The Breast and Cervical Cancer Prevention and Treatment (BCCPT) category, PH20, provides full Medical Assistance (MA) benefits to women for treatment of breast and cervical cancer, including precancerous conditions of the breast or cervix. Public Law 106-354
The woman must:
Be screened and diagnosed with breast cancer, cervical cancer, or a precancerous condition of the breast or cervix. If a woman has any other cancer diagnosis, she is not eligible for BCCPT.
Be uninsured or have no creditable health insurance that covers her condition; Select Plan is not considered creditable coverage when determining eligibility for BCCPT.
Be under age 65.
Be a U.S. citizen or qualified alien; An undocumented non-citizen may be eligible for BCCPT to cover an emergency medical condition if she meets all other eligibility criteria.
Be a Pennsylvania resident.
Provide or apply for a social security number.
NOTE: There are no MA income or resource limits for the BCCPT category.
The application process begins at a provider’s office (see Appendix B). The PA 600B is the application form used for BCCPT. The provider faxes the PA 600B to the Healthy Woman Program (HWP) Community Health Coordinator at 412-201-4702. The Community Health Coordinator faxes the PA 600 B to the County Assistance Office (CAO).
NOTE: The PA 600B is available only at the HWP contractor site or online at:
www.pahealthywoman.org Any provider may refer a woman to the HWP Community Health Coordinator.
The PA 600BR is used for BCCPT renewals.
The CAO sends the woman the PA 600 BR.
The CAO approves all BCCPT applications received from the Community Health Coordinator. The only eligibility factor needing immediate proof is creditable coverage. Creditable coverage is reviewed by the staff at each regional Health Insurance Premium Program (HIPP) office. (See Section 378.31, Verification at Application.)
NOTE: The CAO will not approve MA under BCCPT until the HIPP staff shows proof of creditable coverage. HIPP will give the proof to the CAO within five working days.
NOTE: The CAO will not delay approval of MA under BCCPT while waiting to determine eligibility for another MA category.
Retroactive MA under BCCPT can be approved for up to three months before BCCPT approval if all eligibility requirements are met.
The CAO must determine eligibility for BCCPT using the rules in this chapter and the following chapters:
Medical Assistance Eligibility Handbook
Application - Chapter 304
Identity - Chapter 320
Citizen/Alien - Chapter 322
NOTE: The CAO must not delay approval of MA under BCCPT while waiting for proof of citizenship and identity.
Residence - Chapter 323
Reporting Changes - Chapter 370
Renewal - Chapter 376
Notices - Chapter 377
Verification - Chapter 378
Supplemental Handbook
Appeal and Fair Hearing - Chapter 870
Restitution and Disqualification - Chapter 910
Reimbursement - Chapter 915
Enumeration - Chapter 950
Voter Registration - Chapter 980
Women enrolled in MA under BCCPT receive the following: Public Law 106-354
A Pennsylvania ACCESS card, which is shown to enrolled medical providers
Full MA benefits through the fee-for-service delivery system
NOTE: Women enrolled in MA under BCCPT are not enrolled in the mandatory HealthyChoices program or a voluntary managed care plan.
The following eligibility requirements must be verified:
Creditable coverage. Creditable coverage is defined under section 2701(c) of the Public Health Service Act (42 U.S.C. 300gg(c)). All healthcare coverage must be reviewed to determine if there is enough insurance to cover all the medical services for breast and cervical cancer, including precancerous conditions of the breast or cervix. Staff members from the regional HIPP offices review creditable coverage within five days of getting a referral from the CAO. (See Appendix E for the HIPP BCCPT Template and Appendix F for instructions on HIPP referrals and HIPP regional office listings.)
NOTE: A woman with healthcare coverage that doesn’t pay for prescriptions is ineligible for MA under the BCCPT program, because she is still considered to have creditable coverage.
The need for continued treatment at partial and complete renewals.
Citizenship.
Identity.
NOTE: The CAO will not delay approval of MA under BCCPT while waiting for proof of citizenship and identity.
Updated February 14, 2012, Replacing October 8, 2003