Reference.
(1) The following material is incorporated by
reference in this administrative regulation:
(a) "Treatment of Tuberculosis and
Tuberculosis Infection in Adults and Children (1994)", American Lung
Association; and
(b) "Tuberculin
Skin Test Certificate, 12/98", Form EPID 391A.
(2) Material incorporated by reference may be
inspected, copied, or obtained at the Office of the Commissioner, Department
for Public Health, 275 East Main Street, Frankfort, Kentucky, 40621, 8 a.m.
through 4:30 p.m., Monday through Friday.
STATUTORY AUTHORITY:
KRS
194A.050,
211.180(1)(a),
(c),
214.034(2),
215.520(1),
(2), (4), (5), (8), (9),
215.560
