IM-158 08/28/01 BREAST OR CERVICAL CANCER
TREATMENT MEDICAL ASSISTANCE PROGRAM (BCCT);
FORMS MANUAL REVISION #29 BCC-1, BCC-2, AND IM-1BC AND INSTRUCTIONS, IM MANUAL REVISION # 34 CHAPTER VI, APPENDIX E
|BREAST OR CERVICAL CANCER TREATMENT MEDICAL
ASSISTANCE PROGRAM (BCCT)
FORMS MANUAL REVISION #29 BCC-1, BCC-2, AND IM-1BC AND INSTRUCTIONS,
IM MANUAL REVISION # 34 CHAPTER VI, APPENDIX E
|As of August 28, 2001, Medicaid coverage
is available for uninsured women under the age of 65 who have been screened
through Missouri's 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.
BCCCP Medicaid Providers are allowed to make presumptive eligibility determinations
for Medicaid coverage based on the need for treatment, prior to a determination
of eligibility by the Division of Family Services (DFS).
Medical Assistance based on the need for Breast or Cervical Cancer Treatment (BCCT) is intended for women ineligible for all other Medicaid/MC+ categories. When a BCCT application is received explore possible eligibility for other categories, but do not delay the BCCT approval. The beginning date for coverage under BCCT Medicaid cannot be prior to August 28, 2001. Both regular BCCT and BCCT presumptive eligibility provide full Medicaid benefits.
Note: If the Claimant is eligible for MC+ custodial parent or non - custodial parent coverage she should be placed on the BCCT program due to the MC+ coverage being limited. In addition, if a woman is eligible for both MA spenddown and BCCT, the BCCT coverage should be approved as it is the claimant's advantage.
To qualify for Medical Assistance based on the need for Breast or Cervical Cancer Treatment (BCCT) the following eligibility criteria must be met:
NOTE: To be eligible for a BCCCP screening a woman must have income below 200% of the federal poverty level. It is the BCCCP provider's responsibility to determine eligibility for the screening. The income limit is only for the screening, not for BCCT Medicaid eligibility. If a woman received a BCCCP screening, she is eligible for BCCT Medicaid (if eligible on all other factors). DFS does not evaluate income at the time of the screening or as changes occur.
To be eligible for BCCT a woman must have been screened through the BCCCP program and found to be in need of treatment for breast or cervical cancer. A local BCCCP provider (list attached) will provide verification of eligibility on this factor. The screening may be verified by:
NEED FOR TREATMENT
"Need for treatment" means that, in the opinion of the woman's treating health professional that the diagnostic test following a BCCCP 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 BCCCP 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. The BCC-2 (copy attached) has been created to obtain the physician's certification and the estimated length of treatment. Priorities should be set to obtain a physician's certification at the end of 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 claimant is due for a physician's certification, request that she provide the name of her treating physician and sign a release of information for us to obtain the certification. When the release is obtained, send it to the treating physician along with a BCC-2. The process is similar to requesting medical information to determine eligibility for MA based on disability, except that a Medical Review Team (MRT) decision is not required.
Most women screened through the BCCCP program will have a case manager based at one of the 7 regional BCCCP or Department of Health (DOH) offices (list attached). 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.
To be eligible for BCCT Medicaid a woman must be uninsured. Health insurance is defined as insurance that minimally provides coverage for physician's services and hospitalization. It must also cover breast and cervical cancer treatment. There is no penalty or waiting period for dropping insurance.
Health insurance does not have to cover all medical conditions (such as pre-existing conditions) to cause ineligibility for BCCT, however it must cover breast and cervical cancer treatment services. A woman with insurance that does not cover breast or cervical cancer treatment is considered uninsured.
The term "health insurance" does not include short-term, accident, fixed indemnity, limited benefit or credit insurance, coverage issued as a supplement to liability insurance, insurance arising out of a worker's compensation or similar law, automobile medical payment insurance, or insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in any liability insurance policy or equivalent self insurance.
Women who have exceeded a lifetime maximum for all benefits under their health plan are considered uninsured. If a woman has exceeded an annual maximum or the maximum for one particular service (other than breast or cervical cancer), she is considered insured. The applicant must provide documentation they have reached their lifetime maximum for all benefits.
APPLICATION AND ELIGIBILITY PROCEDURES FOR BCCT
The application form for BCCT is the IM-1BC (copy attached). The BCCCP provider will instruct the claimant to fill out the IM-1BC application and return it to the MC+ Service Center in her area. If referred by the BCCCP provider, the provider's name, phone number and date of diagnosis should be on the form. Women may apply at the county DFS office if they wish. If the IM-1BC does not show the woman was screened through the BCCCP program, contact the local BCCCP provider to verify she has been screened through the program and is in need of breast or cervical cancer treatment.
The IM-1BC requests the applicant to provide identification information, citizenship/alien status and insurance information. In addition it has four screening questions to determine if she might be eligible for Medicaid or MC+ on another basis.
If the IM-1BC indicates the woman may be eligible for another category, send her the appropriate application form (IM-1UA or IM-1MA). Request the woman complete and return the application. Do not delay approval of BCCT while waiting on the other application. All BCCT applications are to be processed within 30 days.
BCCT applications will be registered through IAPP as MA non-spenddown. If eligible, approve the claimant with a "T" level of care and a "W" in the level of care (sanction) reason field. Systems work to allow a level of care (sanction) reason on MA cases has not been completed. Until notified system work is completed, all BCCT approvals must be E-mailed to Carol Wiles, IM Program and Policy Unit, at WILEDHH.
The approval notice for BCCT is the IM-32. The letter should state the woman has been approved for Medical Assistance and in section 4 state, "Your eligibility for Medical Assistance is based on the results of your screening for Breast and Cervical Cancer".
BCCT cases are to be reinvestigated annually. If a claimant is determined ineligible on any factor (either at the annual review or an interim contact) follow normal closing procedures. These include ex-parte procedures in memorandum IM-193 (2000) for the Aged, Blind and Disabled Medicaid programs.
Medicaid 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 BCCCP screening occurred. No coverage can begin prior to August 28, 2001 (although the qualifying screening may have occurred prior to August 28, 2001). For eligible women, regular BCCT Medicaid coverage begins on the latest of the following dates:
Presumptive eligibility determinations for BCCT are made by BCCCP Medicaid providers. When a BCCCP provider determines a woman is eligible for PE, they will issue her a BCCT Temporary Medicaid approval letter (BCC-1). BCCT-PE coverage begins on the date the BCCCP provider determines the woman is in need of treatment and issues a BCC-1. BCCT-PE coverage continues until the earlier of the following dates:
Once the PE decision is entered, BCCT-PE
cases will appear in IM system as MA non-spenddown with a level of care
"T" and reason "L" in the level of care (sanction) reason field.
Distribution # 2
Attachments (in PDF format):
BCCCP Regional Case Managers