Breast Or Cervical Cancer Treatment Medical Assistance (BCCT)

1305.030.00 Need for Treatment

IM-111, November 26, 2007

“Need for treatment” means, in the opinion of the woman’s treating health professional, the diagnostic test following a breast or cervical cancer screening indicates that the woman is in need of cancer treatment services. These services include diagnostic services that may be necessary to determine the extent and proper course of treatment, as well as definitive cancer treatment itself. Treatment services also include treatment services for certain pre-cancerous conditions. However, women who are determined to require only routine monitoring services for a pre-cancerous breast or cervical condition (e.g., breast examinations and mammograms) are not considered to need treatment.

Need for treatment is considered verified by the SMHW provider’s decision for three months from the diagnosis date (or PE decision date). After the initial three-month period, certification of the continued need for treatment and estimated length of treatment must be obtained from the treating physician by use of the BCC-2. Priorities should be set to obtain a physician’s certification at the end of the initial three-month period and in the month it is estimated a course of treatment will be completed. Do not assume that treatment is no longer needed without requesting a new certification from the treating physician.

When a BCCT participant is due for a physician’s certification, request that she provide the name of her treating physician and sign a release of information to obtain the certification. Send the signed release of information and a BCC-2 to the treating physician. The process is similar to requesting medical information to determine eligibility for MO HealthNet based on disability, except that a Medical Review Team (MRT) decision is not required.

Women screened through a SMHW provider who determined Presumptive Eligibility for BCCT will have a case manager based at one of the 7 regional BCCCP (FSD  Intranet Tools) or Department of Health (DOH) offices.  When a certification of continued need for treatment is needed, it may be helpful to contact the case manager to request their assistance in obtaining the information.