1300.000.00  BREAST OR CERVICAL CANCER TREATMENT MO HEALTHNET (BCCT) PROGRAM

IM-120, December 18, 2007IM-111, November 26, 2007IM-158, August 28, 2001

As of August 28, 2001, MO HealthNet (Title XIX) coverage became available for uninsured women under the age of 65 who have been screened through the Missouri Department of Health and Senior Services (DHSS) Show Me Healthy Women (SMHW) program, formerly known as the Breast and Cervical Cancer Control Project (BCCCP), and are in need of treatment for breast or cervical cancer. This includes treatment of certain pre-cancerous conditions and early stage cancer. DHSS considers screenings by both their own SMHW contracted providers and MO HealthNet providers to be SMHW screenings. Screenings by MO HealthNet providers must have been while the participant was eligible for and receiving MO HealthNet benefits under any MO HealthNet program except for Presumptive Eligibility for Children and Temporary MO HealthNet During Pregnancy (TEMP) programs. Contracted SMHW providers are allowed to make Presumptive Eligibility determinations for MO HealthNet coverage based on the need for treatment.

MO HealthNet based on the need for Breast or Cervical Cancer Treatment (BCCT) is intended for women ineligible for all other MO HealthNet categories. 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.

Both regular BCCT and BCCT Presumptive Eligibility provide full MO HealthNet benefits.

1300.005.00  LEGAL BASIS (BCCT)

IM-120, December 18, 2007IM-111, November 26, 2007

Section 1902 [42 U.S.C. 1396a] (a) (10) (A) (ii)(XVIII) of the Social Security Act allows states the option of providing medical assistance to uninsured women under age 65, that have been screened for breast and cervical cancer under the Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection Program and need treatment for breast or cervical cancer. Section 1920B [42 U.S.C. 1396r.lb] allows states to provide a period of Presumptive Eligibility. Missouri opted to provide this coverage when the Breast and Cervical Cancer Treatment Act (HB 762) was signed June 21, 2001. The program began effective August 28, 2001.

The Department of Health and Senior Services (DHSS) is responsible for insuring that providers meet criteria for screening under the Breast and Cervical Cancer Treatment Act. Originally DHSS limited screenings to medical providers that participated in and were paid for screening by its Show Me Healthy Women (SMHW) program, formerly known as Breast and Cervical Cancer Control Project (BCCCP). In 2007 DHSS changed the definition of a SMHW screening to include a diagnosis of breast or cervical cancer by a MO HealthNet provider (fee-for-service as well as Managed Care). A screening by MO HealthNet provider (fee-for service as well as Managed Care) must have been completed while the participant was eligible for and receiving MO HealthNet benefits, except for Presumptive Eligibility for Children and Temporary MO HealthNet During Pregnancy (TEMP) Programs, in order for the participant to qualify for BCCT.

NOTE: An exception would be if the MO HealthhNet Provider is also a SMHW contracted provider.