Transcript FT Course presentation - pbcc

Free Treatment and Full Medical Coverage
for Women with Breast or Cervical Cancer
at no cost to facilities that accept Medicaid
Online Course
PowerPoint Presentation
What we’ll cover
 How women with breast or cervical cancer can receive free
treatment and full medical coverage for and during their
treatment when they have no insurance or the plan they
have is limited
 The role that doctors and nurses play in helping women
receive free medical coverage
 Procedures for processing forms and helping women apply
 The criteria women must meet to become enrolled
What we’ll cover
 What’s meant by creditable coverage
 The basics of the Commonwealth of PA’s Breast and
Cervical Cancer Prevention and Treatment Program
(BCCPT)
 Important facts to help you assist your patients
 Where to turn for more information
Who are we concerned about?
 Women in Pennsylvania who have been diagnosed with
breast or cervical cancer or diagnosed with a
precancerous condition
 Have limited or no health insurance to pay for their
treatment, tests, and medications
There are over 12,000 women
diagnosed with breast cancer in
Pennsylvania each year.
OVER A HALF-MILLION WOMEN ARE
WITHOUT ADEQUATE INSURANCE COVERAGE
TO TREAT THEIR CANCER IN PA.
WOMEN WITHOUT INSURANCE ARE
SIGNIFICANTLY MORE LIKELY TO DIE OF
THEIR CANCER THAN WOMEN WHO ARE
INSURED.
So how can women get help?
Knock on one door at the Pennsylvania
Department of Health
How does
she get to
the door?
Through
her doctor
when…
 The doctor has diagnosed her
with breast or cervical cancer
OR
 A precancerous condition - a
disease, syndrome, or finding
that, if left untreated, may lead to
cancer
How does
she get to
the door?
Through
her doctor
when…
 She informs the doctor that she
doesn’t have health insurance or
her plan is very limited.
 The doctor informs her that she
may be eligible for free medical
coverage and fills out a form and
faxes it to begin the application
process.
What form and where is sent?
 The form is known as PA 600B
 You can get copies of it at
www.pahealthywoman.com
(at bottom of page under the quick links section “Healthcare Providers”)
 It takes only a few minutes to fill out.
 The woman fills out Part A of the Enrollment and
Consent form.
What form and where is sent?
 The physician fills out Part B which is the Medical
Assistance Eligibility section.
 The form is faxed to one central statewide number at
412-201-4702.
Where does the form go?
 It’s processed by the PA Department of Health’s
statewide contractor and if the woman meets the
eligibility criteria it is then sent on to the woman’s
local County Assistance Office.
 The County Assistance Office has 5 business days
from the day they receive the application to
determine if the woman is eligible.
What eligibility criteria is the
County Assistance Office
looking for?
Criteria
 The PA 600B form
 Pennsylvania resident
 A Social Security Number
 Under the age of 65 years
Criteria
 A United States Citizen

However, if a non-citizen or undocumented woman has a
precancerous condition or is diagnosed with breast or cervical
cancer she can apply for “Emergency Medical Assistance” from
her local County Assistance Office.


For Medical Assistance information call the Welfare Helpline at
800-692-7462 or the Medicaid Helpline at 800-842-2020.
If she is accepted, non-citizen or undocumented woman can
only receive treatment specific to either breast or cervical
cancer.

For Immigration and non-citizen information contact the
Pennsylvania Health Law Project at 800-274-3258 or
www.phlp.org.
Criteria
 Without insurance
OR
 Underinsured or limited coverage




This means that a woman’s plan does not adequately cover treatment for
breast or cervical cancer.
In other words, the woman’s plan is not creditable to what a woman can
receive from the Full Medical Coverage program.
Creditable means a plan is equal to or better than what it is being compared
to.
Here are some examples of how a plan is not creditable:



The plan’s lifetime or annual limits have been exhausted.
A woman is in a waiting period for an HMO.
She has only Medicare Part A for hospitalization coverage, and thus, isn’t
insured for outpatient treatment.
Criteria
 Examples of creditable plans, meaning a
woman would not qualify for the program if
she has any of these plans:






Medicare
Medicaid (State Medical Assistance)
Armed forces insurance
A state health risk pool
A group health plan
Health insurance coverage (e.g. HMO, private plan)
Criteria
 Has an income of no more than 250% of
the Federal Poverty Level (FPL).


The Department of Health and Human Services issues
the annual FPL guidelines each year.
The benefit levels of many low-income assistance
programs are based on these poverty guidelines.
Criteria
 Federal Poverty Level (FPL)
 In 2011, the FPL for a family of two was a gross annual income
of $14,710.
To calculate 250%, simply double the amount ($29,420) and then
add half of $14,710 ($7350.00) which equals $36,775.
 A woman’s assets are NOT counted towards her income.


You can find annual FPL charts by going to www.hhs.gov and
entering “poverty guidelines” in the search bar.
If a woman qualifies she will
receive Free and Full Medical
Coverage provided by the:
COMMONWEALTH OF PA’S BREAST AND
CERVICAL CANCER PREVENTION AND
TREATMENT PROGRAM
PA DEPARTMENT OF PUBLIC WELFARE
Her coverage begins the
day she was diagnosed with a
precancerous or cancerous condition
• Her eligibility can be retroactive up to three months prior to
enrollment.
• However, all eligibility requirements under BCCPT must be
met during the retroactive period, including screening and
diagnosis of breast or cervical cancer.
Once she’s enrolled in the
program
THIS IS WHAT SHE RECEIVES…
Free and Full Medical Coverage
She receives a PA Medicaid Access Card providing:
Health care coverage for any health conditions while she is
being treated for breast or cervical cancer.
Medical Treatment for her cancer such as surgery,
chemotherapy, radiation, medications. Physician visits.
No limits on visits. No co-pays. No premiums.
Screening for other Medical Assistance Benefits such
as free transportation for medical visits.
This program is a Medicaid
Program
IT IS A FEE-FOR-SERVICE PROGRAM
NOT AN HMO. AS A RESULT, A
WOMAN CAN RECEIVE SERVICES
ANYWHERE IN THE STATE, NOT ONLY
WHERE SHE RESIDES.
What physicians should do
 Whenever he or she diagnoses a patient with breast
or cervical cancer, ask if the patient has insurance.


If they don’t or if there is any doubt that the insurance she
does have isn’t creditable to cover her treatment -- then tell
the patient and the nurse manager about the BCCPT program.
Offer to fill out the necessary paperwork and fax it to the
statewide number at which point DPW’s Health Insurance
Premium Payment Program reviews policies for creditable
coverage.
What physicians should do
 Every year women must re-enroll and they need the
doctor to submit PA600BR (renewal form) that
verifies she needs continued treatment for breast or
cervical cancer or precancerous condition of the
breast or cervix.
 When valid, the doctor should write that “the cancer
is persistent and incurable” so the patient can
receive treatment during the duration of her cancer.
Once a woman is in the Breast and Cervical
Cancer Prevention and Treatment program
this is what you should know…
What Women Need To Know
 The coverage for the program is for the duration of her cancer
treatment.
 Women must continue to sign up for the program every year
once they have been enrolled. If they do not, they will be
removed from the program.

This means the doctor’s office needs to fill out their section of the PA 600B
every year when the patient brings it in.

Women rely on their doctor submitting the papers quickly.
What Women Need To Know
 Depending on the woman’s diagnosis (ICD code), she
may need to complete a partial renewal more
frequently. For example, women with cervical cancer as
long as “active treatment” is needed renew every three
months. The PA600BR renewal form is sent directly to
the patient and they’ll need the doctor to complete their
portion and sign it.
What Women Need To Know
 If a woman receives a letter from the Department of
Welfare that her Medical Assistance via the BCCPT
program will terminate, she should get as many health
care services that she needs (such as annual exams,
dental care).
 She can appeal if she is denied.
What Nurses And Doctors Need To Know
 Remind women that even though this is a Medical Assistance
program, they can have higher incomes than the standard
eligibility requirements. Her assets (home, car, savings) will not
be affected or counted as income. You’ll help them through the
fear of applying for “welfare.”
 If there is ANY question about a woman’s eligibility or coverage
we encourage you to help her apply for this program! Program
case managers can help navigate the process.
What Nurses And Doctors Need To Know
 Your physician’s office is key in letting women know
about the program and processing the initial
paperwork for them to enroll.
 When a woman is enrolled – all of her health care is
covered for any type of condition throughout the
duration of her cancer treatment.
What Nurses And Doctors Need To Know
 A woman remains in the BCCPT program until all
treatment is completed, including while a patient is taking
tamoxifen.
 Needing follow-up exams and tests does NOT qualify as “in
treatment.”
 A woman’s medications and chemotherapy are covered.
Note: the medication must be administered in a hospital
outpatient clinic, not in a doctor’s office or a cancer center.
What Nurses And Doctors Need To Know
 Any pharmacy that accepts Medicaid will provide
needed drugs/medications to eligible women.
 For all pharmacy questions as to what’s covered call
the Pharmacy Call Center at 800-558-4477 and
choose Option 1.
Final Points
 A woman’s BCCPT benefits end when she:
 Reaches age 65 years
 Has creditable coverage
 No longer needs breast or cervical cancer treatment
 Does not comply with annual renewal requirements
Final Points
 The BCCPT program is a federal Medicaid Program (Title XIX)
administered by the PA Department of Public Welfare.
 Be sure to print the Resource Guide for resources and contact
information that can help you assist your patients receive full
medical coverage for breast or cervical cancer.
 If there is ANY question about a woman’s eligibility or
coverage we encourage you to help her apply for this program!
Final Points
If you have any questions or need help
please call the PA Breast Cancer Coalition
at 717-721-2580 or 800-377-8828.