Eligibility under BCCPT begins on the date the individual 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.
New applicant.
The eligibility begin date is the date in Part II, Date of First Biopsy/Confirmatory Diagnosis.
Individuals screened and diagnosed and eligible for BCCPT who waive their eligibility for MA under BCCPT, are 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
individual signs and dates the original Pennsylvania Breast
& Cervical Cancer Early Detection Program (PA-BCCEDP)
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.
Eligibility under BCCPT ends as follows:
The individual no longer meets the specific eligibility criteria when they:
Reach age 65.
Now have creditable coverage (Family Planning Services is not considered creditable coverage for BCCPT.)
Are no longer in need of treatment for breast or cervical cancer or precancerous conditions of the breast or cervix.
Do not comply with the Renewal process.
For example:
At the partial renewal, they did not provide the medical proof of the need for continuing treatment.
At the complete renewal, they did not submit a renewal form or the medical proof of the need for continuing treatment.
They 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 April 2, 2019, Replacing March 20, 2018