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Staff Tools | Breast and Cervical Cancer Medical Program Manual
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DHS home | APD
Staff Tools | Breast and Cervical Cancer Medical Program Manual
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Effective 10-1-2013, All rules pertaining to this program have been moved to
410-200-0400
The Breast and Cervical Cancer Prevention and Treatment Act of 2000 (Public Law 106 354) amended title XIX (Medicaid) of the Social Security Act to give the option of providing Medicaid eligibility to uninsured women who are screened by the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and are in need of treatment for breast or cervical cancer, including precancerous conditions.
Effective January 1, 2012, women with qualifying breast or cervical cancer diagnoses, including specific precancerous conditions, who meet the eligibility criteria for the Breast and Cervical Cancer Program (BCCP) will be eligible for treatment through BCCTP. Women no longer need to be diagnosed by a specific BCCP provider, but can be presumptively enrolled by a licensed health care provider.
The Oregon Breast and Cervical Cancer Program reimburses local medical providers and tribes throughout the state to administer screening and diagnostic services.
There are no financial eligibility requirements for BCCTP once a woman has been determined by a qualified provider to meet the BCCTP criteria.
To be presumptively eligible for BCCTP, a woman must:
BCCTP eligibility is determined through the licensed health care provider, and is not determined by OHA or DHS/AAA eligibility staff.
When an uninsured woman is found to need treatment for either breast or cervical cancer or precancerous conditions after being screened by a licensed health care provider, the application process is initiated by the provider.
The Breast and Cervical Cancer Treatment Program (BCCTP) Application and Referral Form (OHA 1463) is completed by a woman who has been screened by a medical provider and is found to need treatment for breast or cervical cancer, or precancerous conditions. The provider assists the woman in completing the patient section of the application. The provider must also complete and sign the provider section of the application.
The provider determines the woman to be presumptively eligible for BCCTP and submits the BCCP application form to the Statewide Processing Center (Branch 5503) to establish eligibility. If it appears the woman could be eligible for a mandatory Medicaid program, Branch 5503 will assist the woman in getting an Application Oregon Health Plan and Healthy Kids (OHP 7210) from the application center. The OHP 7210 will be marked “BCP” on the label. If a woman submits the OHP 7210 to a branch office, it is to be forwarded to the Statewide Processing Center.
A woman eligible for the BCCTP program will have her case coded as program P2 with a BCP case descriptor. A woman who has been determined to be presumptively eligible for BCCTP but is eligible for another Medicaid program will have her case coded with that program coding and with a BCS case descriptor.
A woman initially found eligible for BCCTP may be required to complete and return an OHP 7210 or other Department of Human Services (DHS) application to determine if the woman is eligible for another Medicaid program. This OHP 7210 application will be marked “BCP” on the label. If the woman submits the OHP 7210 to a branch office, it should be forwarded to the Statewide Processing Center.
A woman found eligible for the BCCTP program will have her case coded as program P2 with a BCP case descriptor. If the woman is later determined to be eligible under any of the mandatory Medicaid programs, her case will be coded with that program coding and with a BCS case descriptor.
A woman who loses eligibility for another medical program, but has her case coded with the BCS case descriptor, is still eligible for BCCTP as long as she still needs treatment and continues to meet all other eligibility requirements for the program.
Household Group:
When a woman has been referred for presumptive eligibility based on BCCP eligibility, the household consists of people who live in the same house, apartment or other dwelling. A dwelling can contain more than one household if it is divided into separate living units, such as an apartment house, or if a landlord/tenant relationship exists. To have a valid landlord/tenant relationship, the landlord must live independently and bill the tenant for rent at fair market value. They may share bathroom and kitchen facilities, but only in a commercial room and/or board establishment. When people live in more than one household during a month, they are considered to be living in the household where they spend 51 percent or more of their time.
Household group: 461-110-0210
Filing Group:
The filing group for BCCTP consists of the individuals from the household group (see OAR 461-110-0210) whose circumstances are considered in the eligibility determination process
Filing group: 461-110-0310
Financial Group:
The financial group is the filing group members whose income and resources count in determining eligibility and benefits.
Financial group: 461-110-0530
Need Group:
For BCCTP, the need group consists of each member of the financial group.
Need group: 461-110-0630
Benefit Group:
For BCCTP, the benefit group consists of the woman who has been found to be presumptively eligible for this program.
Benefit group: 461-110-0750
A woman is no longer eligible for the BCCTP program when:
Clients who are eligible for BCCTP are also potentially eligible for retroactive medical benefits.
