The Use of Alternate Third Party Payees for STD Care in Public Health Clinics

Background: In the state of Pennsylvania the Communicable Disease Act delineates that “the Department shall provide or designate adequate facilities for the free diagnosis and, where necessary and for the preservation of public health, free treatment of persons infected with sexually transmitted diseases.” Since inception of the act, the STD Program has interpreted the language of this act to imply that reimbursement for STD services service provided could never be pursued from the client or alternate third party payees (TPP) such as Medical Assistance, private insurance or fee payers. Over the last 5 years the STD Program has experienced a 26% decrease ($640,000) in direct state funding, with the majority of the decreases occurring in the last three years. As a result of these funding decreases, the STD Program has been forced to revisit the long held interpretations of the Communicable Disease Act and has argued for a more liberal interpretation of the Act.

Objectives: By the end of the presentation participants will be able to: Identify the potential barriers in seeking reimbursement from TPP, Summarize the internal infrastructure and skill sets needed to pursue TPP, Evaluate the potential of implementing TPP within in their local jurisdiction.

Methods: In May 2011, the STD Program implemented a TPP pilot with a key STD Provider leveraging the state’s electronic laboratory reporting file in conjunction with the local billing system to identify individuals that were eligible for TPP.

Results: The STD Program is anticipating a 72% reduction in costs associated with STD care provided at the pilot clinics.

Conclusions: TPP is a viable method of reducing costs in publically-funded STD clinics.

Implications for Programs, Policy, and Research:: In an environment of shrinking budgets, TPP is one methodology that state’s can utilize to maintain a safety net of STD services in their area.