parallels language required by the California Department of Health Services for all contracts with managed care organizations serving Medical beneficiaries. Similar provisions in Medicaid contracts have also been adopted by Missouri, Oregon, and Minnesota. Although such an agreement appropriately would provide for plan reimbursement for out-of-plan STD-related services, better methods are needed to document billing of the plan for their enrollees' use of such services. The language included in the Los Angeles County model contract suggests that the health department will divulge confidential patient information to the plan and may inhibit infected persons from seeking care-an outcome that would not be in the best interests of the plan or the larger community.

National Surveillance and Information Systems

Public health surveillance is the process of collecting information regarding the frequency and distribution of disease or other health conditions among specific populations. Data are collected at local, regional, and national levels to (a) monitor trends in diseases and other health conditions, (b) identify problems that need intervention, (c) improve effectiveness of prevention or health care resources, and (d) evaluate the impact of specific interventions. The current national system for STD surveillance is a complex amalgam of different reporting systems from multiple sources.

National Notifiable Disease Reporting

The foundation of STD surveillance is the national public health notifiable disease reporting system, coordinated on a national basis by the CDC. This system is fundamentally a "passive" system, that is, reports are brought to the attention of public health officials when health care providers or laboratories submit a report of a positive laboratory test or clinical diagnosis of a reportable health condition. Active case finding is not routinely conducted. Each of the 50 states has the authority to declare certain diseases or health conditions that are to be reported by clinicians and laboratories. Syphilis and gonorrhea are reportable conditions in all 50 states; and 48 states (New York and Alaska are the exceptions) also require the reporting of chlamydial genital infection (CDC, 1995c). Other bacterial STDs, such as chancroid or lymphogranuloma venereum, are not consistently reported from state to state. Viral STDs, such as herpes simplex virus type 2 infections, are generally not well identified through this system.

In general, initial case reports generated by laboratories or providers are submitted to local public health departments and are, in turn, reported to state public health authorities. All states participate in a voluntary system whereby statewide notifiable disease data are reported to the CDC. National STD data reported by the CDC are compiled from individual reports from states, submitted without name identifiers. Not all states report uniform data to the CDC. For

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