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Breast and Cervical Cancer Medical Program BCCM . Overview. Federal Legislation Screening Treatment What ‘is’ BCCM? Who is Eligible for BCCM? What does the BCCM Cover? How does the BCCM Work?. Breast and C ervical Cancer Mortality Prevention Act of 1990

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Presentation Transcript
overview
Overview
  • Federal Legislation
    • Screening
    • Treatment
  • What ‘is’ BCCM?
  • Who is Eligible for BCCM?
  • What does the BCCM Cover?
  • How does the BCCM Work?
slide3
Breast and Cervical Cancer Mortality Prevention Act of 1990

The Breast and Cervical Cancer Mortality Prevention Act of 1990 (Public Law 101-354) established the Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program. The program provides breast and cervical cancer screening exams to underserved women, including those who are older, have low incomes, or are members of racial and ethnic minority groups. The program operates in all 50 states, the District of Columbia, 6 U.S. territories, and 12 American Indian/ Alaska Native organizations.

Screening of Oregon women began in 1995.

Screening and Diagnostics only.

Treatment for diagnosed cancers is expressly excluded.

slide4
Breast and Cervical Cancer Prevention and Treatment Act of 2000

Signed into law on October 24, 2000 by President William Clinton. This Act gives states the option to provide medical assistance through Medicaid to eligible women who were screened for and found to have breast or cervical cancer, including precancerous conditions, through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).

Adopted by Oregon State Legislature in January 2002 and effective 1 April 2002.

slide5
Oregon BCCP / BCCM

Breast and Cervical Cancer Program (BCCP)

Grant from the CDC

Grants from Susan G. Komen and American Cancer Society

Screening & diagnostic services only

No State General Funds

Breast and Cervical Cancer Medical Program (BCCM)

Medicaid waiver

Treatment services through OHP

$3 Fed for every $1 State

No State General Funds

slide6

What is the BCCM?

The BCCM is a Medicaid waiver which acts as a conduit between the BCCP (Screening and Diagnostic program) to the state Medicaid program (Oregon Health Plan [OHP]). It allows BCCP women diagnosed with breast or cervical cancer to receive life-saving cancer treatment.

BCCP - Screening

BCCM is the Link between the Screening Program and the Oregon Health Plan.

OHP - Treatment

slide7

Basic Eligibility for the BCCM

  • A woman who was enrolled in the BCCP and was diagnosed with breast or cervical cancer, including CIN II/III, is presumed eligible for the BCCM.
      • She does not have to fill out an OHP application.
      • She does not have to undergo ‘assets testing.’
      • There is no ‘wait period’ for eligibility determination.
slide8

Who is Eligible for the BCCM?

  • Women who have received a breast or cervical cancer screening and/or diagnostic procedure paid for by the BCCP and have been found to be in “need of treatment” for breast or cervical cancer or CIN II/III and who are:
      • under the age of 65 and
      • legal residents of the U.S.A.
  • Men are NOT eligible for the BCCM.
slide9

What does BCCM cover?

  • Women who are enrolled in BCCM are immediately put into the OHP-Plus Program. Effective date is the date that they were “determined to be in need of treatment” for breast or cervical cancer. This is the date that the cancer was diagnosed which is typically the date of their biopsy.
    • Women can be retro’d as far back as 90 days if needed.
      • E.g., unpaid medical bills within the previous 90 days.
slide10

What does BCCM cover?

  • Women are insured by OHP-Plus for ALL OHP-Plus covered services.
    • Includes non-breast or cervical cancer services, such as routine doctor’s office visits, preventive health exams, injuries, pharmaceuticals, mental health coverage, dental and medical transportation.
    • Call 1-800-273-0557, the OHP Patient Services Hotline for specific coverage information.
slide11

What does BCCM cover?

  • Provides an OHP ‘open card’ vs. a managed health care plan. Women may use their OHP card wherever it is accepted.
  • Women diagnosed with invasive cervical or breast cancer will be enrolled in OHP-Plus for one year.
  • Women diagnosed with CIN II or CIN III will be enrolled in OHP-Plus for six months.
slide12

What does BCCM cover?

  • Children of BCCM-eligible women who are under the age of 19 and still residing within the household are eligible to apply for OHP standard.
  • Women who are still “in need of treatment” for their breast or cervical cancer will continue to be re-enrolled in OHP-Plus until such time as they are NO longer in need of treatment.
slide13

What does BCCM cover?

  • At the end of the enrollment period, the women will be sent a ‘letter of redetermination.’ This is aone-page form that OHP will mail to her toward the end of her eligibility period.
  • She should take this form to her doctor and have him or her sign it.
    • If she is still “in need of treatment” for her breast or cervical cancer, her doctor will sign “yes, she is still in need..,” sign the form and mail it to OHP in Salem.
    • If she is no longer in need of treatment, her benefits are terminated.
slide15

What does BCCM cover?

  • The annual redetermination process will continue for as long as she is “in need of treatment” for the breast or cervical cancer which initially qualified her for the program.
    • There is no time limit; i.e., Tamoxifen or Femara use
  • Upon termination of OHP-Plus eligibility, she may apply for OHP standard and will be given preferential treatment because she will have had continuous health insurance coverage. At that time she must fill out the OHP standard application and meet all of the OHP assets testing.
slide16

How does the BCCM Work?

  • Upon a BCCP client being diagnosed with breast or cervical cancer or CIN II/III, notify the BCCP office at 971-673-0581 or BCCP_info@state.or.us.
  • The BCCM Coordinator will contact you (the provider) and arrange to send the patient a BCCM application form.
    • Preference is email
slide21

How does the BCCM Work?

  • The patient will fill out the BCCM application and FAX it back to the BCCP. Sending this form directly to OHP will delay processing.
  • BCCP will log, review, approve, sign and FAX the BCCM application to a special unit of the OHP in Salem for immediate processing.
  • OHP will log the application into their system assign a recipient ID number and begin processing.
    • About five working days for new OHP recipient to be accessible in OHP system.
    • About two weeks before new OHP recipient receives OHP card via the mail.
slide22

How does the BCCM Work?

  • Things that delay BCCM processing:
    • NO Social Security Number
      • OHP will only process for Emergent Care
    • NO Signature
      • Client MUST sign
  • About one month after initial BCCM application is filed, OHP will send a form to the recipient asking her to declare her U.S.A. citizenship status.
    • No proof required, e.g., passport or birth certificate.
    • Failure to return form will end client’s eligibility.
slide23

How does the BCCM Work?

  • The OHP Processing Center will add the woman’s name into the DHS-OHP database. Providers can access this database.
  • Once the BCCP woman has been put into OHP, the PCP should close out her BCCP cycles. She is now a client of OHP vs. a BCCP client.
  • As a PCP, ensure that you obtain and enter the following information into the BCCP Web Data System. This is important for CDC reporting:
      • Date treatment started
      • Stage of tumor
      • Size of tumor
contact us
Contact Us!
  • Contact us…
    • Contact BCCP at (971) 673-0581.
    • You can also email us at bccp.info@state.or.us.
contact us25
Contact Us!
  • Your participation in the Breast and Cervical Cancer Program helps save lives, and we thank you for your support.