Breast or Cervical Cancer Treatment (BCCT) MO HealthNet Manual

1305.025.00 Screening/Diagnosis

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

To be eligible for BCCT a woman must have been screened through the SMHW program and found to be in need of treatment for breast or cervical cancer. The screening and diagnosis may be done by either a DHSS contracted SMHW provider or a MO HealthNet provider. A local SMHW provider or MO HealthNet provider provides verification of eligibility on this factor. The screening may be verified by:

  • a Presumptive Eligibility determination (BCC-1)
  • a diagnosis date entered by the SMHW provider or MO HealthNet provider on the BCCT application form (IM-1BC)
  • a diagnosis, need for treatment, or expected length of treatment information entered by the provider on the BCC-2 certification form, or
  • a phone call to the provider to verify the diagnosis date

NOTE: A screening by a MO HealthNet provider only qualifies the woman for BCCT coverage, if the woman was an active MO HealthNet participant at the time of the screening/diagnosis.

The screening may have occurred prior August 28, 2001. A screening prior to August 28, 2001, qualifies a woman on this factor as long as she is still in need of treatment as a result of the screening. While the screening may have occurred prior to August 28, 2001, MO HealthNet coverage cannot begin prior to August 28, 2001.

To have the screening paid for through DHSS SMHW program, a woman must meet DHSS eligibility requirements for a screening. Currently these are that a woman 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 provider in order to determine eligibility for BCCT coverage if they are active MO HealthNet participants at the time of the screening, but the cost of the screening cannot be paid for through DHSS SMHW program.

NOTE: Only SMHW providers who have signed a SMHW Participation Agreement with the Department of Health and Senior Services (DHSS) may determine Presumptive Eligibility for BCCT. The DHSS is responsible for insuring a provider meets the criteria necessary to qualify as a SMHW provider. If a woman received Presumptive Eligibility for BCCT, she is eligible for BCCT (if eligible on all other factors). FSD does not evaluate income at the time of the BCCT application or as changes occur.