Policy Manual 2017 - Iowa Manual... · Policy Manual 2017 . ... State Eligibility for BCCT Medicaid...

The Iowa Breast and Cervical Cancer Early Detection Program

Policy Manual 2017

This material is supported in part by Cooperative Agreement 5NU58BO003885-05 funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Chronic Disease Prevention & Management Lucas State Office Building

321 E. 12th Street Des Moines, IA 50319-0075

Phone (515) 281-5616

Toll Free (866) 339-7909 Fax (515) 242-6384

www.idph.iowa.gov/CFY

Table of Contents Introduction ........................................................................................................................... 5 Policies and Procedures ......................................................................................................... 5 Confidentiality Statement ..................................................................................................... 6 Quality Assurance and Quality Improvement ...................................................................... 6 Policies

Program Eligibility ........................................................................................................... 9 Program Services ........................................................................................................... 11

Breast ................................................................................................................ 13 Cervical .............................................................................................................. 13 Patient Navigation ............................................................................................... 16 Case Management .............................................................................................. 18 Diagnostic .......................................................................................................... 21 Preauthorization of Procedures ............................................................................. 22 Treatment .......................................................................................................... 24 Refusal of Services or Lost to Follow-Up ................................................................ 26 Rescreening Services ........................................................................................... 27

Guidelines Calendar of Events ......................................................................................................... 31 Income Guidelines ......................................................................................................... 33 Progression of a Woman Through the IA CFY BCC Program ............................................... 35 Services Guidelines ........................................................................................................ 39 Care for Yourself Program Services ................................................................................. 41 Adequacy of Follow-up Breast ................................................................................................................ 43 Cervical .............................................................................................................. 45 Description of Work and Services .................................................................................... 47 Calculating the 75/25 Core Indicator ............................................................................... 55

Appendix I – IA CFY Program Contact Information IA CFY Program Service Area Map ................................................................................... 61 Local Program Contact Information ................................................................................. 63 Pink Ribbon Advisory Board (PRAB) ................................................................................. 65 State Staff Directory ...................................................................................................... 67

Appendix II – HIPAA Related Information Disclosures for Public Health Activities ............................................................................. 71 HIPAA Privacy Rules and Release of Information .............................................................. 75

Appendix III – Program Reimbursement 2017 Reimbursement Schedule ....................................................................................... 81 ICD-10-CM Diagnosis Codes ........................................................................................... 87

Appendix IV – Data Form Samples Consent and Release of Medical Information .................................................................... 93 Annual Enrollment ......................................................................................................... 95 Screening ...................................................................................................................... 97 Breast Diagnostic ........................................................................................................... 99 Cervical Diagnostic ....................................................................................................... 101

Resources Definitions .................................................................................................................. 105 Breast and Cervical Cancer Resources ........................................................................... 107 CancerCares ................................................................................................................ 111

INTRODUCTION Deaths from breast and cervical cancers could be avoided if cancer screening rates increased among women at risk. Deaths from these diseases occur disproportionately among women who are uninsured or underinsured. Mammography and Pap tests are underused by women who have no regular source of health care, women without health insurance and women who immigrated to the United States within the past 10 years.1 Congress, recognizing the value of screening and early detection, passed the Breast and Cervical Cancer Mortality Prevention Act of 1990. This legislation authorized the Centers for Disease Control and Prevention (CDC) to create a national program “to ensure that every woman for whom it is deemed appropriate receives regular screening for breast and cervical cancers, prompt follow-up if necessary and assurance that the tests are performed in accordance with current recommendations for quality assurance.” Presently, the NBCCEDP funds all 50 states, the District of Columbia, 5 U.S. territories and 11 American Indian/Alaska Native tribes or tribal organizations to provide screening services for breast and cervical cancer. The program helps low-income, uninsured and underinsured women gain access to breast and cervical cancer screening and diagnostic services. These services include:

• Clinical breast examinations • Human papillomavirus (HPV) tests • Mammograms • Diagnostic testing if results are abnormal • Pap tests • Referrals to treatment • Pelvic examinations

The Iowa Care for Yourself Breast and Cervical Cancer Early Detection Program was initially funded in 1993 and began screening women with funds from CDC in August 1995. The Care for Yourself Program focuses on serving women aged 50 to 64 years. Individuals of other ages may be eligible for some services.

The purpose of the Iowa Care for Yourself (IA CFY) Program Policy Manual is to furnish local programs with the policies and guidelines of the IA CFY Program.

To provide services for the IA CFY Program, local Boards of Health must have a signed cooperative agreement with the Iowa Department of Public Health’s IA CFY Program and designate an agency to provide the recruitment, patient navigation, enrollment, tracking, follow-up and case management components of the IA CFY Program. The designated agency is expected to follow program policies and protocols.

Changes in the IA CFY Program policies may be made without advance notice, based on guidance from the CDC. Healthcare providers, facilities, staff and/or billing agencies will receive notification of program updates when indicated.

POLICIES AND PROCEDURES

Written policies and procedures are standard for most agencies and special programs. The purpose is to:

1. Establish and maintain written documents to provide consistency and accuracy of services being offered to eligible and enrolled women.

2. In case an unplanned event occurs, in which a local program coordinator or other IA CFY Program representatives are unable to perform their duties, the written policies and procedures are an added safeguard to maintain the program services.

1 Centers for Disease Control and Prevention. Cancer screening—United States, 2010. MMWR 2012;61(3):41–45.

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6103a1.htm

Each local program is to maintain and follow written policies and procedures addressing the following participant elements:

• Eligibility and enrollment • Patient navigation of participants who have resources to pay for screening, diagnostics and

treatment services • Tracking, follow-up and case management of participants with abnormal screening results • Recall of participants for screening at appropriate intervals • Healthcare provider recruitment, enrollment and orientation • Process for obtaining and reporting data • Process for submitting claims for reimbursement of services

The local program must have policies and procedures written, revised as needed and accessible to appropriate staff. The local program coordinator is responsible to see that this is done.

CONFIDENTIALITY STATEMENT

Confidentiality is both an ethical and legal responsibility. State and federal courts uphold the common patient confidentiality standards such as the American Medical Association (AMA) ‘Code of Ethics.’ Divulging medical information to a third party without appropriate permission from a participant is considered a breach of confidentiality. Revealing such information may include any and all types of communication (verbal, written, phone, fax, electronic, etc.) and is considered a breach of confidentiality whether intentional or unintentional.

To accomplish this, procedures and systems must be in place and maintained at all IA CFY Program sites and by all program representatives. Participant records and information must be secured in a manner accessible only by IA CFY Program representatives. This includes but is not limited to locking files, private areas for verbally communicating with participants (face to face or by telephone) and a method for securing participant information at an agency’s or representative’s workstation (desktop, computer, mail, etc.).

QUALITY ASSURANCE AND QUALITY IMPROVEMENT

Quality assurance and improvement are integral components of the IA CFY Program and contribute to program success. The purpose of quality assurance and improvement is to:

• Ensure the quality of services delivered through the program • Monitor performance and identify opportunities for improvement • Plan effective strategies for improving services

Program requirements and monitoring activities include: • Professional licensure and accreditation – health facilities and professionals must be currently

licensed or accredited to practice • National standards for radiology, laboratory and pathology reports • Standards for adequacy of follow-up – data reports track appropriate and timely diagnostic,

short-term and rescreening services • Patient navigation – local program staff evaluate needs, implement plans and refer participants

who have resources to pay for services and need screening, diagnostic, or treatment services • Case management – local program staff evaluate needs, implement plans and refer participants

who need diagnostic services and/or are diagnosed with cancer • Accurate data and documentation – Minimum Data Elements are reported to CDC semi-annually • Evaluations – reports are completed routinely and as needed to assess statewide progress

toward meeting CDC-set goals • Adherence to CDC policies and guidelines

PROGRAM POLICIES

Program Eligibility ................................... 9

Program Services Breast ............................................ 13 Cervical .......................................... 13 Patient Navigation .......................... 16 Case Management .......................... 18 Diagnostic ...................................... 21 Preauthorization of Procedures ....... 22 Treatment ...................................... 24 Refusal of Services or

Lost to Follow-Up ..................... 26 Rescreening Services ...................... 27

PROGRAM ELIGIBILITY

To qualify for the IA CFY Program, each participant must meet age and income eligibility criteria.

Priority Population Direct efforts should be made to identify and screen uninsured, underinsured, and underserved individuals between the ages of 40 and 64 years.

Eligibility for Services Age criteria:

• Women age 40 and over • A woman of any age who is symptomatic for breast cancer

Income criteria:

• Net household income1 at or below 250 percent of the federal poverty level based on household size (Refer to current year IA CFY Program income guidelines found at www.idph.iowa.gov/CFY on the Information for the Public page.)

• No proof of income is required • Assets do not affect income status

Insurance criteria:

• To receive services reimbursed by the CFY Program, a woman must: o Have no health insurance o Be underinsured (insurance doesn’t cover program services or has a high

deductible or copay) o Not be receiving Medicaid or Medicare Part B coverage

EXCEPTIONS: Medicaid Marketplace with large deductible for breast or cervical diagnostic procedures, Iowa family planning network

• To receive patient navigation services by the CFY Program, a woman must: o Meet income and age program requirements o Have health insurance that pays for breast and cervical cancer screening

services, including Medicaid and Medicare Part B o Have at least one barrier to receiving services

Residency criteria:

• Iowa residency is not required • Women residing in states other than Iowa may receive services if:

o State of residence’s Medicaid Breast and Cervical Cancer Treatment accepts women screened/diagnosed with National Breast and Cervical Cancer Early Detection Program (NBCCEDP) funds. (Refer to Table I on page 10)

Ineligible for Services • Men

o EXCEPTION: A transwoman who has taken or is taking hormones; A transman who has not had a bilateral mastectomy or total hysterectomy.

• Women ages 39 and younger unless they have symptoms of breast cancer 1 Net household income refers to take home pay or the amount of money earned after payroll withholding such as state and federal income taxes, social security taxes, and pretax benefits like health insurance premiums. If enrolled in a flexible spending account to pay for medical costs, the amount withheld from each check is also on a pre-tax basis. Net Household Income is gross income (minus deductions) of each person living in that household whether or not they are related.

http://www.idph.iowa.gov/CFY

Table I: State Eligibility for Breast and Cervical Cancer Treatment (BCCT) Medicaid

State Eligibility for BCCT Medicaid Illinois Accepts women screened and diagnosed by any healthcare provider

Iowa Accepts women and men screened and diagnosed by any NBCCEDP or breast services paid by family-planning agency, federally qualified health center or non-profit organization

Minnesota All screening and diagnostic services must be paid for by the MN BCCEDP

Missouri At least one screening/diagnostic service must be paid by the MO BCCEDP

Nebraska Accepts women screened and diagnosed by any NBCCEDP

South Dakota All screening and diagnostic services must be paid for by the SD BCCEDP

Wisconsin All screening and diagnostic services must be paid for by the WI BCCEDP

Table II: Enrollment telephone numbers for surrounding states’ BCCEDP

State Program Name Telephone Number

Illinois Illinois Breast & Cervical Cancer Program (888) 522-1282

Minnesota Sage Screening Program (888) 643-2584

Missouri Show Me Healthy Women Program (573) 522-2845

Nebraska Every Woman Matters Program (800) 532-2227

South Dakota All Women Count! Program (800) 738-2301

Wisconsin Wisconsin Well Woman Program (608) 266-8311

For information about other states, contact the

IA Care for Yourself Program Health Services Coordinator at (515) 242-6200.

NOTE: Individuals residing in a state whose BCCT does not accept participants screened w ith another state’s NBCCEDP funds should be referred to the BCCEDP in their state of residence (Refer to Table II below). A participant enrolled in the IA CFY Program and choosing to continue receiving IA CFY Program services must be informed that the BCCT Medicaid option in their state of residence may not be available should they need financial assistance for treatment.

PROGRAM SERVICES SCREENING POLICIES The CDC screening policies for the NBCCEDP result from careful review of scientific research, analysis of many complex program issues, and input from partners in the healthcare field. The IA CFY Program has implemented the CDC’s recommendations. Priority Population Direct efforts should be made to identify and screen for breast and cervical cancer individuals who are uninsured, underinsured, and underserved between the ages of 40 and 64.

Eligibility for Screening Services Program-eligible individuals may be enrolled to receive screening services dependent on funding availability for breast and cervical cancer screening.

All IA CFY Program participants The following must be assessed at the baseline screening for all participants:

• Smoking behavior o All participants who currently smoke are to be provided information related to smoking

cessation and referred to the Quitline Iowa o For more about Quitline Iowa: https://iowa.quitlogix.org

• Environmental secondhand tobacco smoke exposure • Blood pressure measurements

o Two systolic/diastolic measurements must be recorded o The two blood pressures must be taken separated by a minimum of two minutes

• Height (inches) • Weight (pounds) • Personal medical history

o Breast cancer o Hysterectomy and reason for having the hysterectomy

• Brief family history, including breast cancer

https://iowa.quitlogix.org/

Breast Services

Breast Cancer Screening Protocol Program eligible individuals may receive breast cancer screening services reimbursed by the IA CFY Program. Refer to Table 1 - IA Care for Yourself Program Screening Services Guideline for clinical breast exam and mammogram recommendations.

Table 1 - IA CFY Program Screening Services Guideline

Cervical Services

These guidelines are developed to address cervical cancer screenings in the IA CFY Program general population. Every effort should be made to ensure that women are screened at the recommended intervals. There is little scientific evidence to support annual cervical cancer screening. Education, systems changes, and surveillance are methods that should be used to increase the understanding of these Cervical Cancer Screening Protocol criteria.

Priority Population For cervical cancer screening, efforts should be made to identify and screen women who have not had a Papanicolaou (Pap) screening test in the last five years (rarely screened) or have never had a Pap test.

1 Refer to Payment for Pap test Following Hysterectomy section found on page 14. 2 Examples of breast cancer symptoms are breast skin dimpling or retraction, palpable mass or nipple discharge, inversion or scaliness or an abnormal CBE. 3 An alternate resource, such as Susan G Komen for the Cure® funds, should pay for mammograms for Individuals under 50 years of age.

Iowa Care For Yourself Program Screening Services

Age B/P, Height, Weight

Clinical Breast Exam (CBE)

Mammogram Pelvic/Pap Test1

Under 40

ONLY if reporting

symptoms of breast cancer2

ONLY if reporting symptoms of breast

cancer

If CBE is abnormal


cancer

40 – 49 Annually

Asymptomatic Annually

Symptomatic As needed

Asymptomatic See Note3

Symptomatic As indicated

Asymptomatic Per IA CFY protocol


50 – 64 Annually





Asymptomatic Per CFY protocol


Over 64 Women over age 64, who do not have Medicare Part B and meet income guidelines, will receive services as above for ages 50 – 64 years.

Payment for Pap test Follow ing Hysterectomy: • IA CFY Program funds may pay for an initial pelvic examination to determine whether the

woman has a cervix after a hysterectomy has been done. It is reimbursed as part of the office visit.

o If a cervix is present (or cervical cuff), IA CFY Program funds may pay for a cervical cancer screening following the Cervical Cancer Screening Protocol.

o If a cervix is not present, IA CFY Program funds may not pay for cervical cancer screening. (See Exceptions to Cervical Cancer Screening Protocol section)

• IA CFY Program funds may pay for a cervical cancer screening in a woman with complete hysterectomy (no cervix remains), if the participant does not know if the reason for the hysterectomy was cervical cancer (refer to Recommendations and Rationale for Cervical Cancer Screening Protocol).

A woman w ith an abnormal cervical screening result should receive timely and appropriate diagnostic testing and treatment as defined by the American Society for Colposcopy and Cervical Pathology algorithms: http://www.asccp.org/asccp-guidelines. When recommended follow-up and treatment are completed, the participant may receive Pap tests paid for by the IA CFY Program following the Recommendations and Rationale for Cervical Cancer Screening Protocol.

Exceptions to Cervical Cancer Screening Protocol • These guidelines do not address high-risk populations who may need more intensive or

alternative screening. These populations include women: o With a history of cervical cancer; o Who were exposed to diethylstilbestrol (DES) while in their mother’s uterus; or o Who are immuno-compromised, such as HIV infection or organ transplantation.

• Women who express concern about their cervical health, or indicate changes in gynecological health status to the healthcare provider, will be reviewed for reimbursement of Pap test services sooner than three (or five) years on a case-by-case basis.

o Documentation from the healthcare provider of the need for a Pap test earlier than three (or five) years for approval and authorization of reimbursement will need to be provided for this review. Documentation can include history of Pap test results or healthcare provider office visit notes expressing reason of concern.

o The Health Services Coordinator will be responsible for the review of the request.

http://www.asccp.org/asccp-guidelines

Table 2: Recommendations and Rationale for Cervical Cancer Screening Protocol6

4 + means Pap test results equal to or more severe than the original pathology of Pap test result listed. 5 Pap test + HPV test = cotest 6 Refer to Services Policy: Cervical Services Abbreviations section for definition of abbreviations.

Population Recommended Screening Method

Management of Screening Results Comments

Ages < 21 Years

No cervical screening

HPV testing should not be used for screening or management of ASC-US in this age group.

Ages 21-29 Years

Pap cytology alone every 3 years

HPV-positive ASC-US or Pap cytology of LSIL+4: Refer to ASCCP guidelines

HPV testing should not be used for screening in this age group.

Pap cytology negative or HPV-negative ASC-US: Rescreen with Pap cytology in 3 years

Ages 30-65 Years

Preferred

Cotest5 Screening every 5 years

HPV-positive ASC-US or Pap cytology of LSIL+: Refer to ASCCP guidelines

Screening by HPV testing alone is not recommended for most clinical settings

HPV-positive, Pap cytology negative:

Option 1: 12-mo follow-up with cotesting Option 2: Test for HPV16 or HPV16/18 genotypes • If HPV16 or HPV16/18 positive: refer

for colposcopy • If HPV16 or HPV16/18 negative; 12-

mo follow-up with cotesting

HPV-negative ASC-US: Rescreen with cotesting in 3 years.

Cotest negative: Rescreen in 5 years

Acceptable Screening with Pap cytology alone every 3 years

HPV-positive ASC-US or Pap cytology of LSIL+: Refer to ASCCP guidelines

Pap cytology negative or HPV-negative ASC-US: Rescreen with Pap cytology in 3 years

Ages > 65 Years

No screening if the woman has had an adequate prior negative screening history

Consult with healthcare provider for individualized case-by-case follow-up care (reimbursement may not be covered by the CFY program)

Women with a history of CIN2/HSIL+ should continue screening every three years for at least 20 years after a period of frequent screening

After hysterectomy

No screening Consult with healthcare provider for individualized case-by-case follow-up care (reimbursement may not be covered by the CFY Program)

Applies to women who no longer have a cervix and do not have a history of CIN2+ in the past 20 years or cervical cancer ever

Abbreviations

ASC-US Atypical squamous cells of undertermined significance LSIL Low-grade squamous intraepithelial lesion ASCCP American Society for Colposcopy and Cervical Pathology CIN2 Cervical intraepithelial neoplasia grade 2 HPV Human papillomavirus HSIL High-grade squamous intraepithelial lesion

PATIENT NAVIGATION SERVICES

The CDC defines patient navigation as “individualized assistance offered to clients to help overcome healthcare system barriers and facilitate timely access to quality screening and diagnostics as well as initiation of treatment services for persons diagnosed with cancer.”

Participants often face significant barriers to accessing and completing cancer screening and diagnostics. Patient navigation is a process that the IA CFY local program coordinator uses to guide participants through barriers in the healthcare system. Barriers to screening, diagnostics, and treatment may include but are not limited to:

• Financial and economic • Fear • Language and cultural • Bias based on culture/race/age • Communication • Need for child/elderly/family care • Healthcare system • Comfort level with provider/facility • Transportation • Disability

Priority Populations Participants who are fully insured, for example, Medicare A & B, Medicaid, or private insurance, are eligible for patient navigation services if a barrier to receiving services is identified. Participants that start receiving screening services reimbursed by the IA CFY Program but then receive insurance may continue to receive services. In such instances, coordinators are encouraged to continue navigating participants to ensure diagnostic procedures are completed, and if cancer is diagnosed, that treatment is initiated. In both instances, coordinators must obtain complete MDE data for the IA CFY Program database.

Policy

Effective November 1, 2015, patient navigation services are to be provided to participants who have other resources to pay for screening and diagnostic services. Women must meet IA CFY Program income guidelines and be of appropriate age per USPSTF screening guidelines to receive navigation services through the IA CFY Program.

Duration of Patient Navigation Services Patient navigation begins with a person contacting the program and it is determined that they have insurance that pays for services without co-pays or deductibles. The person must have at least one barrier to receiving the services needed.

Dependent on screening and diagnostic outcomes, patient navigation services end when a participant: • Completes screening and has a normal result • Completes diagnostic testing and has normal results • Initiates cancer treatment • Refuses treatment

Required Patient Navigation Activities Patient navigation services will vary based on the participant’s needs. At a minimum, patient navigation services must include the following activities as well as a minimum of two, but preferably more, contacts with the participant:

• Written assessment of individual participant barriers to cancer screening, diagnostic testing, or initiation of cancer treatment

o A needs assessment will be completed by the local program case manager and the participant to obtain specific information to identify barriers and concerns

o Local program case managers will actively ensure that each participant receives the services identified

• Resolution of participant barriers

o A plan of care will be developed, reviewed, and revised as needed by the local program case manager and participant. This plan of care is to be kept in the participant’s file. The plan of care is to: Meet immediate, short-term, and long-term needs identified by the assessment Set goals and actions with timelines Delineate each individual’s responsibility for reaching the identified goals

o If local program case managers are unable to resolve problems for meeting identified needs, the IA CFY Program Health Services Coordinator should be notified for assistance

• Participant education and support • Participant tracking and follow-up to monitor participant progress in completing screening,

diagnostic testing, and initiating cancer treatment • Collection of data to evaluate the primary outcomes of patient navigation—participant

adherence to cancer screening, diagnostic testing, and treatment initiation for all participants receiving navigation services

Table 3: Comparison of CFY Program and Patient Navigation Participants

Criteria/Service Participant IA CFY Program Patient Navigation

Eligibility

Age Per eligibility guidelines Must meet IA CFY Program

age guidelines and USPSTF screening guidelines

Income Yes Yes

Insurance • Uninsured • Insured but high deductible

or high copay

Insurance will cover payment of services

Barriers to obtaining services/ Needs assistance Yes Yes

IA CFY Program pays for services Yes No

CASE MANAGEMENT SERVICES

The CDC defines case management as “establishing, brokering, and sustaining a system of essential support services for enrolled women to identify and overcome barriers to definitive diagnosis and treatment.”

IA CFY Program participants with an abnormal breast or cervical screening result must be assessed to determine need for case management services. If any needs are identified, services to address the need are to be provided.

Priority Population Case management services are to be provided to assure that participants of the IA CFY Program receive timely and appropriate diagnostic, treatment, and rescreening services.

Eligibility for Services Women enrolled in the IA CFY Program are eligible for case management services dependent on screening/diagnostic testing results and needs assessment findings.

Policy

All IA CFY Program participants with abnormal breast or cervical results (refer to Table 4) and/or a diagnosis of precancer or cancer will have a needs assessment completed by the local program case manager:

• Within 14 days of an abnormal breast screening • Within 30 days after an abnormal Pap test was conducted (not the date results were

received) • Within 14 days of the diagnoses of breast or cervical precancer or cancer.

If the program does not meet the specified number of days of follow-up, the local program case manager must document why the policy was not met.

Duration of Case Management Services Case management begins with:

• An abnormal breast or cervical screening result (refer to Table 4) • A diagnosis of precancer or cancer

Case management ends with: • A completed diagnostic process with breast or cervical disease not diagnosed • Initiation of treatment • Refusal of treatment, or • When the participant is no longer eligible for the IA CFY Program

A participant may re-enter the case management process with a new abnormal breast or cervical screening/diagnostic result, or with the participant’s request for assistance.

Case Management Activities • A needs assessment will be completed by the local program case manager and the participant

to obtain specific information to identify barriers and concerns. • A plan of care will be developed, reviewed, and revised as needed by the local program case

manager and participant. This plan of care is to: 1. Meet immediate, short-term, and long-term needs identified by the assessment 2. Set goals and actions with timelines, and 3. Delineate each individual’s responsibility for reaching the identified goals

• Local program case managers will actively ensure that each participant receives the services identified.

• If local program case managers are unable to resolve problems for meeting identified needs, the IA CFY Program Health Services Coordinator will be immediately notified for assistance.

Documentation of Case Management Services Documentation of case management services must be maintained in the participant’s file. Documentation should include:

• Consent for case management services • Assurance of confidentiality • Needs assessment, and • Plan of care.

Table 4: Definition of Abnormal Screening Results Requiring Case Management Definition of Abnormal Screening Results:

Clinical Breast Exam (CBE) – Abnormal results (suspicious for cancer) include but not limited to:

- Discrete Mass (Cystic or Solid) - Bloody or Serous Nipple Discharge - Skin Dimpling or Retraction - Nipple/Areolar Scaliness

Mammography – Abnormal results of the following American College of Radiology categories:

- BIRADS III – Probably benign (short-term follow-up indicated) - BIRADS IV – Suspicious Abnormality (consider biopsy) - BIRADS V – Highly Suggestive of Malignancy

Pap Test – Abnormal results include: - Atypical squamous cells – undetermined significance (ASC-US) - Atypical squamous cells – Cannot exclude High Grade SIL (ASC-H) - Low Grade squamous cells intraepithelial lesion encompassing: HPV, Mild

dysplasia/CIN 1 - High Grade squamous cells intraepithelial lesion encompassing: moderate and

severe dysplasia, CIS/CIN 2, and CIN 3 - Squamous cell carcinoma - Abnormal glandular cells including: atypical glandular cells of undetermined significance (AGUS) endocervical adenocarcinoma endocervical adenocarcinoma in situ endometrial adenocarcinoma extrauterine adenocarcinoma adenocarcinoma NOS

Submit diagnostic results form by electronic data system

PARTICIPANT

CONTACTED

Appointment(s) for diagnostic testing made

Needs Assessment completed. Barriers/ Concerns identified Case management

plan initiated

No needs identified

Abnormal test results

Local CFY staff follows & documents

process to contact participant made

Local CFY staff notified

Identifiedresource agencies contacted

Reassess/ monitor

Plan established,

actions taken &

documented

UNABLE TO CONTACT PARTICIPANT

Complete diagnostic results form;

document as ‘Lost to Follow-Up’ or

“Work-Up Refused’

Cancer not

diagnosed

Referred & entered in

appropriate treatment

Diagnostic tests performed & documented

Cancer diagnosed Case Management

Flow Chart

DIAGNOSTIC SERVICES

Timeliness of Follow -up The NBCCEDP has established quality standards for timeliness of follow-up for CBEs and mammograms:

• When diagnostic work-up is indicated – the time from screening (earliest of a CBE or mammogram) to a final diagnosis must be no more than 60 days

• If cancer is diagnosed – the time from the diagnosis to start of treatment must be no more than 60 days

The NBCCEDP has established quality standards for timeliness of follow-up for cervical cancer screening:

• When diagnostic work-up is indicated – the time from screening to a final diagnosis must be no more than 90 days

• If cancer is diagnosed – the time from the diagnosis to start of treatment must be no more than 90 days

Adequacy of Follow-up The NBCCEDP has established quality standards for adequacy of follow-up for CBEs and mammograms: Refer to Table 7: Algorithm for Breast Cancer Screening Follow-up Adequacy found in the Guidelines Section of this Manual.

• A diagnostic work-up must be planned whenever there is an abnormal (suspicious for cancer) CBE and/or when the screening mammogram result is ‘Suspicious Abnormality,’ ‘Highly Suggestive of Malignancy,’ or ‘Assessment Incomplete’

• Appropriate diagnostic follow-up for abnormal CBE and/or mammography results • When a diagnostic work-up is complete, a final diagnosis must be recorded • A ‘Lost to follow-up’ or ‘Refused’ diagnostic work-up is considered inadequate

The NBCCEDP has established quality standards for adequacy of follow-up for cervical cancer screening: Refer to Table 8: Algorithm for Cervical Cancer Screening Follow-up Adequacy found in the Guidelines Section of this Manual.

• A diagnostic work-up must be planned whenever there is an abnormal Pap test finding (ASC-US, LSIL, ASC-H, HSIL, squamous cell carcinoma, or Abnormal Glandular Cells)

• Appropriate diagnostic follow-up for abnormal Pap test results • When a diagnostic work-up is complete, a final diagnosis must be recorded • A ‘Lost to follow-up’ or ‘Refused’ diagnostic work-up is considered inadequate

Enrolling for Diagnostic Services • Individuals aged 40 and over with a recent abnormal CBE, mammogram, or Pap test may be

enrolled in the IA CFY Program for diagnostic breast and cervical cancer screening services. A person must meet eligibility criteria, and the abnormal results must be documented in the program’s database.

• A participant under age 40 is not eligible for IA CFY Program diagnostic services unless they have breast cancer symptoms and has received screening services provided by the IA CFY Program.

Preauthorization

Preauthorization for reimbursement of a procedure can be obtained by calling the Health Service Coordinator at (515) 242-6200. You will need to have the following information available.

• Breast: o Reason for the request of the MRI o If because of family history:

Age Any breast disease in past Height Pre, Peri or Post menopausal Weight Age of menopause Number of children Ashkenazi heritage Age first child born Breast or Ovarian cancers in daughters, sisters,

mother, grandmothers (maternal/paternal), aunts (maternal/paternal), male relatives, cousins or nieces

Length of use of hormone therapy

Any relative test positive for BRCA1 or BRCA2

• Cervical: Pap test result Diagnostic procedure being performed Date of Pap test Date procedure is to be done First, middle initial and last name Healthcare provider name Date of Birth Facility name, address, phone number

Breast Services Preauthorization for reimbursement of a magnetic resonance imaging (MRI) of the breast as a diagnostic procedure must be obtained before performing the procedure. IA CFY Program state staff are responsible for granting preauthorization to healthcare providers. Reimbursement of a MRI may be possible if the participant:

• Has a past history of breast cancer • Has an area on the mammogram that the radiologist is recommending MRI • Has a lifetime risk score of 20 percent or greater on the International Breast Cancer

Intervention Study (IBIS) Breast Cancer Risk Evaluation Tool. This tool looks at family history, use of female hormone, benign disease, risk factors such as age, and how many children the woman had and at what age and other criteria

• Has a first degree relative with breast cancer (parent, brother, sister, or child), or • Has a close relative that has tested positive for the Breast Cancer 1 or 2 gene mutation

(BRCA1 or BRCA2 mutation)

The MRI cannot be reimbursed by the IA CFY Program if it is being used as a screening tool or to assess the extent of disease of a participant that is already diagnosed with breast cancer.

Cervical Services Preauthorization for reimbursement of a loop electrosurgical excision procedure (LEEP), cervical conization, or endometrial biopsy as a diagnostic procedure must be obtained before performing the procedure. IA CFY Program state staff are responsible for granting preauthorization to healthcare providers.

The American Society of Colposcopy and Cytopathology (ASCCP) Consensus Conference on Management of Abnormal Cervical Cytology Reports held in 2012 recommended that, in certain circumstances, invasive procedures for diagnosis of cervical disease are indicated. The IA CFY Program policy is consistent with ASCCP recommendations and NBCCEDP policy.

• High Grade Squamous Intraepithelial Lesions

Reimbursement of a LEEP or conization of the cervix for diagnosis is based on the ASCCP algorithm for Management of Women with High-grade Squamous Intraepithelial Lesions.

• Atypical Glandular Cells Reimbursement of a cold conization of the cervix for diagnosis is based on the ASCCP algorithm for Management of Women with Atypical Glandular Cells. Subcategories are: o atypical glandular cells of undetermined significance o atypical endometrial cells o AGC “not otherwise specified” o AGC “favor neoplasia” o adenocarcinoma in situ

• Atypical Glandular Cells Reimbursement of an endometrial biopsy for diagnosis is based on the ASCCP algorithm for Management of Women with Atypical Glandular Cells.

TREATMENT SERVICES

On July 1, 2001, Iowa Legislators enacted federal legislation called the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) of 2000. During the 2013 Iowa Legislative session, changes were made. Beginning January 1, 2014, changes provided access to Medicaid benefits during their treatment period to Iowan males and females diagnosed with pre-cancerous or cancerous breast or cervical conditions not paid for with NBCCEDP or Komen funding. Eligibility for Referral to the IA Breast and Cervical Cancer Treatment (BCCT) Option of Medicaid

1. An individual (male or female) is eligible for the BCCT option of Medicaid if the individual: a. Is not covered by a mandatory category of Medicaid; b. Has not reached age 65; c. Was eligible, enrolled, and received services under the NBCCEDP or had breast or cervical

cancer screenings or related diagnostic services provided or funded by: i. family planning centers ii. community health centers iii. non-profit organizations;

d. Does not have creditable insurance coverage for breast or cervical cancer treatment. 2. The individual must meet the income eligibility requirements established by the IA CFY

Program. 3. The individual must be diagnosed with a precancerous/cancerous breast or cervical condition

and require treatment for the diagnosis. Presumptive Eligibility (PE) Presumptive Eligibility refers to a federal government program available for states to use that offers immediate health services access by providing temporary health insurance through Medicaid. A local organization has employees authorized by the Department of Human Services (DHS) to make Breast and Cervical Cancer Treatment (BCCT) PE determinations.

PE Rules 1. Must be an Iowa resident 2. Must be a US citizen or qualified alien

Exceptions: Pregnant Women and BCCT applicants 3. Must not have received PE in the last 12 months for the same condition

Exceptions: Pregnant Women and BCCT applicants Notes:

• PE is granted on a day-by-day basis. • An individual may only have PE once during a 12-month period.

Exceptions: An individual is diagnosed with breast or cervical cancer/precancer, has treatment, and

then has a new diagnosis. A woman is pregnant, delivers, and is pregnant within the same 12-month period.

• If the individual’s treatment is expected to exceed 45–60 days, the person will need to complete a full DHS Health Services Application (HSA). The application is available from DHS.

Presumptive Eligibility Provider (PEP) A local organization has employees authorized by the Department of Human Services (DHS) to make BCCT PE determinations.

1. The Qualified Entity can help the individual fill out the necessary information on the DHS’s Health Services Application (HSA) form. To have a valid PE application only the following information is needed:

• First, middle initial, and last name • Full address with county of residence • Application Date (date you received the application with signature) • Gender • Date of Birth • Applying for PE? • Type of PE? • Had PE in last 12 months? • Applying for ongoing? • Receiving Medicaid? • Resident of Iowa? • Signature and date

2. The Qualified Entity will complete the PE application online on the Iowa Medicaid Presumptive Eligibility Portal with the above information.

3. The Qualified Entity should print and make copies of the: • “Notice of Action” • “Application for Benefits”

These forms have the state identification number that is assigned to the individual. Copies are needed as the original Notice of Action is for the individual to show to providers and the copy is for your files.

Not a PEP If the local organization does not have the authorization from the DHS to make BCCT PE determinations, the local entity needs to: 1. Assist the individual to complete a full DHS HSA, 2. Complete a Medicaid Treatment Option Eligibility Verification form. This form is available from

the Health Service Coordinator. and 3. Refer the individual to the DHS office for their county of residence. Ongoing Medicaid may

start on the first day of the month approved for Medicaid by DHS.

ASSISTANCE: Once an individual is enrolled for BCCT Medicaid services, the person has access to full Medicaid benefits for the duration of treatment for a precancerous or cancer breast or cervical diagnosis.

STATE CONTACTS: Department of Public Health

IA Care for Yourself Program: Jolene Carver (515) 242-6200 [email protected]

Department of Human Services: Amela Alibasic (515) 281-4521 [email protected]

mailto:[email protected]


REFUSAL OF SERVICES OR LOST TO FOLLOW-UP

In some cases, participants do not follow through with the recommended screening, diagnostic, and/or treatment services. Every attempt should be made to ensure participants have appropriate diagnostic and/or treatment follow-up required by the IA CFY Program. These processes are only required for follow -up after an abnormal screening result or breast or cervical precancer or cancer finding occurs and the participant is not getting further services.

Refusal Of Services A participant should be documented as “Refused” when:

1. The participant verbally refuses any recommended follow-up care.

2. The participant refuses in writing any recommended follow-up care.

It is recommended that participants be notified verbally, if possible, and in writing of what type of follow-up is needed, when it is needed, and what may happen if the follow-up does not occur. Documentation of the informed refusal should be kept in the participant’s file. This can be done either by documentation quoting the verbal conversation that occurred with the participant or by having the participant sign a form that states specifically what she is refusing, and that she understands the risks involved if she does not complete the recommended follow-up.

Lost To Follow-Up A participant should be documented as “Lost to Follow-Up” when:

1. At least three contact attempts have been completed and documented in the participant’s file. This documentation should include the type of contact attempted, date, and the outcome.

2. The last contact attempt is by certified mail with a return receipt. A copy of the certified letter sent and the return receipt should be kept in the participant’s file.

Methods for Contact Attempts It is recommended that different methods be used to contact a individual for completion of any follow-up services. This includes:

• Telephone, • Written communication, • Call the contact person listed on the last enrollment, but maintain the confidentiality, • Contact the healthcare provider for additional contact information, or • Other options identified and documented.

Local program staff may continue to follow or track a participant’s progress for quality of care issues, but documentation of the participant’s refusal or lost to follow-up status needs to be done.

RESCREENING SERVICES Rescreening is the process of returning for a screening test at a predetermined interval. The CDC defines that interval for the NBCCEDP at ten months or greater. Screening at regular intervals decreases a person’s risk of dying from breast cancer or developing cervical cancer.

Priority Population Direct efforts should be made to provide regular screening services for breast and cervical cancer to eligible women between the ages of 40 and 64 that were previously screened by the IA CFY Program.

Eligibility for Services When it is time for a person to receive rescreening services, they need to be evaluated to verify that they continue to meet IA CFY eligibility criteria. If the person meets the eligibility criteria, she can re-enroll in the program.

Services Offered • Education about the importance of CBEs and mammography for breast cancer screening and

of the Pap test for cervical cancer screening; • A reminder system to facilitate the return of past participants who were screened by IA CFY

Program.

Recall Reminder System Responsibilities • The IA CFY Program data manager is responsible for generating the rescreening reminder lists

from the database. • IA CFY Program state and local program staff are responsible for:

o Reviewing information that is sent to women as a yearly reminder that it is time for screening. Information includes the importance of regular screening leading to early detection and

a better outcome if diagnosed with breast or cervical cancer. o Implementing the reminder system. The system determines when a person is due for

screening services based on the last dates of CBE, mammography and Pap test. • Local program staff are responsible for:

o Indicating whether their local program or the state program will be responsible for the initial yearly reminder sent to the person.

o Determining if a person is still eligible for IA CFY Program services. If the person is not eligible, document the reason in the live web-based data system. A

printout of this form is to be kept in the individual’s file. Note: A person is determined to be ineligible if: - Obtained insurance that pays for these services

Exception: has a barrier to receiving screening and needs patient navigation

- Moved without forwarding address - Age (< 40 years without breast issues) - Net household income > 250 percent of the federal poverty guidelines - Lost to follow-up - Deceased - Declined re-enrollment

The documentation in the live web-based data system must be changed if at a later date the individual becomes eligible to receive services again. A printout of the form is kept in the individual’s file.

o Document the date of the reminder contact(s) in each individual’s file.

• IA CFY Program’s Health Services Coordinator is responsible for administration of the rescreening process. This includes: training, verifying local program compliance, reviewing and updating the policy and evaluating barriers.

Reminder Process • The individual’s initial contact is made approximately 11 months following a screening

procedure date. The individual is encouraged to contact the local program to re-enroll for services.

• If the individual has not contacted the local program approximately one month following the first contact, the local program staff will attempt a second contact to women 50 years or older. The target population of the IA CFY Program breast and cervical cancer screening portion is 50 – 64 years of age. Participants aged 49 years and younger do not need to be notified again.

• If these contacts fail to produce re-enrollment of a individual aged 50 years or older, a letter must be sent to the participant’s last known mailing address approximately two weeks following the second reminder. The letter will inform the individual that they are due for rescreening, explain the importance of regular screening and ask them to contact the local program.

If the person does not respond to the final reminder within approximately 30 days, local program staff should document the individual as “not interested” per the ‘Determine if the individual is still eligible for IA CFY Program services’ section above.

• Each program may choose to continue to notify and enroll individuals aged 40 – 49 if they contact the program after the above process is completed.

• It is recommended various methods be used to contact a individual for rescreening. This includes: o Telephone o Written communication (letter or reminder card) o Contact the individual’s healthcare provider for additional information o Call the contact person listed on the individual’s last enrollment but maintain the

individual’s confidentiality, or o Other options identified and documented

Attempts to contact the individual should be documented in the individual’s IA CFY Program file. It is not necessary to document a reason for not contacting a individual age 40 – 49 more than once for rescreening.

Guidelines Calendar of Events ......................................... 31

Income Guidelines ......................................... 33

Progression of a Woman Through the IA CFY BCC Program

Simplified ....................................... 35 Full .............................................. 37

Services Guidelines ........................................ 39

Care for Yourself Program Services ................. 41

Adequacy of Follow-up

Breast ............................................ 43

Cervical .......................................... 45

Description of Work and Services .................... 47

Calculating the 75/25 Core Indicator ............... 55

FY18 CALENDAR OF SCHEDULED EVENTS FOR LIMITED SERVICES

JULY 2017 M T W T F

3 4 5 6 7

10 11 12 13 14

17 18 19 20 21

24 25 26 27 28

31

AUGUST 2017 M T W T F

1 2 3 4

7 8 9 10 11

14 15 16 17 18

21 22 23 24 25

28 29 30 31

SEPTEMBER 2017 M T W T F

1

4 5 6 7 8

11 12 13 14 15

18 19 20 21 22

25 26 27 28 29

OCTOBER 2017 M T W T F

2 3 4 5 6

9 10 11 12 13

16 17 18 19 20

23 24 25 26 27

30 31

NOVEMBER 2017

M T W T F

1 2 3

6 7 8 9 10

13 14 15 16 17

20 21 22 23 24

27 28 29 30

DECEMBER 2017 M T W T F

1

4 5 6 7 8

11 12 13 14 15

18 19 20 21 22

25 26 27 28 29

3 – Tracking Log due 4 – State Holiday (office closed) 21 – Final Progress Report for FY17

1 – Tracking Log due 1-2 – Limited Annual Meeting 10 – Special Komen report due Contract Performance Review (TBD) 1 – Tracking Log due 4 – State Holiday (office closed) 10 – Special Komen report due 2 – Tracking Log due 10 – Special Komen report due 17 – PRAB conference call @ 11:00

1 – Tracking Log due 1 – East Regional Meeting 2 – West Regional Meeting 9 – Special Komen report due 10 – State Holiday (office closed) 23-24 – State Holiday (office closed)

1 – Tracking Log due 8 – Special Komen report due 25 – State Holiday (office closed) 31 – Screening Services Performance

Measure deadline

JANUARY 2018 M T W T F

1 2 3 4 5

8 9 10 11 12

15 16 17 18 19

22 23 24 25 26

29 30 31

FEBRUARY 2018 M T W T F

1 2

5 6 7 8 9

12 13 14 15 16

19 20 21 22 23

26 27 28

MARCH 2018 M T W T F

1 2

5 6 7 8 9

12 13 14 15 16

19 20 21 22 23

26 27 28 29 30

APRIL 2018 M T W T F

2 3 4 5 6

9 10 11 12 13

16 17 18 19 20

23 24 25 26 27

MAY 2018 M T W T F

1 2 3 4

7 8 9 10 11

14 15 16 17 18

21 22 23 24 25

28 29 30 31

1 – State Holiday (office closed) 2 – Tracking Log due 10 – Special Komen report due 15 – State Holiday (office closed) 19 – Semi-Annual Report due 31 - Screening Services Performance

Measure data deadline

1 – Tracking Log due 9 – Special Komen report due 13 – PRAB conference call @ 11:00 1 – Tracking Log due 6 – East Regional Meeting 7 – West Regional Meeting 9 – Special Komen report due

2 – Tracking Log due 10 – Special Komen report due

1 – Tracking Log due 15 – PRAB conference call @ 11:00 15 – Screening Completed 28 – State Holiday (office closed) 1 – Tracking Log due 18 – Diagnostics completed 29 – All FY17 data documentation entered 29 – Screening Services Performance

Measure paid out

2017

JUNE 2018 M T W T F

1

4 5 6 7 8

11 12 13 14 15

18 19 20 21 22

25 26 27 28 29

2018

2017 Income Guidelines1

Net household income refers to take home pay or the amount of money earned after payroll withholding such as state and federal income taxes, social security taxes, and pretax benefits like health insurance premiums. If enrolled in a flexible spending account to pay for medical costs, the amount withheld from each check is also on a pre-tax basis. Net Household Income is gross income (minus deductions) of each person living in that household whether or not they are related. Iowa Care for Yourself Program Income Guidelines are updated annually. For updates, contact:

Iowa Care for Yourself Program Iowa Department of Public Health Lucas State Office Building 321 E. 12th Street Des Moines, IA 50319-0075 Phone: (515) 281-5616

Source: Iowa Department of Public Health, 01/2017

1 Iowa Care for Yourself Program Income Guidelines are set at 250% of Poverty Guidelines issued by the U.S. Department of Health and Human Services for 2017. 2 Up to 138% of federal poverty level individuals are eligible for Medicaid or the expanded Medicaid.

Persons in family/ household

100% of Yearly

Income

138% of Yearly

Income2

250% of Monthly Income

250% of Yearly

Income 1 $12,060 $16,643 $2,513 $30,150 2 $16,240 $22,411 $3,383 $40,600 3 $20,420 $28,180 $4,254 $51,050 4 $24,600 $33,948 $5,125 $61,500 5 $28,780 $39,716 $5,996 $71,950 6 $32,960 $45,485 $6,867 $82,400 7 $37,140 $51,253 $7,738 $92,850 8 $41,320 $57,022 $8,608 $103,300

For families/households with more than 8 persons add for each additional person:

$ 4,180 $ 5,768 $ 871 $ 10,450

Progression of a Woman through the Care for Yourself BCC Program*

*Simplified Flow (refer to additional information on the next page for what is involved with each step)

Eligibility

Enrollment

ScreeningDiagnostics

Rescreening

Progression of a Woman through the Care for Yourself BCC Program

DETERMINE

ELIGIBILITY

Age

• 40 years and older

• If not age eligible and needing service, give options

Household Income

• ≤ 250% FPL

• If not income eligible, give options

Insurance Status

If contacting for rescreening and no longer meets criteria, make

ineligible in the database but tell the person if circumstances

change to contact Program to re-enroll.

ENROLLMENT

• Consent signed

• Annual Assessment completed

• Decide who will set up appointments (Office visit,

Mammogram)

PATIENT

NAVIGATION

• States that insurance will pay for everything

• Needs assessment done, need(s) identified and need(s)

addressed (using Program Needs Assessment and Plan

of Care forms, document)

SCREENING

Office Visit

• Clinical Breast Exam

• Pap test, if eligible

• Two blood pressure readings

• Height and Weight

Mammogram, if eligible

CASE

MANAGEMENT

• Needs assessment done and documented if CDC-

defined abnormal screening results obtained

• If need identified, need documented and addressed

SHORT TERM

FOLLOW-UP

(STFU)

Returning for procedures earlier than a rescreening procedure

(usually prior to 10 months)

DIAGNOSTICS

Tracking/Follow-up of client

Preauthorization needed for:

• Breast

MRI

• Cervical

LEEP

Cold Knife Cone

Endometrial Biopsy

SHORT TERM

FOLLOW-UP

(STFU)

Returning for procedures earlier than a rescreening procedure

(usually prior to 10 months)

TREATMENT During treatment the woman is not eligible for our program

RESCREENING Reminding a woman at the correct interval to get regular screening

procedures (10 months or greater)

Table 5: IOWA CARE FOR YOURSELF PROGRAM SCREENING SERVICES

1Examples of breast cancer symptoms are breast skin dimpling or retraction; palpable mass; nipple discharge, inversion, scaliness; or an abnormal CBE. 2IA CFY Program services are not available for cervical cancer screening in women with hysterectomies unless the hysterectomy was performed due to cervical cancer or neoplasia. If a woman does not know if she has a cervix, a pelvic exam will be provided as initial physical examination to determine if a woman has a cervix. If the cervix is intact, services may be reimbursed for cervical cancer screening according to IA CFY Program protocol. 3 Use Susan G. Komen Foundation funding, if available, to help pay for mammograms of individuals less than 50 year of age.

IOWA CARE FOR YOURSELF PROGRAM SCREENING SERVICES

Age BLOOD

PRESSURE, HEIGHT, WEIGHT

CLINICAL BREAST EXAM (CBE) MAMMOGRAM1 PELVIC/PAP2

Under 40


cancer3


cancer If CBE is abnormal


cancer

40 – 49 Annually



Asymptomatic See Note3




50 – 64 Annually







Over 64 Annually

IA Care for Yourself Program is not able to reimburse for services if a woman has Medicare Part B. Women over age 64, who do not have Medicare Part B and meet income guidelines, are eligible to receive services reimbursed as above for 50 – 64 year old.

Table 6: IOWA CARE FOR YOURSELF PROGRAM DIAGNOSTIC SERVICES

DIAGNOSTIC SERVICES AVAILABLE

AGE BREAST CERVICAL

Under 40

Diagnostic services available if: 1. Symptomatic for breast cancer and 2. CBE and/or mammogram is

abnormal and 3. Screening services received through

IA CFY Program Services same as 50 – 64 year old

Diagnostic services available if: 1. Symptomatic for breast cancer and 2. Pap was abnormal and 3. Screening services received through

IA CFY Program Services same as 50 – 64 year old

40 – 494 Same as 50 – 64 year old Same as 50 – 64 year old

50 – 644

Diagnostic services available if CBE and/or mammogram is abnormal IA CFY Program funds will reimburse5 for:

1. Surgical consultation visit for repeat CBE

2. Mammogram 3. Biopsy/Lumpectomy 4. Ultrasound 5. Fine needle/cyst aspiration 6. Pathology fees 7. Pathology consult during surgery 8. Anesthesia time

If procedure is preauthorized, IA CFY Program funds will reimburse for breast MRI as diagnostic procedure. IA CFY Program funds cannot be used to reimburse for any treatment of breast cancer or pre-cancer.

Diagnostic services available if Pap is abnormal IA CFY Program funds will reimburse5 for:

1. Surgical consultation 2. Colposcopy (with or without biopsy) 3. Pathology fees

If procedure is preauthorized by IA CFY Program funds will reimburse for:

1. LEEP or conization 2. Endometrial biopsy (for AGC Pap

results only) IA CFY Program funds cannot be used to reimburse for any treatment of cervical cancer or pre-cancer.

Over 644

IA CFY Program services are not available if a woman has Medicare Part B. If a woman does not have Medicare Part B, she should receive services as 50 – 64 year old.

4For this age group, IA CFY Program funds can be used to reimburse for diagnostic services for program-eligible individuals referred to the program with abnormal screening results. Diagnostic services must not be performed prior to referral/enrollment. 5Refer to current ‘Care for Yourself’ Reimbursement Schedule for complete listing.

IA CFY Breast and Cervical Cancer Early Detection Program

Services for Eligible Individuals

Table 7: IOWA CARE FOR YOURSELF PROGRAM LIMITED SERVICES

Type of Service Services Included:

Limited:

An office visit that includes appropriate/recommended breast and cervical cancer screening:

• Two blood pressure measurements • Height and weight • Clinical breast exam • Pelvic exam • Pap test as eligible (if provider feels that a Pap test is needed

more frequently than every 3-5 years [protocol], the request must be made to the state program staff)

Mammography, as recommended by provider

Breast and/or cervical diagnostic services, as recommended by provider (specific services need to be preauthorized by the Health Services Coordinator)

Tobacco cessation referral

Referral for precancer and cancer treatment, as recommended by provider

Table 8: Algorithm for Breast Cancer Screening Follow-up Adequacy1

CBE RESULT MAMMOGRAM RESULT DIAGNOSTIC PROCEDURES REQUIRED FOR ADEQUACY2

• Normal/Benign (including fibrocystic, lumpiness, or nodularity)

• Negative • Benign • Probably Benign (Short term

follow-up indicated)

• No work-up required • If work-up is planned, at least one

diagnostic procedure must be done and a final diagnosis recorded

• Abnormal (suspicious for cancer)

• Negative • Benign • Probably Benign (Short term

follow-up indicated) • Assessment Incomplete

One or more of the following: • Surgical consult for repeat breast

exam • Ultrasound • Biopsy/Lumpectomy • Fine Needle/Cyst Aspiration Note: A mammogram or additional mammogram views only are not considered adequate

• Abnormal (suspicious for cancer)

• Suspicious Abnormality • Highly Suggestive of

Malignancy

One or more of the following: • Biopsy/Lumpectomy • Fine Needle/Cyst Aspiration


• Suspicious Abnormality One or more of the following: • Surgical consult for repeat breast

exam • Ultrasound • Biopsy/Lumpectomy • Fine Needle/Cyst Aspiration

• Normal (including fibrocystic, lumpiness, or nodularity) • Abnormal (suspicious for cancer)

• Highly Suggestive of Malignancy

One or more of the following: • Biopsy/Lumpectomy • Fine Needle/Cyst Aspiration


• Assessment Incomplete One or more of the following: • Additional mammography views • Ultrasound

Timeliness of Follow-Up Care: • From screening (clinical breast exam or mammogram) to diagnosis must be ≤ 60 days • From diagnosis to start of treatment must be ≤ 60 days

1 This algorithm is inappropriate as a tool for clinical decision-making for individual women or to determine whether individual providers are performing according to accepted national practices. 2 Clinical interventions based on clinical guidelines endorsed by the Commission on Cancer of the American College of Surgeons, the American College of Obstetrics and Gynecology, and the National Cancer Institute.

Table 9: Algorithm for Cervical Cancer Screening Follow-up Adequacy3

NOTE: Pap Specimen Adequacy must be “Satisfactory” for Pap Test results to be recorded.

PAPANICOLAOU (PAP) TEST RESULT DIAGNOSTIC PROCEDURES REQUIRED FOR ADEQUACY4 BETHESDA (TBS) 2001

1. Negative for Intraepithelial Lesion or Malignancy

• No work-up required

2. ASC-US (Atypical Squamous Cells – Undetermined Significance)

• No work-up required, but follow-up at one year required • If HPV test negative, co-testing follow-up at 3 years • If HPV test positive, colposcopy required • If work-up is planned, colposcopy must be done

3. Low Grade SIL encompassing: • HPV • Mild Dysplasia/CIN 1

One or more of the following: • Negative HPV, repeat co-testing at 1 year • Negative HPV, colposcopy (with or without biopsy) • No or Positive HPV, colposcopy (with or without biopsy)

4. ASC-H (Atypical Squamous Cells – Cannot exclude High Grade Squamous Intraepithelial Lesion [SIL])

One or more of the following: • Colposcopy • Colposcopy with biopsy

5. High Grade SIL encompassing (with features suspicious for invasion): • Moderate & Severe Dysplasia • CIS/CIN 2 & CIN 3

One or more of the following: • Colposcopy • Colposcopy with biopsy • Loop Electrode Excision Procedure 5 • Conization 5

6. Squamous Cell Carcinoma One or more of the following: • Colposcopy • Colposcopy with biopsy

7. Abnormal Glandular Cells including: • AGUS (Atypical Glandular cells of

Undetermined Significance) • Endocervical adenocarcinoma • Endocervical adenocarcinoma in

situ • Endometrial adenocarcinoma • Extrauterine adenocarcinoma • Adenocarcinoma NOS

One or more of the following: • Colposcopy • Colposcopy with biopsy • Cold knife Conization 5 • Endometrial Biopsy 5

Timeliness of Follow-Up Care: • From screening (Pap test) to diagnosis must be ≤ 90 days • From diagnosis to start of treatment must be ≤ 90 days

3 This algorithm is inappropriate as a tool for clinical decision making for individual women or to determine if individual providers are performing according to accepted national practices. 4 Clinical interventions based on the American Society for Colposcopy and Cervical Pathology’s 2012 Algorithms from the Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities. 5 Must be preauthorized with IA BCCEDP state staff

Contractual Description of Work and Services 2018: Article VI - Description of Work and Services: In compliance with the Care for Yourself – Breast and Cervical Cancer program manual, the Department approved work plan and the Centers of Disease Control (CDC) strategies and interventions for FY18, the Contractor shall: Core Service 1: Enrollment and Screening

1) Arrange for screening and diagnostic services as identified in the Service Provision Table listed in Article V for eligible applicants (low-income, underinsured or uninsured for individuals ages 40 or over who earn less than the set income guidelines [250% Federal Poverty Level], are not enrolled in Medicare Part B, or who are under age 40 and symptomatic for breast disease).

2) Track the number of participants age 49 and younger who received program funded mammograms. No more than 25% of the participants who receive mammograms can be of age 49 and younger.

3) Determine eligibility on individuals to enroll as a participant in the CFY-BCC program. Eligibility is based on income, age and insurance status. Once determined eligible and having signed the Consent Form, a participant is eligible for program services for 12 months from the date the consent form is signed. If an individual is eligible for services, the Contractor shall:

a. Assure appointments are scheduled for each participant. 4) Assure all enrollment information is collected, entered and submitted into the live

web-based data system: https://careforyourselfiowa.com. a. Enter BCC eligibility enrollment dates prior at least 30 days prior to receiving any

screening service. b. Complete an Annual Enrollment form (pages 1-2).

5) Assure participants have one office visit that includes appropriate/recommended breast and cervical cancer screening services as determined by the CFY-BCC Project Coordinator. The visit will include the following screening services:

a. Two blood pressure measurements collected during the same office visit b. Height and weight c. Clinical breast exam b. Pelvic exam

6) Arrange additional screening services for participants as they are eligible: a. Pap test and HPV testing b. Mammography

7) Arrange diagnostic follow-up services as determined appropriate by the healthcare provider: a. Breast and/or cervical diagnostic services

• If diagnostic work-up is indicated, the time from screening to a final diagnosis must not exceed 60 days for breast and 90 days for cervical. For invasive cervical cancer, the time from screening to a final diagnosis must not exceed 60 days.

b. Referral for precancer and cancer treatment • If cancer is diagnosed, the time from the diagnosis to the start of the treatment

https://careforyourselfiowa.com/

must be no more than 60 days for breast and 90 days for cervical. For invasive cervical cancer, the time from final diagnosis to treatment must not exceed 60 days.

8) Refer participants to Quitline Iowa for cessation services. 9) Refer participants to Quitline Iowa for cessation services. 10) Document and maintain a monthly tracking log of enrollments for breast and cervical

screening services. All tracking logs must be sent either encrypted and password protected or by using secure client software when sending and retrieving data. If the Contractor does not have access to a secure software a request should be made to the Program Consultant.

Core Service 2: Recall of Participants Screening at regular intervals leads to participants having decreased risk of developing breast cancer and/or cervical cancer. The participant’s recall reminder is generated approximately eleven months following the screening date for breast and cervical cancer screening services. The Contractor shall:

1) Indicate yearly whether the Contractor or the state program will be responsible for rescreening letters sent to persons who have previously enrolled in the CFY-BCC program.

2) Review the rescreening list on a monthly basis. The rescreening list is comprehensive, utilizing the person’s last dates of clinical breast exam, mammogram and Pap test to determine when a person is due for screening services within a 12-month period.

3) Determine if the person is eligible for CFY-BCC program services. a. If a person is no longer eligible, enter and submit the information into the live web-

based data system on the Ineligible Form. Core Service 3: Documentation of Refusal of Services or Lost to Follow-Up Status In some cases, participants do not follow through with recommended screening, diagnostic and/or treatment services. Documentation of attempts to contact and encourage the participant to obtain services is required. If after an abnormal finding is reported, the participant refuses diagnostic screening services or can no longer be contacted (considered lost to follow-up), the Contractor shall:

1) Communicate with the participant with abnormal screening results, both verbal and in writing, about diagnostic follow-up services that are needed, and when they should be performed. Communication will also indicate what may happen if the follow-up services do not occur.

2) Document the informed refusal in the participant’s file. A participant must be documented as “lost to follow-up” when a minimum of three contact attempts have been completed and documented in the participant’s file. The Contractor shall:

a. Document type of contact attempted, date and outcome. b. Complete and distribute a certified letter stating that they were unable to be reached and

further follow-up is needed. Core Service 4: Diagnostic Services Participants age 40 and over with a recent abnormal clinical breast exam (CBE), mammogram or Pap

test may be eligible to receive diagnostic breast and cervical cancer services. Participants under the age of 40 are not eligible for diagnostic services unless symptoms of breast cancer are present or the person has received screening services from the CFY-BCC Program. In addition, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has established quality standards for timeliness of follow-up for breast and cervical cancer screening services. If an abnormality with a clinical breast exam (CBE) or a mammogram is identified, the Contractor shall:

1) Follow up with the enrolled participant to assure receipt of diagnostic services as indicated by the healthcare provider. The time from screening (earliest of the CBE or mammogram) to a final diagnosis must not exceed 60 days.

2) If cancer is diagnosed, the time from the diagnosis to start of treatment must be no more than 60 days.

3) When diagnostic work-up is complete, a final diagnosis must be recorded. 4) If an abnormality with a cervical cancer screening is identified, the Contractor shall: 5) Follow up on diagnostic services as indicated by the healthcare provider. The time from

screening (earliest of the CBE or mammogram) to a final diagnosis must not exceed 90 days. If cancer is diagnosed, the time from diagnosis to start of treatment must be no more than 90 days.

6) Refer participants (who are diagnosed with breast or cervical cancer) to ensure that they receive additional resources and support related to the diagnosis through the American Cancer Society (ACS).

7) Obtain preauthorization from the CFY-BCC Health Services Coordinator at 515-242-6200 prior to scheduling the following diagnostic procedure(s): Loop Electrode Excisional Procedure (LEEP), Cold Knife Cone (CKC), Endometrial Biopsy, and Breast Magnetic Resonance Imaging (MRI).

a. All preauthorization information must be entered into the live web-based data system prior to any additional screening services being received.

8) Refer participants to the Iowa Breast and Cervical Cancer Prevention and Treatment Act Medicaid Option (BCCT), if eligible. The participant must be diagnosed with a precancerous/cancerous breast or cervical cancer condition and require treatment to qualify. Verification must be obtained from the CFY- BCC Health Services Coordinator at 515- 242-6200.

Core Service 5: Patient Navigation Patient Navigation is defined as “Individualized assistance offered to clients to help overcome healthcare system barriers and facilitate timely access to quality screening and diagnostics as well as initiation of treatment services for persons diagnosed with cancer.” Participants screened by the program in prior years and who are subsequently insured may continue to receive patient navigation services if they need barrier reduction assistance in order to be screened. The Contractor shall:

1) Provide patient navigation services to eligible individuals. Eligible participants will meet age and income guidelines and must be insured.

2) If providing patient navigation services, the Contractor shall assure all enrollment information is collected, entered and submitted into the live web-based data system: https://careforyourselfiowa.com.

a. Complete a BCC Consent form b. Enter BCC eligibility enrollment dates prior at least 30 days prior to receiving any

screening service. c. Complete an Annual Enrollment form (pages 1-2)

https://careforyourselfiowa.com/

d. Complete a Screening form e. Complete a Needs Assessment f. Complete a Plan of Care g. Complete a Patient Navigation form

3) The Contractor shall: a. Resolve barriers that prevent a participant from obtaining screening and/or diagnostic

services. b. Conduct and document a minimum of two contacts associated

with patient navigation services. c. Document and maintain a monthly tracking log showing which participants are enrolled

for Patient Navigation services. Information in the tracking log can be individualized, however documentation must be on the Department-approved Excel file.

d. Collect all screening and diagnostic data, enter and submit into the live web-based data system.

Service Provision Deadlines

Breast and Cervical Cancer Screening Completed (includes Patient Navigation Services)

May 15, 2018

All Diagnostic Follow-Up Completed June 15, 2018

Data Entry Deadline Within six-months from the date the participant received the service, and no later than June 29, 2018 whichever is first.

Core Service 6: Data Collection and Reporting The CFY-BCC program uses a database system for collection of enrollment, screening, diagnostics, patient navigation, treatment referral services and participant ineligibility. The contractor shall become familiar with the database system and understand the capacity for how it functions. The Contractor agrees that all data collected and released through the Care for Yourself program is property of the Iowa Department of Public Health and its designee. The Contractor is required to sign a confidentiality form within 30 days of contract execution. The Contractor must abide by the Department’s policy related to transmission of data. All confidential data must be either encrypted and password protected or sent using secure client software when sending and retrieving data. If the Contractor does not have access to a secure software a request should be made to the Program Consultant. Storage of hard copy documents must be maintained in a locked room within locked file cabinets. Documents should only have access to paper records on an as needed basis.

Data Reporting System The Department contracts with the University of Iowa to maintain and operate a live database system for data collection and reporting by the Contractor. Data shall be collected and reported for each participant screened and/or provided diagnostic services. A service is not considered complete until all data is submitted by the Contractor and accepted in the CFY-BCC live web-based data system. For collection and reporting of required data, the Contractor shall:

1) Enter and submit all applicable data into the live web-based data system: a. Enter BCC eligibility enrollment dates prior at least 30 days prior to

receiving any screening service. b. Annual Enrollment c. Screening d. Patient Navigation (as applicable) e. Breast Diagnostic (as applicable) f. Cervical Diagnostic (as applicable) g. Participant Ineligibility (as applicable)

2) In the event that a participant has been screened by one local program in a prior year, yet enrolls for services by another local program in a subsequent year, a transfer of the participant’s screening and/or diagnostic information may be made. A transfer of the participant’s information from one program to another must be initiated through the live web-based data system.

3) Data must be accurately submitted and accepted into the live web-based data system by the last business day of each month at 11:59 p.m.to be included in the monthly data report which documents the number of participants screened, number of participants navigated, number of participants who received a mammogram paid for by Susan G. Komen.

Core Service 7: Outreach Outreach activities shall be conducted by the Contractor to promote and recruit eligible applicants for the CFY- BCC program. Outreach consists of targeted activities that assist with communication and engagement of eligible participants with the program. The Contractor shall collaborate with the Department to conduct outreach. Outreach activities may include:

a. Distribution of evidence-based outreach materials. Materials may be provided to the Contractor by the Department. With approval from the Department, the Contractor may develop, purchase and distribute brochures and other promotional items to direct program eligible persons to the CFY-BCC Program.

▪ The Contractor must: • Obtain Department approval with electronic copies of the any

developed or purchased outreach materials. • Obtain prior approval on developed or purchased materials from the

Department staff. Allow at least two weeks for obtaining Department approval. Assure that outreach materials adhere to the Department’s logo policy. The Department will provide its logo upon the request of the Contractor.

Per the General Conditions, the Contractor agrees that the Department shall become the sole and exclusive owners of all materials developed with the use of outreach funds.

Core Service 8: Provider Recruitment and Education The CFY-BCC program provides reimbursement for screening services based on approved CPT codes paid at Medicare Part B provider rates for Iowa. The healthcare Corporation/Lead Facility and sub-facilities must be enrolled to provide appropriate/recommended BCC screening services to eligible participants. The healthcare Corporation/Lead facility agrees to abide by the terms and conditions of the program guidelines listed in the Healthcare Provider Manual. Individual healthcare Providers must be licensed or certified to practice in the state in which they service program participants. The CFY-BCC Cooperative Agreement is effective for six (6) years from the date signed. The Contractor shall work

with Department staff to: 1) Identify, recruit and update healthcare facilities and providers to enroll as needed, to serve as

official providers of healthcare screening and diagnostic services for the CFY-BCC program. 2) Complete and assist with the following documents:

a. CFY-BCC Update Form (Only for current Cooperative Agreements in place. To update healthcare facility/healthcare provider information as needed).

b. CFY-BCC Cooperative Agreement. c. Application for Provider Status. d. Copy of facility W-9. e. CLIA certificate if applicable.

3) Provide orientation to the enrolled healthcare facilities/providers on CFY-BCC requirements and program updates as needed.

4) Assure all enrolled healthcare facilities/providers within the designated service area collect and report the required breast and cervical screening data.

5) Reimbursement for the healthcare Corporation/Lead Facility will be provided from the Department through a third party payer according to the current Medicare Part B Participating health care provider rates in Iowa. The Department will serve as a payer of last resort.

6) Reimbursement for screening services will not be provided until a Cooperative Agreement is signed by the healthcare Corporation/Lead facility and the Department.

Required Meetings

Meeting Date

General Conditions Training - Data and Subcontracting via Youtube

https://www.youtube.com/watch?v=4uCfkDTI9hE&feature=youtu.be Each staff person affiliated with the CFY program is required to

complete within 30 days of the executed contract. Documentation will need to be completed through Iowagrants.

Annual Meeting - Summer 2017 August 1 & 2, 2017 Required CFY Fall 2017 Regional Meeting November 1, 2017- Cedar Rapids

November 2, 2017-Carroll Required CFY Spring 2018 Regional

Meeting March 6, 2018-Carroll

March 7, 2018-Cedar Rapids Outreach Informational Trainings (mode of

trainings to be determined) To Be Determined

* Fall 2017 Contract Performance Review via telephone Dates and times to be announced

Article VII – Performance Measure CRITERIA: The Contractor shall conduct 40% of their allotted screening numbers by December 31, 2017. MEASURE: At least 40% of the Contractor’s screenings are completed on unduplicated participants by December 31, 2017, evidenced by data submitted no later than January 29, 2018; the Contractor will receive a $500.00 incentive payment. Evidence of completion will be verified by the Department from the monthly Vouching Reports.

https://www.youtube.com/watch?v=4uCfkDTI9hE&amp%3Bfeature=youtu.be

Payment of incentives will be made with the June reimbursement. The Contractor shall submit any documentation required for the performance measure into the progress reports component of the grant site within IowaGrants.gov. Article VIII – Reports: The Contractor shall complete and submit the following reports as indicated:

Report Method of Submission Due Date BCC Participant Tracking Log Monthly electronic copy

emailed to the Program Consultant via SecureMail

1st business day of each month to Program Consultant

The Contractor shall complete and submit the following reports in the grant site located in IowaGrants. Report Form Type Date Due

Komen Report Monthly 10th of the following month (August, September, October, November, December, January, February, March, April, May and June)

BCC Progress Report Semi-Annual January 19, 2018 and July 21, 2018

Calculating the 75/25 Core Indicator

The CDC NBCCEDP’s uses 11 core indicators to assess a Program’s performance. One of the core indicators is that 75% of the CDC funding used to reimburse for mammograms must provide mammograms to women ≥ 50 years of age. This leaves 25% that can provide mammograms for women ≤ 49 years of age using CDC funding.

The IA CFY Program applies for Susan G. Komen for the Cure Breast Foundation® funding to help meet this core indicator. The funding received from the Komen Foundation is used to reimburse for mammograms for women < 50 years of age without using federal funds. The program can still provide mammograms for other women < 50 years of age with federal funding. This combination of funds increases the number of women < 50 years of age that can be provided mammography services.

Example:

“Any County” CFY Program begins the year with 190 participants to enroll. It has 37 Komen slots to use to pay for mammograms. How many women under 50 years of age can have their mammogram paid using CDC funds and still maintain the program’s 75/25 split?

190 Participants - 37 Komen funded mammograms 153 Total number of mammograms to be federally funded

The 153 is what the 75/25 Core Indicator will be calculated from…

153 Total number of mammograms to be federally funded X 0.25 percent 38.25 38 (rounded down as below 0.5) mammograms for women under 50 years of

age can be federally funded

153 Total number of mammograms to be federally funded X 0.75 percent 114.75 115 (rounded up as above 0.5) mammograms for women 50 years of age and

over can be federally funded

38 women under 50 years of age federally funded mammograms 37 women under 50 years of age Komen funded mammograms 75 women under 50 years of age can have paid mammograms in the “Any County”

CFY Program The “Any County” CFY Program will meet the 75/25 Core Indicator if at least 115 of women over age 50 receive federally funded mammograms. This Core Indicator is determined by looking at the number of mammograms reimbursed by using CDC funding. Do not calculate how many that can be done and do all of the under 50 year of age women without doing the women 50 years of age and over.

What to do if Core Indicator is not being met:

In order to meet this Indicator, three women 50 years of age and over must be screened for every woman under 50 years of age.

If the Program is not meeting the 75/25 Core Indicator, consider starting a waiting list of women < 50 years of age until you meet the Core Indicator again.

Appendixes

Appendix I: IA CFY Program Contact Information ....................................... 59

Appendix II: HIPAA Related Information ....................................... 69

Appendix III: Program Reimbursement and ICD-10 Information ..................... 77

Appendix IV: Data Form Samples ........ 91

APPENDIX I: IA CFY Program Contact Information

IA CFY Program Service Area Map .......... 61

Local Program Contact Information ........ 63

Pink Ribbon Advisory Board (PRAB) ........ 65

State Staff Directory .............................. 67

Refer to Contact list following.

IOWA CARE FOR YOURSELF PROGRAM Service Area Map

June 29, 2017 - June 30, 2018

Refer to the IA Care for Yourself Program website for the most up-to-date service area contacts. The list can be found at the web address www.idph.iowa.gov/CFY/public under the section entitled “Contact a Program Near You.”

http://www.idph.iowa.gov/CFY/public

Lead County /Counties Program Contact Lead County

/Counties Program Contact

4-Appanoose Davis Wapello Wayne

Appanoose Co Public Health 209 E Jackson Street Centerville, IA 52544 (641) 437-4332

20-Clarke Decatur Warren

Clarke County Public Health 144 W Jefferson Street Osceola, IA 50213 (641) 342-3724

7-Black Hawk Buchanan Fayette Grundy Tama

Black Hawk Co Health Dept. 1407 Independence Ave Waterloo, IA 50703 (319) 292-2225

23-Clinton Jackson

Visiting Nurses Association 611 N 2nd Street Clinton, IA 52732 (563) 242-4925

11-Buena Vista Pocahontas Sac

Buena Vista Public Health 1709 E Richland Street Storm Lake, IA 50588 (712) 749-2548

31-Dubuque Allamakee Clayton Delaware Winneshiek

Dubuque VNA 1454 Iowa Street Dubuque, IA 52001 (563) 556-6200

12-Butler Bremer Floyd Franklin Mitchell

Butler Co Public Nurse Serv. 428 6th Street Allison, IA 50602 (319) 267-2934

41-Hancock Hancock Co Community Health 545 State Street Garner, IA 50438 (641) 923-3676

13-Calhoun Greene Hamilton Webster

Calhoun Co Public Health 501 Court Street Rockwell City, IA 50579 (712) 297-8323

44-Henry Des Moines Lee Van Buren

Henry County Public Health 407 S White Street Mt Pleasant, IS 52641 (319) 385-6568

14-Carroll Audubon

St Anthony Regional Hospital 318 S Maple Street, Ste. 3 Carroll, IA 51401 (712) 794-5400

57-Linn Benton Cedar Jones Iowa

Linn County Public Health 501 13th Street Cedar Rapids, IA 52405 (319) 892-6081

15-Cass Guthrie Harrison Mills Montgomery Pottawattamie Monona Adair

Union Crawford Shelby

Cass Co Memorial Hospital Public Health 1408 E 10th Street Atlantic, IA 50022 (712) 243-7443 Adair County Home Care (641) 743-7205 Crawford Co Public Health (712) 263-3303 Shelby County Public Health (712) 755-4312

63-Marion Lucas Mahaska Monroe

Marion County Public Health 2003 N Lincoln Street Knoxville, IA 50138 (641) 828-2238

17-Cerro Gordo Cerro Gordo County Dept. of Public Health 22 N Georgia Street, Ste. 300 Mason City, IA 50401 (641) 421-9323

70-Muscatine Keokuk Jefferson Johnson Louisa Washington

UnityPoint Health Trinity Muscatine Public Health 1609 Cedar Street Muscatine, IA 52761 (563) 263-0122

Lead County /Counties Program Contact Lead County

/Counties Program Contact

74-Palo Alto Clay Dickinson Emmet Osceola

Palo Alto PHNS 3201 1st Street Emmetsburg, IA 50536 (712) 852-5419

82-Scott Genesis Health Dr Kenneth H McKay Center for Breast Health 1228 East Rusholme Street MOB 1 Suite 2100 Davenport IA 52803

55-Kossuth

Kossuth Community Health 1515 S Phillips Street Algona, IA 50511 (515) 295-2451

97-Woodbury Cherokee Ida Lyon O’Brien Plymouth Sioux

Siouxland District Health Dept. 1014 Nebraska Street Sioux City, IA 51105 (712) 279-6119

77-Polk Dallas Jasper Madison Marshall Poweshiek Story

Polk County Health Department 1907 Carpenter Ave Des Moines, IA 50314 (515) 286-3605

State Staff Adams Boone Chickasaw Fremont Hardin Howard Humboldt Page Ringgold Taylor Winnebago Worth Wright

Iowa Dept of Public Health IA CFY Program 321 E 12th Street Des Moines, IA 50319 (515) 281-5616 (866) 339-7909

Pink Ribbon Advisory Board (PRAB)

Member’s Role ~ Serve in an advisory capacity to state program throughout the two-year term; ~ Serve as a representative of local program staff from within the member’s region; ~ Act as liaison and provide communications between local program staff in the member’s

region and state program staff; and ~Help problems solve and initiate program ideas to state staff.

Communicate with local program staff within the member’s region ~ Participate in scheduled quarterly PRAB conference calls;

Discuss and provide agenda items; questions, concerns; Discuss program issues including barriers, comprehension, implementation; Outcomes from PRAB meetings or conference calls held; and Provide (as indicated) a summary of discussions, rationales, etc. of agenda items

and program issues discussed.

Communicate with state program staff ~ Propose agenda items

Input/feedback from local program staff of agenda topics; consensus of opinion, or various opinions that merit attention;

Provide ideas for Annual Meeting, Regional Meetings, Quarterly Meetings, and additional trainings as needed;

~ Present local program staff concerns or questions on program issues; barriers, comprehension, implementation; and

~ Proposals for solutions to barriers, comprehension, and implementation.

Region Representatives as of April 2017

East

Cathy Tieskoetter Dubuque Program (T) (563) 556-6200 EXT. 1918 (F) (563) 556-4371 [email protected]

Dona Bark Clinton and Scott Programs (T) (319) 244-4925 (F) (319) 242-7197 [email protected]

Carla Boat Marion Program (T) (641) 828-2238 (F) (641) 842-3442 [email protected]

Patty Nordmeyer Butler Program (T) (319) 267-2934 (F) (319) 267-2113 [email protected]

West

Candy Bisenius Palo Alto Program (T) (712) 852-5419 (F) (712) 852-5513 [email protected]

Karla Akers Cass Region (T) (712) 243-7443 (F) (712) 243-7442 [email protected]

Stephanie Claussen Cass Region (T) (641) 743-6173 (F) (641) 743-6157 [email protected]

Stephanie Shields Clarke Program (T) (641) 342-3724 (F) (641) 342-2603 [email protected]

State Staff Ellen Maahs, MPH









Iowa Department of Public Health STATE STAFF DIRECTORY Bureau of Chronic Disease Prevention and Management 321 East 12th Street, Des Moines, Iowa 50319-0075 FAX: (515)-242-6384 PHONE E-MAIL

Jill Myers Geadelmann, BS, RN (515) 242-6067 [email protected] Program Director; Chief, Bureau of Chronic Disease Prevention and Management.

Responsible for management and compliance with CDC program guidance. Denise Attard-Sacco, MPH, CHES (515) 281-0917 [email protected] WISEWOMAN Program Evaluation Specialist

Responsible for WISEWOMAN Program evaluation projects. Lori Byrd, MS (515) 281-7709 [email protected] WISEWOMAN Program Intervention/Community Resource Coordinator

Responsible for planning, assuring implementation and evaluating the WISEWOMAN Program.

Jolene Carver, MSN, RN (515) 242-6200 [email protected] BCCEDP Health Services Coordinator

Responsible for patient navigation and case management including tracking, follow-up, rescreening services and quality assurance/improvement issues within the BCCEDP. Monitors program compliance and provides technical assistance.

Gena Hodges, BA (515) 281-4909 [email protected] Resource Manager

Responsible for contracts and agreements. Liaison for billing, contract monitoring and vouching.

Lindsey Jones, MPH, BS (515) 281-6779 [email protected] BCCEDP Implementation Coordinator

Responsible for coordinating day-to-day efforts of the BCCEDP including program design, implementation, evaluation, quality assurance and compliance with CDC guidance. Provides technical assistance.

Sonya Loynachan, MA (515) 725-0693 [email protected] WISEWOMAN Program Manager

Responsible for coordinating day-to-day efforts of the WISEWOMAN Program including program design, implementation, evaluation, quality assurance and compliance with CDC guidance. Provides technical assistance.

Ellen Maahs, MPH (515) 281-5462 [email protected] BCCEDP Outreach and Professional Development Coordinator

Responsible for outreach and professional development activities. Monitors program compliance and provides technical assistance.

PHONE E-MAIL

Yumei Sun, PhD (515) 281-0925 [email protected] Data Manager

Responsible for data collection and submission of minimum data elements to CDC for the BCCEDP. Develops and provides reports on program outcomes and participant services.

Casey Young, AS, BA, RPCV (515) 281-5616 [email protected] Administrative Assistant

Provides clerical support.

Appendix II: HIPAA Related Information

Disclosures for Public Health Activities .................................... 71

Letter from Iowa Attorney General’s Office ......................................... 75

OCR HIPAA Privacy December 3, 2002 Revised April 3, 2003

DISCLOSURES FOR PUBLIC HEALTH ACTIVITIES

[45 CFR 164.512(b)] Background

The HIPAA Privacy Rule recognizes the legitimate need for public health authorities and others responsible for ensuring public health and safety to have access to protected health information to carry out their public health mission. The Rule also recognizes that public health reports made by covered entities are an important means of identifying threats to the health and safety of the public at large, as well as individuals. Accordingly, the Rule permits covered entities to disclose protected health information without authorization for specified public health purposes.

How the Rule Works

General Public Health Activities. The Privacy Rule permits covered entities to disclose protected health information, without authorization, to public health authorities who are legally authorized to receive such reports for the purpose of preventing or controlling disease, injury, or disability. This would include, for example, the reporting of a disease or injury; reporting vital events, such as births or deaths; and conducting public health surveillance, investigations, or interventions. See 45 CFR 164.512(b)(1)(i). Also, covered entities may, at the direction of a public health authority, disclose protected health information to a foreign government agency that is acting in collaboration with a public health authority. See 45 CFR 164.512(b)(1)(i). Covered entities who are also a public health authority may use, as well as disclose, protected health information for these public health purposes. See 45 CFR 164.512(b)(2).

A “public health authority” is an agency or authority of the United States government, a State, a territory, a political subdivision of a State or territory, or Indian tribe that is responsible for public health matters as part of its official mandate, as well as a person or entity acting under a grant of authority from, or under a contract with, a public health agency. See 45 CFR 164.501. Examples of a public health authority include State and local health departments, the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention, and the Occupational Safety and Health Administration (OSHA).

Generally, covered entities are required reasonably to limit the protected health information disclosed for public health purposes to the minimum amount necessary to accomplish the public health purpose. However, covered entities are not required to make a minimum necessary determination for public health disclosures that are made pursuant to an individual’s authorization, or for disclosures that are required by other law. See 45 CFR 164.502(b). For disclosures to a public health authority, covered entities may reasonably rely on 1


a minimum necessary determination made by the public health authority in requesting the protected health information. See 45 CFR 164.514(d)(3)(iii)(A). For routine and recurring public health disclosures, covered entities may develop standard protocols, as part of their minimum necessary policies and procedures, that address the types and amount of protected health information that may be disclosed for such purposes. See 45 CFR 164.514(d)(3)(i).

Other Public Health Activities. The Privacy Rule recognizes the important role that persons or entities other than public health authorities play in certain essential public health activities. Accordingly, the Rule permits covered entities to disclose protected health information, without authorization, to such persons or entities for the public health activities discussed below.

• Child abuse or neglect. Covered entities may disclose protected health information to report known or suspected child abuse or neglect, if the report is made to a public health authority or other appropriate government authority that is authorized by law to receive such reports. For instance, the social services department of a local government might have legal authority to receive reports of child abuse or neglect, in which case, the Privacy Rule would permit a covered entity to report such cases to that authority without obtaining individual authorization. Likewise, a covered entity could report such cases to the police department when the police department is authorized by law to receive such reports. See 45 CFR 164.512(b)(1)(ii). See also 45 CFR 512(c) for information regarding disclosures about adult victims of abuse, neglect, or domestic violence.

• Quality, safety or effectiveness of a product or activity regulated by the FDA. Covered entities may disclose protected health information to a person subject to FDA jurisdiction, for public health purposes related to the quality, safety or effectiveness of an FDA-regulated product or activity for which that person has responsibility. Examples of purposes or activities for which such disclosures may be made include, but are not limited to:

< Collecting or reporting adverse events (including similar reports regarding food and dietary supplements), product defects or problems (including problems regarding use or labeling), or biological product deviations;

< Tracking FDA-regulated products; < Enabling product recalls, repairs, replacement or lookback (which includes locating

and notifying individuals who received recalled or withdrawn products or products that are the subject of lookback); and

< Conducting post-marketing surveillance. 2


See 45 CFR 164.512(b)(1)(iii). The “person” subject to the jurisdiction of the FDA does not have to be a specific individual. Rather, it can be an individual or an entity, such as a partnership, corporation, or association. Covered entities may identify the party or parties responsible for an FDA-regulated product from the product label, from written material that accompanies the product (know as labeling), or from sources of labeling, such as the Physician’s Desk Reference.

C Persons at risk of contracting or spreading a disease. A covered entity may disclose protected health information to a person who is at risk of contracting or spreading a disease or condition if other law authorizes the covered entity to notify such individuals as necessary to carry out public health interventions or investigations. For example, a covered health care provider may disclose protected health information as needed to notify a person that (s)he has been exposed to a communicable disease if the covered entity is legally authorized to do so to prevent or control the spread of the disease. See 45 CFR 164.512(b)(1)(iv).

C Workplace medical surveillance. A covered health care provider who provides a health care service to an individual at the request of the individual’s employer, or provides the service in the capacity of a member of the employer’s workforce, may disclose the individual’s protected health information to the employer for the purposes of workplace medical surveillance or the evaluation of work-related illness and injuries to the extent the employer needs that information to comply with OSHA, the Mine Safety and Health Administration (MSHA), or the requirements of State laws having a similar purpose. The information disclosed must be limited to the provider’s findings regarding such medical surveillance or work-related illness or injury. The covered health care provider must provide the individual with written notice that the information will be disclosed to his or her employer (or the notice may be posted at the worksite if that is where the service is provided). See 45 CFR 164.512(b)(1)(v).

Frequently Asked Questions

To see Privacy Rule FAQs, click the desired link below:

FAQs on Public Health Uses and Disclosures

FAQs on ALL Privacy Rule Topics https://www.hhs.gov/answers/hipaa/where-can-i-find-information-about-health-information-privacy/index.html 3


(You can also go to http://answers.hhs.gov/cgi-bin/hhs.cfg/php/enduser/std_alp.php, then select "Privacy of Health Information/HIPAA" from the Category drop down list and click the Search button.) 4

APPENDIX III: Program Reimbursement and

ICD-10 Information 2017 Reimbursement Schedule .............. 81

ICD-10-CM Diagnosis Codes ................... 91

For current program Reimbursement Schedule and ICD-10 listings, go to www.idph.iowa.gov/cfy/information-for-healthcare-providers. These items can be found in the section “Before You Get Started…”

http://www.idph.iowa.gov/cfy/information-for-healthcare-providers

REIMBURSEMENT SERVICES The IA CFY Program contracts with a third party payer to process claims and reimburse healthcare providers for covered services.

Reimbursable Services

Federal law requires that reimbursement with federal funds may not exceed Iowa Medicare Part B rates. Medicare and IA CFY Program reimbursement rates are updated annually after the rates are released by the Centers for Medicare and Medicaid Services (CMS). Updated information is available on the IA CFY Program website found at http://www.idph.iowa.gov/cfy on the Information for Healthcare Providers page.

Beginning July 1, 2017, claims for payment of IA CFY Program services will only be accepted for reimbursement for one year following the individual’s date of service. Claims received after the filing deadline will be entered into the Billing System and denied for not being filed in a timely manner. Claims denied for late filing may not be billed to the client(s).

The IA CFY Program is the payer of last resort. An Explanation of Benefits (EOB) must be obtained from an insurance company when appropriate. The IA CFY Program will reimburse for co-pay and deductibles up to the amount indicated on the IA CFY Program Reimbursement Schedule for the portion not covered by insurance.

An individual enrolled in the IA CFY Program should not be billed for: • Any IA CFY Program covered service • Claims denied for not filing in a timely manner • Collection and transportation of specimens. These costs are to be covered by the office visit

reimbursement. They should not be billed separately

Claims Reimbursement Report

When claims payment is made, the third party payer will enclose a list of participating patient/participants with the payment. The list will include the individual’s name, date of birth, date of service, the CPT and ICD-10 codes, amount billed, amount allowed and the amount paid. An individual may not be billed for IA CFY Program-covered services.

If reimbursement is denied, an explanation of denial will be included on the list. An IA CFY Program participant may be billed for services not covered by the program. QUESTIONS

Questions about your claims should be directed to Medical Billing Services (MBS) at (515) 237-3974.

Questions about Cooperative Agreements should be directed to the Iowa Department of Public Health’s Care for Yourself Program at 1-866-339-7909.

Note: The participant may be billed for services not covered by the IA CFY Program. The participant must be made aware before the service is provided that the IA CFY Program will

not cover the procedure and the cost will be her responsibility.

http://www.idph.state.ia.us/CFY/Providers.aspx

Appendix IV: Data Form Samples

Consent and Release of Medical Information ....................................... 93

Annual Enrollment ................................. 95

Screening ............................................. 97

Breast Diagnostic .................................. 99

Cervical Diagnostic ............................... 101

Resources Definitions .......................................... 105

Breast and Cervical Cancer Resources .................................... 107

CancerCare .............................................. 111

Definitions: BCCEDP - For documentation purposes, CFY funds were used to pay for the procedures.

BCCEDP/Insurance - For documentation purposes, a combination of insurance and the CFY program were used to pay for services such as, assistance with co-pay or deductible, co-insurance.

Case management - CDC definition is establishing, brokering, and sustaining a system of essential support services for enrolled women to identify and overcome barriers to definitive diagnosis and treatment.

Co-insurance - After a deductible is met, the individual pays a percentage of the total bill. An example is 80/20. The insurance is responsible for 80%, the individual is responsible for 20%.

Co-pay – The amount paid by a health insurance plan covered individual for each office visit, emergency department visit, or purchase of prescription drugs, in addition to the amount paid by the insurance company.

Deductible - A stipulated sum a health insurance plan covered individual must pay toward the cost of healthcare before the benefits of the program go into effect. This amount is usually an amount set annually. An example is $5,000.

Insurance Only – For documentation purposes, this category includes Medicaid, Medicare A & B, and other private insurances that were used for payment of services.

Other – For documentation purposes, payments were made from out-of-pocket or may have been provided by a free clinic, non-state Komen funding.

Out-of-pocket maximum - Total amount of money paid by the health insurance plan covered individual in a year not reimbursed by the health insurance company. Some common costs include the deductible, co-pay, and co-insurance.

Patient Navigation - Individualized assistance offered to clients to help overcome healthcare system barriers and facilitate timely access to quality screening and diagnostics as well as initiation of treatment services for persons diagnosed with cancer.

Unknown – For documentation purposes, the sources of payments were not known (should rarely be used)

Breast and Cervical Cancer Resources1 Breast Cancer Resources

• Advanced Breast Cancer Community advancedbreastcancercommunity.org

• AdvancedBC.org advancedbc.org

• African American Breast Cancer Alliance 612-825-3675, aabcainc.org

• Avon Foundation for Women avonfoundation.org

• Breast Cancer Alliance 203-698-0014, breastcanceralliance.org

• BreastCancerTrials.org 415-476-5777, breastcancertrials.org

• Facing Our Risk of Cancer Empowered (FORCE) 866-824-7475, facingourrisk.org

• Jill's Wish 702-237-9123, jillswish.org

• Living Beyond Breast Cancer 888-753-5222, lbbc.org

• Men Against Breast Cancer 866-547-6222, menagainstbreastcancer.org

• Metastatic Breast Cancer Network 888-500-0370, mbcnetwork.org

• Mothers Supporting Daughters with Breast Cancer 410-778-1982, mothersdaughters.org

• My Hope Chest 727-642-4243, myhopechest.org

• National Breast and Cervical Cancer Early Detection Program 800-232-4636, cdc.gov/cancer/nbccedp/screenings.htm

• National Breast Cancer Coalition 800-622-2838, natlbcc.org

• SHARE for Women Facing Breast or Ovarian Cancers 866-891-2392, sharecancersupport.org

• Sharsheret: Your Jewish Community Facing Breast Cancer 866-474-2774, sharsheret.org

1 This resource listing is also available on the coordinator’s website.

http://www.advancedbreastcancercommunity.org/

http://www.advancedbc.org/

http://www.aabcainc.org/

http://www.avonfoundation.org/

http://www.breastcanceralliance.org/

http://www.breastcancertrials.org/

http://www.facingourrisk.org/

http://www.jillswish.org/

http://www.lbbc.org/

http://www.menagainstbreastcancer.org/

http://www.mbcnetwork.org/

http://mothersdaughters.org/

http://www.myhopechest.org/

http://www.cdc.gov/cancer/nbccedp/screenings.htm

http://www.natlbcc.org/

http://www.sharecancersupport.org/

http://www.sharsheret.org/

• Sisters Network® Inc. - A National African American Breast Cancer Survivorship Organization 866-781-1808, sistersnetworkinc.org

• Support Connection 800-532-4290, supportconnection.org

• Susan G. Komen for the Cure 877-465-6636, komen.org

• The Breast Cancer Research Foundation 646-497-2600, bcrfcure.org

• The Catherine H. Tuck Foundation catherinefund.org

• The Kristy Lasch Miracle Foundation 412-872-4125, kristylasch.org

• The Pink Fund 877-234-7465, thepinkfund.org

• The Sister Study 877-474-7837, sisterstudy.org

• Tigerlily Foundation 888-580-6253, tigerlilyfoundation.org

• Triple Negative Breast Cancer Foundation 877-880-8622, tnbcfoundation.org

• Young Survival Coalition 877-972-1011, youngsurvival.org

Cervical Cancer Resources

• Cancer Schmancer Movement Information on cancer and advocacy.

• Cervivor.org – Cervivor is a community, a learning tool, an advocacy resource, and an online retreat for healing, connecting and thriving.

• LIVESTRONG Offers cancer information and one-on-one support.

• Hyster Sisters A woman-to-woman support site for hysterectomy information, support and recovery.

• Chemocare.com Provides information on chemotherapy for patients, family members, and caregivers.

• Royal Crown of Glory Foundation Provides 100% human hair lace front wigs absolutely free to all women that are hair loss victims due to a treatment/illness, no matter if the hair loss is temporary or permanent. (866) 552-8080

Financial Assistance • CancerCare offers limited assistance for cancer-related costs as well as referrals to help you find

additional resources. Assists with such cost as transportation to and from cancer treatment, home care, child care, and pain medication. Download information online or call 800.813.HOPE (4673).

http://www.sistersnetworkinc.org/

http://supportconnection.org/

http://www.komen.org/

http://www.bcrfcure.org/

https://catherinefund.org/

http://www.kristylasch.org/

http://thepinkfund.org/

http://www.sisterstudy.org/

http://www.tigerlilyfoundation.org/

http://www.tnbcfoundation.org/

http://www.youngsurvival.org/

http://www.cancerschmancer.org/

http://www.cervivor.org/

http://www.livestrong.org/

http://www.hystersisters.com/

http://chemocare.com/

http://www.crownofgloryinc.org/

http://www.cancercare.org/financial

http://www.cancercare.org/financial

Financial Assistance (continued)

• The CancerCare Co-Payment Assistance Foundation is a not-for-profit organization established in 2007 to address the needs of individuals who cannot afford their insurance co-payments to cover the cost of medications for treating cancer.

• Patient Advocate Foundation’s Patient Services provides patients with arbitration, mediation and negotiation to settle issues with access to care, medical debt, and job retention related to their illness. 800.532.5274.

• The Cancer Financial Assistance Coalition (CFAC) is a coalition of financial assistance organizations joining forces to help cancer patients experience better health and well-being by limiting financial challenges. CFAC provides a searchable database of organizations that provide financial assistance.

http://www.cancercarecopay.org/

http://www.patientadvocate.org/

http://www.cancerfac.org/

CancerCare CancerCare provides limited financial assistance to individuals affected by cancer. As a nonprofit organization, funding depends on the sources of support received at any given time. If funding is not available at the time needed, CancerCare counselors will work to refer to other financial assistance resources. With a gift from the Avon Foundation, CancerCare, Inc. established a special assistance fund for low income, under-, uninsured, and underserved individuals (male and female) with a breast cancer diagnosis and their families. Eligibility

• Individuals with a diagnosis of breast cancer may qualify for assistance from CancerCare • Be in active treatment breast cancer • Meet CancerCare eligibility guidelines based on the federal poverty guidelines (proof of

income required) • Live in the US or Puerto Rico • No citizenship requirements

Assistance from CancerCare

Financial All requests must be for current services (within one month)

Limited assistance to be used for: • Transportation to and from treatment services • Childcare • Home care • Pain and anti-nausea medication, oral hormonal medication, and durable

medical equipment Services not paid for: • Any screening or diagnostic services • Basic living expenses such as rent, mortgages, utility payments, or food

Professional • Oncology social workers will provide emotional support, counseling, and practical assistance to individuals with cancer, family members, and caregivers over the telephone, online, or in person in limited geographical area

• Oncology social workers will help people find needed information and provide informative materials about cancer and treatments

• Educational seminars and workshops provided by experts designed to provide information about early detection, risk reduction, wellness, treatment, and coping with cancer

Other • Assists with finding needed resources in local communities for home care, child care, transportation to and from treatment, pain management, or entitlements

• Provides publications online or in print that include up-to-date reliable cancer-related information

• Offers referrals for obtaining prostheses and wigs to women who have breast cancer or who have lost their hair due to treatment and are unable to afford services on own

• Spanish speaking staff available

Steps for Applying (for complete information go to www.cancercare.org):

1. Call 800-813-HOPE (4673) and complete a brief interview with a CancerCare social worker.

2. If eligible to apply, an individualized bar coded application and a request for documentation to verify income will be sent to the individual.

3. The individual must submit a legible completed application. An application is not a guarantee of receiving funds.

Compiled by Iowa Care for Yourself Program Reviewed: 5.09, 8.11, 6.13, 4.16, 5.17

Revised: 8.14, 6.15

Policy Manual 2017 - Iowa Manual... · Policy Manual 2017 . ... State Eligibility for BCCT Medicaid...

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