Beginning in October 2000, signed federal legislation allows funded programs in the NBCCEDP to participate in the MO HealthNet BCCT Act. In July 2001, Governor Bob Holden signed legislation authorizing matching funds for Missouri to participate in the Missouri Medicaid program, now known as the MO HealthNet program, effective August 28, 2001. (State Statute RSMo Section 208.151 [25] is available at https://revisor.mo.gov/main/OneSection.aspx?section=208.151&bid=47992&h….)

Most women who receive a SMHW paid screening and/or diagnostic service, and are found to need treatment for breast and/or cervical cancer or a precancerous condition, may be eligible for BCCT in Missouri.

Once a client is enrolled into BCCT, they are qualified for full MO HealthNet benefits, as well as medical services for cancer care. Please note there is also transportation assistance available for the client enrolled in BCCT. Eligibility criteria for MO HealthNet are based on need. Details for BCCT are at http://dss.mo.gov/mhd/general/pages/about.htm.

Basic BCCT Act Eligibility Guidelines

Those who are eligible for the BCCT program must be enrolled in the SMHW program prior to tissue biopsy and have screening or diagnostic tests paid by SMHW.

• A Missouri resident.
• A female.
• Under the age of 65.
• Social Security Number.
• Citizenship or Qualified Alien Status.
• Diagnosed with breast and/or cervical cancer or cervical precancerous condition through SMHW.
• Need treatment for breast and/or cervical cancers or precancerous conditions as listed below.

BCCT Temporary MO HealthNet Authorization Letter Presumptive Eligibility

The BCCT Temporary MO HealthNet Authorization letter (page 10.16 or download online), also referred to as Presumptive Eligibility (PE), provides temporary and immediate full MO HealthNet benefits. Clients must meet basic BCCT eligibility guidelines (above) to qualify for PE.

MO HealthNet determines the date PE begins. Typically, PE coverage begins on the date of the procedure or diagnostic test that indicates either a precancerous condition or cancer of the breast and/or cervix by tissue pathology that determined the client is eligible for BCCT (pages 7.2-.3).

In order for a SMHW client to obtain PE, e-mail the completed BCCT Temporary MO HealthNet Application (page 10.16) to the MO HealthNet Service Center, Greene County Family Support Division (FSD) (page 7.4). The client receives a copy of the BCCT Temporary MO HealthNet Authorization Letter. An additional copy is retained for the client’s record. Notify the RPC of eligible clients. This procedure allows for minimal delays for women in receiving the necessary treatment indicated.

Submit the previously noted documentation for MO HealthNet to determine the date PE begins. PE coverage continues until the earlier of the following dates:

• The last day of the month following the PE decision, if the client does not submit an application for regular BCCT MO HealthNet coverage (page 10.17), 

  OR

• The date the client is determined ineligible or eligible for BCCT MO HealthNet.

BCCT MO HealthNet Application (Extended BCCT Coverage)
Extending MO HealthNet Treatment Eligibility beyond the presumptive period

For evaluation of continued MO HealthNet coverage, submit the (extended) BCCT MO HealthNet Application form for medical assistance to the FSD’s MO HealthNet Service Center at the time of cancer diagnosis.

The client must meet the basic BCCT guidelines (page 7.2) and:

• Have a Social Security number
• Be uninsured or underinsured for breast or cervical cancer treatment
• Show proof of citizenship/alien status
• Submit a completed, signed (extended) BCCT MO HealthNet Application form to the MO HealthNet Service Center via Greene County FSD

It is important for providers to assist clients in completing and e-mailing the Missouri BCCT MO HealthNet Application for medical assistance as soon as possible (refer to page 10.17). SMHW providers e-mail a copy of the application/temporary documents to MRT.ProcessingCenter@dss.mo.gov. The forms will then be forwarded to the appropriate person. E-mailing the forms is preferable; if unable to utilize e-mail, please fax the form to 573-526-9400 and mail the paper copies to 101 Park Central Square, Springfield, MO 65806. Please see the address listed above. Application-related questions can be addressed by calling 888-275-5908.

Upon review of the application, and if the client is determined eligible for BCCT MO HealthNet coverage, full MO HealthNet benefits will continue until the treating physician determines treatment for the breast or cervical cancer is complete.

Copies of the BCCT forms are located in Section 10 or downloadable online:

Clients determined ineligible for BCCT medical assistance may receive, with prior authorization from SMHW, a cervical conization by LEEP or cold knife.

Instructions to Transfer a Client from Another State BCCT Program

• The client should complete the Full BCCT MO HealthNet Application Form (page 10.17)
• Complete the Certification of Need for Treatment Form (pages 10.18-10.19)
• Provide the clinic’s name and telephone number as contact information to MO HealthNet.
  Information is used to verify enrollment in the Breast and Cervical Program of that state.

• E-mail all documentation to MO HealthNet Service Center at MRT.ProcessingCenter@dss.mo.gov

  OR

• Fax, if necessary, to 573-526-9400, and mail all paper copies to:

  FSD Customer Relations Unit
  101 Park Central Square
  Springfield, MO 65806

MO HealthNet Treatment Services Covered

Covered Services

• Cervical conization
• LEEP or cold knife – if a client received a pap test diagnosis of HSIL or worse, or colposcopy test diagnosis of moderate dysplasia or worse
• Incisional and/or Excisional breast biopsy – if ultrasound result is category 4 (suspicious abnormality) or category 5 (highly suggestive of malignancy)
• Incisional and/or Excisional breast biopsy – if fine needle aspiration, core needle, or stereotactic biopsy result is malignant
• Breast Cancer Treatment is indicated including chemotherapy, surgery, radiation, and breast reconstruction
• All other MO HealthNet covered medical services, including services not related to the breast or cervical cancer

SMHW Provider Responsibilities

SMHW Providers will:

• Notify client of diagnosis and recommended follow-up (preferably in person). If a specialist is treating the client, ensure that the client received the diagnosis and recommended follow-up.
• Explain the BCCT program and application processes to the client.
• Determine the client’s presumptive eligibility; complete the BCCT Temporary MO HealthNet Authorization letter (page 10.16).
• E-mail the letter to the FSD’s MO HealthNet Service Center within five days of BCCT qualifying test results or diagnosis.
• When MO HealthNet coverage is needed beyond the temporary PE period, assist the client in completing and signing the (extended) Missouri BCCT MO HealthNet Application (page 10.17) or download online.
  Ensure:
  • The client receives a copy of the completed application form.
  • A copy of the completed form is retained in the client’s medical record.
  • Verify dates included on eligibility documents are correct before sending to MO HealthNet Service Center.
  • Submit the application to the MO HealthNet Service Center for application evaluation as soon as possible after cancer diagnosis.
  • FSD’s MO HealthNet Service Center shall evaluate the application of each client for other MO HealthNet programs the client may be eligible to receive.
• Notify the SMHW RPC of clients who become eligible for the BCCT MO HealthNet Treatment program. The RPC will track the treatment provider’s name, date that the client’s treatment regimen started and the type of treatment initiated.
• Ensure entry of the client’s history and abnormal screening forms into the MOHSAIC reporting system prior to submitting the BCCT application forms. Utilize the Department Client Number (DCN) assigned to the client when entering the SMHW green history form (page 10.8-.9) into MOHSAIC.
  • This number serves as the MO HealthNet client number for the temporary PE letter and the full BCCT application for benefits.
• Submit date treatment was initiated, type of treatment that was started, and name of treatment provider by completing Section D on the purple breast form, and/or Section D on the yellow cervical form.
• Check the “yes” box in Section A of the SMHW purple breast or yellow cervical form(s) when BCCT services initiated.

SMHW Regional Program Coordinator BCCT Responsibilities

Regional Program Coordinators will:

• Check with client to assess status of the client’s cancer treatment upon request from FSD’s MO HealthNet.
• Assure treatment initiated and documented in MOHSAIC.
• Inform FSD’s MO HealthNet of the following:
• Follow-up biopsy result that does not document cancer diagnosis. In these cases, typically the PE BCCT has been issued for results of ultrasound category 4, category 5, or for HGSIL Pap smear result and the biopsy obtained during the PE timeframe is benign. No treatment is needed, so the extended full BCCT application does not need to be approved.
• Continue to track client’s BCCT treatment status and plan of care for breast and/or cervical cancer. MO HealthNet eligibility ends when treatment for the breast and/or cervical cancer is completed. After the MO HealthNet eligibility end date is documented, SMHW annual services can be offered to the client if all areas of eligibility are met.
• Date client gains insurance coverage.
• Date client moves out of state.
• Date client is determined lost to follow-up after documented attempts by the provider and RPC to inform and assist client with barriers to care, or
• Date client refuses care (signed waiver form or certified letter returned).

Family Support Division Responsibilities

Family Support Division will:

• Enter BCCT Temporary MO HealthNet Authorization letter for presumptive eligibility in the FSD system upon receipt from SMHW provider.
• Enter Missouri BCCT MO HealthNet Application for medical assistance into the FSD system upon receipt from client or the SMHW provider.
• Determine MO HealthNet eligibility for breast and/or cervical cancer treatment and other MO HealthNet programs.
• Report eligibility determination result to the client and the appropriate SMHW provider or RPC.
• After establishment of MO HealthNet approvals for breast and/or cervical treatment, track client’s need for continued treatment and continued enrollment in MO HealthNet.
• Request the treating physician’s plan of care for breast and/or cervical cancer treatment.
• Utilize SMHW RPC for assistance, if needed.
• Terminate breast and/or cervical cancer treatment eligibility after treatment is completed.
• Notify client and SMHW provider or RPC of termination of breast and/or cervical cancer MO HealthNet treatment eligibility.
• Provide tracking for initial treatment type and date to the SMHW RPC.