CDC History of Tuberculosis Control - Medical and Public Health ...

Since 1994, however, CDC has received
approximately level funding for TB-related
activities. The Tuberculosis Elimination and
Laboratory Cooperative Agreement was
revised for FY2000 to ensure prioritization of
the core TB activities (completion of therapy,
contact investigation, surveillance, and laboratory)
for all TB programs, with separate
funding provided on a competitive basis for
targeted testing and treatment of latent TB
infection for high-risk groups in programs
demonstrating good performance on the core
activities.
Federal funds are intended to supplement the
state and local activities for TB control and
prevention, and in many states, federal funds
represent only a small fraction of the total
funds available to the TB program. However,
in many other states, federal funds represent
the majority of TB funding available. Furthermore,
some areas are actually reporting a
reduction in their state or local TB funding.
Yet the level of federal funding is expected to
again remain the same in fiscal year 2000 and
2001, which will result in a decreased amount
of available funds when inflation factors are
applied. Although cases have declined since
1993, the case rate of 6.8 per 100,000 in 1998 is
still far short of the target of 3.5 per 100,000
by the year 2000 set by CDC, and aggressive
TB prevention and control efforts must be
sustained to continue on a successful course to
elimination. This will require the continuation
of our current efforts and the development
of new or increased funding initiatives at
every level, including federal, state, and local.
The Advisory Council for the Elimination of
Tuberculosis (ACET) published “Tuberculosis
elimination revisited: obstacles, opportunities,
and a renewed commitment” in the MMWR,
August 13, 1999/Vol. 48/No. RR-9, and also
stated the need for additional resources to fully
implement effective elimination strategies. In
addition to fiscal resources, ACET recommended
building a stronger advocacy at every
level of government as well as engaging new
Notable Events in TB Control
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partners at the local level, and strengthening
coalitions by revitalizing the National Coalition
for the Elimination of Tuberculosis
(NCET) to garner more private support, and
strategically utilizing the media to inform the
general public and legislators regarding TB.
Managed Care and TB Control –
A New Era
by Bess Miller, MD, MSc
Associate Director for Science, DTBE
After the TB sanatoria were closed during the
1960s and 1970s, typically both clinical care
and public health functions for TB control
were carried out in the health department
setting. However, during the past three decades,
there has been an increasing trend
toward the provision of clinical care for
patients with TB by the private sector. By
1998, about 50% of the care for patients with
TB was provided either partially or totally by
the private medical sector. More recently, the
managed care transformation has increased
this movement of patients with TB away from
clinical care in health department settings.
Patients with TB may be enrolled in managed
care organizations as a result of coverage under
employee benefit plans, privately purchased
insurance policies, or as a result of enrollment
in Medicaid or Medicare programs. The
Omnibus Budget Reconciliation Act of 1993
(OBRA) permitted states to extend Medicaid
coverage to persons with TB, and some states
have used this legislation to enroll such patients
in their Medicaid programs. In addition,
as part of overall Medicaid managed care
restructuring, a few states have expanded
coverage to include previously uninsured
persons. The vulnerable populations among
the newly insured are likely to include persons
at high risk for TB. The shifting of care of
patients with TB into managed care plans,
with the emphasis on management of costs,
has raised new concerns in the public health
community with regard to the ability to
maintain adequate community TB control as
well as to provide optimal management of