Menu of Suggested Provisions For State Tuberculosis Prevention and Control Laws

VII. Interjurisdictional Collaboration

A. Agreements

Descriptive Note: Statutes or regulations that require or authorize state or local health agencies or healthcare providers to collaborate or otherwise interact with counterparts in other jurisdictions may be enacted for a variety of reasons. States may choose, for example, to enact laws that broadly authorize any cross-border agreement that will serve to improve TB control programs. A state lacking a specialized TB treatment facility may authorize its health department to enter into an agreement to transfer a TB patient to a state having a specialized facility. The first provision below enabled the Texas Department of State Health Services to enter into such an agreement with the New Mexico Department of Health. The final bullet is an example of a Wisconsin provision that is not specific to TB but could be used to enter into agreements regarding interstate care and treatment of TB patients.

• The department may enter into an agreement with an agency of another state responsible for the care of residents of that state who have tuberculosis under which:
  • Residents of the other state who have tuberculosis may be admitted to a state chest hospital, subject to the availability of appropriate space after the needs of eligible tuberculosis and chronic respiratory disease patients who are residents of this state have been met; and
  • The other state is responsible for paying all costs of the hospitalization and treatment of patients admitted under the agreement. Tex. [Health & Safety] Code Ann. § 13.046 (West 2009).

• The tuberculosis control officer may, with the approval of the director, contract with any federal agency, foreign government, Indian tribal government, any agency of this state or other state or of any political subdivision of this state or another state or any private entity to assist in the support of its tuberculosis control program with monies available to the department for that purpose. This program may include preventive, therapeutic and rehabilitative services and shall be used to encourage the fullest development and maintenance of an integrated statewide tuberculosis control program. Ariz. Rev. Stat. § 36-714 (LexisNexis 2009).
• The [state public health official] or the [state public health official’s] designee may enter into reciprocal agreements with federal agencies, foreign governments, state agencies, Indian tribal governments, political subdivisions and other jurisdictions to facilitate the return of any person who has or who based upon reasonable grounds is suspected of having active tuberculosis. The expense of this transportation may be paid by the [insert name of agency/department here].
• Reciprocal agreements: The [state public health official] may, on behalf of the [State], enter into a reciprocal agreement with another state providing for care and treatment of persons having active tuberculosis disease who are residents of the other state, or for the transportation or return of any such nonresident person from one of the states to the other state of which such person is a resident. Okla. Stat. tit. 63, § 1-409 (2009).
• The department shall have the power and authority, and it shall be the duty of such department, to arrange for the care on a contractual basis of [individuals with tuberculosis], without regard to residence or means tests, at public or private medical installations, within or outside the state, at which care may be provided and paid for by the state after any insurance, worker’s compensation, retirement plan, or other benefits accruing to the patient shall have been exhausted; provided, however, that this section shall not be deemed to preclude supplementation by state funds of such other sources of benefits prior to the exhaustion of the latter. S.D. Codified Laws § 34-22-15 (2009).
• Nothing in this chapter requires the admission of an enrolled Indian, resident on any reservation in this state, to any off-reservation institution except upon written request and authorization of the superintendent of the reservation on which said Indian is enrolled. However, in the public interest and with the objective of eradication of tuberculosis in the [State], an Indian with tuberculosis off any reservation is subject to this chapter. It is the responsibility of the Indian affairs commission pursuant to the commission’s powers and duties stated in [state law], to work closely with the tribal councils and other reservation officials to adopt any agreements found necessary in assisting the state health officer in carrying out responsibilities under this chapter so that all residents of this state will benefit, and eradication of tuberculosis in [State] can be achieved. N.D. Cent. Code § 23-07.1-13 (2009).

• Municipal interstate cooperation.
  • 1) In this section, “municipality” has the meaning given in [statutory definition that includes the state or any department or agency thereof, or any city, village, town, county, school district, city-county health department, etc.]…
  • 2) A municipality may contract with municipalities of another state or with federally recognized American Indian tribes or bands located in another state for the receipt or furnishing of services or the joint exercise of any power or duty required or authorized by statute to the extent that laws of the other state or of the United States permit the joint exercise.
  • 3) (a) Except as provided in par. (b), an agreement made under this section shall, prior to and as a condition precedent to taking effect, be submitted to the attorney general who shall determine whether the agreement is in proper form and compatible with the laws of this state. The attorney general shall approve any agreement submitted under this paragraph unless the attorney general finds that it does not meet the conditions set forth in this section and details in writing addressed to the concerned municipal governing bodies the specific respects in which the proposed agreement fails to meet the requirements of law. Failure to disapprove an agreement submitted under this paragraph within 90 days of its submission constitutes approval. The attorney general, upon submission of an agreement, shall transmit a copy of the agreement to the governor who shall consult with any state department or agency affected by the agreement. The governor shall forward to the attorney general any comments the governor may have concerning the agreement. (b) An agreement under this section between a municipality of this state and a municipality of another state that relates to the receipt, furnishing, or joint exercise of fire fighting or emergency medical services need not be submitted to or approved by the attorney general before the agreement may take effect.
  • 4) An agreement entered into under this section has the status of an interstate compact, but in any case or controversy involving performance or interpretation of or liability under the agreement, the municipalities party to the agreement are real parties in interest and the state may commence an action to recoup or otherwise make itself whole for any damages or liability which it may incur by reason of being joined as a party. The action by the state may be maintained against any municipality whose act or omission caused or contributed to the incurring of damage or liability by the state. Wis. Stat. § 66.0303 (2009).

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B. Interstate Movement of Patients

Descriptive Note: A state statute or regulation may require a healthcare provider or local health department to provide notice to a jurisdiction to which an infectious TB patient is relocating. Providing notice facilitates continuity of care and fosters interstate coordination of TB prevention and control. The first bullet below is an example of a provision that authorizes domestication of out-of-state court orders for commitment.

• Filing and Status of Foreign Court Orders
  • In the case of a person who is not a resident of this state and who may be admitted to a state chest hospital in accordance with [statutory provision on admission of nonresident patients], the attorney general, at the request of the department, shall file a copy of an order issued by a court of another state that authorizes the commitment of the person to a health care facility for inpatient care in the manner provided by the Civil Practice and Remedies Code, for enforcement of foreign judgments.
  • The application must be filed with the district court in the county in which the state chest hospital to which the person will be admitted is located.
  • A filed foreign court order that authorizes the commitment of a person to a health care facility for inpatient care may be enforced in the same manner as a court order of the court in which it is filed.
  • A foreign court order that authorizes the commitment of a person to a health care facility for inpatient care is subject to the contractual agreement with the foreign state. Tex. [Health & Safety] Code Ann. § 81.211 (West 2009).
• Those persons with a legal residency outside the [state] and known to have infectious tuberculosis may be admitted temporarily to an approved hospital and receive other tuberculosis services to protect the public health of the citizens of the [State]. Tenn. Comp. R. & Regs. 1200-14-1-.14 (2009).
• State, district, municipal and county health officers involved in tuberculosis control and elimination shall notify appropriate health authorities of jurisdictions in the appropriate states, territories, and municipalities when an individual with confirmed or clinically diagnosed infectious tuberculosis or currently under treatment for tuberculosis disease relocates from [State] into another jurisdiction, such notification being subject to approval of the state health officer or such officer’s designee. Notwithstanding any provision of law to the contrary, the commissioner of health is authorized to notify the appropriate tuberculosis infection control staff of this or another state of an individual’s tuberculosis infection for the sole purpose of containing a potential threat to the public health and welfare or to assure completion of proper treatment of the diseased person. All persons who receive notification of the infectious condition of an individual under this subsection shall hold the information in the strictest confidence and shall not reveal the information to others. A person making disclosure by providing patient identifying information and medical information related to the patient’s tuberculosis status is immune from liability for making this disclosure of information for the purpose of preventing the further spread of disease and assuring completion of proper treatment of the [person with tuberculosis]. Tenn. Code Ann. § 68-9-201 (2009).
• Return of a tuberculosis patient to location of residence
  • A [State] resident who is receiving tuberculosis health care services in another state and desires to return to [State] shall be referred to the local health official where the patient resides. The information requested of the other state by the local health official regarding the patient, shall include at least the following: 1) medical history including sufficient clinical data to indicate need for further care and treatment of tuberculosis; 2) a statement that the patient is physically able to travel without harm to himself or others, and arrangements have been made for his transfer to [State]; 3) information for residence verification; 4) a statement indicating the patient’s willingness to return to [State] for further care and treatment of tuberculosis; and 5) names and addresses of individuals who will assume responsibility for the patient.
  • Once residence is established and the patient is able and willing to return, final arrangements for transfer shall be made by the local health official directly with the authorities of the other state.
  • When a non-resident tuberculosis patient is willing and able to return to the political subdivision in which the patient resides in another state or country, the local health official where the patient’s provider is located, or the Commissioner’s designee, shall make arrangements with the health official of the political subdivision in which the patient resides so that the patient can be met on return and be provided the health care services needed. Copies of provider reports shall also be forwarded to said health official. N.Y. Comp. Codes R. & Regs. tit. 10, § 43-1.16 (2009).
• Tuberculosis; removal of patients to another state or country; costs
  • When any state charge, as defined in this article, who has not acquired state residence has settlement or residence or otherwise belongs to or in any other state or country, has legally responsible relatives or friends willing to undertake the obligations to support him or to aid in supporting him in such other state or country, the department may furnish him with transportation to such state or country, provided, in the judgment of the commissioner the interest of the state and the welfare of such person will be promoted thereby.
  • The commissioner shall designate or employ nurses or attendants to accompany such persons being removed out of the state unless it appears that such persons are in suitable condition to travel alone with safety.
  • The expense of such removal shall be paid from the state treasury on the audit and warrant of the comptroller pursuant to a verified account submitted by the department, and the commissioner shall thereupon seek reimbursement for such expense from the state or country of residence. N.Y. Pub. Health Law § 2204 (Consol. 2009)

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C. Miscellaneous – Local Travel Restrictions and Notices

Descriptive Note: The provisions in this section relate to intrastate coordination of TB prevention and control. Public health officials may generally impose travel restrictions for persons with infectious TB to prevent interruption of treatment and to protect the public’s health from TB transmission.

• A health officer or health care provider treating an individual with tuberculosis or suspected tuberculosis may: (1) Impose limitations on travel; and (2) Place restrictions on hospital discharge. Md. Code Regs. 10.06.01.21 (2009).

• An individual with active tuberculosis who intends to travel or relocate shall notify the county or district tuberculosis control unit. The unit shall notify the department of health when an individual with active tuberculosis relocates. The department shall notify the tuberculosis control unit of the tuberculosis control district to which the individual intends to travel or relocate or the appropriate public health authority of the state to which the individual intends to travel or relocate. Ohio Rev. Code Ann. § 339.82 (LexisNexis 2009).
• When a tuberculosis patient leaves the hospital against medical advice, the administrator shall, within 24 hours thereafter, notify both the local health officer of the county responsible for the tuberculosis patient’s hospital care and the local health officer of the jurisdiction to which the tuberculosis patient is believed to have gone. Mich. Admin. Code r. 325.178 (2009).
• Whenever any local health officer learns that any person with infectious or noninfectious tuberculosis has been or is being transported into or out of his health jurisdiction, the health officer shall immediately notify the department of such movement. Both the new and old address shall be stated. 410 Ind. Admin. Code 2-1-4 (2009).

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