|TO:||ALL COUNTY OFFICES|
|FROM:||JANEL R. LUCK, DIRECTOR|
EXPANSION OF BCCT PROGRAM
Effective immediately, the Department of Health and Senior Services (DHSS) changed the definition of a Show Me Healthy Woman (SMHW) screening, formerly known as a Breast and Cervical Cancer Control Project (BCCCP) screening, to include all MO HealthNet providers (fee-for-service as well as Managed Care). This will result in more women applying at their local Family Support Division (FSD) offices and being determined eligible for the Breast and Cervical Treatment (BCCT) program. This program provides MO HealthNet benefits to women under 65 who have a diagnosis of breast or cervical cancer and are in need of treatment.
Women must be diagnosed and determined to be in need of treatment for breast or cervical cancer by a SMHW or MO HealthNet provider as an eligibility factor for BCCT. To have the screening paid for through DHSS SMHW program, a woman must be between the ages of 35 up to 65, be uninsured, and have income of less that 200% of the federal poverty level (FPL). Women not meeting these requirements can be screened by a SMHW or MO HealthNet provider in order to determine eligibility for BCCT coverage, but the cost of the screening cannot be paid for through DHSS SMHW program.
NOTE: A screening that results in a diagnosis of breast or cervical cancer not paid for by either the SMHW program or MO HealthNet still qualifies a woman for BCCT.
The MO HealthNet Service Center will continue to accept and process BCCT Presumptive Eligibility (PE) determinations and evaluate those participants for BCCT eligibility. FSD offices will accept and determine BCCT eligibility for any woman who applies locally. Only SMHW providers may determine Presumptive Eligibility (PE) for BCCT. MO HealthNet providers who have not signed a participation agreement with DHSS to do SMHW screenings may NOT determine PE.
The BCCT manual is updated to reflect these changes and to reflect name change from Medicaid to MO HealthNet.
There are no changes in the eligibility requirements to qualify for MO HealthNet based on the need for Breast or Cervical Cancer Treatment (BCCT) except that a diagnosis of breast and/or cervical cancer by any MO HealthNet provider (including Managed Care providers) is considered a SMHW screening.
MO HealthNet coverage under BCCT begins on the 1st day of the month of application, if the woman meets all eligibility requirements. Prior quarter coverage can also be approved, if the woman was eligible. Coverage cannot begin prior to the month the woman is diagnosed with breast or cervical cancer by a SMHW provider.
The application form for BCCT is the IM-1BC. The IM-1BC may be submitted to Family Support Division (FSD) in one of two ways:
If the woman received screening services through a Show Me Healthy Women (SMHW) provider and was determined eligible for BCCT Presumptive Eligibility, the SMHW provider will:
Instruct the claimant to fill out the IM-1BC application, and
- Return it to the MO HealthNet Service Center.
If referred by the SMHW provider, the provider’s name, phone number and date of diagnosis should be on the form.
Women who have been screened and diagnosed with breast or cervical cancer by a SMHW or a MO HealthNet provider may apply at their local county FSD offices.
NOTE: The BCCT program is for women who have already been diagnosed with breast or cervical cancer. FSD will not pay for a medical examination to determine whether a woman has breast or cervical cancer. Eligibility for MO HealthNet benefits for women who are not diagnosed with breast or cervical cancer must be explored under other MO HealthNet programs. If a woman believes she may have breast or cervical cancer, but cannot afford to pay for a screening, refer her to a SMHW provider who can determine eligibility for screening services. A listing of SMHW providers who have signed a participation agreement with DHSS is available at http://www.dhss.mo.gov/BreastCervCancer/Providerlist.xls .
If the woman was not determined eligible for BCCT Presumptive Eligibility by a SMHW provider, send a Medical Referral and Authorization (IM-60) form and the Certification of Need for Treatment - Breast/Cervical Cancer (BCC-2) form to verify she has been screened by a SMHW provider or MO HealthNet provider and is in need of breast or cervical cancer treatment. The medical provider must enter his/her MO HealthNet Provider Number or MO HealthNet Managed Care Provider Number on the BCC-2. A copy of the BCC-2 Instructions is attached.
The BCC-2 and the IM-60 are in the process of being revised. Use the copy of the BCC-2 attached to this memorandum until it becomes available on the Forms link. On the IM-60 currently available on the Forms link, write in “Has breast or cervical cancer” next to the listings of disabling claims. After “To help us, we would appreciate it if you would:”…write in “Fill out attached Certification of Need for Treatment.”
When a BCCT application is received, explore possible eligibility for other categories, but do not delay the BCCT approval. If a woman is eligible for Mo HealthNet for the Aged, Blind and Disabled (MHABD) spend down and BCCT, the BCCT coverage should be approved as it is to the participant’s advantage. If the participant is approved for BCCT and it is later determined that the woman is eligible for MHABD non-spend down coverage take action to transfer eligibility from BCCT to MHABD non-spend down.
All BCCT applications must be processed in 30 days. BCCT applications are currently entered and maintained in the Legacy system.
EXAMPLE: Ms. Smith, age 20, comes into her local FSD office on December 15, 2007. She states her doctor (who is a MO HealthNet provider) had diagnosed her as having cervical cancer. Ms. Smith has limited insurance that does not provide for cancer treatment and meets all other BCCT eligibility criteria. She requests prior quarter coverage. The eligibility specialist takes the following steps:
Registers a BCCT application for Ms. Smith.
Obtains Ms. Smith’s signature on the IM-60, and then sends the IM-60 along with the BCC-2 form to Ms. Smith’s physician or gives a copy of the BCC-2 to her along with an IM-31A Request for Information requesting she have her physician complete and return the BCC-2 to verify breast or cervical cancer diagnosis and need for treatment.
The BCC-2 is received by the eligibility specialist, showing a diagnosis date of October 10, 2007. Eligibility specialist approves with eligibility start date of October 1, 2007.
Effective immediately, begin accepting and processing BCCT applications at all FSD county offices and out-based facilities.
Accept documentation from a SMHW provider or a MO HealthNet provider that the woman is diagnosed with breast or cervical cancer and is in need of treatment.
Use the BCC-2 certification form attached to this memo.
Review this memorandum with appropriate staff.