Treatment for Breast or Cervical Cancer

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					TREATMENT FOR BREAST AND/OR CERVICAL CANCER

Only currently enrolled BCHC clients who have been screened, diagnosed and found to
need treatment by a BCHC provider are eligible to be referred to the Department of
Public Assistance (DPA) for application to Breast and Cervical (B&C) Medicaid.

B&C Medicaid will cover all treatment costs for women with biopsy proven diagnosis of:
 Breast cancer and/or;
 Cervical dysplasia; or
 Cervical cancer.

DPA makes all final eligibility determinations for B&C Medicaid based on its own
criteria.

Providers should contact BCHC with questions related to diagnosis and treatment when
they find apparent exceptions to this BCHC referral policy.

Process for referring BCHC clients for application to B&C Medicaid:
1. The BCHC screening provider notifies BCHC staff that a BCHC enrolled client has a
   diagnosis of breast or cervical cancer and/or cervical dysplasia requiring treatment.
   Providers should notify BCHC staff of need for treatment by direct phone call rather
   than by voice message or Fax. A BCHC Annual Enrollment Form signed and dated
   within the past 12 months by both the client and the provider must be on file with
   BCHC and the provider prior to initiating the referral to DPA. If the client‟s Annual
   Enrollment Form is not on file with BCHC, it should be faxed immediately to 907-
   269-3414.
2. A completed BCHC Breast or Cervical Cancer Diagnostic Evaluation & Data
   Collection Form must also be faxed 907-269-3414. This form must clearly describe
   the biopsy results indicating treatment.
3. BCHC staff must notify DPA of BCHC client enrollment and eligibility to apply for
   B&C Medicaid prior to any client‟s consideration for B&C Medicaid coverage.
4. BCHC staff mail a DPA Breast and Cervical Medicaid application directly to the
   client. The client may mail the completed application directly to DPA using the pre-
   addressed envelope included in the packet. Clients needing assistance with the
   application should call DPA in Anchorage at 269-7880. Clients outside the
   Anchorage area should call collect to 907-269-7880.

The Centers for Medicare and Medicaid Services (CMS) which sets and monitors policy
and regulation for Medicare and Medicaid at the federal level has issued the following
clarifying statement regarding treatment for women enrolled in B&C Medicaid: “The
term „needs treatment‟ means, in the opinion of the client‟s treating health professional
that the diagnostic test following a breast or cervical cancer screen indicates that the
client 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. Based on the physician‟s care plan, clients who are
determined to require only routine monitoring services for a pre-cancerous breast or



Rev 1/03                                                                               G-1
cervical condition (e.g., breast examinations and mammograms) are not considered to
need treatment.”

BCHC interprets this to mean if a client is diagnosed with CIN III by biopsy and then
requires a LEEP, she may apply for treatment funding even though she has not been
diagnosed with cervical cancer.

Clients are eligible to remain on B&C Medicaid until it is determined by a provider that
they are no longer in need of treatment.


Referral Flowsheet:

Breast or cervical cancer or pre-cancerous cervical condition requiring treatment is
diagnosed:

BCHC Screening Provider:
1. Calls BCHC.
2. Faxes Annual Enrollment Form to BCHC
   (if not already done.)
3. Faxes Breast or Cervical Diagnostic Form to
   BCHC with final diagnosis and care plan noted.


Once BCHC has been notified and Forms received:

BCHC Staff:
1. Notifies DPA of client‟s potential eligibility for
   B&C Medicaid.
2. Mails Medicaid application packet to client.



Once client receives application:
Client:
1. Returns application to DPA using pre-
    addressed envelope included in packet.


Once DPA has received completed application:

DPA:
1. Determines eligibility for B&C Medicaid or
   other Medicaid programs.
2. Notifies woman.
3. Notifies BCHC.




Rev 1/03                                                                                G-2