Eligibility under BCCPT begins on the date the woman is diagnosed with breast or cervical cancer or a precancerous condition of the breast or cervix. The date is determined as follows, using information from the PA 600B: 55 Pa Code § 140.751
New applicant.
The eligibility begin date is the date in Part II, Date of First Biopsy/Confirmatory Diagnosis.
Woman screened and diagnosed and eligible for BCCPT who waives her eligibility for MA under BCCPT, is still in need of treatment, and later wishes to apply for MA under BCCPT
The eligibility start date is the Date of First Biopsy in Part II or as early as the first day of the third month preceding the date the woman signs and dates the original Healthy Woman Program (HWP) enrollment information form.
Retroactive eligibility under BCCPT is as follows:
Eligibility can begin as early as the first day of the third month preceding the approval date but no earlier than the date the treatment began.
All eligibility requirements under BCCPT must be met during the retroactive period, including screening and diagnosis of breast cancer, cervical cancer, or precancerous conditions of the breast and cervix. 55 Pa. Code § 140.771
Eligibility under BCCPT ends as follows:
The woman no longer meets the specific eligibility criteria when she:
Reaches age 65.
Now has creditable coverage (Select Plan is not considered creditable coverage for BCCPT.)
Is no longer in need of treatment for breast or cervical cancer or precancerous conditions of the breast or cervix.
The woman does not comply with the renewal process. For example:
55 Pa. Code §133.84(c) 55 Pa. Code § 133.84(d) 55 Pa. Code § 140.741 See Chapter 317.7
For example:
At the partial renewal, she did not provide the medical proof of the need for continuing treatment.
At the complete renewal, she did not submit a renewal form or the medical proof of the need for continuing treatment.
She did not prove creditable coverage.
NOTE: The CAO must review the case for MA in other categories when MA eligibility under BCCPT ends.
NOTE: The CAO will not end BCCPT benefits before receiving notification from OMAP.
See Chapter 317.7
Updated January 16, 2014 Replacing July 24, 2013