MiCMRC Educational Webinar · MiCMRC Care Management Educational Webinar: Breast and Cervical...
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MiCMRC Educational Webinar Breast and Cervical Cancer Control Navigation Program July 26, 2017
Transcript of MiCMRC Educational Webinar · MiCMRC Care Management Educational Webinar: Breast and Cervical...
MiCMRC Educational WebinarBreast and Cervical Cancer Control Navigation Program
July 26, 2017
MiCMRC Care Management Educational Webinar:Breast and Cervical Cancer Control Navigation Program
Expert Presenter:
E.J. Siegl, Program Director
BREAST AND CERVICAL CANCER CONTROL NAVIGATION
PROGRAMMay 18, 2017
E.J. Siegl, Program Director
Objectives
At the end of this webinar the participant will be able to:
1. Discuss services provided by the BCCCNP to low-income women.
2. State the process for referring uninsured and underinsured women to a local BCCCNP agency to receive reimbursed screening/diagnostic services.
Program Goal
Assure low-income Michigan women receive timely access to needed breast and/or cervical screening, diagnostic and/or cancer treatment services.
Program Overview
Since 1991, the BCCCNP has provided breast/cervical screening and diagnostic services to 498, 108 enrolled women
From 1991 to present:
4,171 breast cancers diagnosed (include DCIS, LCIS, Invasive cancer)
5, 875 cervical pre-cancers (CIN 2, CIN 3) and invasive cervical cancer diagnosed
Since 2001: > 8,400 women enrolled in BCCCNP Medicaid Treatment Program
Program History/Expansion to Meet Changing Client Needs
Component # 1 - Clinical Services (1991 to present)
Component # 2 - Navigation Services (2015 to present)
Component # 3 - Health Systems Change Organizations (2017)
BCCCNP Clinical Services
• Underinsured women: women with a high deductible – as defined by the woman - or whose insurance plan does not pay for diagnostics
15 agencies(14 LHDs/KCI)
FY2018 Goal7,000 women
BCCCNP Navigation Services
25 agenciesLHDs/ Health
Plans/Community Centers/FQHCs
FY2018 Goal2,000 women
5 Health Systems
Evidenced Based Intervention Strategies to
increase breast/cervical screening rates
Client Reminders Provider Reminders/Recall Provider Assessment/Feedback Reducing Structural Barriers Small Media One-on-one Education
BCCCNP Clinical Services
Screening Guidelines/Diagnostic Follow-up• National guidelines (ACS, NCCN, ASCCP, USPSTF)
reviewed by Breast and Cervical Cancer Medical Advisory Committee members
• Guidelines comprise BCCCNP medical protocol
BCCCNP Breast Cancer Screening Guidelines
BCCCNP Cervical Cancer Screening Guidelines
Women Eligible for BCCCNP Clinical Services
1. Income ≤ 250% FPL (<$40,600 for family of 2)
2. Age
• 40-64 and requires breast/cervical cancer screening/ diagnostic services
• 21-39 and referred to BCCCNP with an abnormal Pap Test OR clinical breast exam/mammogram requiring diagnostic services
Women Eligible for BCCCNP Clinical Services
3. Uninsured or underinsured
4. Current Michigan Resident (Michigan address) or
- Migrant worker or
- Women living near the border of a neighboring state (Indiana, Ohio, Wisconsin, Minnesota) who plan to receive services in Michigan
Referring Eligible Clients• Contact the BCCCNP Local Coordinating Agency covering
the county where the woman lives: http://www.michigancancer.org/BCCCP/PDFs/LCAListing/ReferralsbyCounty.pdf
Referring Eligible Clients
Call the program directly at:
• 844- I GOT SCR (EENED)
• 844-446-8727
BCCCNP Clinical Services CoveredBreast Services Cervical Services
Mammogram (Screening/Diagnostic) Pap test
Ultrasound (diagnostic, not screening) HPV typing
Tomosynthesis Urine tests- pregnancy to be billed with colposcopy services
MRI, Ductogram (MDHHS authorization) Colposcopy with/without biopsy, ECC
Biopsies (FNA, US guided, Core, Excisional)Anesthesia with Excisional Biopsy
Diagnostic LEEP/Cone/EMB (MDHHS authorization) with Anesthesia
Office visits/Surgical Consults Office visits/Surgical Consults
Genetic Counseling/testing (MDHHS authorization)
Process for Obtaining MDHHS Authorization
MDHHS authorization is required PRIOR to the following services being performed:
• Breast Services (MRI, Ductogram)
• Cervical Services (Diagnostic LEEP, CONE, EMB)
Contact local BCCCNP agency to obtain approval.
Provide justification for ordered service.
Genetic Counseling Referrals
• In 2014, the Breast Cancer Awareness License Plate was introduced. Money raised by sale of these plates supports the BCCCNP.
• Funds are used to provide genetic counseling and testing (if needed) to women with a strong family history of breast cancer.
• License Plate Information:http://www.michigan.gov/sos/0,4670,7‐127‐1585_1595_9026‐336982‐‐,00.html
Genetic Counseling Referrals cont.
• To determine if a woman should consider genetic counseling refer to:
NCCN Guideline: Genetic/Familial High-Risk Assessment: Breast and Ovarian www.nccn.org
• Clinician or Genetic Counselor MUST contact BCCCNP agency for approval.
• Approval for referrals will be reviewed on a case by case basis by Ann Garvin, BCCCNP Nurse Consultant ([email protected] or 517-335-9087)
Genetic Counseling Referrals cont.For more information and step by step procedure:
www.michigancancer.org/bcccp
BCCCNP Medicaid Treatment Act for Cancer Treatment
BCCCNP Medicaid Treatment Act Program: est. 2001
• Specialized Medicaid program that provides full Medicaid benefits as long as the woman meets BCCCNP and MTA eligibility criteria.
1. Age 21-64
2. Income ≤ 250% FPL
3. Current Michigan resident (living in Michigan)
4. US citizen/legal resident, registered alien or refugee as defined by MI Dept. of Human Services
Medicaid Treatment Act cont.
5. Insurance Requirementsa. Uninsured (No health insurance)
b. Underinsured (Insurance meets criteria as non-creditable)
- Insurance has limited or no coverage for cancer treatment
- Insurance deductible > $1,500.00
Clients covered under Medicare Part A & B are not eligible for BCCCNP MTA
Medicaid Treatment Act cont.
6. NEW or recurring breast or cervical cancer diagnosis
• Clients with private insurance are NOT eligible for BCCCNP MTA if they have received treatment reimbursed by their insurance.
• Clients enrolled in Michigan’s Healthy Michigan Plan or another type of Medicaid ARE eligible to transfer to BCCCNP MTA at any point during their cancer treatment.
Questions regarding Medicaid Treatment Coverage can be directed to:
E.J. Siegl, Program Director ([email protected], 517-335-8814)
Program Contacts
E.J. Siegl, Program Director: [email protected] 517-335-8814
Ann Garvin, Nurse Consultant: [email protected] 517-335-9087
Tory Doney, Lay Navigator: [email protected] 517-335-8854 OR 844- I GOT SCR (EENED) (844-446-8727)
For more information:Visit our Web site:www.michigancancer.org/bcccp
Questions
